Troubles and Worries

The “troubles” that one patient experienced was not a “worry” to the staff at the Department of Corrections until the inmate showed up late for meals and roll call.  Months later, he wended his way through the medical system and got a neurosurgery referral to Jacksonville.

As this white-haired, stoop-shouldered African-American shuffled along in leg irons, his shuffle looked little different from other men in leg irons.  But when the guard removed the shackles, the inmate clearly had the spastic gait of a man with spinal cord compression.  Further testing confirmed a narrowed spinal canal and degenerative disk disease in his neck as the cause.

This patient, whom I will call Daniel, needed a decompressive cervical laminectomy.  But in truth, few operations worry me more.  The operation is necessary–without surgery he would be wheelchair confined within several weeks, and lose hand function shortly thereafter.  And though the results of surgery are usually good–90% of patients improve, and another 9% will stabilize–another 1% will be paralyzed as a complication of the surgery.

It’s that remaining 1% that worries me.  If Daniel gets worse, the fact that ninety-nine strangers got better after the same operation will give him, and me, little comfort.

We talked for a long time about the costs of surgery–not the financial costs, but the costs in terms of pain, suffering, recovery time and, especially, risk.  Daniel had vague fears about why he couldn’t walk easily anymore and what the future held.  I needed to share my medically-based fear about his future without surgery.  Then I needed to share the hope that surgery would make him better, and my fear that it could make him worse.  This is a melding of purpose: his hopes become my hopes, his fears become my fears.  His troubles become my worries.

I scheduled the surgery.

Then we waited.  The Department of Corrections, due to security concerns, budgetary constraints, and logistics, decides when the surgery will take place.  Literally months passed. Calls to the D.O.C. went unheeded.  I became increasingly worried that by the time the surgery was done, it would be too late; the spinal cord would already have been permanently damaged.

Finally, the surgery was scheduled and Daniel showed up at the hospital with barely enough time to complete his pre-op checklist.  He looked inexplicably content, shackled to a stretcher, a complacent guard at his side.  It had been so long since we talked that I wasn’t sure he remembered anything about his condition or the surgery.

I wanted to give him the whole pre-op talk again with time for questions and answers, give him a day to think about it, and return for more questions if necessary; it was that serious.

But I didn’t really have that option.  If I cancelled this operation, I didn’t know if the surgery could be re-scheduled before he was wheelchair bound.  I had only a few minutes.

“The operation could kill you or paralyze you,” I said.  “But it’s your only chance to walk normal again.”  I skipped all the information about expected recovery times, percentage chances, pain, or even where the incision was going to be.

Daniel smiled.  He still did not appear to be nearly as concerned as I thought he should, and it worried me.  I wondered if he was intellectually impaired.

I started again. “You understand the risks–”

“I heard you, Doctor,” he interrupted, still with that inexplicable smile.  “And I remember what you tol’ me before.”

I must have looked unconvinced because then he reached out with a shackled arm and patted my hand.  “I got troubles,” he said.  He reached over and touched the crucifix tattoo on his forearm.  “But I ain’t got no worries.”

Worries filled me, but by comparison to Daniel, I had no troubles.  I didn’t have decades to serve a prison sentence, a crippling illness, nor did I face a painful and life-threatening operation.  At the end of the day I was going home to a comfortable house and a loving family; if things went well, he would go back to prison.

The operation did go well, and Daniel walked again, normally now, able to get to meals and roll call on time.  He still had troubles, of course.  But spinal cord damage wasn’t one of them.

Days of trouble have come to me before, and they will come again.  But when they come again, I remind myself:  like, Daniel, I ain’t got no worries.