Fifteen months ago, I fell off a ladder and crushed my first lumbar vertebra. My internist sent me to Chris Noonan, a back surgeon. Noonan put me in a metal brace for six weeks and suggested a surgery called a kyphoplasty in which he would inject cement into the broken vertebra. I read up on kyphoplasty and found that it is of no longterm benefit, and that the cement sometimes escapes and breaks surrounding vertebra. Noonan became angry when I mentioned these things, and his anger, alongside his usual callousness and arrogance, inspired me to go to another surgeon, Jonathan Sherman. Sherman agreed with me about the kyphoplasty, and instead suggested monitoring the vertebra for further collapse. On my third visit, he announced that it had gone from 20 to 24-degrees in three months, and that a surgery called a pedicle subtraction osteotomy with thoracolumbar fusion would be necessary if it got beyond 30-degrees (in plain English, he would re-break my back and fuse four vertebra, two above the break and two below it). When I asked for further details, he refused to answer, saying that they would only upset me!
I went home and Googled the surgery and learned the following: he would cut through my belly to reach my backbone; the surgery has a 50% risk of serious complications; it would leave my entire body severely weakened; it has a very long recovery period; and it wouldn’t restore me to anything approaching normal. I also noted that it’s mostly done on people with severe scoliosis, so I questioned his competence in recommending it for a broken vertebra, and, if the surgery proved necessary, I had no thought of having it in Eugene. I then went back to my internist and asked for a referral to a surgeon in Portland at Oregon Health Sciences University (OHSU doctors see the worst of the worst). He said he would have recommended it if I hadn’t, so I started the four month wait to see Dr. Ahmed Raslan (pictured) in a sixteen story medical building that is just one of OHSU’s many facilities. My appointment was yesterday.
After an office exam, Raslan sent me downstairs for two X-Rays and two CAT-scans. Less than an hour later, I was back in his office. The first thing he said was that I didn’t need surgery. He then showed me how the angle of collapse is measured and said that Sherman measured it entirely wrong, but that even if he had gotten it right, I wouldn’t need such a surgery at 40-degrees much less 30, that is unless my back was so out of alignment that my head no longer rested above my hips, and even then, a lesser surgery should suffice. This was the best possible news.
I then told him that, between the pain in my back and the pain in both shoulders, I found it extremely difficult to sleep even with all the pills I take. He said he would send me to a pain specialist here in Eugene with a recommendation for pain-killing injections. I know what to anticipate because I’ve had fluoroscopically-guided injections into my neck vertebra, and they’re scary, but happy drugs make them downright enjoyable. I really like happy drugs.
When I write about my medical adventures, it is with the hope that those who are as naive as I once was will take note of the following: (a) the letters MD don’t, of themselves, mean squat, (b) half of all doctors are callous, arrogant, and incompetent, and (c) it is a serious mistake for the patient to simply sit back and trust that everything that should be done will be done, and that it will be done right. Even if your doctor is the best, many other “caregivers” will have an opportunity to maim or kill you (400,000 Americans a year die of medical errors, making it the third leading cause of death behind heart disease and cancer).
Two of the few things that are more stressful than medical problems are medical care and, in America, the resultant insurance hassles. The more I am exposed to these things, the more I approach them with an adversarial attitude. On the downside, this sometimes makes it hard for me to hide my hostility when dealing with greed and incompetence, but on the upside, I’ve completely lost my adolescent notion that doctors are demigods. I have also learned that it’s good to have Peggy go to doctors’ appointments with me for moral support, to ask additional questions, and to remember what was said. We all like to believe that we’re strong enough to go it alone, but the truth is that having backup helps us get better care, and the stakes are too high to settle for anything less.
Peggy (who worked as an RN for three decades) says that she needs this support more than I because doctors don’t treat women, including women who are nurses, with the same respect that they treat men, so having me there makes it more likely that her thoughts, questions, and concerns will be taken seriously. There was a time when it was widely believed that the influx of women into medicine would humanize it, but it has been my experience that women doctors are as bad if not worse than men. It’s as if they had to renounce the virtues of womanhood (empathy and attentiveness) while taking on and exaggerating the weaknesses of manhood (haste, cockiness, and a contempt for weakness) in order to complete their training.
I came away yesterday feeling that, although the pain is as bad ever, the road has become a lot smoother. Now, I’m just mad at that Sherman idiot for causing me so much unnecessarily anxiety.