Essay by S M Chen, submitted April 29, 2015

“I have always depended on the kindness of strangers.”  – Blanche DuBois, A STREETCAR NAMED DESIRE, Tennessee Williams

Chen, Get well card

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 which indicated that patients who underwent surgery were better at 1 year, but about the same as those who opted for more 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 on the local high school track, which was padded.

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 a boy 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 give me the peace of mind that I didn’t have something serious, such as metastatic prostate cancer, as the cause of my sciatica.

What I did have was 2 level adjacent spinal stenosis.  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 the sciatica.

Fast forward to 2012, when I moved from one county in CA to another, to experience coastal climate and be geographically closer to my daughter and her family, including my namesake grandson.  Despite the move being grueling, made more so by the timing of the move, little assistance with sorting and packing, finding tenants for my townhouse, and dropping 10% of my body weight, my sciatica was not particularly worsened by lifting heavy objects or other increased physical activity associated with such a project.

In fact, I wasn’t particularly worse during a 6-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 not informed her about the sciatica).

Some time later, I encountered a fellow I had known but briefly in college, decades earlier.  He was in tennis garb at the post office, and told 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 than I’d once been.  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, to some extent, mended me 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, likely because of my erstwhile college acquaintance, 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 roundtrip path from my house to the coast on a vintage (1970s) 5 speed Schwinn, and did this at least once or twice a week.

In 2014 my sciatica had worsened to the point that I felt the need for medical evaluation (the adage that says that the physician who treats himself has a fool for a patient is not far off the mark).  I had joined Kaiser Permanente by that time.  A repeat MRI showed similar abnormalities as had the one in 2009 (comparison by an independent reader was not conducted, in that the two studies had been performed at different institutions), but my symptoms were clearly worse, and asymmetric.

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, I stopped tennis, in that I noticed that I had new discomfort down the backs of my thighs and legs after playing.  I continued biking, however, for aerobic exercise; it did not seem to particularly aggravate symptoms.  I also consulted a neurosurgeon.  Very matter of fact, he showed me my latest MRI scan and discussed proposed surgical treatment, including risks.  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, some less so.  I was reminded of the 3 score and 10 years that the Psalmist wrote of, more than 3 millennia ago, and considered myself fortunate that I had reached that figure.  Particularly as one ages, there are so many conditions and diseases to shorten or amputate life that I sometimes think it’s a wonder that as many of us are alive and reasonably healthy as are.

The afternoon before my surgery, I received a voicemail from a brother who left a touching and comforting prayer.  I saved and will treasure it.

I had prepared the best I could.  Hoping for the best, but preparing for the worst, I had updated my son, who is the executor of my will, with details in a long e-mail.

Perhaps overly prone to making lists, 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 neurosurgeon had informed me the likelihood of improvement from surgery was 50-75%).  Anything beyond that I would consider a bonus.

My daughter drove me to the Kaiser facility, about half hour from my house, the morning of April 10.  I was supposed to arrive at 6 am.  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 (purple is a favorite color) Kaiser provided and resolved to share them with my 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 07:25 and 10:45, during which I knew nothing, after having received IV Versed and Fentanyl.  No vivid dreams of giant gold balls clanging against one another, as I had when, as preschooler, I’d had my tonsils out under what I think was ether anesthesia.  During the above time span, my welfare, and, indeed, my life, was 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 5 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 as he undergoes a clinical trial of possible chemotherapy.  His visit touched me more than anything else that happened that day (“I was sick, and ye visited me.”  Matt. 25:36).  I hope he is among the 50% who survive 5 years beyond surgery.

Well wishes in form of text messages and e-mail arrived from family and friends.  My daughter has been so solicitous I wonder if I erred in encouraging her to become a dentist rather than a nurse.  She purchased a desk for me to use, at which I sit as I write.  My 4-year-old grandson made me the get-well card you see above.

I am not yet out of the woods, but feel as if I am approaching the clearing.  The pain and paresthesias seem largely gone.  I am ambulating, albeit gingerly.  I am grateful beyond words for what has transpired so far.