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Thursday, August 4, 2011

The Surgeon

The Surgeon

Susie walked slowly out of the examining room.  I heard the clicking sound of the bottom of her metal cane hitting the carpeted floor, as she came to get me in the waiting room.  She moves like an old lady now, because of the pain, the stiff neck brace, and the need for caution.  A slip and fall could be life-threatening at this point.  So is the next stage of her medical treatment.

“He wants you to come in.”  I knew Dr. Schwartz needed to explain to me, as Susie’s primary caretaker, what she can and cannot do when she takes the brace off.  Obviously, he hadn’t told her the neck had healed enough that she could take it off for good.  But at least she’d be able to take it off a few hours a day, not all in one fell swoop but maybe a half-hour here, fifteen minutes there, that sort of thing.

I was happy Susie was finally going to get some relief, albeit temporary, from having her head held straight, chin pushed up in a white plastic stranglehold, fixed in place by the front end of the brace, which wanted to dig hard into her upper chest.  One of the four blue pads softened the pressure which the front of the brace maintained on the area between, and just above, her breast line.

For four weeks, actually twenty-nine days, we had, Susie really, worked hard to do everything right, to make this wonderful day of Brace Liberation possible.  Matt Raider, the family doctor at Apple Rehab, who had taken care of my mother and even my father before Susie, had told us that many people get so weary of wearing the brace that they just take it off and chuck it away.  “There are really no double-blind studies to tell us who needs the brace to stabilize the broken vertebrae and who doesn’t.  Maybe one out of a hundred who take it off suffer severe side-effects.  Most of the time you probably don’t even need to wear the brace, but the neurosurgeons want you to just to be safe.”  Susie’s the type of person who keeps the brace on, and accepts the pain, just in case.

From the time Susie was in Hartford Hospital, we’ve been confident the neck would heal on its own.  No surgery would be necessary.  Everything looked good for a full recovery, without having to let the doctor cut into her neck.  Once you start messing around with God’s integument, all Hell sometimes breaks loose.  But fortunately, we weren’t going to have to cross that bridge.  She just did everything she was supposed to do, and good things would come to pass.  God would provide a complete healing of her broken neck without any bodily invasion.  “Praise God from whom all blessings flow,” was the refrain I learned to repeat, eventually without feeling overly religious, from my good friend, Neely Bruce.  Sure, bad things happened to Susie, a good person, who follows all the rules, but God was going to follow through on His part of the contract from now on. 

I followed Susie back down the short hallway to the small examining room.  It was rectangular, with two chairs against the wall opposite the doorway, a chair against the opposite wall, and a standard-issue black examining table with white paper covering its entire length.  Susie looked at me and burst into tears.  “I have to have surgery.  It’s not healing right.  This is just SO frustrating.  I’ve done everything they told me.  It’s just so aggravating.”  Tears welled in her eyes and began to trickle down her cheeks.  I wondered if this is the way she looked as a child, when she got bad news and it made her cry.

I hope I betrayed no negative emotion and I think I was able to conceal my fear from her.  In her weakened emotional state, she was prepared to believe that I was The Rock, The Strong One.  So she let herself feel the mushy side of things.  “It’s okay, Suze.  I liked him when I finally met him last week.  He seems to know what he’s doing.” 

I believed what I was telling her.  When Susie first told me about Dr. Schwartz, I didn’t like what I was thinking about him.  That was when Susie had been moved from the Step-Down Unit to the 9th floor at Hartford Hospital, on about the third day of her hospitalization.  “I really like him.  He’s funny.”  With that comment, I already didn’t like this guy.  Women are suckers for men who make them laugh.  This guy was no dummy. 

“Are you a neurologist?”  “Are you kidding?  Neurologists don’t operate.  I’m a Neuro Surgeon.  I do surgery.  I’m hoping that we won’t need to operate on your neck, to stabilize it.  Hopefully Nature, and the neck brace, will be enough.  But that growth in your brain is another matter.  I could go in through your nose, grab it, and pull it back out the same way, except it’s a little too large to get it through your nose.  We’ll take another MRI of your brain in six months and then go from there.  If it has to come out, I can go in through a tiny incision above your eyebrow and just take it out that way.” 

On some other round, the doctor kept the comedy routine going.  “I’m a short, red-headed, neurosurgeon.  You wouldn’t think of getting another doctor to take care of you now that you know all that, would you?”  This also amused Susie, but not me.  I imagined this guy had Little Man syndrome, a big cocky sense of himself and his surgical abilities, and probably insufficient experience getting his rear-end kicked by his patients’ morbidity and mortality.  At that point, I didn’t consider the possibility that he just found my wife attractive, truly cared about her well-being, and honestly thought he had the skills and the self-confidence to go into her brain if necessary to remove the offending mass.  Was I zealously vetting the doctor or jealously sizing up a rival for Susie’s affections?

It was just seventeen hours ago that Dr. Schwartz walked into the examining room in Hartford, greeted me, and sat down in the chair opposite the two Susie and I were sitting in, waiting for him.  He was wearing the same dark suit, the same red and black checked tie, and the same gold tie tack chain and bar as he wore when I first met him last week in his more luxurious Farmington office.  I again noted his pale blue-green eyes, the goatee, his blondish, very pale reddish hair, his very short stature. 

“I can show you on this MRI why we need to do the surgery.”  He had set up his black laptop on the white paper covering of the examining table.  It was almost like looking at an x-ray image of Susie’s vertebrae, as if a section of her cervical spine had been unscrewed from the rest of her body and balanced on its end on the white paper, bloodlessly, and in black-and-white.

“You can see that this vertebrae is not lined up on top of the other one,” pointing with his short index finger, “and bottom of the front side of the top vertebrae is raised up just a little bit more than the other ones, which creates a little extra space between C6 and C7.”  I could see with my own, untrained eyes exactly what he was talking about.

“There’s also this little piece of floating bone tissue which broke off the wing of the upper vertebrae when the two of them were crushed together by the force of the impact.  I’m concerned that if we don’t operate, and stabilize the vertebrae, they’re going to grow back in mis-alignment.”  I immediately saw where that scenario would lead.  “And if they heal the wrong way, the only thing you can do then,” I imagined, “is re-break the vertebrae and start all over agin.”  “Precisely,” he nodded. 

“Are you feeling any tingling in your left thumb and first finger?,” he asked Susie.  “Now that I’m feeling a little better in the rest of my body, I am feeling some in my fingers, although I’m not sure it’s not partly that now that I know what’s going on in my neck I’m imagining I’m having symptoms there as well.” 

“In this operation, we could go in through the back of the neck but there’s a cerebral artery right here,” pointing to a round object on the MRI on the computer screen of his laptop.  “The problem is, I’ve got to put the Titanium screws into the holes I’ll drill in her vertebrae, very near that artery.  There’s little room for error.  And if we hit the artery, it’s all over.  So the best way to go in is through the front of her throat.  That way, I’ll use a retractor to hold aside her neck tissue and organs, and then I’ll have a better angle to remove the disc and replace it with a thicker plastic piece which will be held I place by the screws.”

Now I needed to do what I call a Visual Credit Check on this man.  “How many of these surgeries have you done?”  “Well, I do about one a week, and that’s for the past three years, and then when I was in residency I did a lot of them and assisted in even more.” 

“What is the risk she’ll die or become paralyzed?”  “About a four per cent risk of paralysis, and one per cent of death.  She could also get an infection and die, but that doesn’t happen that often.”  “Probably,” I suggested, half-jokingly, “if somebody doesn’t wash her hands.”  No, he explained from his experience and training, the neck is more resistant to infection than other parts of the body.  Infection is not that big a risk.

“If she were your wife, or sister, or daughter, would you tell her to have the surgery?”  Unequivocally “yes.” “What if you had the same condition, would you have it done?”  Yes again, without hesitation.

“Would you go to yourself if you needed to have the surgery?”  And then his good humor took over again, and charmed me, too.  “Well, it’d be a little hard to operate on my own neck, but yes, I’d recommend I have the surgery done by me, if it came to that,” he said, putting his hands up to his neck in a mock commencement of cutting his own neck open.

“Do you like your job, being a surgeon?”  No hesitation, and firmly: “I love my job.”  “Okay, when the shit hits the fan in the operating room, do you have any problem bringing in another doctor to help you deal?” “I’ve got a big ego,” The Surgeon said, “you have to to deal with the nurses.  But I’m not too proud to seek help if I need it.”  I liked that answer too.

“Where are you from, Dr. Schwartz?”  “The Buffalo area.”  “And I see from your card that you have a PhD as well as your MD.”  “Yeah, I got the PhD at Johns Hopkins, in neuroscience, and then got my MD degree.” 

“Do you like to do carpentry on wood, the same way you love to do carpentry on a woman’s body?”  “As a matter of fact, when I was younger I had an old car in which I replaced the entire engine and then, near the end of the job, I almost lost a finger on my right hand.  That would have been the premature end of a surgical career.” 

“When should Susie have this operation if she decides to go ahead?  I’m comfortable with her having it, and your doing it, but she’s the boss on her own body.”  “I can get her in to see another neurosurgeon, Dr. Whitehead, if she wants to get a second opinion.  I think he’s just getting back from two weeks of vacation, but if I ask him, he’ll probably squeeze her in.”  “That’s up to Susie.  She’ll probably want to talk with her family doctor and then let you know if she wants a second opinion from another surgeon.”  “No problem, whatever you want to do is fine with me.”

We then learned more about his ethnic background, his interest in fishing, and other facts about him which further assured me at least, that Susie was in good hands.

Susie also had a lot of questions, but what I’ve said so far pretty much covers all the bases.

After meeting with The Surgeon’s Scheduling Assistant, Jan, we left the office, bought some dark chocolate cherry nugat candies at Munson’s in the West Hartford Mall, bought four semi-sweet chocolate chip walnut cookies at Mrs. Fields, and drove back to Middletown to pick up dinner purchased for us by my former partner, Jen Zettergren, whose three-year-old daughter, Brenna, is undergoing a very debilitating round of chemotherapy for a child-hood blood cancer, which she gets at the Smilow Cancer Center at Yale-New Haven Hospital.

I tried my best to rub the inside of Susie’s gorgeous, hairless, smooth left thigh to comfort her on the ride to the mall and then back home, and assured her that we were in excellent hands with Dr. Schwartz.  Although she cried some tears and expressed continuing frustration that conservative medical treatment would not be a safe way to go, I’m quite certain she agrees that this surgeon is The Surgeon for her.

Keep your fingers crossed ye pagans, and pray to God for a safe and effective operation, ye religious souls.  I opt to “Praise God from whom all blessings flow.”

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