WOMEN&PAIN: “Appropriate Treatment” by Thalia Mostow Bruehl

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X-ray courtesy of author

I began golfing in my early twenties after developing an overwhelming desire to better know my father and grandmother, who both believe the best place to spend a sunny, or rainy, or overcast Saturday is on the golf course. I wasn’t a natural, but I did have a big swing and quickly came to love using my three-wood to whack at the small white balls that magically appeared at the Chelsea Piers driving range from below the ground, like Liberace rising on a platform from beneath the stage at Madison Square Garden. On the four-story range, overlooking the Hudson River, my long game improved; I could hit the ball further every week, with only a few air shots thrown in for good measure. My short game, on the other hand, was a disaster. I took each mistake, each whiff, to heart, and the worse my chip shot or putt, the more trapped I became in my head; I would overthink and under-play. It wouldn’t take long for my whole game to break down, and before I knew it, an uncontrollable rapid-fire of “fucks” would be shooting from my mouth.

This type of failure was new to me; I had previously been a professional ballet dancer before a back injury forced me into early retirement just before my eighteenth birthday. With ballet, the more frustrated I became, the more I’d channel my rage into my work. Rage proved a phenomenal motivator. I would practice a turn or a jump dozens, even hundreds, of times until I had it just right. That desire to make it right, to make it perfect, was what I lived for. It was also what caused my body to wear down way before it had any right to. (Wear and tear is a nice way to describe something more akin to abuse.)

While I was dancing, there were very parts of my body that weren’t injured at some point; I’d had tendonitis, broken toes, strained hamstrings, sprained ankles, pulled quads, Osgood Schlatters disease, bursitis, snapping hip syndrome, slipped disks, pinched nerves, sciatica and so very many spasms. But all the pain felt brilliant and necessary, it was sacrifice for my art, until it wasn’t. My body gave up on me, or maybe I gave up on it, but together we agreed, with a few physicians mixed in, that my dancing days would need to end if I wanted to live a “normal” life. It was too late to live a pain-free one—my back injury had become chronic by the time I retired—but I’d be able to work, participate in low-impact activities (like golf), and one day use my body to carry a child, though probably not without some amount of difficulty.

My golf game steadied with time, though I still loved smacking the ball with all my might—about 160 yards on a good day. I became a writer, got some degrees, and found ways to manage my daily pain with medication, physical therapy and alternative treatments. A dear friend and I fell in love, he asked me to marry him, and I did. I was happier than I’d been since I’d stopped dancing, and our future seemed beautiful and wide open. We left New York for Chicago, and were soon talking about babies.

I’d been warned by various physicians since I retired from dance, that my back injury would make pregnancy challenging and that I’d likely end up on bed rest. For years, the possibility seemed too far away to truly comprehend, and for someone who’d once spent eight or more hours a day dancing as hard as she could, the idea of lying in bed for months on end seemed unfathomable. But, my husband and I wanted kids, so six months into my marriage, at the age of twenty-seven, I decided to meet with a back specialist to see if there was anything I could do to prepare my body for pregnancy, and possibly heal it enough to avoid a bedridden fate.

Unfortunately, my back injury was complex and couldn’t be reduced to a single issue, and so the specialist explained that while one treatment might help with the spasms, it wouldn’t necessarily touch the sciatica. The injury was both structural and muscular, and there was also nerve damage, as well as some underlying scoliosis, which was exacerbated by the spasms that frequently ran up and down the left side of my back, further tugging my spine off its center line. The risks were very high with back surgeries, and the outcomes weren’t very positive in cases like mine.

With a back procedure off the table, he presented a different proposal. Something else had been detected during the MRI he’d ordered: a tear in the cartilage of my left hip, as well as an impingement. News of a tear wasn’t shocking, my hip had been clicking for ages and I’d had some degree of pain in the joint for my entire adult life, though nowhere close to the pain I felt in my back. The specialist believed that an arthroscopic hip surgery to fix the tear could even out my gait, and that this change in my gait would most likely take some of the strain off my spine and relieve some of the constant pressure I felt in my lower back. It could make the spasms stop and help with the sciatica. It almost seemed easy.

The back specialist referred me to Dr. X, and said, “He’s the best hip guy in Chicago. I send all my hip patients to him.” For the first time in almost a decade, it felt like real relief might be within reach.

Dr. X was young and confident, exactly the type of hotshot you’d expect to work with a professional hockey team on the side, which he did. He concurred with the back specialist and was certain he could help. Even though my husband and I questioned the scheme of opening my hip to help my back, the struggle to get out of bed some mornings made me feel older than my grandmother, who in her late seventies could still golf thirty-six holes most weekends. I signed the paperwork and scheduled the procedure for a month later.

After a delay, because the hockey team made the playoffs, I had my surgery. And the surgery went well—that’s what I was told and what my files say—but somewhere around the six-week post-op mark, I became concerned that something wasn’t healing right. I had no proof, only my intuition and a lifetime spent living in my body. I was following the doctor’s protocol, I was taking the pills, wearing the brace, doing the physical therapy, and icing my hip for hours each day, but I had been a dancer for fifteen years, a pain patient almost since childhood, and I knew when something was off. When most kids were out learning to ride a bike, I was teaching myself how to calculate the amount of pain I could dance with and still make the performance the next day. I didn’t go to classmates’ birthday parties, I was too busy in the studio making mental notes about which pains meant serious injury instead of a sore or tired muscle.

In our regularly scheduled post-op appointments, Dr. X was quick to dismiss my pain and the fears that went with it. “Recovery is a rollercoaster,” he’d say. “Give yourself time.” “Rest more, it’ll be fine. Just keep up with your exercises.” My physical therapist, a young and chirpy woman the surgeon’s office had recommended, told me to trust my doctor, he knew best.

I longed to move. I longed to golf. It was summer and I wanted to be back with my father, continuing to work on my pitch shots.

“Do you think it’ll be safe for me to golf this season, maybe by next month or so?” I asked Dr. X.

“The safest way for you to golf is with a physician by your side,” he replied.

It was so subtle. A response to my question. And yet I spent days questioning whether it was something more than it was. He must not have meant anything by it? It was a nothing, some words thrown out casually. Thoughtlessness then? Or was it a joke? Simple bad bedside manners? I’d heard that surgeons were horrible care providers, great at the technical work, a disaster with patients. There was no way Dr. X had meant anything by it, right? He didn’t really want to go golfing with me?

I now understand that this type of quiet manipulation, saying something without saying anything, gives great power to the person doing the talking. I was feeling more helpless than I ever had in my life, and the doctor who was supposed to be healing me was making me question my basic understanding of human interaction. My body was broken and being held together by a brace; a cane never left my right hand because my leg gave out constantly; my new husband (we’d been married for only nine months when I had my surgery) had to help me shower, help me use the toilet. And I couldn’t figure out if my doctor was hitting on me or not.

After finally graduating from the brace, I was back in Dr. X’s office for another follow-up. We started to talk about New York, he’d done his residency there. “Did you ever have those Sex and the City cupcakes people wait in line for?” he asked me. I said I’d had many, probably too many. Casually, his back to me, he said, “They’re opening up a store here in Chicago, might be fun to go try one sometime.”

If only he was facing me and I’d been able to read his expression. Was he asking me to go get one with him, or just saying he wanted one? I tried to bring the conversation back around to my pain, which was getting worse instead of better, and was once again told to be patient. “Big surgeries take a long time to heal, at least six months, don’t worry.” But I was worried, and I wanted that worry to count. I couldn’t even walk my dog. I couldn’t sit in a chair. Sometimes my leg would start spasming and within minutes my whole body would shake.

I thought of getting a second opinion, but I’d repeatedly been told that Dr. X was the best. I made a new plan—my husband would come to my next appointment with me. My husband and I, together, would force Dr. X to hear me, we’d all discuss the dull ache, the pull I felt whenever I took a step, the stabbing in my joint. My husband would hold my hand, he’d bring me the extra strength I needed, and keep the questions on my hip.

“I’m not sure there’s much more I can do for you.” Those are the only words I remember from the appointment. I don’t think Dr. X even stayed in the room long enough to sit down, certainly not long enough for me to tell him I was scared I’d never walk again.

Our rapport had been friendly up until that point. There was always a bit of laughter, I’d rarely felt him rush through our appointments, and having spent so much time with doctors in the past, I knew this was rare. But that day, with my husband at my side, I sat in my paper gown in the examination room, near tears. I felt more vulnerable than I’d been since my surgery, when I was asleep and naked on a cold metal operating table as Dr. X drilled holes in my hip. It was worse than not being heard, it was as if I didn’t exist. And yet, the feeling that overwhelmed me was regret at bringing my husband; I couldn’t see then that my husband wasn’t the problem, my doctor was.

I’d like to say I stopped seeing Dr. X immediately after that appointment, but I went back once more. I needed to know I wasn’t crazy, and finally when he asked me if I wanted to hang around his office until he finished with his last patient so we could go get a coffee and talk about my concerns regarding my recovery, I felt ready to move on.

We are taught to treat doctors as gods. We go to them in pain and hopefully leave well and healed. We are taught to respect them and their opinions above our own senses, and this blind trust, this antiquated confidence in a broken, and often sexist system, had left me hollow and shattered.

I found a second opinion in a new doctor, a woman this time, and she heard every word I said. She looked at me and she saw me.

Now, when I’m making an appointment at a new practice for the first time and am asked if I’d prefer a male or female doctor, I don’t hesitate to say female.

My family and I discussed reporting Dr. X, but at the time my pain, my mobility, and my quality of life seemed a much greater concern than whether or not my doctor had been flirting. Something was very wrong with my body and we all needed to know what it was. The spasms were increasing both in frequency and in duration, and my days were spent crying, propped on pillows in a recliner. The pain was too great for me to read, to work; writing a single sentence would take me an hour, even the smallest amount of concentration on anything other than what was happening to my body became impossible. I had to start using plastic cups for drinking instead of our regular glass ones because I dropped so many; the more I hurt, the more my hands trembled. My fingers and arms were covered in burns from taking things out of the oven. I, once a graceful ballerina, once a swan, a flower, a fairy, had become so incredibly clumsy and uncoordinated I moved through space like a newly born foal. I was a constant toddler in an antique store; put something delicate near me and it was destined to end up broken. And no matter how hard I tried, I couldn’t seem to control my body. For the first time in my life I saw myself and my body as two separate entities.

My second opinion led me to a different surgeon, who, after taking all new images and doing a full examination of my weak and scarred body, informed me I’d need another surgery to repair the harm done during my recovery from the first one. I’d developed severe tendonitis in my iliopsoas muscle that would need to be released surgically. New impingements had formed and caused new tears in the cartilage. Small fragments of bone and cartilage had broken off due to the impingements, and would need to be removed. My bursitis had returned with vengeance, and I was now showing signs of early arthritis. Had these injuries been caught early enough, I wouldn’t have needed more interventions than good physical therapy and maybe some steroid injections to deal with the inflammation, he explained. But they hadn’t been caught. Not by anyone but me.

Reps from my insurance company urged me to sue for negligence, but I didn’t want to go backwards and return, even if only in my mind, to the appointments where I’d felt so small and insignificant. In a few years, my memories of Dr. X would turn into an endless well of fury, but at the time I was mostly depressed and simply felt wounded. I wanted desperately to feel like I had control of my life and body. I needed to work again, to walk again. And I still wanted to have a baby.

I’d gone to Dr. X with minor hip pain and a severe back injury that had taken me from the active life I’d once pursued; I left his office for the final time with a chronic hip condition that disables me even now, seven years and two more surgeries, both to repair the damage from his carelessness, later. Oh, and I still have the original back injury.

Three years and one month after my first surgery, I was finally pregnant. I was on bed rest for the last few months, as predicted, both because of my back and hip injuries, and because the pain was so severe that my blood pressure would start to get high if I spent too much time on my feet. I spent my last week of pregnancy in and out of wheelchairs. It didn’t feel like a beautiful or happy time, it just felt sad, and painful.

My daughter though, she’s pure joy, and the love of my life. And worth every day I spent in bed.

            In a few days, I will undergo my fourth arthroscopic hip surgery. This time the work will be done on my right hip, which has taken all my weight since my first surgery on the left side. I no longer think to ask when I’ll be able to golf again; instead my questions are about being able to stand, and how I’ll carry and chase my daughter, now an incredibly active four-year old. My body barely resembles the one that sat in Dr. X’s office all those years ago. Muscles have atrophied, weight has been gained, and even my skin appears to lay differently on my legs, which haven’t run or jumped or skipped in so long they may not remember how. I have one long scar running down my left outer thigh where my IT band was harvested during my third surgery, and eight portal holes mapping a constellation on my hip. My husband and I rarely eat in restaurants, the chairs are too uncomfortable, and we only see movies in theaters with recliners. I never put on my shoes without discomfort, and I no longer own a single pair of heels. Every move I make is calculated, each step has a consequence.

I feel robbed of the freedom my body once gave me, robbed of the autonomy I had before I had to ask my husband to help me put on my socks for the first time—and every time since. I may never get over the fact that I didn’t demand better care for myself, that my worth seemed less important to me than a doctor’s ego. But I will never make that mistake again, the pain and the anger won’t let me.

I like to imagine another version of my pain story sometimes, one where my surgery and recovery both went well. In that one, I’m heard and seen. I’m treated appropriately, and my pain is made better, not worse. In that version of my story, my grandmother, my father, my daughter and I all get a chance to golf together. My short game still sucks, but I swing with abandon.

 

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Thalia Mostow Bruehl is an essayist, fiction and freelance writer. She has an MFA in creative writing from the New School, where she also received her BA, and was one of the first group of Riggio Honors scholars. She’s published essays with NYMagazine, TalkSpace, Babble and YourTango, and has also worked for Playgirl and Esquire; her fiction has been published in 12th Street and 6S. Thalia has also been featured on NPR’s The Takeaway. She lives in Chicago with her husband, daughter, and forever-puppy, Henry, and is currently finishing a novel, as well as working on a memoir about her experiences as a chronic pain patient. acm56 thalia