Responsibility

The doctor’s statement came as such as shock that I almost gasped.  Did I hear him correctly?  I was in a neurosurgeon’s office for a third opinion on whether to have surgery to repair a ruptured disc in my neck.  His recommended plan of treatment, and the reason for it, was so completely unexpected that I almost gasped with shock. 
 
I was desperate for a cure for the pain in my neck.  To cope with the pain, I was having to take narcotic pain killers.  Even with narcotics, there were days when I was in so much pain I couldn’t sit up to work at a desk.  On days when I did work, I would be in so much pain afterwards that I couldn’t carry on a conversation with my children when I picked them up from daycare. 
 
It all started when I worked very long hours to complete an appellate brief in a highly contested death penalty case.  I had one week, or maybe ten days, to write a brief which defended the death penalty handed down by a jury to a retarded man after he shot two sisters to death in the parking lot of a Wal Mart store.  During the ten days or so that I worked on that case, I basically worked all day and long hours into the night, including on the weekends, going home basically long enough to eat and sleep.  The transcript of the trial was roughly 3,500 pages long, and there were roughly sixteen, separate issues which needed to be briefed on appeal.  The final copy of my appellate brief ended up being 88 pages long after I had parsed and whittled my arguments into as brief a form as I could possibly make them. 
 
"Ah, relief," I thought, as I submitted my final, bound copies to the state supreme court.  My neck was sore and stiff from working such long hours at my computer desk.  I could hardly turn my head from side to side.  I told my boss I was taking a few days off, and I went home for a much needed rest.  After one day, my neck was no better.  After three days, it was still no better.  I went to an orthopedic doctor.  To my utter shock, he said, "you have a ruptured disc in your neck."  Then he said, "It took a long time to get this way, and it’s going to take a long time to get better."  He sent me to physical therapy where I was given exercises to stretch and strenghten the muscles in my shoulders and neck. 
 
But after months of therapy, I was still in terrible pain.  I had recovered some range of motion in my neck, but the pain was ever present.  That’s when my daughter’s pediatric neurologist agreed to treat me, even though he normally only sees children.  He was the first doctor who felt my pain was worth treating and prescribed pain killers, explaining to me the "pain muscle spasm cycle:"  pain causes muscle spasm, muscle spasm causes pain, and it creates a vicious cycle.  This was the first real breakthrough in my treatment.  But moreoever, he sent me to a neurosurgeon to be evaluated for surgery.  The first neurosurgeon told me I needed surgery, but a second neurosurgeon disagreed.  This third neurosurgeon was, thus, to cast the deciding vote.  So, we are talking a long history, a lot of doctors, and a desperate patient.  The ramifications rippled all through my life, including my ability to work or be a contributing member of my family. 
 
"You don’t need surgery," said this new neurosurgeon.  "Further," he continued, "It’s something you’re doing that is causing this.  It’s a continuing injury.  The body’s natural tendency is to heal itself.  If this weren’t an ongoing injury, you would be better by now.  It’s probably something that you’re doing every day, and you’re the only one who can figure out what it is." 
 
Then, he said the most shocking thing of all:  "No doctor cares enough about you to sort out what is causing this problem with your neck!  You’re going to evaluate everything you’re doing in your life and figure it out on your own!" 
 
"What?!" I thought, utterly taken aback.  "My doctors didn’t care about me?!  A doctor couldn’t figure it out?  A doctor couldn’t fix it?  Did this doctor not care?"  This guy was very brusque.  He wasn’t smiling; he didn’t have a kind demeanor.  Then he elaborated. 
 
"It’s probaby something you’re doing for several hours per day.  You should examine every aspect of how you are using your body every day:  how your desk is set up at work, how your car seat is adjusted, how you are sleeping at night, what your pillow is like.  But the bottom line is, only you can make yourself better.  You’re going to have to figure it out and then do whatever it takes to change it.  It will probably involve a whole change of lifestyle." 
 
I left his office in a state of shock and disbelief.  This man had told me that my doctors didn’t care about me.  He had told me that surgery wouldn’t fix my problem.  He had told me that I was, in fact, on my own to solve the mystery of what was causing this terrible disability and pain.  I thought he was a very callous person, to make light of my obvious suffering. 
 
After the intial shock wore off, however, I realized he was right.  In the end, I’ve come to consider his advice to be the most valuable medical advice I’ve ever received.  His insight did, in fact, point me to the realization of the truth:  the habits that had caused a ruptured disc in my neck were, indeed, continuing habits, related to things I was doing every day.  I researched and learned about ergonomics, particularly proper posture and proper setup of a computer desk. 
 
Because in my job as an appellate lawyer, I was spending hours daily hunched over books in a library or crouched in front of a poorly fitting computer desk:  keyboard, monitor, and chair all at improper heights, with improper arm or back support as well.  Even the angle of my car seat in my car needed to be changed. 
 
And here’s the other fact:  No doctor cares as much about me as I care about myself!  It is only me, and my immediate family, who feel the consequences of health or poor health in a profound way.  Unless the doctor is my friend or relative (and there are some for whom I’ve very grateful), he’s not going to be personally affected if his diagnosis is wrong or if I don’t get better.  So, his investment in me is limited.  "Ten minutes, here’s a prescripton, and that will be ninety dollars, thanks."  This is okay for something simple like strep throat, but when the causes are complex and harder to tease out, it becomes more problematic. 
 
The bottom line is, in fact, that each of us must — absolutely must — take responsibility for our own health.  When we have health issues, it is only through being proactive and self assertive that we will gain insight, knowledge, and appropriate treatment.  If we are lucky enough to have caring, involved doctors who help us with this process, so much the better, but the bottom line is that it is an individual responsiblity.  Health is something we must take personal interest in and responsibility for, it is not a responsibility that can be shifted on to someone else. 
 
Over time, with research and self analysis, I learned about and addressed each of these daily issues, and gradually my symptoms did improve.  Unfortunately, I couldn’t undo the damage that had already been done, but by taking responsibility for and addressing all the things I could do on my own, I did more for myself than any doctor could have done for me. 
 
He was right.  I didn’t need surgery, I needed to change my life.  And nobody could tell me how to do that other than myself.  Thanks, doc.  I remain grateful for those shocking words of advice. 
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