No one has ever called me “spineless,” yet there have been times when I’ve sorely envied those creatures without one:
Give praise to the invertebrates, for they shall inherit the Earth.
I don’t know who said that. Thought I did, but looked up the source and it wasn’t where I thought it would be. But never mind. For the past, oh, month or so, give or take, I have been limping around on one or another of my limbs. My knee locked up; my hip hurt; and now my back has eclipsed the rest. My back has been, for me, a symbol of the level of support I am getting from those close to me. And while some may argue that what’s physical is physical, and that the mental/emotional/psychosocial arenas cannot cross over purely physical lines to cause or worsen structural damage, I disagree.
My point of view lines up with that of the “biopsychosocial model” on which I was nursed and weaned by my Very Special Medical School, the University of Illinois at Champaign
Nirvana Urbana, smack in the middle of Corn Country, Illinois, USA. The biopsychosocial model, as it indicates, teaches that our health and wellbeing are not compartmentalized, but a living organism that is affected by everything in our environment, inside and outside. There is certainly a genetic component to my spinal maladies: my dad started having awful back problems in his early thirties, just as I did. So I guess I have him to thank for that, along with a lot of other inherited traits, most of them good.
My adventures with Degenerative Disk Disease (DDD), which is a progressive disintegration of the intervertebral disks, started in 1987, in the Big Yellow Truck that carried our little family away from Champaign Nirvana, into the uncharted territory of Rochester, NY, which is even colder than it sounds, being just across the lake from Ontario. I should define terms here, in case there are people reading this who have the good fortune not to know them. An intervertebral disk is an ingenious structure composed of a thick outer wall of tough yet supple ligament, filled with a gel. It is in the shape of a hockey puck, and alternates with the vertebrae, insulating them from shock and serving as the means for our spines to be flexible. Think of gymnasts, or contortionists, or Tango dancers and you’ll get the picture. Speaking of pictures: Here is an X-ray of a normal lower back. Note the clean lines and clearly defined spaces between the vertebrae, which look like boxes with little things sticking out of them. Here is a nice comparative image of a normal lower back, top, and its unfortunate cousin on the bottom. Mine looks like that one, only worse. All sorts of treatments and non-treatments exist for this extremely painful and often debilitating condition. I have experienced quite a few of them. When we were driving from Champaign Nirvana in the Big Yellow Truck (or “Big Lellow Truck,” as my son called it, being two at the time and in awe of the Ryder Rental), I noticed that I couldn’t find a comfortable way to sit. When I was driving, a hot river of molten pain flowed down my right leg into the accelerator. When I was riding shotgun, the only way I could sit even mildly-to-moderately comfortably was cross-legged, bolt upright. No sleep on that trip.
When we arrived in Rah-cha-cha, there was far too much to be done to pay attention to a mere case of low back pain, so I forged ahead with helping to unload the van, unpack, set up, and immediately start my internship in Pediatrics. By then I had developed a matching pain in my neck, such that I had to build a set of pillows molded around my neck so that I couldn’t move–or else I would wake up suddenly paralyzed with pain. But I had an internship to start, and my ex had a post-doctoral fellowship to start, so I soldiered on and started my residency.
As is the nature of things, before one starts anything significant, one has to sign all the papers first. That was a good thing, in the case of the residency, for it gave me something I had been lacking and would be needing shortly: insurance. At that point in my internship/residency program, we were fully staffed, so “call” duty was every third night. That meant that you came in at your regular time, 5 am, then worked until 5 pm sign-out rounds. You met with the lucky creatures who were going home, and conferred with them about their patients, whose care you would be assuming until 8 am sign-in rounds the following day. Then you would continue your work-day till 5 pm, when you “signed out” your patients for the night, went home, and fell on your back in the bed, staring at the ceiling and feebly trying to repel your husband and child, who are trying to greet you after your long absence.
As luck would have it, my first night on call was Night One of my internship. It was the debut appearance of the infamous “black cloud” that would follow me throughout my medical career. My neck had been in spasm all day, but I did my best to ignore it and soldiered on. Sign-out rounds came and went, and I was on my own with my resident. It was just the two of us to cover all of Pediatrics, Labor and Delivery (the baby part), Newborn Nursery…and admissions from the Emergency Department, which seemed to be a very busy place that night.
My neck felt like it was trying to rip itself off my body and fly away on its own. I was wishing it would. We admitted a sick little girl with a fever of 104 F (40 C), to the toddler ward for diagnosis and treatment. Part of the diagnostic work-up involves the collection and subsequent examination of every kind of fluid there is in the body (gas, oil, antifreeze, brake fluid…just kidding). You have to collect things in a sterile a manner as possible, so as not to introduce germs from the outside of the body into the fluid samples.
Long story short, we needed to get a sterile urine sample from this little girl, and that involved a catheter, and cleaning the “outer parts,” and someone with experience to do that part, and anyone at all to do the all-important Holding The Patient Down part. I shudder. I was once Held Down for a medical procedure when I was 5, and I still remember it.
At last we had the hapless little girl spread-eagled and ready for the 30-second procedure. My job was to keep her in that position, so that 30 seconds would remain 30 seconds and not, say, 20 minutes, which is what might happen if we messed up the first try and had a furiously fighting toddler on our hands. So I got a good grip on the little chubby thighs, and prayed that my superior would get the job done chick-chock, which is Hebrew for “right now.”
The outraged little victim jerked her leg away from me, and looking me straight in the eye, kicked me a good one right in the center of my forehead. POP. That was the annular ligament of C5-6 you heard popping, there. In layman’s terms, the tough outer covering of the disk between the 5th and 6th vertebra in your neck, of which there are seven, gave way and all the gelatin from the center of the disc poured out like fire, compressing the nerves that emanated from my spinal cord at that level.
I was paralyzed with pain.
But I would not give in.
This was my first on-call night of my internship, dammit, and besides, where would we get a replacement for me at 2 am? I have always said that the reason more people don’t die during their residencies is that the program does not allow time to attend one’s own funeral. So I soldiered on, until sign-in rounds, where the Chief Resident noticed that I was in agony and sent me to the Emergency Room.
There I was examined by a medical student, an intern, a resident, the Chief Neurosurgery Resident, and finally, the neurosurgeon himself, who looked at the X-rays and agreed with all the others that I had an acute rupture of C5-6. They sent me home to rest for a week, with a prescription for Tylenol with Codeine. I rested, felt absolutely no better, and went back to work.
Another week, and another on-call night, and I truly felt like my head was going to just fall off and roll around on the floor, because my neck could no longer bear its weight.
Another morning in the ER for me. This time the neurosurgeon just happened to be in the building. He stopped by and saw me. “What, are you here again?” angrily joking. “What’s the problem this time?”
I sheepishly explained that I couldn’t move because of the pain in my neck. I got a terse lecture regarding the subjective nature of pain, that it was “only pain,” and that I really should suck it up and go back to work. But my hair was all wet from my tears, so in obvious disgust he ordered a CT scan of my neck. MRIs did not exist yet. He looked at the scan himself, and his attitude flipped 180 degrees.
“I’ve never seen such a huge rupture in someone your age. The nucleus (gel center) is sitting completely outside of the disc space! We will schedule surgery. Until then, you will wear this spiffy hard cervical collar and don’t take it off.” Surgery was a week from then.
I spent the time arranging for child care (my ex was not good at that), and begging for insurance coverage. My insurance, you see, did not kick in until I had worked a full week in the program. Somehow, in some office, someone was compassionate, and I got my insurance. I was kind of eagerly anticipating surgery, hoping that it would get rid of the awful pain that had somehow become my entire life. To be continued…….