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By Dr. Robert Burton

July 9, 1999 | In March, I wrote an editorial questioning most present-day treatments for back pain. I quoted the New England Journal of Medicine. I relied upon my own history of minor self-resolving bouts of sciatica as back-up experience. My advice: exercise and time. Stay away from the surgeons.

Apparently the article was overnighted to the gods of irony and retribution.

A week later, while on a working vacation in Manhattan, I awakened with a fiery stabbing pain in my back and left leg. For three days I literally couldn't move.

I could hear myself asking my patients, "Could it be stress?" I ran through the circumstances of my life, passed my own psych evaluation, though I knew that self-awareness in such matters is often nothing but self-delusion. No, I chided myself. The problem was definitely anatomic, a ruptured disc, not some frayed moral fiber. I knew stress, and this wasn't stress. Not me.

How to describe the pain? "It's killing me," came to mind, but I didn't want to sound like a complainer. Doctor to doctor one must always be stoic. But my back was killing me, and I wouldn't mind saying so, though I was fully aware that obituaries seldom listed sciatica as a cause of death.

Cut out the sickbed hyperbole. No need for panic. You'll be just fine. The neurologist in me reminded me that 80 percent of people have an episode of acute back pain. The majority heal within a few weeks to a couple months, even if they have a disc protrusion.

But what if I was wrong? I practiced saying, "It's nothing," while trying not to contemplate the worst.

Look tough, act tough. Be macho in small things; keep your appointments. I had my wife tug on my socks and pants, in a chilling rehearsal of ... no, let's not go there, not even in silent print. I am superstitious. I step around ladders and cracks in the sidewalk, worry what might happen as counterbalance if I won the lottery. Let's not talk about what not being able to move reminds me of. I do confess to having tried swimming laps with my eyes closed, just to imagine what it might be like to be blind. But never have I pretended to be paralyzed with pain.

A brief digression. The unspoken operant word driving many physicians is counterphobia. Ask anyone who treats M.D.s as patients. I can't imagine a more anxious, fearful group, yet these are the same folks who poke fun at cadavers, perform amputations and autopsies to rock 'n' roll, who strut and swagger as though granted diplomatic immunity from mortality. Most normal people, who are repulsed by sickness or frightened by illness, simply stay away and go into other professions. They do not consider getting used to gruesome pathology a measure of strength.

One might argue that physicians make bad patients because they know too much, know what might go wrong or what might be wrong. True, but I suspect the anxiety came first, the squeamishness and mortal fear hidden beneath layer upon layer of denial. I know firsthand. Illness has always seemed incomprehensible. I might know the pathophysiology down to the molecular level, but never have I understood what illness actually is. All I know for sure is that pain and suffering are personal and lonely, existential in dimension.

I was stuck in the worst of predicaments -- I was a metaphysically uncertain physician trying to reassure a frightened patient.

Next page | Would they see some yet-to-be-announced catastrophe of the flesh?