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Some perspective

December 2011

“A Piece of My Mind” in JAMA and like editorials in other medical journals often serve as the great “keeping it in perspective” piece. Recently, I read a passionate tribute to a deceased doctor by the physician who picked up his patients. The doctor’s death at age 35 was the definition of tragic. Over the years, these stories of loss, pain and mind-numbing suffering have been a sobering reminder that there but for the grace of God go I.

And so I went. It has been a mild winter, allowing this avid cyclist to enjoy a 60-mile ride on an uncharacteristically warm December day. Never felt better. A few days later, I moved some bags of books that were far too heavy, and I moved them too far. My back felt off for a week but hardly more than I could have expected given my age and the stupidity involved in trying to act as if I was still 20.

Then I developed a cold and cough. One cough in particular rattled my back, causing me to drop to the floor. Great, now I pulled a muscle. The pain increased over the week, from awful to unbearable. I made it through work on Monday, but barely. I knew something was more than amiss when my chest pain patient started asking me if I was OK. I realized I could barely stand after taking his history.

Tuesday brought a near complete inability to get out of bed. I had made it through the night thanks to a Percocet that I still had in my cabinet from a 2005 knee surgery. Despite the 2006 expiration date, it provided the relief I needed to fall asleep.

I texted a spine surgeon, “Hate to ask for a professional favor, but can you see me today?”

Somehow I made it to his office with the assistance of my wife. Because I was neurologically intact, he sent me down the hall for X-rays. Then I fell and could not get up. Literally. The spasms were so severe that the best I could manage with the help of others was slithering my way onto a couch. After no relief, it was a stretcher by way of 911.

Whose life was I watching out of my own eyes? I saw paramedics, the ambulance ceiling. The ER so commonly observed vertically from a 6-foot perspective, I now witnessed at half that height horizontally.

Pain takes on an otherworldly characteristic. At this point, even with ample IV narcotics, I was otherworldly. But despite the sedation and agony, I was able to snap back to reality when the techs pulled me out of the MRI.

“You have a pathologic compression fracture of L3.”

A pathologic compression fracture? I am 40, I don’t have osteoporosis, I didn’t have trauma. What’s left? Only the obvious: cancer, probably metastatic.

It didn’t take long to have my self-diagnosis confirmed. In walked my spine surgeon. His face was empty. He sat at the end of my bed. This was the surreal part: He was looking at me with the same vacant eyes that I have looking at others. Trying to find the right balance between hope and concern without providing false optimism. Been there, done that. Yet it is, needless to say, a radically different experience when you are the one lying on the bed.

Yes, it was probably cancer. But it could still be infectious or a benign hemangioma. Being an internist, I was confident I didn’t have discitis. No fevers or chills, so that curable diagnosis was off my differential. Next up was a stat CT of my spine, and I was clinging to a vertebrae hemangioma.

And those were four very long hours. My meal came. I told my bedside friend that even the condemned get the option of surf and turf for their last meal. I recalculated my life insurance; my family would be fine. I decided I wanted hospice unless there was a real chance of significant prolonged palliation. I was thankful that my years in medicine had taught me that protracted suffering for an added month or two was completely out of the question.

I stared at the clock but never once registered the time. I didn’t feel sorry for myself but I was, of course, pissed. Really, really pissed off. Fortunately, my friend and I remembered that laugher is always the best medicine, and I asked him to check Groupon for cremation specials. He wanted to know if he could have my nice office. My wife was a rock. My 3-year son watched “Megamind.”

Out of the corner of my eye, I noticed my surgeon in the hallway. He had returned to check the CT. Eternity set in. My friend and I said nothing.

That strange tranquility was disrupted by the surgeon bursting into the room with his arm outstretched, holding a piece of paper.

Focus! Focus! “L3 compression fracture with pathognomonic findings of benign hematoma.”

Like a sleep-deprived three-year-old denied ice cream, I lost complete control of my emotions. Hugs, tears and catharsis ensued. My wife had gone home to put our son to sleep. Rare is the call, “Hey honey, good news, I am not going to die. And I will be sure to pick up milk on the way home.”

Recovery is awful. I am now one week out of a kyphoplasty and I am using a walker. I am looking at medical leave for probably a month or more. Strangely, I feel denied any existential catharsis. Maybe that is a good thing. I have a wonderful family and friends. I miss my job already. I must have already been a damn good doctor because this experience did not teach me empathy.

Right now, I just want the pain and the walker to go away. And I want to wait 40 more years until the next time this expletive happens. By then, I will be more than ready to go to sleep.