Emergency Surgery

Days 1-2

September 2-September 3, 2024

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I woke up and the sciatica was worse.  Man, did I wish I could go back to the chiropractor.  I had just been on Friday August 31st.  I had gone because of some mild back discomfort, which usually resolved after a couple of visits. Typically, I was simply out of alignment and had no major back issues.

The next day, I experienced increasing pain. I wished that the chiropractor was open today. Clearly I needed more than one adjustment. It continued to increase over the weekend. My discomfort grew and I convinced myself it was sciatica.

This morning though, September 2nd, I went into the bathroom and fell to my knees, I had thrown out my back.  The exact thing that I had been working to avoid.  If you’ve ever thrown out your back you know that you need your back for literally everything—sitting, walking, lying down.  Nothing was comfortable with a thrown out back.  I used Bengay, took a warm bath, and used a heating pad.  Jay (my boyfriend) was out grocery shopping with my kids Kennedy (daughter, 2.5) and Beckett (son, 6.5) so I had a few minutes to take care of myself.

Typically when I throw out my back I can still move around like a hunchback, but not today.  Today I was crawling.  Off the bed, to the floor, crawl to the stairs, crawl down, crawl up (much harder and slower).  Since I had thrown out my back before, I assumed I just needed the chiropractor.  Surely I twisted something or was out of alignment or maybe it was sciatica. There was one more day of meetings on September 3rd and the first day of school was September 4th.  My chiropractor appointment was scheduled for 3:45 on the 3rd.  Worst case scenario?  I would miss the 3rd, but would be able to start on our student’s first day which was the 4th.  

Things just got worse over the course of the day.  I had a lot of help with the kids, but if you know me, you know I’m not one to lay around all day.  I cut up strawberries on a plate on the kitchen floor, did my toddler’s hair from the side of the bed, read books on the floor, and played Little People on the floor while feeding Kennedy.  I washed the kids’ hair over the side of the tub and did the best I could all day.  I couldn’t pick up toys, make meals, load the dishwasher, change the bedding, prep food, or do laundry—but I was still functional, or so I thought.  

Right before bed time, I stood up and my right leg was numb.  I sat down and opened Google.  “When to go to the ER for sciatica.”

It read:

You should seek immediate medical attention for sciatica if you experience any of the following symptoms:

-Loss of bladder or bowel control

-Severe pain that lasts for more than a few hours

-Sudden severe pain, numbness, or symptoms after an injury

-Weakness or numbness in both legs

-Numbness around the genitals

-Difficulty urinating or blood in the urine

-Pain that wakes you up at night or worsens when you lie down

Other symptoms that may indicate a serious condition include:

-Unexplained fever with back pain

-Redness or swelling on the back or spine

-Pain traveling down your legs below your knee

-Burning with urination or blood in urine

-Fever, chills, and/or night sweats

-An itchy feeling in painful areas of the leg

-A cold area in the feet or toes

-Change in color of the skin over the legs or feet

Only one leg was numb and that was consistent with a pinched nerve which I had before.  I decided to go to bed.

At 3:30 AM I got up to go to the bathroom.  My whole pelvic region was numb.  I dropped to the floor, I couldn’t stand as it was, and cried.  Some of the tears were for pain, the others because of fear.  It was extremely disconcerting to lose sensation in your body—it felt like I was slowly becoming paralyzed.  

3:45 AM.  I didn’t want to wake anyone to come watch the kids while Jay brought me to the ER and if I called 911 I would end up at Heywood.  This is not the hospital I wanted to trust with my care.  I crawled back into bed and Googled, “Sciatica pain with genital numbness.”  I came across:

Cauda Equina Syndrome

Cauda equina syndrome is a rare but serious back condition which can lead to permanent damage or disability. If you develop this condition you’ll need to be seen by an emergency specialist spinal team.

The patient’s outcome is closely related to the timing of surgery. The earlier surgery is performed, the better the outcome will be. For the best results, decompression surgery should be carried out within 24 hours of the onset of symptoms. After 48 hours, the chances of a patient regaining normal function are ebbing away.  If you waited more than 48 hours for an operation, you could be facing long-term injuries. This can include problems such as pain, bladder dysfunction, bowel dysfunction, and sexual dysfunction.

That was it.  All I needed to read.  I called my mom.  Jay was already up getting dressed.  I’m not sure if he heard me crying or calling my mom first but he knew we needed to leave.  I wanted to go to Worcester.  Usually I go to the ER in Gardner or Leominster if I have to go, but this felt different.  The chances of Cauda Equina are rare, about 1 in 65,000-100,000 and only 1% -3% of herniated disc injuries.  I decided that although it wasn’t likely, the potential for permanent disability if I was wrong wouldn’t be worth the risk.

I crawled on my hands and knees to get to the car.  I climbed in the front seat facing backward, the only way that felt tolerable for the pain.  I thought about getting into the hospital.  Maybe I could walk, it would just be painful.  I would rather do anything than use a wheelchair.  Well, anything except maybe crawling on the ER floor, that was probably worse.  

When I was in labor the second time, I drove myself to the hospital.  I’m stubborn, didn’t want to miss my chance for an epidural and was headed to Emerson Hospital in Concord.  Rush hour traffic was horrific and it was 4:30 AM.  Jay had to wait until someone arrived to watch the kids, but I couldn’t wait anymore.  I was having contractions but was able to drive and 100% never used a wheelchair.  I was eligible for an epidural upon arrival and was in active labor.  Active labor and I wouldn’t be caught dead in a wheelchair.

When we arrived at the hospital I hobbled out of the car and immediately sank to the ground.  Nope, wheelchair it was.  Jay grabbed it and wheeled me inside and then had to go park the car.  When it was my turn I awkwardly kicked myself to the window in visible agony.  I guess I knew to wheel with my arms but it was urgent—I didn’t want to be cut in line and kicking myself over seemed like the faster option.  

When I go to the window the nurse said, “Can I help you?”

“Yes.  I need to be seen,” I responded.

“By a doctor?”

I was so confused, “Is this the ER?  Am I in the wrong place?”  I mean, I could read, the flashing red ER signs were pretty hard to miss. Did she mean or a nurse? Like if I only needed stitches? I had no idea.

“It is the ER, but I need to know if you are here as a patient or a visitor,” the nurse clarified.  

I wanted to laugh.  I was in visible distress, dragging myself to the counter, pale and a mess and she thought I was visiting someone?  C’mon.  “Yes as a patient.”

I handed her my license and she checked me in and told me I needed to go through security.  She actually watched me try to hobble and came out to help me.  She pushed me to security and I handed them my bag.

“I just want you to know that I am only in the wheelchair because I physically can’t walk or I wouldn’t be caught dead in it.  It was either that or crawl through the door.”

“Well we would have looked at you like you were crazy if you did that,” one of the officers laughed.  

We had a lighthearted conversation and he brought me to registration.  I gave a synopsis of what had been going on and then was brought back out to the waiting room.  The position of sitting in the chair was excruciating so I found myself on my knees with my arms draped over one of the waiting room chairs.  You know it’s bad when you willing touch your clothes to the ER floor and hover your face inches above the filthy chairs.

Eventually I had to go to the bathroom and had no idea how this would work.  With my knees bent and feet flat on the floor I shuffled myself to the door.  Jay offered to help but at this point the idea of anyone touching me or moving me the wrong way seemed worse.  I reached up for the door and made it inside.  I went to the bathroom and luckily could reach the sink in my squat.  I flung the door open and sought the reprieve of waiting room chairs so I could lean over and rest.  At one point I glanced up and saw the nurses looking at me with horror or confusion—I’m not sure which.  I will tell you that they didn’t offer me so much as Advil as I suffered in that room.

Finally they brought me back.  Either they were ready for me or were done watching me like a hamster in a wheel constantly moving and getting nowhere—-I’m not sure which. 

I got into the room and heaved myself onto the bed with an audible gasp.  I explained my situation to the doctor and he nodded his head and said that we would proceed after they got me comfortable.  The nurse administered morphine and Ativan and even 30 minutes later, still no relief.  

They asked where the numbness was and said that getting an MRI in the emergency room was unlikely unless I started peeing myself or lost control of my bowels.  My groin was numb though.  After consulting with a spinal surgeon, it was decided to give me an MRI at 1:50 PM.

The surgeon explained, “You see there are different levels of concern.  Some people come in here and we direct them to follow up with the PCP and schedule an MRI sometime within a couple of weeks.  Others receive an urgent MRI.  You are somewhere in between.  So we will get you the MRI and chat after.”

After a nurse passing by saw me huddled on the floor I was given IV dilaudid, or hydromorphone.  It is a synthetic opioid 10 times more powerful than morphine.  This didn’t touch the pain either.  Lying down was so uncomfortable that I had to frequently get up and relocate to a hunched position on the floor.  About an hour prior to the MRI they gave me another dose of dilaudid and Ativan with the hopes that I could stay still enough for the procedure.  While evaluating me flat on my back for two minutes earlier my muscles started spasming and I had to jump to the floor.  

Finally they came to bring me to get an MRI.  They positioned me on the table, gave me something that felt like a rubber ball to squeeze in case of an emergency, and ear plugs.  I squeezed my eyes shut and tried to disassociate from the searing pain of lying flat on my back.  

After about 15 minutes I couldn’t stand it anymore and squeezed the rubber ball.  I don’t know what I was expecting when I came out, maybe an “I am so sorry, are you okay?  Take a minute and we will try to finish up” or something to that effect.  What I got was, “You aren’t even done” in an impatient and brusque tone.  

I flung myself off of the stiff table and onto the refuge of the floor where I could get in position and take some of the pressure off of my back.  I was just as ready to get this over with so after about 4 minutes I reluctantly climbed back up onto what felt like a torture device and back into the machine I went.

I gritted my teeth, said a prayer, and fought the compelling urge to squeeze the rubber ball and make it stop.  I tend to internalize my pain, never once during childbirth did I audibly moan or yell.  But this was too much.  The tears stung my cheeks and I was crying out in anguish.  I never gave up and refused to squeeze the rubber ball.  After  about 10-15 minutes they released me.  Even though I needed to be wheeled back on the bed, I once again leapt to the floor for some relief.  The two attendants said nothing.  Not, “You did it” or “Good job, it’s over now” or “You are a trooper and they are going to help you.”  Nothing.  Just the direction to get back onto the bed so they could bring me back.

One I returned to my room in the ER it was pretty much a blur.  I was alone because I told everyone I was okay and going to be scheduled for a spinal consult and MRI the following day.  They left before resident spinal surgeon Dr. Lambert evaluated me.  He showed me the scans of my back and said that I had a severely herniated disc that needed to be operated on immediately.  He said it was causing compression of my nerves and was indicative of Cauda Equina Syndrome. I was right. I never wanted to be made fun of for googling my symptoms again. Ever.

I would need emergency spine surgery.  I had to sign a couple of releases about risks of death from anesthesia and potential permanent nerve damage resulting from surgery.  I signed whatever they gave me only half hearing what they were saying, disoriented from the pain and combination of painkillers.  I was given a hair net, a hospital gown, and my back was marked with sharpie. I met with the anesthesiologist and the spinal surgeon Dr. Pieters.  I had time to call my family and let them know about the surgery.  Since it was so urgent, nobody had many details.  

They told me that they planned to make one incision but if it was too narrow of an area they would need to make a second.  I just nodded and they whisked me away to the operating room. 

They prepped the room and put a mask over my face asking me to take a series of deep breaths.  The next thing I knew I was in recovery.  My sister and Jay were there.  They told me the procedure had been 3.5 hours long.  Originally they expected it to be just about 1-1.5.  Visiting hours were over but my sister insisted on speaking with the surgeon since my family still had no information on what the surgery actually entailed.  

Dr. Lambert came down and told me that they removed 8 cm or about 3 inches of tissue from my spine and that they needed to make two incisions.  He explained that I had a pump in my back to drain the blood from my body and that he would check in on me in the morning.

I was wheeled upstairs to the neurosurgery floor and given my own room.  The first thing I noticed was that my groin and right leg were still numb.  I could move but it was like if your leg and groin fell asleep and were impossible to wake up.  I was given more pain medication and slept until 3 AM when I realized I still couldn’t feel parts of my body correctly.  I froze in a panic and watched the clock tick by until morning.