On August 18th, 2015, a week after I came home from California, I had an appointment with a new neurosurgeon who would resume my care here in Canada. My mother-in-law has a particular connection at St. Michael’s Hospital in Toronto who recommended Dr. J to us, ever since we all thought I could come home soon after after my neck surgery in California. St. Mike’s is designated as a Level 1 trauma hospital with a specialized neurosurgery unit, plus my doctor had outstanding patient reviews online, so I was assured that I would receive the best care available.
As usual the wait time was excruciatingly long. That day my dad and two teenage siblings came with me to what they called the Fracture Clinic. By now my siblings have gotten used to waiting endlessly for doctors to call me. I gave the staff all my medical records on paper and copies of six CD’s of my films, all of which I had prepared a few days before.
Finally I was called into the examination room to meet Dr. J, a young-looking Chinese man no older than 40, who asked if I wanted my family to come along with me. I politely said, “No, it’s fine.” What could possible go wrong at this appointment that my family needed to be there?, I thought. His assistant already had my most recent CT scan from two weeks ago loaded on the computer for him to review.
What exactly did I want to come out of this appointment? Well, at the time, my plan of care seemed simple: spend five more weeks in the Minerva jacket, then take a CT scan, and if my neck was all healed then I could take it off. Because my neurosurgeon in California said, verbally and in writing, that I was practically “all healed,” it seemed to me that the six weeks total in this new neck brace was just a precaution.
My thinking was, Hey, if I actually don’t need this, then why bother? I’ve read about certain doctors who are against neck bracing altogether, claiming that 1) it does even more damage as the patient has to regain the range of motion lost by total immobilization, and 2) the wires or whatever support in place are usually stable enough to prevent unwarranted neck movement. At this appointment with Dr. J, I was going to plead (and/or beg?) that he would take a look at my most recent CT scan and judge himself whether I would be fine without any brace at all.
What happened was the complete opposite.
With the amount of free time I had, there were many opportunities to speculate about my future in the neck brace. At the best, most optimistic circumstances, I could get the brace off right then and there. The worst would be to carry on with the intended plan of care. But no… there would actually be an even worse turn of events.
“So, how do you know Ms. G?” Dr. J asked as I came in the examination room.
I wasn’t really expecting that question, about my mother-in-law’s connection at the hospital. “My mother-in-law knows her.” That lady, who is pretty high up on St. Mike’s org chart, was the sole reason why I got this appointment in the first place. Dr. J’s neurosurgery practice is busy and sought-after in downtown Toronto – he has hundreds of patients, if not a few thousand, and a two-year waiting list for non-life-threatening surgeries.
As I have done when meeting new health care professionals, I told Dr. J the story of how I broke my neck as well as going through the terrible halo. I told him the plan moving forward with my new Minerva jacket. Despite the gravity of what I was telling him, we talked like we were buddies. (I wasn’t joking when I said he looked and acted young for a neurosurgeon.) He asked me if I had a job as he scrolled through the images of my CT scan.
“I’m a geologist at a mine,” I said.
Dr. J continued to inquire, “Are you fairly active? Do you run? What do you do on weekends?”
I laughed at the seemingly odd questions. “Well, I don’t know, I just met you! Maybe you just like to sit around and read books on weekends,” he joked.
“No, I really like to hike and exercise a lot.”
He continued to scroll through my CT scan and developed a more serious tone. “I don’t know how to tell you this… but you’re really not all healed. See here?” He pointed to areas posterior of my C6 and C7 vertebrae. “There are parts in your spine that don’t have any bone that grew at all. I don’t even know why they put you in a halo and then this jacket here. And you’ve been in these things for so long! I never put anyone in halos anymore. I don’t even see your jacket anymore.”
“Here in Toronto we have more advanced, more aggressive techniques of getting patients up and moving. You have a really unstable fracture and most people end up quadriplegic if the spinal cord is damaged, so you’re extremely lucky. I really don’t know how to tell you this… but you need another surgery to stabilize your neck with plate and screws and put another bone graft in there.”
I was stunned.
“Where did you have your surgery again?”
“California,” I said.
“Where exactly? LA?”
I replied, “Lancaster, it’s not a major city. It’s in the middle of nowhere.”
“I see,” he said. “Was your doctor, like, an older fellow?”
“Yeah,” I said, still in disbelief of having to get another surgery. “Maybe like 60,”
“Yeah,” Dr. J said. “What they’ve done is an older method of doing things. They performed the surgery posteriorly and put this little flimsy wire, plus they put you in that halo. Not all the bone that was supposed to grow from your graft actually grew. With that wire, I can’t even get an MRI now to see what’s going on.”
Tears welled up in my eyes. I really couldn’t take it anymore. Basically the last three and a half months was an utter waste of my life because they didn’t do my surgery right, at least to today’s standards? Now I have to get another one?
He referred me to the report of the CT scan:
We were talking about the same thing over and over again, as I couldn’t understand and accept it all. He also told me I would have to wear a new neck brace, called an Aspen collar, which would be much less restrictive than my current brace. I would wear it for another six weeks – another month tacked on my expected date of freedom from the Minerva jacket.
“Umm, can my dad come in here?”
I went out of the examination room and called my dad in the waiting area. He was surprised to see me crying. “O, bakit?” (“What’s wrong?”) We both went in to see Dr. J again. Dr. J explained the situation at hand to my dad. He too was in shock.
Just to get off the disappointing topic, I asked Dr. J questions I had written down in my notebook for weeks. Can I do yoga? No. (Darn, I was in contact with a private instructor even!) Can I go on a recumbent stationary bike? Yes. Can I go on an elliptical? Umm, let’s start with the bike first.
Because I had already been in a neck brace for over three and a half months with little progress in the way of bone fracture growth (resulting in what is called a “non-union” between my C5 to C7 vertebrae from my first fusion surgery), Dr. J was compassionate enough to accept me as a patient and perform my revision surgery. Normally he doesn’t even accept patients from the US. One reason being is that Canadian and American neurosurgeons don’t agree on certain standards and practices – the use of the halo brace, for example. (Don’t quote me on this, this is just what I understood.)
If my mother-in-law didn’t have that connection at St. Mike’s, I don’t know what I would have done. There are only ten other similar trauma and neurosurgery centres like St. Mike’s in Ontario. And then I would have to clamor my way into getting an appointment with another neurosurgeon.
Dr. J advised me to go to the emergency room in about two weeks, on August 30th, Sunday, so I could get a new set of CT scans and X-rays. I would then be put on a wait list for my surgery. It would likely happen between the following Monday to Wednesday when he was scheduled to operate on patients. Unless there was a stat or emergency patient, I was to be called immediately when his OR schedule frees up. This was the only way I could get the surgery as soon as possible. There was no way on Earth I would wait two years after hundreds of patients!
I couldn’t even handle the prospect of another month or two!
“If you were an old person or really sedentary, I would just let it be. But since you say you work at a mine and you’re really active, your spine, at this point, isn’t robust enough to handle that. I just want to make sure you’re solid with the plate and screws before we get you out of this brace,” Dr. J told me many times over.
Another surgery and several more weeks of being in a neck brace in exchange for my active lifestyle? Working at the mine and hiking and climbing mountains and biking and doing T25 videos with my workout buddies again?
Sure, I’ll take it. But it wasn’t without sadness, bitterness, and anger that I unwillingly accepted my fate.