Illustration by Anna Godeassi
Last January, I began losing feeling in my right hand. My index and middle fingers buzzed and then fell numb. For months I had waged a pitched battle with my insurance company to authorize testing for a sharp pain in my neck, shoulder and right arm that had not responded to first-line remedies: physical therapy, acupuncture and blistering rounds of steroids that left me wide-eyed at all hours of the night.
At last, the insurance bureaucrats conceded to my doctor’s request. After three months, I had an MRI of my spine and, in the days that followed, consulted with several doctors. I vaguely understood that my case was being fast-tracked due to its urgency. But I was startled when each physician — looking at the images — asked the same two questions:
“Have you sustained blunt trauma to the head?” and, somewhat more alarmingly, “Have you been thrown from a horse?”
We were in a global pandemic. I live in a densely populated city where there is barely room to park a Volvo never mind a thoroughbred. I have been on horseback four times in my life, if I count the pony rides. So no, I had not been thrown from a horse, although the question made me think of Saul being cast down from his saddle in the New Testament, violent surprise leading to spiritual conversion.
I was in another kind of saddle when I found myself humbled or, in the etymological sense of humility, brought low to the humus, which is “earth” in Latin. Much of American culture celebrates large personalities: In figures from Teddy Roosevelt to Ernest Hemingway, we have tended to valorize the game hunters and gunslingers. More recently, attention has turned to the role of introverts, for whom quiet is both a wellspring and a way of being.
After a decade of quiet work, my first book of poems had appeared just as the pandemic began. It won two prizes, but the book tour went online. All of my classes — in creative writing and literature — went online, too. Shy by temperament, I had to develop an online persona, one with a Zoom stage, good lighting and eyeliner.
I paid less attention to the orthopedic challenge of my new workplace.
I thought I was well equipped. Twenty years ago, after a serious back surgery, I bought an ergonomic chair that does everything but levitate. Yet my hours hunched over a laptop tripled or quadrupled as I — like professors across the globe — tried to replicate the rapport of my classroom in the antiseptic space of the Zoom room. My college students were not wriggling 5-year-olds, but they were exhausted by enforced solitude and glum about being sent home to parental oversight. Some had relatives sick with the virus. Some caught it themselves. In the midst of a sustained public health emergency, I wanted them to take heart and keep learning.
I thought of John Berryman’s “Dream Song 14” in which the poet recounts his mother’s accusatory advice: “‘Ever to confess you’re bored / means you have no / Inner Resources.’” Rebelliously, Berryman counters: “I conclude now I have no / inner resources, because I am heavy bored.” My typically vivacious students often looked heavy bored. Yet I was convinced that this was a time for cultivating inner resources — for making art and literature — as we waited, like the characters in Boccaccio’s Decameron, for plague to subside.
Stories, in Boccaccio’s masterpiece, keep a sequestered band of friends engaged, entertained and alive, and I worried about my students — without that privilege — working frontline jobs in nursing homes, hospitals and grocery stores. I was concerned that some would drop out of college entirely to bolster their families’ incomes. The virus put my working-class students at higher risk of both illness and ill-timed delays in their education.
And that hit home. When I was a senior in high school, a freak fall during a track workout had forced me to take a year off before college for an involved back surgery. Afterward I was told I had to quit competitive sport. I was also advised that bearing children would imperil my repaired pelvis and back.
At my students’ age, I had felt a door slam shut. My adulthood would not include a traditional family or, at least, biological children. My path would look different from most young women’s, although I had been brought up in a cheerful suburb with enviable advantages. I come from a line of formidable Irish American mothers and grandmothers, but I would not be continuing the tradition of lending a child the loving gravitational pull that I had once felt governing the planet of my childhood.
Language and stories would populate my life and its absences. A writer partakes of another kind of reproduction, of rendering something meaningful in the world. I would write, and I would pursue a profession that allowed me to live partially by my pen.
With hubris, I had thought that my accident at 17 was my version of being thrown from a horse and, as in the case of biblical Saul, of being forced to adopt new convictions. I thought I was done with catastrophe, which, in its etymological roots, connotes a sudden downward turn. For 20 years, I had done everything in my power to avoid another medical crisis like the one that had radically reshaped how I saw myself as a person. I thought I had already learned the lesson of living with humility and care. But good habits — and meaningful work — are not a bulwark against disaster. Striving to keep my students learning during the pandemic, my deadlines met, I had given myself much more than the “typing injury” I had assumed was the cause of my numb hand.
Fittingly, my internist’s last name is Frank. In the five years in which she has been my doctor, I have come to value the kindly bossiness with which she insists I follow her counsel. With the MRI showing a “very large” disc herniation indenting my spinal cord and a second disc narrowing the spinal canal, surgery was no longer in question.
But I was in shock. My second book was in draft. I had beaten the odds to secure tenure at a university near Boston. I had accepted what fate had handed me and constructed a family of sorts among fellow artists. Never one for roller coasters or rodeos, I had lived a cautious life, exercising daily and taking multivitamins. How had I injured myself writing quietly in my study?
“Look, I know this is your worst nightmare,” Dr. Frank said during our telemedicine appointment. “I wish there were another route, but there is no way out but through.”
She leaned into the computer portal, her brown eyes glimmering.
“If you wait, you risk nerve damage and paralysis. In the meantime, if you lose motor control, fall inexplicably or have speech problems, get to the emergency room immediately. In that scenario, you don’t get to choose: The surgeon is whoever is available.”
I nodded in agreement, admiring how deftly she was playing to my desire to choose, to control as much of a terrifying situation as I could. I promised Dr. Frank I would schedule the surgery soon; I understood that it was, in my insurance company’s euphemism, “nonelective.”
The acclaimed surgeon and memoirist Richard Selzer notes in his essay “The Knife” that the surgeon and the scalpel conspire “for a most unnatural purpose, the laying open of the body of a human being.” Selzer describes the vocation of surgery with reverence and humility; his source of awe, however, is the material of my nightmares.
Facing spinal fusion surgery, which would require an incision across the front of my neck, I was forced to acknowledge that I had never recovered, psychically, from my earlier operation. It had been performed at a private hospital by a renowned surgeon who was in my parents’ social circle; he had handled the cases of sports stars I saw in the newspaper.
Despite the surgeon’s stellar credentials, things went wrong.
Trauma theorists note that distressing events tend to be remembered in one of two ways. For some, traumatic memory is all but obliterated from conscious thought. It is deeply repressed, buried in the psyche’s backyard. It becomes almost inaccessible, an archive that cannot be retrieved without a clinician. For others, trauma leads to an indelible transcription of the event in all its graphic particularity. The traumatic memory is emblazoned in the neon colors of fright and adrenaline. It is startlingly detailed to include vocal tones and specific smells, a ticking wristwatch, an angle of light, a shoe’s squeak, a passing remark. It remains as fresh as if it happened yesterday, a record that can be replayed — at blaring volume — at the press of any button or trigger.
This turn in my life’s narrative has taught me that I am not its only author.
My first back surgery falls into the latter category. I remember being disrobed of my civilian identity in four consecutive rooms — winter coat and mittens doffed in the waiting room; clothes and shoes removed in the intake room; glasses and earrings jettisoned in the examination room; my mother’s presence and a Latin textbook removed in the last room as I climbed onto the gurney. I felt like a Russian doll, getting smaller and more naked in each iteration. I remember the surgeon, thick-bodied and ebullient, gray hair protruding from under his surgical cap, assuring me — loudly, across the preoperation room — that I had nothing to worry about. His voice had the syrupy tone used to comfort children when adults are less than assured of an outcome.
I remember being wheeled into the operating theater, where gloved hands arranged metallic surgical instruments in all their delicate clink and gleam. I remember glaring lights and Mick Jagger singing “Satisfaction” on the radio. My gown was raised, my naked flank swabbed, my leg marked and positioned. Only the anesthesiologist spoke to me.
“I’m going to ask you to breathe deeply and count down from 10.”
As the mask settled, I heard my surgeon’s voice. He was joking with someone, possibly his trainee.
“So this blonde walks into a bar with a wonderful —”
I had tried to accept what was happening as the outcome of an accident, largely out of my control, but now anger flared in my gas-filling lungs. How could the surgeon be joking, lewdly, before cutting into my flesh?
I awoke groggily in a large white room. I began to cry in relief that it was over. The young attending physician asked the nurse for Demerol. I assured him I was not in pain, and I did not want to be knocked out again. But he injected the drug into my intravenous line.
“This will help,” he said with authority.
“But I’m not in pain,” I said, my voice falling mute before I could ask for my parents.
Legally I was a minor, an inconvenient set of tears that could be silenced. When I awoke again, I was in a private room. The surgeon was describing to my parents what he found in his explorations. I remember looking at his hands, wondering how large a scar had been cut to accommodate them.
I knew better than to cry. So I screamed, inwardly, for much of the next year.
This surgery would be different. I was determined to use my status as a fledged adult, as a fellow professional, to secure better care. I had learned that credentials are not the only measure of value in choosing a surgeon. Humbled by my predicament, I needed to find an expert for a most delicate procedure, one that would stabilize my spine and forestall paralysis. But I also needed someone who could regard me with humility and compassion as a fellow human being seeking relief from danger and pain.
As hospital waivers remind us, the risks of surgery, however routine, always include death, the possibility of not arising from the table on which you place yourself with faith that you will be made better, restored to some measure of health and function. According to the Massachusetts Chapter of the American College of Surgeons, Americans have an average of 3.4 inpatient surgeries in their lifetimes. For those of us lucky enough to have access to health care, surgery has become a fact and facet of life. But it is one of the stranger practices we accept as an ordinary, even inevitable, part of living.
My first appointment is with Dr. X, as I’ll call him, a star of an Ivy League medical school’s faculty. His office is in an expensive-looking building with a glass atrium that glitters in the sun, reflecting its surroundings. His receptionist, dressed to the nines, sits behind a set of computers that look as though they could launch a NASA mission.
As I take a seat, a young man enters wearing a metal halo, an Erector Set square box screwed into his skull. I have read about these devices. I pray that I won’t have to wear one as he eases himself rigidly into a chair, unable to move the stiff parrot of his head in its cage.
When it’s my turn, a physician assistant takes my medical history before Dr. X breezes into the room, accompanied by a high-heeled personal assistant who reminds him that he has 13 minutes before he must leave for the airport: Despite the pandemic, he is speaking at a conference abroad.
He shakes my hand, stares at my head and strides over to the screen that displays my MRI.
“Have you sustained any blunt trauma to the head?” he asks without looking up from the films. “Were you thrown from a horse?”
I assure him that the answer to both questions is no. He looks at me appraisingly and manually moves my neck as far as it can swivel and nod. He taps at my numb hand and asks me to grip his, testing my strength.
“I could do this next Tuesday. My only concern with you and spinal fusion, which you obviously need, is that you’re skinny,” he says, squeezing my bicep like a blood-pressure cuff. “Lean muscles and very little fat, so this surgery is going to be hard on you. That being said, you have to have this done. If you wait, you risk —”
The personal assistant knocks on the door.
“Permanent nerve damage. Paralysis. Bad stuff.”
“Time to leave,” the assistant says with brusque cheer.
“One more thing,” he says, as he heads toward the door. “How old are you?”
“41,” I answer.
“That will help. You don’t look your age,” he says with a wink. “Talk to Rachel at the front desk.”
As I gather my things from the exam room, I look out the window. The personal assistant is ushering Dr. X into the passenger side of a blue Porsche. I wonder: Are there rules governing surgeons and jet lag? Do I want my operation performed by someone just back from Zurich or Helsinki? And what was that wink about?
My interview with Dr. Chadi Tannoury a few days later is utterly different. Instead of a glass-plated building in an expensive suburb, Dr. Tannoury’s office is in a busy public city hospital, one that serves all comers. My aunt and my best friend trained at this hospital, in nursing and psychiatry, respectively, their skills honed by the sheer heterogeneity — and severity — of the cases. Because it deals with the medical complications of poverty and violence, the trauma care is exceptionally good.
Dr. Tannoury, I later learn, is my age. Raised in a small village in Lebanon, he studied medicine in Beirut before immigrating to the United States. He is now the director of orthopedic spine research at Boston Medical Center, and a medical illustrator, an indication of his precise eye and hand.
Our meeting is much longer than my hurried consultation with Dr. X. He studies the MRI carefully, as if it were a museum painting, considering it from different angles; he asks about my symptoms, reconstructing their chronology, and gently tests my strength and reflexes.
Though he reaches the same conclusion — my spine must be fused with titanium and bone from my hip — he asks me if I have questions. And I have many. In the course of our dialogue, I recount my earlier experience of surgery, and my account dredges up tears. Quietly, he excuses himself. He returns to the exam room with a box of Kleenex, and we discuss how this surgery can be different. We talk about his secondary work as a medical illustrator and my work as a writer and the artistic drive. At the end of our conversation, he offers his phone number. While technically Dr. Tannoury is the “second opinion,” my choice of surgeon is clear.
During our follow-up phone call, in which we discuss the titanium hardware and cosmetics of the scar, he says he will keep me in his prayers. I am heartened by his heartfelt intention, his humble nod to the fact that the outcome of this procedure is ultimately outside of my hands and, to some extent, outside of his as well.
If I have learned anything in my second tango with medical crisis, it is that my body is carbon. There is no way out but through the human experience of physical crisis, limitation and debility. We can at least seek fellow travelers who, with humility, know this to be true.
I schedule the surgery with Dr. Tannoury 12 days out, gambling that the herniation will not cause irrevocable damage in that time. I write course syllabi and a will. I assign my bank accounts beneficiaries. I do laundry. I have Zoom sessions with my classes and introduce them to the instructor who will serve in my stead. Matching socks and choosing heirs, I think about death in concrete ways that had never occurred to me. I speak with Dr. Frank, who prescribes an anti-anxiety medication I can use as needed to get myself through major surgery without chickening out in the hospital vestibule.
As if I am preparing for a graduate seminar, I write a handout with my medical history for the surgical team. It covers everything from drug allergies to resuscitation orders.
In the stark waiting room of the city hospital, I watch a mother my age with her daughter of 4 or 5. The mother is clearly trying to be brave for her child. Her daughter seems to intuit that she, too, must be courageous, if only to ease her mother’s worry. I marvel at this dyad, at all that is communicated between them below the level of speech. Due to pandemic restrictions, I will be alone until I am dismissed the following day. But I take heart in this mother-daughter pair, thinking of friends who have sent me gifts from matzo ball soup to pajamas.
Things run smoothly as I disrobe, accept the IV and distribute my handout to the preop nurse, the surgical intern, the anesthesiologist and the EMG technician. When Dr. Tannoury arrives, we chat amiably and calmly. He asks again if I have questions, and I inquire about complications. It is possible that I may have difficulty swallowing or speaking afterward, as my air pipe and larynx will be pulled aside so the spine can be reached. I can return home, Dr. Tannoury says, as soon as I can swallow; my mind fixes on that goal.
I am offered — and accept — a drug that allows me as planned to forget the transit between the preoperating room and the surgical theater. I feel myself being shifted onto a hard table. I have one moment of lucidity in which the surgeon asks what kind of music I’d like in the background. I request classical, and I fade out to Bach.
When I awake, I am in the post-surgical unit. Dr. Tannoury notes that things went well and asks how I’m feeling. I wriggle my fingers and notice that my hand, miraculously, is no longer buzzing.
“So, how many plates?” I ask, referring to the traditional hardware in a spinal fusion. “And how many screws?”
“Neither,” he says. “We used titanium blades to secure the cages with the bone grafts. They lock directly into the vertebrae.”
I picture the retractable blade on a penknife arcing into my spine.
“Thank you,” I say, somewhat weakly. Dr. Tannoury leaves for his next procedure, and I fall under the tide of drugs again.
I wake to terrible thirst. The postoperative care unit is as busy as a bus station. Nurses seem to be sprinting past me. I call out, but my voice is stuck. Awkwardly, I raise my hand as if flagging a taxi in Manhattan. As I wave to the nursing staff, I think of Stevie Smith’s poem “Not Waving But Drowning,” in which a man who seems to be waving from the ocean is, in fact, sinking to his death. Eventually a nurse comes over, offering an additional bag of saline and painkillers.
“Could I have some ginger ale and my clothes instead?” I ask, gathering my moxie. After all, a deadly airborne virus is afoot, and I think I am well enough to leave. The nurse seems surprised, even alarmed, but I put on my best professorial air and ask her to call an orderly to take me down to the exit in a wheelchair. The nurse complies, and a pharmacist delivers a take-home bag of 11 drugs.
Approximately 2 ½ hours after major surgery, I eject myself from the hospital. A friend picks me up and stewards me home. Dr. Tannoury, meanwhile, calls my cellphone and the phone of my medical proxy, which I do not realize until I am home. He had not expected I would leave quite so early — an overnight was planned — but I assure him that I am home in reasonable condition and able to swallow.
The next several weeks are a trial of body and spirit. The pandemic means I must weather most of my recovery alone. Pain is a severe, constant companion, as the narcotics do not work. I sleep for snatches of time sitting up. I make short calls and spoon yogurt. Mostly I look at the walls and ceiling, feeling for the edges of the blanket and my being.
One restless night, I begin listening to audiobooks. Edna O’Brien’s memoir is first in my queue: I fall asleep to her giving an all-night dinner party in London and awake at 3 a.m. to her tense interview with a member of the Irish Republican Army. Books themselves, in my liminal state, have become new inventions, startling narratives of unexpected endings.
I do not yet know how this particular narrative ends. At eight months, Dr. Tannoury and I assess my progress. I have returned to work and writing. I am not without daily pain. It seems unlikely I will ever feel fully at ease driving a car.
But I am alive and my spine is stable.
And this turn in my life’s narrative has taught me that I am not its only author. I have been humbled — reminded that I am of the humus and, as an earthly creature, subject to debility and decay. But humility has also served as a divining rod: a means of finding a surgeon who would safeguard my humanity while he delicately placed titanium in my spine and enabled me, having been thrown from a metaphoric horse, to walk away with a story — and sensation — in my two hands.
Heather Treseler is a poet and essayist whose first collection of poems, Parturition, received the Munster Literature Chapbook Prize in Ireland and the Jean Pedrick award from the New England Poetry Club. She is an associate professor of literature and creative writing at Worcester State University.