Editor’s Note: A recent story about a study that questioned the efficacy of epidural steroid injections (ESI) caused some response from doctors and patients who think they work well. This story is from Marylee James, who teaches at a private university in Louisville.
In 2012, forced to retire from my college professorship at age 72 as a result of unremitting and disabling back pain, I moved close to a city several hours away. Once settled there, my back pain continued to be so severe and disabling that I often spent the night trying to find a position that would ease the fierce pain, while my eyes ran with tears and I begged God to take my life–to end the pain. I would later write these words:
And then I experienced FEAR. I was afraid.
Deeply, paralyzingly, mind-numbingly afraid.
The deepest betrayal of all had happened
And allowed fear into my life.
I had been betrayed by my own body, my own mind.
I could no longer take care of myself.
My mind no longer submitted to my bidding, my body knew nothing but pain.
I prayed for death, but it did not come.
I would not implement my own demise–
Not out of courage, but out of fear.
Not fear of death, but fear of coming face to face with a
Creator who had not summoned me, had not released me
From realizing my worst fears.
It took some time for the new set of physicians who were treating me to become aware of the severity of my back pain, due to other immediate problems (cardiac, respiratory, diabetes, thyroid) that had been exacerbated by my long-term severe chronic pain,. My new primary care physician (PCP) finally told me he was going to refer me to a pain management physician. I was stunned, and then just plain mad. “No, thanks!” I told him, and he probably understood my unspoken question “Have you lost your mind!?!” though I tried to hide it.
I should explain. My introduction to the specialty of “pain clinics” had taken place in the hills of Eastern Kentucky, where that phrase easily translated into “pill mills.” Over the last few years I had taught there, I had watched many students ‘ lives destroyed by the ease of obtaining prescription drugs from these so-called clinics, and I had encountered nothing to alter that observation. It took some time for my PCP to convince me, first that the physician in question was highly skilled in interventions like epidural and nerve blocks for the pain, and second that he was completely legal. Even so, early in our first meeting I did not hesitate to firmly inform said pain management specialist (Dr. James Patrick Murphy) that I did not need his services except for the epidurals. I was to become profoundly grateful that he seemed outwardly to take no offense. I am sure, now, that my attitude had to have been deeply hurtful.
It was not that I feared the epidural. I had received two such procedures more than 40 years previously from an orthopedic surgeon in Virginia who was experimenting with this means of easing pain for women in delivery rooms, in his own practice. He had done the procedure for several patients to relieve their severe back pain and sciatic nerve issues, and I allowed him to include me in the experiment. The first lasted six months, and the second for more than 2 years. There were no unpleasant side effects whatsoever. I have not had the opportunity to be near a practitioner since they became more widely used, however. No, I had no fear of the epidural, or even of the physician I did not yet know. My fears ran much deeper than that. I (again, later) wrote:
—“Do (I) want to be healed?”
Dare I say yes?
What if it is a hoax—a lie offered by a brain
Too old, too confused, too shattered by pain?
“What have you got to lose?” the challenged brain responds.
I don’t think I really have that choice, I respond.
Besides, to choose life means to once again pick up
All those burdens, all those challenges.
The ones known are bad enough;
What about the unknown suffering that might come?
Can I bear it?
My long-suffering PCP, Dr. Trommler, finally prevailed. Dr. Murphy has performed 6 epidurals for me over the past 16 months. The first two (lumbar) lasted 14 months; since then I have had two lumbar procedures that are still effective, and two recent cervical procedures. I had them all without anesthesia, believing that two minutes of potential pain could not be any worse than the continuous pain I already experienced. At least I knew the epidural pain would end, and soon. Further, I was unwilling to add any more chemicals to my body than absolutely necessary.
The latter conviction is the result of my inability to tolerate many medications, including pain relievers stronger than OTC NSAIDs (and definitely not opioids!), anesthesia with fentanyl, oral diabetic meds, and statins. I have had to learn how to manage pain using physical therapy, ultrasound therapy, and all the methods that are now being widely utilized: i.e. meditation, music, and mild exercise. The most effective therapy I have found for even moderately severe pain is involving myself in activities that I love, like teaching, socializing, church, and volunteer work. But the degenerative nature of my back problems eventually overcame my ability to utilize these methods effectively. So, I ended up in Dr. Murphy’s procedure room, much against my better judgment.
Did I trust him? Only to do the procedure. However, his record of success, the respect his patients and staff accorded him, and Dr. Trommler’s firm support of his ability all served to convince me he knew what he was doing. As to his Pain Center, I reasoned that since I could not take medications, and “that was what Pain Clinics” were said to really be about, I would not attend—I thought. In fact, experiencing Dr. Murphy’s compassion, skill, genuine respect for his patients and willingness to be totally “with” them during visits and procedures soon won my complete trust and respect for him, and for the way he practices medicine. Also, for Dr. Murphy, medicine is not a profit-seeking enterprise. He often writes and always practices that medicine is a sacred calling. So do I trust him now? Implicitly.
Six months after my first epidural (and already in much better health largely as a result of the care received from Dr. Murphy) I became a patient in the pain management clinic, where my physical intolerance of narcotics and other medications is taken in stride. That is to say, I finally remembered my sociological training (to say nothing of my own teaching on the subject) and realized that no matter what my experience was in my former life, it did not come close to describing an entire branch of medical expertise and practice, and more precisely, the work of the Murphy Pain Center. There, I am treated with respect. I am listened to, and my concerns taken seriously. Everything is explained to me. The result? Over the past year my ability to function has advanced to the point that I am now teaching part time at a local university (and loving it!), working with three volunteer organizations (on the Board of one), serving in several capacities at my church, and thoroughly enjoying my life again.
Is it a life without pain? Of course not. But the pain is manageable, and not debilitating.
Before this “resurrection,” when I no longer had the will to keep fighting the illness and pain, I thought my life was (finally) over. Pain/medical management, along with an ever-expanding group of loving friends and the patience of an understanding God, restored not only my will but also my ability to rejoin the human race. I am not the same person I was before, but then who of us can claim to be the same as our younger selves?
I had to adjust to a “new normal,” to begin to pick up the unraveled threads of living; to once again look beyond the immediate desperation of losing control of my life and to see, and feel, the enticement of a world that had somehow managed to retain its fascinations even when I was not paying attention. I joked with friends that I now know how Lazarus might have felt, when Jesus brought him back to life. What a thrill it has been!
Yet coming back to life has its challenges, as well as its joys. Old ways of coping with day to day living have had to be relearned after years of coping with pain and desperation and of serving the egocentric needs of being a patient. This change has been both an outward and an inward journey. That journey has been faithfully accompanied and supported by Dr. Murphy and his staff. How often I have heard him say “Don’t fret. It will be OK.” Some activities remain beyond the scope of my physical and/or mental ability, but still I often think in terms of “before the end of my pain and illness” and “after I began my new life.”
Can I put this story into a simple summary paragraph? Not really. I can only list the primary factors, as I see them:
- The skill, compassion, and faithful commitment of a physician of integrity;
- The loving support of my priests and members of my church, family, and friends;
- The ongoing care of my other outstanding physicians;
- My own newfound ability to accept the care and help of others; and
- Last, first and always: The purposeful work of a loving God.