I first saw “Mary” as I entered the exam room. She was lying on the table in tears, complaining of a three-year history of excruciating back pain. She had seen two neurosurgeons and an orthopedist (my specialty), had had an MRI and, despite great hesitancy on the part of the neurosurgeon, had had a (failed) back surgery: her pain had been relieved for three days before it recurred exactly as it had been before. Following a second MRI, she had been referred to me because the neurosurgeon thought I was a “pain specialist,” whereas really I was interested in mind-body medicine as it related to the orthopedic patient — how emotional and psychological stress lead to pain.
Mary’s exam was basically unremarkable, with no evidence of neurological deficits or tension signs. Throughout the time we spent together, she was in tears, though nothing in the exam elicited a painful response. She pleaded to be sent to the local university medical center, convinced that that was the place to get cured.
With nothing to go on but her complaints, I pulled a question from the ether — a question I don’t think I had ever asked before (being new to this arena of mind-body orthopedic medicine, though I’d been in practice for over 20 years). “Has anyone in your family or in your experience ever had a painful condition like this?” She looked at me and said, “Yes, my father.”
“Can you tell me what his experience was?”
She then described the exact same pain symptoms and story — a three-year history of pain and multiple doctors and a failed back operation. The latter resulted in three days of pain relief followed, of course, with recurrence of the pain.
This story got my attention! So I asked the (logical?) next question, “What happened after that?” She looked at me and said, “He committed suicide.”
Grief is a powerful entity, as this story illustrates. Unresolved grief in this instance was not something another operation or medication could resolve. And I, the “consultant,” was not really the one to suggest psychological counselling, though the thought crossed my mind — but I was not certain she could even accept that suggestion. I referred her back to the neurosurgeon after a phone call. I am not sure what became of her after my visit.
What would you have done?
Matthew Zwerling
Santa Rosa, California
Santa Rosa, California