THE YEAR OF PAIN

“The day I had my colonoscopy was the best day of my life,” Everett Staley told me. Staley liked to shock. But he tended to tell the truth.

“I hated the prep of course. But the colonoscopy itself lingers in my memory like a comforting dream.” Even now, the thought evoked a sigh from Staley.

I should explain something. Everett Staley’s colonoscopy occurred toward the end of what he called his “Year of Pain.” He was in pain, more or less constantly, for more than twelve months. It had nothing to do with his colonoscopy. The colonoscopy was merely a foil to make the Year of Pain more understandable.

“Whenever I go in for a colonoscopy, I always ask them to go easy on the anesthetic so I can watch,” Staley said. “The inside of your intestines are up on a monitor, you know. If you’re not fully knocked out, you can watch the doctor’s progress.  I like to watch and pose questions and offer advice. At least I think that’s what I’m doing. Maybe I’m just dreaming.” Staley paused and reconsidered. “The truth is, I asked them to go easy on the anesthetic this time so I’d be conscious enough to enjoy it.”

“Enjoy what?” I asked.

“The absence of pain.”

Hospital Corridor

Staley and I used to run along the Embarcadero in San Francisco, a thoroughfare that hugs the shoreline, allowing runners to go for miles without encountering a traffic light. At the beginning of the Year of Pain, Staley was still running normally – once he got going. But it took him longer and longer to get going because of his back pain. At first, he thought he just needed to stretch more. But even with prolonged stretching, his back made it difficult to start. So he would warm up by walking. First a block. Then a couple of blocks. Then half a mile. Then, to his profound embarrassment, he had to ask me to just go on without him as he walked an entire mile, the length required to make his back pain tolerable, so he could run.

I insisted on waiting for him to warm up. In retrospect, that was a mistake. It embarrassed him to make me wait. So he started coming up with excuses for why he couldn’t join me for our daily run. After a while, he didn’t bother with excuses. He just stopped showing up.

But we kept in touch, exchanging emails and occasionally meeting for lunch. That’s how I got to know about Everett Staley’s Year of Pain.

Everett’s back pain was not related to his muscles. He could have stretched for ten hours and it wouldn’t have made any difference. His problem was his spine.

The human spinal anatomy is a marvelous combination of interlocking vertebrae, strong muscles, flexible tendons, ligaments, and sensitive nerves. When it works right, it allows humans mobility and wide range of motion. But there’s a lot that can go wrong with it, especially as we age.

In Staley’s case, the canals between the vertebrae were narrowing, causing pressure on the spinal and nerve roots. A disc between two of the vertebrae became herniated. It bulged outward, irritating the nearby nerves. A cyst developed, further exacerbating the pain. The pain was most intense in his lower back, but it radiated outward to his hips, down his legs, all the way to his feet.

Spine (2)

Staley and I know all this now because we read the medical report accompanying the MRI administered to Staley shortly before his surgery. But during the Year of Pain, Staley’s main awareness was that his life was changing.

Staley was no stranger to pain. He was old school. He believed in running through it. He ran his first marathon with almost no training. He had flown back East to visit family, where he watched the Boston Marathon. He thought it would be a good idea to run one when he got back to California. To his pleasant surprise, he found upon returning that the San Francisco Marathon was scheduled in only two weeks. So he decided to squeeze all his training into that amount of time. He was a physical wreck when he arrived at the starting line, but he powered through the 26 miles with a decent time.

He got better at training, but he was never a smart runner. To improve his time in the Sacramento Marathon, he decided not to stop at aid stations to drink. He became so dehydrated, he fainted at the finish line, and woke up in a medical tent, where nervous doctors were searching for a vein for an IV injection.

As he grew older, he also grew more conservative, and his running misfortunes became more mundane. Blisters. Sore knees. Strained hamstrings. Whatever the problem, his solutions were always the same: rest, persistence, and a willingness to endure.

But none of those solutions worked during the Year of Pain.  This was a different kind of problem. It was impervious to his will. No matter what Staley did, the pain was always there. And it kept getting worse.

Running become infrequent, then stopped altogether. The impact of foot against concrete was too much for his spine to bear. Walking became difficult. Then standing still, for any length of time.

Pain took over his life, and changed it in many ways. He commuted by ferry, but waiting in line proved a problem. So he changed his schedule, aiming to arrive just before boarding so he wouldn’t have to stand. There was construction near the pier. On days when the ferry was late, Staley discovered that by interlocking his fingers through the chain link fencing, he could shift his weight to his forearms, reducing the stress on his spine and rendering the wait almost bearable.

There was a ten-block walk from the ferry to Staley’s office, a walk he once enjoyed. Now he found it an ordeal, one impossible to accomplish without stopping. He found buildings along the way, where a visitor could enter to stop and rest. His walk now included first one rest per trip. Then two. Then three, which meant a rest every other block.

Staley had been a rude pedestrian, sprinting across streets just as the light was changing, a nanosecond before traffic resumed. Now he became cautious because running, even the short distance from curb to curb, was impossible. So he waited, and crossed streets properly, only when the pedestrian sign was an unblinking white.

There were a hundred other ways in which Staley learned to accommodate the pain. Each accommodation was a reluctant surrender to this implacable enemy. Once made, he deemed the change his new normal and strove to get comfortable with it. Run? No, had never run. He had only walked slowly. Speed up to cross a street? No, he had never taken such chances. He had always crossed at the proper time. Stand in line? No, he had never stood in line. He lied to convince himself that this was how things had always been. Nothing had changed, so nothing was wrong.

During his Year of Pain, Staley embarked on a long search for relief. It started with physical therapy, which Staley enjoyed because his therapist was young and pretty, and she always laughed at his jokes. But after several sessions, it became clear that the physical therapy was having no effect. His pain was intensifying.

So he sought advice from doctors, colleagues, friends – even from strangers he met on his commute to work. He tried everything recommended. Acupuncture, yoga, pilates, hot compresses, cold compresses, turmeric powder. When marijuana became legal, he tried cannabis. He enjoyed eating brownies, but they had no effect on his pain. They just made him dizzy. Cannabis-infused salves did nothing for him.

He read a bestseller that preached that back pain was psychosomatic, and that his brain was creating pain to distract him from negative emotions. The author advised readers to resume their normal physical activity. He wanted to believe this, so he convinced himself it was true. He immediately felt better. So much better that he decided to go out for a run, his first in months. He was fine until he had finished and showered. Then the pain returned with a vengeance, and he could barely walk back to his office. He realized that he could not wish away the pain.

His GP told him that surgery was an option, but advised against it. Instead, she urged him to have an epidural steroid injection. She warned him that the shot would be painful, and it would not cure his back pain. But in most cases, she said, it would provide three to six months of relief, long enough to buy time for other methods to work.

He tried it. The injection felt like someone was inflating balloons in his thighs. Face down lying on his stomach, he swore vigorously, then apologized to the doctor and attendants outside his line of vision.

The epidural worked. The back pain disappeared. But not for three to six months. It worked for two days. On the third day, Staley could feel the pain creeping back. After a week, he was right back where he had begun.

The prospect of three to six months pain free was so alluring that he was willing to give it another try. Perhaps he had done something wrong – maybe he was writhing too much — and that’s why the first injection had failed to take. So two months after the first injection, he returned to the same hospital and met with the same crew for a second injection. He knew it would be painful, so this time he apologized in advance for his swearing.

The second injection had no effect. His pain returned the next day.

Staley began to talk to surgeons.

Based on his X-rays and MRIs, the surgeons he consulted recommended a discectomy to remove the portion of the bulging disc, which was pressuring the nerves. They also recommended a laminotomy, to remove part of the arch of the vertebrae that had narrowed, along with the newly discovered cyst. This procedure involved using a drill and bone-biting tools to remove bone material. Staley, who fancied himself a handyman, found that part very interesting.

But they also told him that the surgery, while likely to eliminate the pain in his buttocks and legs, would probably not address the pain in his back. When he asked what was needed to relieve his back pain, the surgeons shrugged and advised physical therapy, including body mechanics, stretching, core strengthening, and general conditioning. He told them he had been doing all those things for the past twelve months. They shrugged some more. One quietly admitted: “The truth is, we really don’t know what causes back pain.”

During our most recent lunch together, Staley was visibly depressed. “I feel I’ve invested a year of my life feeling pain and looking for answers, and there aren’t any.”

I asked him what he intended to do. “I’m not going to accept this. I don’t believe we were put on this Earth to suffer. The doctors tell me that the surgery will probably fix the pain in my butt and my legs. All right. I’ll take that. I hope it will also deal with my lower back pain. If it doesn’t, it doesn’t. In that case, I’ll just have to keep looking for answers.”

He told me he had scheduled a surgery for the following week. He had picked his surgeon based on her sense of humor. He had asked each one how many such procedures they had performed. She had told him: “Not many, but I’ll keep an instruction manual open by the bed.”

When we left the restaurant and were outside on the sidewalk, I wished him luck.

“We were not made to suffer,” he said again, very firmly. “Five years from now I’m scheduled for another colonoscopy. I don’t know how it will turn out. I’m just determined that it will not be the best day of my life.”

 

 

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