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Thursday, July 28, 2011

Susie Update--Smashing Vertebrae

My wife, Susie, really IS a nice person.  Probably the most thoughtful person I've ever met.

This morning, I looked at the envelopes of three thank-you notes Susie had written yesterday, two waiting for me to transfer to the mail box out at the street of our home, and one awaiting hand-delivery by me to Apple Rehab.  That one, addressed to Pam Ferguson, Susie's physical therapist at Apple, had no stamp on it, as, I'm sure, Susie figures I'll be going by Apple on my daily rounds and we thereby save 44 cents, the cost of a first-class postage stamp.

So not only is Susie one of the most good-naturedly parsimonius people I've ever met, she's also thinks about the knee pain Pam Ferguson must be experiencing in recovery from her recent knee replacement.  In the note, which I read because the envelope was not sealed, Susie told Pam she was thinking of her and knew Pam was probably in a lot of pain.  But, Susie added, from her own recent experience in Pam's care, if Pam works really hard, she'll be free of the pain, or most it, sooner rather than later.  Susie never once mentioned her own, excruciating, daily, 24/7 pain from her own bicycle accident and ongoing recovery.  She didn't pity herself or compare herself with Pam.  Had I not known what Susie has been going through these past few weeks, I never would have guessed, reading the note to Pam, that Susie was having any physical problems of any kind.  Hence, my conclusion: Susie is the nicest and most thoughtful person I've ever had the privilege to know.

Which brings me back to Susie's story.  Yesterday, she was seen in follow-up by Dr. Schwartz, the neurosurgeon who had also attended her broken neck and brain mass, at Hartford Hospital.  Susie didn't want me coming in to the examining room, because I'd developed a prejudice against Dr. Schwartz, without having met him, based on some of the things Susie had told me about him.  Having had no direct contact with the doctor, all I had to go on was Susie's reports.  What I didn't like about him, from hearing Susie's account, was the way he joked about his short height, red hair, and pride in being a neuro-SURGEON, not a mere neurologist.  "Why would you ever want to be seen by some other doctor when you've already got the short, Jewish, red-haired, funny guy for your brain and neck doctor," Susie had told me Dr. Schwartz kibitzed with her.  Also, he reassured Susie that if the meningoma in her brain needed to come out, he might be able to go up through her nose and pluck it right out or, if it were too big for that, he'd be able to go right in and extract the mass.  All of that just left me cold.  He seemed, at a distance, too flip, too "funny," too confident to be thinking about putting his scalpel anywhere near my wife's gray matter.  Ultimately, of course, the final decision on things medical will be left, by me, to Susie, as the Chairwoman of her Body's Board.  However, as her Consigliere, I will do everything in my power to help her make a wise decision about who gets to go poking about in her brain.

So while Susie was in seeing Dr. Schwartz, I went downstairs in the medical building in West Hartford and had a cappuccino and some small talk with the two young women in the basement cafe, trying to guess their ethnic backgrounds from their appearance and their speech patterns.  These two presented an interesting challenge, because their histories were somewhat hard to discern, merely from their appearances.

After going back up to the doctor's office, Susie was just leaving the examining room area.  She told me that she had to return in one week because the trauma team at Hartford Hospital, not including Dr. Schwartz, had failed to schedule Susie for an x-ray of her broken cervical vertebrae.  Dr. Schwartz, therefore, had no way to discern the current healing status of the bones.  I also determined that Dr. Schwartz had not told her she could begin wearing a smaller, more comfortable, neck brace.  "Does he know that you're taking 3 Ibuprofen every 6 hours because that big neck brace causes muscle spasms, in addition to the 24/7 Oxycodone and occasional Dilaudin for the rest of the body-wide pain you're feeling?", I asked in a fairly loud, irritated voice? With that, I heard Dr. Schwartz walking around the corner and approaching Susie and me.  I introduced myself and quickly determined that he would not have been able to let Susie out of the painful neck brace even if he had a current x-ray.  It was nature, not administrative problems with respect to the scheduling of the x-ray, which was the responsible agent for keeping Susie in the irritating neck brace.  Once I was reassured of that fact, I relaxed and assumed a more friendly attitude towards the doctor.  Dr. Schwartz seemed genuinely compassionate towards Susie's situation.  I found this enormously reassuring, and immediately revised my non-fact-based prejudice about him.  It was especially confidence-building that this "little man" obviously had heard my plaintiff irritation about Susie's painful existence and immediately came out to meet me and talk with me, rather than avoid me and either send an assistant to deal with me or ignore my concerns entirely.  That's what I call a "visual credit check" of the doctor.

Dr. Schwartz did strike me as a character from a 19th century cowboy drama.  He is about five feet, 2 inches tall, very light-reddish-toned somewhat naturally curly hair, light blue eyes, a goatee, and wearing a formal dark suit with red and orange patterned tie, and a very old-fashioned, nerdy tie tack, at about the level of his sternum.  The tie tack was a gold chain, hanging down in an arc, with a gold bar, parallel to the floor, to each end of which was attached one end of the gold chain.  His eyes appeared just a touch watery, as if my complaints, or Susie's pain, had moved his tear ducts to release just enough liquid to cover his corneas with a very think coat.  I had a positive emotional response to that aspect of his person also.  If Dr. Schwartz had been wearing one of those old-fashioned, Union soldier blue hats, with crossed gold swords on the brim above his head, and curled up sides, and a silver sword hanging from his left side in a saber,  he would have looked like Commander Cody or some other Civil War or Old West, refined cavalry commander.

Susie and I thanked Dr. Schwartz and left to go back to her Prius for the ride home.  On the way home, Susie explained that the doctor had done a very careful and thorough examination.  He removed her neck brace, told her it was performing well its function of keeping her neck in the right position for healing.  Next week, when he sees a current x-ray, he'll be able to see if that's the case.  In his clinical office examination, he asked Susie to flex (bend forward) her neck.  She said it hurt her at the base of her neck, just above her shoulders.  He said that that was not from the broken vertebrae but from stiffness in her upper neck, from the neck brace.

If the x-ray looks good, he'll be able to tell her next week that she can periodically remove the neck brace to get relief from the pain of the spasms which result from having her neck stuck for so long in the same position. If she gets the go-ahead next week to remove it from time-to-time, it'll have to be on her neck for 8 weeks.  If she can tolerate not taking it off at all, the brace will only have to be worn for 6 weeks.  That'll probably be her choice, after the next office visit.

As for the brain lesion, he'll want to have another MRI done, 6 months after the accident.  If it hasn't grown in size, he'll leave it alone.  If the brain mass had not been uncovered due to the bike accident, it could have grown in size, slowly, without being detected, until, at some point, Susie might have begun having memory difficulties and balance issues.  These symptoms would have resulted from the lesion growing in size and pressing on brain cells responsible for memory and balance.  And who knows if a doctor would in that case have thought the clinical symptoms warranted an MRI or, instead, have chalked it up, diagnostically, to "the aging process?"

As for the broken neck, Dr. Schwartz told Susie the rear "wings" of her C6 and C7 cervical vertebrae had crushed together by virtue of the force of her body hitting whatever it hit, on her right side.  As the stable object she hit, whether tree or sidewalk, stopped her body's movement, suddenly and abruptly, the force which a millisecond before had moved her body through the air, with the lightness of a ballet dancer, was unfortunately transferred fully through her neck and into the rear wings of C6 and C7, pushing the adjacent bones together with sufficient G-force to crush the calcium-made-by-God structures and come just millimeters away from severing her spinal column irrevocably.

Praise God from whom all blessings flow.  Amen.

I've got to go to an appointment in Essex, so I'll continue this missive later.

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