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

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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.
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