It seems that I have been putting off writing this post until I can’t anymore.
The reason I have procrastinated so long is…well, there are two reasons: fear, and pain.
I came to Flagstaff several weeks ago in search of a hand surgeon. I took a nasty fall over a log, as some of you might remember, and after waiting a suitable number of days to make sure it wasn’t just sprained, sought care at an orthopedic urgent care facility.
There I met a young, arrogant, and completely disagreeable orthopedist, who humiliated me in numerous ways until his assistant hipped him to the fact that he and I share a first name, to wit: “Doctor.” Then he became all cozy and collegial, remarking on the skill of the last hand surgeon’s handiwork, as we gazed at my Xray together. I was musing how overexposed the film was. He was burbling away. I had dissociated long since and have no idea what he said after that.
But I picked up the hand surgeon’s card on my way out, and spied the spine surgeon’s as well.
The chirpy receptionist volunteered to make me some appointments if I needed them, right there on the spot, so I took her up on it.
Let’s see, hand surgeon, since that came first. And my poor arthritic shoulders were killing me, especially after the recent acrobatic stunts. I’d have an appointment with the non-interventionist arthritis doctor, please.
And then there is my spine, bane of my existence since 1985. A couple of lumbar discs ruptured back then. In 1987, emergency surgery for a ruptured disc in my neck. Oh, and that rupture occurred on the first night of my internship. I drew call my first night, of course. “Black Cloud.”
Over the three years of my residency I would go on to rupture at least five discs. The spine surgeons threatened me with putting metal rods on both sides of my spine. I demurred, and opted for a custom molded hard plastic exoskeleton type of thing that extended from armpits to groin, to be worn 23 3/4 hours per day. Fifteen minutes to shower, then back into the Plastic Maiden.
In the intervening 30 years, my spine has had its moments of freedom from having to drag me into its consciousness. Curiously enough, my best years were when I had horses and rode daily. The gentle rocking motion kept my spine well oiled, and the occasional eruption of a bucking episode provided any needed adjustments.
Then I got Rolfed by the former Captain of the Venezuelan Olympic Women’s Luge Team. She was gigantic. She was good. It was excruciating.
My back didn’t dare go out if it meant going back to Alejandra.
After I returned from Israel to be with my father in his last years, my neck began to bother me enough so that I went to see a Physiatrist.
For those who are unfamiliar, a Physiatrist is an M.D. or D.O. who is trained in evaluating and treating musculoskeletal disorders non-surgically, with things like hydrotherapy and massage. Sound good?
Actually, I did not choose this person specifically because she would be the most likely to send me to a Turkish Bath; it was simply a matter of Cut vs. Not-Cut.
Dr. Not-Cut did not send me to the Turkish Bath, nor even to Physical Therapy, but packed me off to her partner who does one thing exclusively: epidural injections.
Now, while I’ve had many a needle inserted into my spine at the lumbar region, I have never permitted such an intrusion into my neck, for the simple reason that it’s easy enough to prick a blood vessel by mistake, which can be problematic in the lumbar, but catastrophic in the cervical, because there is simply no room for anything like a blood clot in the spinal canal of the neck.
I went for it, purely because I couldn’t look down to tie my shoes for the pain. My head felt like it was going to fall off at any moment, and at times I felt like beheading myself just to get it over with.
The procedure was terrifying. It was painful. It didn’t work.
Fast forward through several medication trials and much condescension on the part of Dr. Non, and at last I had an appointment with her Nurse Practitioner, who wisely prescribed a muscle relaxant, voila. And a special hardshell collar to keep my head from falling off. A wise and practical woman…And she even snuck me a small Rx for some tramadol, miracle!
And until the tumble over the log incident, that’s been keeping my neck pain down to a barely noticeable hum.
Post-log-jam, things started kicking notches up the Pain Scale until I was hovering in the 8 range and started using my beastly hard surgical collar again. This thing provides a tiny bit of traction, and it gets rid of the feeling that my head is falling off, but it digs cruelly into my flesh and is no fun.
I did not wear the collar to my appointment with the Instant Ortho Clinic.
Two things you must never do, if you go to any kind of emergency services place: do not wear a cervical collar, and never never never reveal that you have a mental illness; otherwise you will be instantaneously branded as a drug seeker, and no one will ever listen to you or even notice the bone sticking out of your leg at a crazy angle.
And there is a third one, I have discovered, to my dismay:
Don’t be elderly. You won’t count.
Time passes, and I get my turn with the Arizona Spine Specialist Dude, very highly Ivy League Specialty Boarded And Fellowshipped, all very nice to know. Confidence.
He seemed like a nice chap for a surgeon. Asked me why I was there, seemed to listen, actually examined me and discovered, dismal dismal discovery…I have lost virtually all muscle strength in my left arm. I have no reflexes at all in my right arm, and abnormal ones in my left. This must be why it takes me two hands to get my coffee cup up to my face.
It is no longer an issue of mere pain management. It is an issue of preserving what function remains to me.
I need surgery.
The MRI could have looked worse. It also could have looked better. What is clear, is that the degenerative disease is crunching my spine like Pac Man.
I have had two appointments with the Spine Surgery People. The first was with the actual surgeon, whom I liked, who treated me respectfully and did a good job of hitting the diagnostic nail on its head.
The second appointment was with the Physician’s Assistant. I have no confidence in Physician’s Assistants, for the simple reason that in my opinion, there is some difference between the education of, for instance, my new Spine Surgeon, who had (after his Bachelor’s Degree) 4 years of medical school, 5 years of residency, 3 years of spine fellowship, and assorted certificates; whereas, a Physician’s Assistant has a grand total of 26 months of post-college training: the equivalent of a Master’s Degree, very nice, but not enough to develop much clinical experience.
So, with some trepidation, I met with the PA to go over my MRI results. How could a person with so little training interpret advanced imaging and recommend treatment?
I was relieved to find out that she is, in fact, operating as the surgeon’s assistant and not as an independent entity, as so often happens today.
She had been thoroughly briefed by the surgeon on the MRI results, conveyed them to me, and explained the recommended treatment: spinal fusion at two levels. She explained how this was done, and showed me an example of the titanium plate that would be installed, to stabilize things.
Uh, well, yes…what would happen if I opted to do nothing?
Well, of course, your disease would progress and those nerves would continue to lose function….
Oh. Yes. Definitely. I see.
Any questions? She gives me the crisp smile that is the equivalent of shooting one’s cuffs to glance at one’s watch.
Not at this moment, I tell her, but I’m sure I will have.
All right then, just call and let me know what you want to do.
We rise, shake collegial hands…
Several days later I realize I remember absolutely nothing about the visit. Except the part about Surgery, and Fusing Vertebrae, and Possible Side Effects Including Quadriplegia…shit.
I called and left a message for the PA. Two days later, she returned my call.
Yes, what was it? Very snappish. It’s five o’clock, poor thing must be hungry and tired…shit, there I go again making excuses for other people’s bad behavior.
It’s that I have some questions about the surgery.
–I explained that in the office. We place a tube down your windpipe, pull your windpipe and food tube to one side, and…(what is going on here? She has my chart in front of her. Why is she using the sixth grade description garbage?)
Yes, thank you, you did explain that part. What I want to know is where, exactly, you place the titanium plate.
Exasperated sigh. Again, with feeling:
–I told you, we move your windpipe and food tube…
Cheezes K. Reist, woman. I want to know whether the plate is placed LATERALLY or IN THE MIDLINE???
Good. How long will I be in the rehabilitation hospital postop?
–That depends on you. She drops the phone. Oh sorry.
How long until I am able to drive?
–That depends entirely on you.
What does that mean, exactly, please?
–That means however long you are on pain medication. Could be two weeks, could be six weeks, depends on you. Each patient is different.
Ah, now I have some useful information: they give you pain medicine postop! What a good idea.
It really was like pulling teeth. Look, if someone is going to do violent things to my neck bones, I want to know the details. All of them. Not the sixth grade version: for better or worse, I am a physician, and I need DETAILS.
So now I am spooked, very spooked, by the fact that the surgeon’s right hand woman is sidestepping badly. It’s bad enough that I have to make a decision of this magnitude, without this person giving me the power trip.
I know I need the surgery. I’ve investigated the surgeon and he comes up kosher.
But what about this other person on his team, who seems to have enough power vested in her that she could cause me to suffer?
It happens that there is a branch of the Mayo Clinic in Phoenix, several hours from here. I think I’ll mosey over there and see what it’s like. I don’t believe there will be huge changes in my condition in the near term…I hope. Maybe they have some other, brighter ideas.
And then…there is the first appointment with the Hand Surgeon to look forward to, in a week or so. Something is very wrong with my wrist, because of the fall. Very wrong.
I wish I could get someone to order the MRI of my wrist BEFORE I see the Hand Surgeon, to save time. I think I’ll call his office tomorrow and ask. Can’t hurt.
I have waves of feelings of futility. What is all this for? The wrist, yes, that’s an injury and must be repaired, if possible. But what about the spine? I watched my father’s spine degenerate until finally he was literally a helpless bag of bones.
I must ask this surgeon, whose opinion I respect: what am I looking forward to? How long will it be until another unstable section of my spine needs to be fused, and another, and another? How much of this can the body endure? Am I really buying time with this? What sort of quality time? How long till the wheelchair and the nursing home? I need to know. I will make another appointment.