“I have always depended on the kindness of strangers.”
– Blanche DuBois, A Streetcar Named Desire, Tennessee Williams
It was near the end of 2008 that I developed symptoms that I recognized as sciatica. The Internet is a wonderful source of information (and some misinformation). I decided to educate myself. In my reading, I encountered one study that indicated that patients who underwent surgery were better at one year, but about the same as those who opted for conservative measures at 4 and 10 years. This, as well as the fact that some patients improve on their own, gave me some comfort. I determined I would not seek surgery unless: 1) I became incontinent; 2) I developed motor weakness or muscle atrophy; or 3) symptoms became unbearable. I was not particularly active at the time; my main form of exercise was brisk walking the padded local high school track.
However, I had lived long enough to know that a myriad of maladies lay in potential wait (I was reminded of the undertow misunderstood as a giant “Under Toad” by the boy protagonist in the World According To Garp by John Irving, waiting to grab him if he swam too deep in a body of water). So, in 2009, I had an MRI lumbar scan, mainly to provide peace of mind that something serious, such as metastatic prostate cancer, wasn’t the cause of my sciatica.
What I did have was spinal stenosis at two adjacent levels. Despite the accuracy of MRI scans in evaluating sciatica, some discord exists between the findings on MRIs and symptoms. Regardless, I was somewhat relieved to know that I had sufficient anatomic abnormality to explain symptoms.
Fast forward to 2012, when I moved from one county in California to another, to experience coastal climate and be geographically closer to my daughter’s family. Despite the move being grueling, made more so by the precipitous move, little assistance with sorting and packing, finding tenants for my townhouse, and dropping 10 percent of my body weight, the sciatica was not noticeably worsened by lifting heavy objects or other increased physical activity.
In fact, I wasn’t particularly worse during a six month period after my move when I was a member of a local fitness center, during which time I had a personal trainer, who put me through a fairly rigorous regimen (I had neglected to inform her about the sciatica).
Some time later, at the local post office, I encountered a fellow I had known in college, decades earlier. Attired in tennis garb, he informed me he played almost every day, including a couple times a week at the complex in which we both reside.
I had abandoned tennis a couple years earlier because of tennis elbow and a troublesome rotator cuff, both of which combined to render me less capable (recalling the somewhat waggish: “The older I get, the better I used to be”). I didn’t think it fair to my fellow players (we’d played men’s doubles) to continue.
But the several years of tennis activity had mended me somewhat, and I decided to test the waters. Somewhat to my surprise, they were salubrious, and I began to play regularly a couple times per week. Then I was asked to play at a dedicated tennis center with more competitive, accomplished players. I found myself able to keep up, but my sciatica worsened.
I had also taken up biking a 6-mile round trip path from my house to the coast on a vintage (1970s) 5 speed Schwinn, and did this at least once or twice a week.
By 2014, my sciatica had worsened to the point I felt the need for medical evaluation (the adage saying that the physician who treats himself has a fool for a patient is not far off the mark). I had joined Kaiser Permanente (KP) by that time. A repeat MRI scan showed abnormalities similar to the one in 2009, but my symptoms were clearly worse.
I continued tennis, although my mobility was curtailed, and I played in pain. I was still determined to have surgery as a last resort. I tried a variety of accepted conservative measures, including two epidural injections, acupuncture, physical therapy, and analgesics. Nothing helped. My natural walk had become a limp.
In January this year, I stopped tennis, in that I noticed new discomfort down the backs of my thighs and legs after playing. I continued biking for aerobic exercise; it did not seem to particularly aggravate symptoms.
I also consulted a KP neurosurgeon. Very matter of fact, he showed me my latest MRI scan and discussed proposed surgical treatment. He didn’t encourage me to have surgery until he saw me limp out of his office.
Shortly thereafter, I scheduled the surgery. I was booked for April.
My 50th medical school reunion was held in early March. 17 of the 78 graduates had died. Of those attending, several had a variety of ailments, some serious. As we age, there are so many diseases that can truncate life.
I prepared the best I could for surgery. Hoping for the best, but preparing for the worst, I updated my son, who is the executor of my will, in a long e-mail.
I’d formulated some modest goals: 1) to awaken from anesthesia; 2) to wake up with faculties intact and without paralysis; and 3) to be no worse, symptom-wise, than before surgery. The KP neurosurgeon had informed me that the likelihood of improvement from surgery was 50 to 75 percent. Anything beyond that I would consider a bonus.
My daughter drove me to the KP facility, about half hour from my house, the morning of April 10. I was supposed to arrive at 6 a.m. Because of a misunderstanding, we took a couple wrong turns and arrived a little late. In my haste to exit her vehicle, I neglected to tell her I loved her. She knew I did, of course, but there are certain things that cannot be overstated. I thought of this as I was being prepared for surgery, and hoped I would be given the opportunity to rectify this omission.
After disrobing and donning the paper gown I was given, I put on the purple tube socks KP provided and resolved to share them with my little grandson (he also likes purple and would, I thought, enjoy the little white imprinted designs of bear paw prints).
I had the most restful time in recent memory between 7:25 a.m. and 10:45 a.m., during which I knew nothing, after having received IV Versed and Fentanyl. During the above time span, my welfare, and, indeed, my life, were in the hands of others. Strangers, even.
I received a semi-unexpected visit during my time in post anesthesia recovery. A medical school classmate who had undergone a recent nephrectomy for kidney cancer came to see me. A retired orthopedist, he had had five back surgeries and had performed back surgery similar to what I had just had. Prior to my surgery, he had offered his home as a site for recuperation, and then, with exquisite timing, showed up to be supportive despite the fact that he himself was still recuperating — and from a far more serious illness. I was dismayed to learn that his tumor stage was more advanced than I’d originally thought, and wished him well. His visit touched me more than anything else that happened that day. I hope he is among the 50 percent who survive five years beyond surgery.
Well wishes in form of text messages and email arrived from family and friends. My daughter was so solicitous I wonder if I had erred in encouraging her to become a dentist rather than a nurse.
The surgery itself was not what I would call “failed surgery” in that I am somewhat, although minimally, improved. Despite the outcome at six months (long-term outcome remains to be seen), I am grateful beyond words for the kindness of so many involved in my care.
A caregiver’s empathy cannot but be heightened by role reversal, by having the shoe on the other foot, by viewing matters through a different lens, as physician becomes patient for a time and puts his welfare in the hands of others.
Samuel M. Chen is a radiologist.
Image credit: Shutterstock.com