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What’s Important: Lessons on Life, Death, and Disability

Farrar, Edward MD1,a

Journal of Bone & Joint Surgery - American Volume: 3 May 2017 - Volume 99 - Issue 9 - p 797–798
doi: 10.2106/JBJS.17.00148
The Orthopaedic Forum
Disclosures

1Wenatchee Orthopedics and Confluence Health, Wenatchee, Washington

E-mail address: elfarrar@me.com

As orthopaedic surgeons, we are blessed with lives that are rewarding, and by most measures, mine had been successful. Good grades in medical school, training at a prestigious residency program, and additional training as a spine surgeon eventually led to a rewarding practice in a wonderful community.

The mountains of the Northwest brought challenges outside of work. These challenges eventually led me to 5 Himalayan expeditions and work as a volunteer surgeon in Nepal. Back at home, I was able to serve as the President of the Washington State Orthopaedic Association for 2 years. So it seemed reasonable to feel confident that I knew what was important in life. One morning in 2008 changed all that.

While riding my bicycle to work, a car suddenly crossed the road and hit me head-on, crushing my chest and completely severing my spinal cord with a fracture-dislocation at the T4 level. In a matter of seconds, my life as a surgeon was over. I became a critically injured patient.

Remarkably, I did not die. After a month on a ventilator and 6 weeks in the intensive care unit, rehabilitation to learn how to live as a high thoracic paraplegic began. After 3 complicated months in the hospital, it was time to go home. That’s when I realized how little I knew about spinal cord injury, despite having been a spine surgeon for 25 years! In the medical world, it is “normal” to be abnormal while in the hospital. On the rehabilitation ward, it is even “normal” to be paraplegic. But we should remember that when paralyzed patients go home, nothing in life will ever be normal again.

In this new world, one of the hardest lessons was the incredible impact that the injury level had on the ability to use my hands. As a surgeon, I had always “grouped” all thoracic spine injuries together. I was incredibly thankful not to be quadriplegic. But the reality of no trunk control meant that functionally I had only 1 hand. Any task requiring both hands would lead to imbalance and a forward fall. Rapidly having to place one hand on a thigh for balance has the same effect as amputating that hand for functional use. So, one of the early lessons was that the life of a patient with a high thoracic injury is very different from the life of a patient with a lower thoracic injury. This reality is something that deserves more appreciation by our profession and the insurance industry.

The other sad reality is that, with the exception of a few research projects, treatment options for the injured spinal cord remain nonexistent, in stark contrast to major advances in most other fields of medicine. For the past 60 years, there have been medications to treat most bacterial infections. Fifty years ago, patients with leukemia began getting bone marrow transplants using stem cells. As an intern, I took care of patients who were receiving organ transplants. During this time, open heart surgery was becoming commonplace, and even hearts were being transplanted. In recent years, cancer care has exploded with treatment options that can lead to a cure for many. And, as orthopaedists, we have witnessed remarkable advances in musculoskeletal medicine and surgery.

So, in our lifetimes, almost every field of medicine has seen incredible progress. And yet to this day, if you become paralyzed from a brain or spinal cord injury, there are still no proven treatment options. In the past century, we have become better at keeping patients with paralysis alive, but we can’t make them better. They get better wheelchairs but no hope of repair. Spinal cord injury today is just as devastating for patients and families as it was 50 years ago. Sadly, the fact that there is no quick profit from treating paralyzed patients on Medicaid has paralyzed spinal cord injury research and development in our country. If we considered long-term costs instead of short-term profit, treatment of paralysis would become more important. For patients, this might bring hope for the future. Even a small amount of hope would be huge.

Despite the lack of treatment options, patients with paralysis still have to find a way to keep moving forward. Although paraplegic, I was fortunate to remember that I was still a physician. I was able to return to the office and begin seeing patients, even though I could no longer operate. This proved to be more valuable to patients than I ever could have imagined. And, in a surprising way, by returning to work as a “healer,” I actually began to heal myself. I became a better listener and realized how much this has helped my patients and me.

Another important realization was how incredibly valuable our connections to others are. One of those connections developed with a nurse who had become my partner on the road to recovery. But the challenges were not over. Just 2 years after my own injury, she was diagnosed with a disseminated glioblastoma. Early on, a lesion in her thoracic spinal cord rendered her a paraplegic as well. Suddenly, even though paraplegic, I became a caregiver. It was hard to believe that life could become more difficult. And yet, for the first time since my own injury, I did not have time to think about myself. As we cared for her in the last months of her life, another change occurred. Making another person’s life more important than my own led to even more of my own healing and recovery. She passed away about 8 months after her diagnosis, leaving more lessons on life and death.

These lessons may seem extreme. But the truth is that life is fragile. None of us gets out of here alive. When things get hard, I can tell you that “living for the present moment” really does help. In the short term, it is a practical way to get things done. In the longer term, it helps us focus on what really is important.

Life also has taught me that we may not always find the meaning and purpose that we were searching for, yet meaning and purpose can find us. I have learned that as long as we remain connected to others, we have meaning in our lives. And, as physicians, we are blessed with a role that connects us to others, with purpose, in a very special way. The surprise for me was the impact that putting others first has had on my own recovery. I now know the deeper meaning of an old quote: “We make a living from what we get, but we make a life from what we give.” I have learned that this is true, even when life takes from you.

Disclosure: The author indicated that no external funding was received for any aspect of this work. The Disclosure of Potential Conflicts of Interest form is provided with the online version of the article (http://links.lww.com/JBJS/C821).

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