Chapter One: The Straw That Broke the Camel's Back
"Art, you're taking this operation too lightly", said Dr. Masferrer, my neurosurgeon. "I'm afraid you just don't understand. I'm going to break your back!"
It was July of 1986 and I was lying in bed at the U.S. Air Force Regional Medical Center with excruciating pain and numbness running down my right leg into my foot and toes. The myelogram, a special X-ray of the spine, showed a large disc rupture between the fourth and fifth lumbar vertebrae. After two weeks of bedrest with no let up in the pain and numbness, it was time to go in and operate.
How did I end up in this mess, me, a doctor of all people? Besides the pain, it was embarrassing to be a patient in my own hospital!
To my best recollection, my back trouble began when I was about 21 years old. I was still in school when I took a job loading and unloading trucks at a large warehouse to help support myself. I put in long, grueling days that involved a lot of lifting. It seemed like the "manly" thing to do, and besides, I was young and strong and enjoyed sweating and doing hard physical labor. I was at that age when I thought I was invincible. I never said no to work of any kind. In fact, I never said no to much of anything, and that, I discovered later, was a major drawback to the future health of my spine.
On the job, one of the games we played in our spare time was King of the Warehouse. In this test of male macho strength, we would stand at opposite ends of the warehouse, lower our shoulders, and charge at each other like human battering rams, trying to knock each other over. Having been a surfer and a football player, I had good balance, timing, and strength. Additionally, I loved contact sports.
My boss, Bob, at 6'5" and 305 lbs, loved to square off against me, even though he could never defeat me. As we charged from opposite corners of the warehouse like a couple of raging bulls, I would come up on him from underneath, flicking my shoulder and smacking into him at the last possible moment. Upon impact, Bob would be sent flying.
One day, however, while playing this game, things didn't quite work out right for me. As Bob and I squared off in opposite corners prior to charging, I was feeling a little tired. When we slammed into each other my timing was slightly off. I knocked him down anyway, but absorbed the entire force of the blow in my lower back. That night I went home feeling a little stiffer than usual.
The next day in chemistry lab at UCLA, while bending over to get my glassware from the bottom drawer of my desk, I felt an electric shock travel clear up through my neck and into my head. It was a sudden, jolting sensation. In an instant, my legs gave out beneath me as I found myself sitting on the floor with both feet splayed out in front of me. There was no strength in my legs whatsoever. Strangely, there was no pain either. I brushed myself off, stood up, and as there were no residual symptoms, I decided to continue on with my activities as if everything were fine. I completely dismissed the significance of this event. To this day, I have never told a soul, not even my doctors.
Less than two years later, while wheeling a half-ton operating room table into one of the operating rooms at UCLA, my back did something funny again. As I returned to a standing position after bending down, I found I couldn't straighten up all the way, as if someone had jammed a broomstick up my hind quarters. It was rather unnerving. "I certainly can't resume my duties in this condition," I thought to myself. I ducked into a vacant room and cautiously backed up to the side of another operating table. Reaching down with my arms, I forced myself into a backbend as far as I could go until I heard a "pop." Miraculously, my back had snapped back into proper alignment. I was both grateful and relieved to find that now I could straighten up and move without any restrictions. Once again I went back to work, resuming my normal duties as if nothing had happened.
Two years later, during my first year in medical school, I found myself alone and isolated in a strange city. Philadelphia, where I was now living, was experiencing its worst winter in 25 years. I was an hour and a half away from school by rail commute and the trains kept breaking down because of the deep snows and sub-zero temperatures. I was also in the middle of a strained relationship that eventually broke apart.
By itself, the first year in medical school is emotionally demanding. With these complications, however, my standing as a first year medical student was in serious jeopardy, especially since I couldn't get to class for lectures and labs. On the occasions that I did make it into school when the trains were running, I worked off the stress by playing basketball.
During one basketball game, while coming down for a rebound, my back went out just like it had done that day in the operating room two years before. This time, however, I couldn't straighten myself up and pop my back into place.
I showered and then grabbed my books and athletic bag with great difficulty. My body was stuck in a bent-over position. Hobbling to the curb outside of the medical school, I reasoned that if I could make it to the library across the street, perhaps my back would slip back into place on its own. I glanced up and saw an elderly woman crossing the street, slowly, but with ease. I was envious of her and at that moment, I felt very old. The bags I was carrying felt like they weighed two tons each. It was horrible to feel so helpless.
Somehow I made it to my seat in the library and while turning to my neighbor, Rob, who was also a medical student, I mentioned something about my back to him. Before I knew it, Rob had brought a wheelchair to my seat, insisting on wheeling me to the emergency room. As I reluctantly got in, I felt embarrassed being wheeled past all the other medical students, doctors, and nurses in the library.
In the emergency room, after a four-hour wait, I had X-rays taken. The orthopedic resident (doctor-in-training), after looking at the films in a back room, gave me all of two minutes of his time. He managed to tell me on his hurried way out of the examining room that despite my being bent over sideways and unable to straighten up, all that was wrong with me was a simple muscle strain. "But I'm sure I slipped a disc or something," I pleaded with the resident. "Then go to another orthopedic surgeon for a second opinion if you don't believe me," he said. In the midst of my pain and confusion, this was all he could offer me.
I refused to believe that all that was wrong with my back was a simple muscle strain. It was way too painful for that. As an athlete, I had experienced many muscle strains before. I had also separated both shoulders and had ruptured an inguinal hernia while lifting weights when I had the flu. I felt I wasn't a sissy and had a fairly good tolerance for pain. The diagnosis that the resident had given me, according to my understanding, did not correlate with my pain. I felt slighted. Either he was wrong, which I was determined to prove, or if he was right, then I was being a big baby about this whole thing. My mind was reeling at a hundred miles an hour trying to figure out what was going on with my body! Why was I in so much pain?
Dr. Hoffman, a professor of orthopedics at my medical school, had a private office not far from our school. He examined me briefly, reviewed my films, and concluded that it was possible that my disc had slipped. Inwardly, I was comforted that now my pain was justified with this more serious diagnosis. "You better take care of yourself or you're headed for an operation," he informed me. I didn't realize how prophetic his words were at the time.
I took a room near my medical school so I wouldn't have to deal with the hassles of the lengthy rail commute and the inconsistent trains. Unable to walk without support, I hobbled to class on a pair of crutches through the snow.
I phoned my father, a psychiatrist at the UCLA School of Medicine, and told him what had happened. "Are you under stress?" he asked. "Dad, I was coming down from a rebound while playing basketball. What the hell does stress have to do with it?!" I retorted angrily. It would take me 15 more years of back problems before I would realize the accuracy of my father's line of questioning.
After about a month, my back slowly improved. With this incident, however, I could no longer ignore my back. I needed to make some changes in my life if I wanted to avoid back surgery.
I enrolled in a yoga class to help bring some flexibility to my body and, in particular, to help me avoid the possibility of surgery. I also needed to deal with the anxiety of medical school and to learn how to relax and manage my stress. My yoga teacher assured me that if I were a sincere and regular student, all of these things were possible. While practicing yoga for the next five years, the condition of my back improved tremendously, and I did learn how to relax.
There were several setbacks during this period, however, as my back went out at inopportune times during periods of accumulated stress. The triggering events were physical traumas that while sometimes severe, could also be quite minor. One time my back went out lifting two full five-gallon water bottles, another time while wrestling with a friend, still another while bending down to pull on a boot. There seemed to be no correlation between the degree of trauma and the severity and duration of the pain. One thing seemed true, however; each time my back went out, it took longer to heal, and this had me worried.
In September of 1983 I entered the Air Force and was sent to the Philippines on active duty as payback for a military scholarship I was awarded during medical school. In this physically demanding environment, I ran 4-6 miles a day, swam 1,000 meters a day, biked 20-25 miles a day, and surfed 5-10 hours every weekend to maintain a warrior's level of fitness. For three full years, I participated in helicopter rescue missions and did extensive flying all over the Far East without any back problems whatsoever.
In May of 1986 however, dark, ominous clouds appeared on my horizon. My mother, brother, and father had all passed away in the last three years, and my wife at the time was at home dying of cancer, where I was trying to take care of her.
We had just purchased an expensive piece of property in Hawaii. The political climate of the Philippines was tense as the Marcos regime was ready to fall. The military was preparing for conflict. It was all too much, and like the proverbial straw that broke the camel's back, my back went out as well.
To take my mind off my problems, I had flown down to a remote outer island with some friends. On the airplane ride back home, while merely turning around to talk to the person in the seat behind me, my back began to stiffen. After an hour or so, I was locked in a deathgrip of painful back muscle spasms and could barely shuZe my way off the plane.
With my back out, I tried to give it rest. The military, however, ordered me back to work. This added to the underlying tensions of being incapacitated. So once again I went into my familiar denial mode, put on a back brace, swallowed some pills, and tried to ignore the pain as I reported back to work like a good soldier.
My back was making its own efforts to heal, but the improvements were too slow for the fast pace of the Air Force. I felt pressured for time. I tried to accelerate the healing process with anything I could get my hands on -- pills, electronic devices such as infra-red lamps, TENS (transcutaneous electrical nerve stimulators), heating pads, traction devices, hanging boots, braces, balms, and plenty of other stuff.
Sitting is the worst thing for an injured back, and having to man my desk for eight hours on end did not help my situation. As a member of the military, there was also the constant stress of war readiness, having to respond to contingencies on short notice.
In the previous three years, when my back had shown improvement, surfing had helped me overcome stress. I headed out to the ocean practically every weekend with a few buddies. Now, however, with my painful back, I found that I was unable to surf. I wondered how I would be able to manage my stress.
After more than a month, as stress kept building, I was eager to get back in the water. My back was still pretty bad, but the call of the ocean and the waves was strong.
On a chance visit to Base Operations, headquarters for all flight operations including the latest weather information, I saw a satellite photo of a huge typhoon that was heading our way. I could tell from the storm's size and direction that the waves were going to be good on the weekend. I couldn't resist. I decided to go surfing.
After a three-hour drive, when I finally got to the beach, my back was stiff and sore. I had no right to be there, but in my sheer pig-headed stupidity, I told myself that this would be good for me. As I carried my board to the water's edge, I told myself that I would be careful once I was in the water.
In the water, lying flat on my board while paddling out, felt good because now all the weight was off my spine. But I had made one fatal mistake. In my haste to get out in the water, I had failed to apply wax to the back part of my board. In the surfer's world, wax is more valuable than gold because it keeps you from slipping on your board.
While standing up on the first wave that I paddled for, my rear foot slid off the back of the board as I did the splits. I experienced intense pain as I heard a popping sound. At that very moment I knew I was in trouble, that I had made one of the biggest mistakes of my life.
The next day my right leg was numb and painful down to the toes. Because of my medical training, I was pretty sure that I had ruptured a disc in the lower part of my spine. It was time to see our neurosurgeon at the Air Force Regional Medical Center, Dr. Roberto Masferrer.
After Dr. Masferrer examined me, I was admitted to the hospital where the myelogram confirmed the presence of a large ruptured disc. My worst fears were true; it was decided that I would need surgery. This is where my story began.
After my surgery, the pain and numbness down my leg was greatly diminished. What a relief! But the pain in my back was excruciating. My back now had a huge hole in it. There was a gap between the rear portions of the two vertebrae where Dr. Masferrer had to cut away the bone to get to the ruptured disc. I thought the removed portions of bone would be rewired back in place. I was wrong. They were thrown in the garbage can and muscle was sewn together to cover the hole. I realized then that what Dr. Masferrer said was true. My back was indeed broken!
Upon release from the hospital, I was instructed not to drive or climb any stairs for one month. Two days later, I was driving my car and got locked out of my office at the hospital, so I had to use the stairs.
At home I had a pair of hanging boots that I used to stretch out my back. Following the axiom "physician heal thyself," I decided that I could give myself traction and get an upper body workout at the same time by hanging upside down while holding small dumbbell weights in my hands. Can you imagine the stupidity? Predictably, I never even made it that far!
Only three days out of the hospital, standing in the checkout line of our base's only department store with 30 pounds of dumbbell weights in my arms, I felt the left side of my back collapse.
As I stood there grimacing in pain, not speaking a word, a petite female store employee noticed my pale and clammy face and offered to take the weights off my hands. For the first time in my life, I, Mr. Macho, "superman extraordinaire," accepted help from a woman. As my male ego crumbled with my back, I noticed how grateful I was to be relieved of the physical burden of those weights.
When I reached home, however, the muscles in my back orchestrated a major spasmodic rebellion. They seized up violently, locked themselves into a deathgrip, knotted themselves into fist-sized lumps, and simply refused to budge. Laid out flat once again, this incident was a huge setback in my rehabilitation.
I was in so much pain that just going to the toilet was a major ordeal of the day, taking from 2-3 hours just to crawl down the hall on my hands and knees before returning back to my bed. Sitting on the john or taking a bath were impossibly excruciating, and I had to psych myself up for several hours in advance, anticipating this dreadful, yet necessary daily ritual.
Due to the proximity of the intestines to the spine, when my bowels moved they would set my back off in a wave of painful spasms. Thereafter I fasted on mango and carrot juice for two weeks to avoid any bowel activity whatsoever. Without any food in my intestines, I didn't move my bowels for the entire two-week period.
The Air Force gave me a choice. Return to work or face a medical board to go on disability with an early separation from the military.
Clearly, my back was in a bad way. This was despite the fact that I was now eating 10 mg Valiums and an ungodly number of other medications as if they were candy. These pills had no effect on the pain in my spine. All they did was make me feel stupid.
I thought about the Air Force offer and decided I didn't want to give in to the prospect of permanent disability. I knew if I had taken their money, that's precisely what would have happened. I've seen it too many times in my profession. "All that glitters is not gold," I reminded myself. To this day, I've never regretted my decision to decline disability.
Stubbornly, I forced myself back to work, refusing to cut short my service obligation. I donned a back brace and, swallowing pills by the handful, toughed out the next year, completing my tour of duty on schedule.
After my service was completed, like a wounded animal retreating to the safety of a cave to lick his wounds, I sought refuge in a quiet place. I needed a break from the world, so I journeyed to India to stay at a yoga institute. It was a very quiet place located in the remote highlands in the western part of the country. I had no car and no telephone and for the next seven months, instead of taking care of other people as I had been trained to do as a doctor, I concentrated on my own healing.
I decided to throw away my pain pills and face the pain head-on. After nearly a year and a half of dependency, this was a big step for me. Now I felt naked and vulnerable to my pain. It was frightening! But I was stuck in a hole and I wanted out. This was the obvious first step that had to be taken.
Without medications, the pain overwhelmed me, and I plunged into a deep, dark cavern of hopelessness and despair. Anybody who doesn't think that pain can drive a person to the depths of depression and despondency, to the point of contemplating suicide, has never experienced true pain. It is pure hell, nothing less! Nothing can demoralize your spirits like steady, consistent, unrelenting, chronic pain!
At the institution where I was staying, I followed a regimen that consisted of various stretching, breathing and relaxation exercises, reading inspirational books to keep my spirits up, and a simple diet that was free of toxins and highly refined, processed foods. I devoted myself exclusively to this program, and scheduled all of my daily activities around the healing of my spine.
All was not easy. During this period I had to deal with the tremendous physical, mental, and emotional exhaustion that the pain was causing. Every day, awakening to more pain after having worked so hard the day before, was demoralizing. My spirits were at an all-time low.
I was still in the process of trying to understand my pain and not be terrified of it, but my pain carried a huge psychological advantage over me of having completely intimidated me for almost 15 years. In other words, it was well-established in my psyche and could not be easily shaken.
During this period, I read all the experts' books on back pain and was not getting the answers I wanted so I threw them away and surrendered to the guidance of my own intuition and inner spirit. Because I was basically charting unexplored territory, I decided to trust my instincts and proceed from a very fundamental level.
I knew I had a body, and I believed that if I could learn to listen to it, it would guide me in the right direction. All I had to do was pay attention and work with the pain, accepting it as the voice of my body. My intuition told me that if I honored my body and was patient, the healing process would occur on its own.
According to the experts, I did everything wrong. I bent my body forward when I shouldn't have, and I knelt down in the wrong fashion. But I didn't care what the experts said because I was moving with more awareness than ever before and I was learning to listen to my body in a way that I knew was good for me. As I became acquainted with my body's wisdom, I began to hope that my personal suffering would soon come to an end.
After two months, I took a personal inventory. While I wasn't getting worse, clearly I wasn't getting any better and that was discouraging. Perhaps my expectation of a speedy recovery was unrealistic. I decided to get out my mental magnifying glass to measure my progress in micrometers instead of inches. In spite of my hard work, improvement was elusive. Depression and suicidal thoughts intermittently renewed their onslaught, and many times I felt like quitting.
After several months of floundering and experimenting, however, I began to notice small changes in my body that let me know I was on the right track. These were the first clear signs that the healing process was underway. With this encouragement, I continued on the course that I had set.
I found out later that the seeds of healing are sewn during such plateau phases where no apparent progress is being made. It is important not to get discouraged at such times, but rather to be patient.
One of the more helpful elements of my healing program while in India consisted of going to a large, flat rock in the middle of a secluded rice field and standing in the hot sun every afternoon for two hours at a time. With the heat searing down on my bare back, I would place my feet at different angles, practicing the simple art of standing. I stood in various positions, bending my knees, shifting the weight from one foot to the other as I changed the direction in which my feet were pointed, ever mindful of how these changes impacted the muscles of my back. I became acutely aware of the connection between my feet and back, and how I had not paid enough attention to this important anatomical relationship before. When I got tired of standing or when the pain became too intense, I would lie down with my back directly against the surface of the rock and let the radiating heat penetrate deep into the muscles of my back. Over a seven-month period, this large, flat slab of stone became my hospital and healing sanctuary.
I kept a journal by my side to document my insights and discoveries. I called it my Pain Journal. Proceeding this way, I found my body to be a huge storehouse of wisdom. Pain, I discovered, was one of the ways my body communicated this wisdom to me. I also discovered that painful memories were somehow stored in my body in the form of muscle tension, and that this pain could be released once I could relax and release the tension in my body.
As I stretched and moved my back, I began to see that I could no longer keep running away from my pain. I was committed to this journey; there was no turning back at this point. I was willing to face whatever pain I discovered in my life, wherever I found it.
Then, I began to understand that my physical pain, powerful as it was, was just the tip of the iceberg. A much deeper emotional and spiritual pain had been buried in my soul and suppressed for years. My physical pain was making me aware of my emotional and mental pain. As I worked with my body, I found myself reflecting on painful issues in my life, from incidents of my early childhood, up through the present day.
And I gained another valuable insight through this process. I had never learned to stand up for myself; I had avoided confrontation and interpersonal conflict at all costs. Learning to stand up physically required a corresponding commitment to stand up for myself mentally and emotionally, to take a stand on who I was and what I believed in. Did I have the courage to defend my principles and say no to others when necessary? If not, I would have to learn. It was amazing to discover that these deep, emotional principles could somehow express themselves in my body.
Through the help of my body, the deep layers of pain in my life were coming to the surface of my conscious awareness where I could confront the pain, understand it, and then release it. As I did, my body began to heal, so I knew I was heading in the right direction. I decided to follow the pain in my body. It was really as simple as that.
When I returned to the United States, I enrolled in a two-year training program in guided imagery, sometimes called visualization. I learned how the mind can heal through the skillful application of imagination. As I practiced what I learned, my back continued to improve.
I read John Bradshaw's books on the family and the need to heal childhood wounds. I enrolled in a week-long intensive course that dealt with this topic while I explored the relationship of my physical pain to deeper, unresolved emotional issues within my own family.
I was also assisted by many healers, including chiropractors, acupuncturists, osteopaths, massage therapists, yoga teachers, nutritionists, herbalists, and a host of others, some highly conventional, others quite unorthodox. Almost all of these healers helped me in one way or another, adding a new piece to the puzzle I was assembling on my way to reclaiming my wholeness.
The intimate relationship I discovered between my mind and body during this healing process was fascinating; I had no idea just how closely they were connected before I went through this ordeal. My pain was showing me how responsive my back was to my thoughts, particularly those that dealt with concern, worry, or fear. Such thoughts immediately made me feel a twinge or tightening of the muscles in my back and made me realize that they were causing tension in my body.
Positive thoughts wouldn't disturb my back in the least. They would actually relax it. I discovered that my thoughts could influence the health of my back, and that if I listened to my back, it would help me identify healthy, constructive thoughts that would not create tension or stress in my life.
I learned to consult my back at every possible opportunity. I would check with it before making important decisions. If something didn't make my back feel good, I would avoid it. In this way I allowed my back to influence my choices, and modify my lifestyle. As a result, my lifestyle is healthier today than ever before and so is my back. It proves that by listening to your body, you can enjoy a healthy, happy life.
Over the course of time, as I slowly climbed the psychological and physical mountain of pain, I began to sense a deeper mental and emotional purification taking shape. My body felt healthier, lighter, freer, more relaxed, and more flexible. It wasn't long before the pain was no longer in control of my life, even though it wasn't completely gone.
I now see that my back pain was a catalyst for a profound personal transformation in my life.
I am grateful for the understanding that my back pain brought me. It made me a better person and a more compassionate doctor. Without going through the pain, I never would have made the changes that were so necessary for my growth and evolution. I now see how pain is a blessing in disguise.
While pain descends upon your life initially as an unwelcome visitor, if you have the courage to study its deeper lessons, it will be a consummate instructor. Because pain has guided me into the spiritual fabric of my soul, the source of all healing, I can now offer you a way out of your pain.
Copyright © 1999 by Arthur H. Brownstein