My first surgery in July of 2007, was billed as a Tarsal Tunnel Release based on a diagnosis of Tarsal Tunnel Syndrome, similar to Carpal Tunnel Syndrome except the squeezed or pinched nerves are in the ankle rather than the wrist. (I promise I had not been typing too much with my toes.) The surgery went just as we’d hoped, as did my second surgery ten months later in May of 2008, my third in October of 2008, and my fourth in January of 2009. All four surgeries met our hopes. My problems came between each trip to the operating room.
Two months after the first surgery, I was back in Dr. B’s office. In September, over a period of three weeks, I went from being near pain free to feeling the same, if not worse than before. I hadn’t gone fishing and taken another fall, or injured my foot in any way. And yet, it was as if the Tarsal Tunnel Syndrome had come back with the vengeance of a spurned lover. It takes a long time for nerves to recover or heal from surgery, typically a full year. My progress, however, wasn’t just slow; it was moving in the wrong direction, intensifying rather than decreasing.
By December, Dr. B— suspected that scar tissue was developing around the same nerve, causing the same pressure and pain that led us to the first surgery. Throughout that winter and spring, each time I came to the office he mentioned his concern (scar tissue) and his hope (avoiding a second surgery). And we threw ourselves behind his hope with action. I began physical therapy, a regimen of exercises along with deep fiber massage to break up scar tissue. Dr. B— sent me to a local pain management doctor, Dr. Frank* (not his real name), who unfortunately fit the caricature of the worst of his profession. At my appointment, his P.A. (Physician’s Assistant) visited with me for a few minutes. Then Dr. Frank stepped into the room. We spoke briefly, and then he took out his prescription pad and began to scribble. He made no physical examination or independent assessment of my foot. His shop was a classic one-stop injection and prescription store. But with limited resources in Abilene and pain serving up constant reminders, I made the best of the situation and followed his directions.
As the pain increased, I kept teaching and taking care of the department the best I could. Some days, if I was careful and limited my movement, the pain would slacken. Other days, no matter what I did, the pain was intolerable, progressively radiating up the back of my left calf. Dr. B— refused to give up hope. He discussed my case with other podiatrists, orthopedists, and neurologists. He tried new medications and a series of injections every two weeks directly into the most tender and painful areas of my foot. I even tried wearing my old walking boot from the stress-fracture days. But nothing slowed the steady advance of pain, much less reduced it. So finally, hoping for a better outcome, Dr. B— scheduled a second surgery for May 9th—the Friday at the end of spring final exams.
I graded papers and exams like a madman, calculated, and submitted final grades before checking into the outpatient wing of Hendrick Hospital. Once in surgery, Dr. B— cut out the original half-moon scar on the inside of my ankle and extended it further toward my toes and a few inches higher up my ankle. He cleared scar tissue and ran his fingers up and down the nerve, ensuring there was nothing else putting pressure on it. Finally, he stapled me back together, leaving an eleven-inch scar. (The picture below was taken a week or so after surgery.) The second surgery had gone just as we’d hoped.
Obviously, after a doctor slices open your ankle from stem to stern, there is going to be considerable post-operative pain. Even so, compared to the months before surgery, the intensity of my pain immediately dropped, and, by mid-June, I began to wake from the fog of narcotics I’d been taking to survive the past year.
Then, like the second installment of a terrible movie, the plotline repeated itself. I’d spurned the same lover, but not only was she coming for her vengeance, this time her father, mother, brothers, aunts, and uncles were coming too—with pitchforks and hoes, and they were really angry. By early July, I was having trouble standing in one place to carry on a simple conversation. By the end of July, the offended nerves were making me pay for every step I took.
Dr. B— and I began again: Cortisone injections (with Marcaine, to block the pain), oral steroids, more tests and scans, more consultations, and more medications. I went back to physical therapy: more exercises followed by hot packs, ice massage, ultrasound, and deep oscillation to break-up new scar tissue. Some of it felt good, but nothing produced any long-term benefit.
When I resumed teaching in late August, pain was the first to greet me in the morning when I stepped out of bed. By the time I went into class at eight o’clock, I was already in a hydrocodone stupor. By ten o’clock and class number two, the medication was wearing off and pain was breaking through. At lunch I reloaded with meds and tried to keep working. When I finally went home, all I wanted to do was take narcotics and pass out for an hour or two, wake up, repeat the process, and go to bed, hoping for relief through sleep that was becoming less cooperative. Frankly, it wasn’t much of a life. And soon enough, I began receiving random visits from the same ghosts that haunted me after the first surgery.
The first ghost has fiery red eyes that glare at me, and a long, bony finger pointing back to the first surgery. “What would your life be like without that surgery? What if you toughed it out and lived with the pain? Wouldn’t life be better?”
A second ghost steps into the light. “And isn’t it true that without the first, you would’ve never needed the second surgery? Did you wait long enough? Did you really give the nerves enough time to heal? Or did you push your recovery too fast? Expecting too much and doing too much, it’s no wonder you had so much pain.”
The first ghost returns, pointing his finger at me. “Why? Why did you go to the scalpel the first time? Why did you return? For God’s sake, why?”
The longer I’ve had to think about these two surgeries and the nine months between, the less I remember about the pain then, and the more I doubt myself. At the same time, the more I think about it, the more I’m convinced that nothing would’ve changed. Surgery may have sped up the process, or it may have delayed the inevitable. But with or without surgery, the pain would’ve continued to grow. So why did I go to surgery? It’s taken years for me to understand and be able to articulate an answer: hope. At the time, there was still reason to believe or expect that there was a solution: a silver bullet to cure whatever was causing my pain. And just because we hadn’t found it yet didn’t mean it didn’t exist. Hope is a powerful drug—strong enough to influence what we feel and how our bodies respond. Isn’t this why we tell cancer patients they must fight the disease and why those who are optimistic, who hold onto hope, respond better to treatment? And isn’t this why those who give up hope have a greater tendency to lose the fight? With any serious illness or situation, hope can change everything. It’s the little magic pill that causes us to see things differently and to respond differently to what we see—whether we’re on an athletic field (you gotta believe!), facing a crisis, or staring down pain that won’t leave us alone.
Hope isn’t the same as wishful thinking: merely “hoping” something will happen without any underlying cause, action, or reason. Athletes have hope when they have worked enough to believe they are just as good or better than the other team, no matter what the sportswriters say. I have hope in a crisis when I know I am prepared, or I know credible help is on the way. And we put our hope in others when they’ve shown us they’re reliable, worthy of our trust.
It was hope that led me into surgery in July and hope that led me back in May. Hope motivated me to work hard in physical therapy, to endure the physical affliction the therapists dished out. Unfortunately, however, hope consists of more than just our dream and the willingness to work for it, to do whatever it takes to see a dream realized. It might be nice if this was all it took to see our hopes come true; I don’t know—because I don’t live in that world. In my world, our hopes are also affected by intangibles beyond our control. We hope to have many children so we have a lot of sex, but that’s no guarantee of success. We hope to pursue our dream of becoming a physician so we study hard and save money, but that’s no guarantee. I may hope to go to the Olympics, but pull a muscle or catch the flu just before the qualifying run.
I see bumper stickers that say, “Shit Happens.” I disagree; it’s life that happens. Learning disabilities, infertility, illness, and even shit are part of a normal, healthy human life. And these are the intangibles also required for bringing our hopes to reality. So we dream, we work, and we live into the intangibles beyond our control. We can’t give up just because we don’t control every factor of success. We hope for what we are willing to invest ourselves, to give everything, even as we know that we do not control the outcome. So, it was hope that led me to surgery—once, and then twice, but not the third time.
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