P. T. !!!

My wife, Katie, is diligently subjecting herself to variations of Medieval torture as part of post-shoulder surgery physical therapy. The house is outfitted with ropes, pulleys, weights and rubber bands a thousand times larger than the ones that hold a pony tail in place. Moans and groans intermittently form an auditory back-drop, and they don’t indicate satisfaction.
Increasingly, at social gatherings among middle-aged people, maladies and therapies dominate the conversation, and more medical information is exchanged than I wish to acquire. My personal accumulation of unwanted medical knowledge commenced twenty years ago, when I was thirty-seven, and awoke to find a burning arrow wedged in the lower section of my back. Not a literal burning arrow, of course, but it may as well have been. I had never felt anything like it as I tried to stand up. I fell to my knees and crawled, ashen, towards the bathroom.
“What is it?” asked Katie.
“I don’t know,” I said through clenched teeth. “But it’s, it’s, it’s amazingly painful.”
“What does it feel like?” she asked.
“Indescribable,” I said, honestly, for I could not find words to do justice to the distress calling from a part of my body I’d never contemplated.
“What caused it?” she asked.
“Um,” I said. “Maybe lifting the children yesterday? Maybe ice skating last week? Maybe playing soccer fifteen years ago? Does it matter?” I didn’t intend to be snippy, but my mood was darkened by agony.
After pulling myself up with the help of the sink I found that standing ramrod straight provided some relief. Laying flat on my stomach, too, merely yielded pain, several steps down from anguish. Any position in between was excruciating.
“I’ll drive you to see Keith,” said Katie, referring to a client of mine who was a chiropractor. “He’ll know what to do.”
“I’m not sure I can sit in the car,” I said.
“We’ll use the station wagon,” she said. “You can lie flat in the back.”
“Like luggage?” I asked.
“Like a pair of skies,” she said.
“Wonderful.” I grimaced.

Keith needed only to look at my facial expression to take me in ahead of a full waiting room. After he elicited several unnerving cracks from my lower back, he declared: “It’s a strain of your gluteus maximus, a large butt muscle. It’ll loosen up as the day goes on.”
“Well, I’m certainly skipping my tennis game tonight,” I said.
“No, you can play tonight; it’ll be good for it.”
I looked at Keith incredulously, but he appeared confident. “Call me tomorrow,” he said, “to let me know how you feel. Then, if you come three times a week for a month or so, we can make sure this doesn’t happen again.”
With his “adjustments” and several Tylenol I was able to work that day, standing. Katie drove me home in the rear of the car.
“Should I really play tennis tonight?” I asked.
“Keith seemed to think it would help,” she replied.
When we arrived home, I shook my head as I gingerly changed for my weekly doubles game.
“This seems crazy,” I said.
I drove myself to the courts holding my body straight like a plank to reach the pedals. I hobbled onto the court and took a few warm-up swings. Immediately, the pain erupted like a volcano. I could barely utter apologies to my playing partners before staggering back to the parking lot. The drive home was luckily without incident as I drove in a haze of pain. Once there, I brushed past Katie at the door and fell, clothed, onto my bed for a largely sleepless night.
Before I could call Keith in the morning, he called me, which made me wonder how confident he felt about his diagnosis.
“How’s your back?” he asked.
“I’m really suffering,” I croaked. “Tennis was NOT helpful.”
The line was silent for a moment. Perhaps, Keith was reviewing his malpractice insurance policy.
“Um, let’s schedule you for an MRI,” he said, finally.

My first lifetime MRI was memorable. I had no problem with claustrophobia, as some do. And the odd, metallic clunking noises didn’t bother me. But lying flat on my back meant I was directly on top of the pain source.
“I think I know what childbirth feels like,” I said afterward, recalling Katie’s facial expressions during those events. Having seen me crawl out of bed, she didn’t disagree.
The radiologist immediately declared my condition to be a herniation of the L-5 S-1 disk, for those keeping score. Newly familiar with such descriptive terms as “lumbar” and “thoracic,” I told Keith, and he said: “Come in for some adjustments and electrical stimulation. I’ve fixed many a herniated lumbar disc. It might just be a bulge.”
For nearly a month, I worked standing all day at my law practice and traveled prone in the back of Katie’s station wagon or in the back of accommodating realtors’ or clients’ cars. I avoided sitting, even at closings, though that made me the subject of intense curiosity, and subjected me to other peoples’ sore back stories which, to my surprise, nearly everyone had. Keith “manipulated” and “adjusted” and “stimulated” my lower back every other day. At a minimum, Keith’s efforts served to pay his mortgage that month.
“The difference between how a herniation presents and how a strained gluteus maximus presents is subtle,” he started to explain one day.
“Unh,” I grunted in unsympathetic skepticism.
“If it’s just a ‘bulging’ disk, it can recover,” he reassured. “You definitely don’t want surgery.”
He was right about not wanting surgery. However, at Katie’s insistence, we sought a second opinion from an orthopedist. “If it’s merely ‘bulging,’ the chiropractor is correct,” said Dr. Bellotti, after probing my lower back for a brief instant, sufficient to nearly make me scream. “But I think yours is fully ‘extruded.’”
“What does that mean?” I asked.
“You know how when an egg breaks, you can’t put the yolk back in the shell?” said the doctor. “That’s fully extruded.”
Dr. Bellotti referred me to Dr. Quain, whom he described as “the best neurosurgeon around.” Katie drove her human cargo across the George Washington Bridge to his office at Columbia Presbyterian Hospital the next day. There, Dr. Quain, a bald, sixty-something man of imposing girth and booming voice, banged my kneecap for a reflex that elicited no response and declared, like in the movies: “you’re not going home tonight. We will operate at dawn.”
“But the chiropractor said…” I started
“Chiropractors are merely one evolutionary step above slime,” he said in a tone that allowed no disagreement. “Your extrusion is extreme. Your sciatic nerve is completely blocked, so we must remove the disk material. When there’s no reflex, effective use of your leg is at risk.”

Sciatic nerve? Worse and worse. I was learning additional new vocabulary, and now I was slated for emergency surgery. The situation had only one consolation: my room on the twelfth floor at Columbia Presbyterian had an unobstructed, priceless view of the George Washington Bridge. I gazed at it all evening from my unmoving position in bed while I awaited the excavation of my lower back. I recall being delighted the bridge’s lights danced like fireflies, but I’m sure painkillers had something to do with my enchanting vision.

I recall little from the day of surgery except that Katie told Dr. Quain sternly: “You’re going to perform the surgery, right? Not an intern.” In this instance, her tone of voice allowed for no disagreement. The doctor agreed.
When I awoke after surgery, I felt instant relief, as though the herniation had never occurred. Once painkillers wore off, I experienced spasms for several days while the sciatic nerve reverted back to its old route down the spine. (More acquired knowledge!) But the interesting part of the experience was that the doctor did not visit me the next day.
“Does the scar look okay to you?” he asked Katie on the phone.
“I guess,” she said.
“Then he’s okay for discharge,” said Dr. Quain. “Come see me in a month. Meanwhile, have him take it easy.”
“That’s it?” she asked.
“He’ll be fine,” said the doctor. “Good-bye.”

One month later, now totally pain-free, Katie and I visited Dr. Quain. He looked at his handiwork briefly, and concluded: “Looks good. Now, nothing but walking or swimming for you.”
“For how long?” I asked.
“For life,” he said.
“But I play tennis, and soccer,” I said. “I want to play with my children, too.”
The doctor shook his head.
“What about physical therapy?” asked Katie.
“Not necessary,” said Dr. Quain.
Katie was not convinced. “I’d like a physical therapy prescription, in case he feels up to it.”
The doctor shrugged and wrote out a sheet. “Twice a week, if you insist,” he said. “But not before six months. Just remember, I’m not in favor of strenuous activity.”

Taking the doctor’s words to heart, I treated my lower back like a Tiffany egg. I didn’t touch it. In accordance with suggestions from “bad back” magazine articles (practically an entire genre) I made sure to exit cars with both legs first, to never twist around to reach behind, to roll out of bed without abrupt movements. I warded off physical contact with the kids, and let my racquets gather dust in the closet with my golf clubs.
Exactly six months after surgery, Katie scheduled a physical therapy appointment for me.
“Are you sure this is a good idea?” I asked.
“No,” she said. “But you’re going to try it. You can’t just give up all activities in your mid-thirties.”
She was right. I had to try, but how could a stranger touch my lower back? I barely ran my fingertips over the scar when I took a shower. I pictured it as a hot-spot of total disaster, like the button for a nuclear weapon.
When I arrived at the office for my appointment, I was relieved to see my randomly assigned therapist, Susan. She was a petite blonde, about five-foot-two, and clearly not capable of inflicting pain. I wondered if she worked with adults or only small children. Her hands looked too small for her profession.
“So, what have you got?” she asked.
I lifted my shirt to show her my small scar just above the belt-line.
“How does it feel?” she asked. “Does it hurt?”
“I don’t know,” I said. “I never touch it.”
“Never?” she said, “for six months?”
“Doctor Quain said to ‘take it easy,’” I said, sheepishly.
“Ah, Dr. Quain. He’s ‘old school.’ Doesn’t believe in therapy and, incidentally, he believes his ‘cure rate’ is better if his patients never move. Lie down and lift your shirt,” she said, with a smile in which I thought I detected a glint of sadism.
Apprehensive, I arranged myself carefully on the therapy table. “Are you going to touch…?”
Before I could finish my sentence, Susan plowed into my scar with her knuckles, as though she were kneading the toughest cookie dough in history. In my shock, I almost screamed in anticipation of the tsunami of pain waves that were rushing at me. Then I realized, I felt… nothing at all. My back was totally healed.

For two months, I visited Susan twice a week. She provided a regimen of stretches. I commenced performing them daily to keep my back in shape. It is fair to say that my lower back is now the strongest part of my body; it’s the only part that has been exercised at least 350 days a year for twenty years.
I resumed playing soccer with the children shortly after therapy ended, and I play vigorous tennis now. I am still careful to “bend my knees” when I lift something, to avoid excessive sitting, and to walk every day. I am a BELIEVER in physical therapy, which will doubtless be necessary again. Let’s see, occasionally clamoring for attention these days are the right elbow, the left knee, and the right wrist. Time does not go backwards.

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