The transformative powers of pain
There are two kinds of people in the world: those who have back problems and those who don't. I'm not thrilled to acknowledge that I date the origin of my own back problems to the period, nine years ago, when I repeatedly threw my infant daughter up in the air and carried her around in a Snugli. It's a dubious etiology, since another cause would surely have come along soon enough; my back, one physical therapist has explained to me, was an accident waiting to happen.
I wish I got to indulge in the luxury of being lionized as Atlas by my daughter, but I can't. At parties, I look first for a chair, since I can't stand more than a few minutes. I can't hula-hoop with my daughter or dance with my wife. I try to jog, but I often get pins and needles down my right leg. When we take trips my wife has to carry the heavy luggage; at home, she moves the furniture. Atlas I ain't.
You might suspect, I might suspect -- my wife definitely suspects -- that maybe I just have a pathetically low pain threshold. And yet my back doctor assures me that with 'my back,' some people play golf and tennis while others have been on disability for 15 years. I fall somewhere in the middle: I've never missed a day of work due to my back, but I certainly complain about it a lot. I'm not so much a hypochondriac as a misery miser, fascinated by dysfunction.
I'm in the awkward position of being exactly half as old as my father is -- I'm 46; he's 92 -- and being in decidedly worse physical condition. He still swims and jogs and golfs and lifts weights (sometimes, all on the same day), whereas I'm grateful if I simply go to bed at night without lower back pain. A couple of years ago I heard an elderly woman interviewed on This American Life say she would welcome entering the kingdom of heaven because she would finally be granted relief from her incessant physical pain. While I was listening to this, I was driving, my back was killing me every time I turned the steering wheel, and I must admit: I could relate.
Over the past decade, I've seen therapists and therapists and therapists, doctors and doctors and doctors. One doctor said I should immediately have back surgery -- he had an opening later that afternoon. Another doctor said all I had to do was perform one particular leg-lift exercise that Swedish nurses did and I'd be fine. One therapist said I should run more; another said I should run less. One said that human beings weren't built to sit as much as I sit; another said people were never meant to stand upright. One thought I would need to keep seeing him for years and years; another criticized me, after a few months, for not cutting the cord.
I finally saw a back doctor who, unlike 99 percent of doctors I've ever seen, presented himself as a person rather than as an authority figure; ask him how his day is going and he'll say, 'Terrible -- no one's getting better.' He, too, has a bad back, and when he drops his folder, he'll squat down to pick it up, the way back patients are instructed to do, rather than just lean over, the way everyone else does. When I speak to most doctors, I feel slightly (sometimes not so slightly) crazy, whereas I feel like a person, like myself, when I'm talking to this doctor. At my first appointment with him, he emphasized how many of his patients carve their entire identity out of the fact that they're patients; their whole existence is given structure and purpose by the fetishization of their pain, their victimhood. The message was subtle, but I got it: Don't let myself become a suicide bomber.
My doctor recommended that I see a physical therapist named Wolfgang, who goes by the name Wolf and looks and moves in a rather wolflike way as well. One morning when I called to say I felt too bad to come in for my appointment, he said, 'You have to come in; that's what I'm here for,' and he gave me electronic stimulation and a massage. One of my favorite experiences in the physical world is a massage from Wolf. I used to throw my back out completely -- the classic collapse on the sidewalk and yowl to the heavens -- but now, due in large measure to the Wolf program, I seem to have it under control. (Knock on lumbar.) I sit on a one-inch foam wedge on my chair, sleep on my side, on a latex mattress. After lying down, I don't just sit up but rather first 'find my center' (there really is such a thing, I'm pleased to report). During the day, I get up every hour from sitting and do exercises or at least tell myself I do or at least take a hot shower or apply an ice pack or a heat pad. Every day I walk or swim or even, of late, play a little light basketball. Wolf keeps reminding me that neither he nor my doctor has a solution: I have to become my own authority and view recovery as an existential journey.
And what existential journey hasn't been aided by chemistry? I've been in and out of speech therapy all my life, but nothing has mitigated my stuttering as effectively as taking 1 milligram of Alprazolam, a sedative, before giving a public reading. The ibuprofen and muscle relaxants have certainly helped my back, but the antidepressant Paxil has been transformative. At first I strenuously resisted my doctor's prescription. My father has suffered from manic-depression for most of his adult life and his first major breakdown occurred in his mid-40s, but assurances were given that I wasn't being 'secretly' treated for depression or anxiety; Paxil has apparently been used to treat chronic pain for more than a decade. For three months I've been taking one 20-milligram tablet of Paxil a day. I worry a little about becoming a grinning idiot, but I figure I already have the idiocy part down, and I'm so far over on the grouchy side of the continuum that a little grinning isn't going to kill me.
Now rather than endlessly rehearsing how my life might have been different, I tell myself about how grateful I am for my life -- with my wife and daughter and our relative health and happiness together. (Knock on lumbar.) I'm newly in love with my wife -- aware of her weaknesses and completely accepting of them, because I'm so blisteringly aware of my own. I go to sleep with a night guard jammed between my teeth and a pillow between my legs. I walk around with an ice pack stuck in one coat pocket and a baggie of ibuprofen and muscle relaxants in the other. I'm not exactly king of the jungle.
I like the humility and gravity and nakedness of this need, for -- and this is apparently a lesson I can't relearn too many times -- we're just animals walking the earth for a brief time, a bare body housed in a mortal cage. My back will always hurt a bit, or rather the pain will always come and go. But, as my doctor likes to say, 'Pain is inevitable; suffering is optional.'
Writer David Shields is the author, most recently, of Body Politic: The Great American Sports Machine (Random House, 2004). Adapted from SpineLine (May/June 2002), the little-known bimonthly trade magazine of the North American Spine Society (NASS). Subscriptions: $100/yr. (6 issues) from NASS, Dept. 77-6663, Chicago, IL 60678; free for NASS members; www.spine.org/spinelinetocs.cfm.