If you’ve ever found yourself driving with no control of your car, you know that you experience every micro-second in slow motion. That’s exactly what happened to me one cold grey morning in late February of 2011, when I hit a patch of ice entering a roundabout on the University of Massachusetts campus in Amherst, just after a car ahead of me did as well.
That car, a green Nissan from the late ‘90s, began sliding sideways and the grey-haired driver and I made eye contact as our cars glided slowly toward each other.
At the same time that I noticed his crinkled face and look of alarm, I jerked my steering wheel to avoid a collision. A searing jolt of pain in my upper left arm caused me to gasp. I struggled to concentrate on our two sliding cars while my brain registered the extreme pain I was feeling in my arm. I continued my slow-motion slide, straightened out the steering wheel with my right hand and our cars somehow missed each other.
The Nissan ended up in the roundabout’s island. Since we hadn’t collided and had been traveling slowly, and since my pain was not subsiding, I continued on my way to work.
I parked in the Converse Hall parking lot at Amherst College, climbed the three flights of marble stairs in the old library building that had been converted to classrooms and offices, walked into my office, turned on my computer and sat down at my desk. As I gingerly tried to lift my left arm to my desktop, I couldn’t do it without feeling a stab of intense pain.
That’s not good. Not good at all. I hope I can still go on that trip.
In less than two weeks my wife Katharina and I were leaving for Belize to celebrate our 25th anniversary and take the honeymoon trip we couldn’t afford when we were married at age 21, in Vienna in 1986. I wanted to make sure I had this nagging injury looked at and taken care of before our trip, maybe with a sling or a brace.
I’d been seeing a physical therapist for several weeks to deal with pain in my shoulder and upper arm that I thought was a result of an exercise routine that included swimming, pushups, and sets of chin-ups. Teingo West, my physical therapist, had me doing various range of motion exercises, and I seemed to making steady progress, until the ice slide and my steering wheel jerk.
Teingo will sort it out. He’ll just give me some new exercises, and I’ll start doing them. I’ve got almost two weeks to get better – no problem!
Later that day at his clinic, West was puzzled that I was unable to lift my left arm much at all, either to the side or over my head. A muscular man from Ghana with a pleasant manner, West was especially struck by how much pain I felt and how little resistance I could offer when he would push against my fingers, with my arm locked in a right angle at the elbow.
“Did I just hear a click?” he asked after gently moving my hand back and forth.
“I don’t know,” I said. “Maybe.”
“Hmm,” he said. “I’m not sure what that could be, but if it doesn’t get better by Thursday, you should go see an orthopedic surgeon,” he said.
I can’t wait that long doing nothing. If I broke something, I want to get it treated now. Better to nip a small problem in the bud before it becomes a bigger problem. Better to do something, anything, rather than waiting around until Thursday.
I moved my left arm and once again had to gasp.
Because I can feel right now that things are not going to get better by doing nothing.
So I called the office of my primary care doctor, Richard Wu, and his assistant scheduled me for an appointment the next day. It was Dr. Wu who had written the order for physical therapy about four weeks earlier, so he was somewhat familiar with my case.
Dr. Richard Wu
Dr. Wu’s medical practice was located in a low-slung brick building that shared space with the town newspaper. It was near the U-Mass campus, across the street from an outpost of Cooley Dickinson Hospital that included a blood lab and a radiology department.
The waiting room was about three-quarters full this morning, with mostly older patients reading magazines from seats that were arranged along three walls. I took my place among them, flipping nervously through pages of Sports Illustrated until my name was called. A nurse’s assistant led me to an examining room, where she checked my blood pressure and other vital signs, then instructed me to strip to my t-shirt and undershorts. Given the immobility of my left arm, this took some doing, and caused more pain.
I had picked Dr. Wu soon after starting my job as Amherst College’s Director of Public Affairs in the fall of 2008 according to the following criteria: he was on my insurance company’s approved list, his office was close to my work, he was taking on new patients, and his online profile mentioned that he was an avid cyclist.
I was active as well, and enjoyed cycling, swimming, running, hiking and skiing, both cross country and downhill, along with sailing and kayaking. I wasn’t a jock by any stretch, but I had found exercise of any sort, even it was mowing the lawn or shoveling snow (and there was plenty of that during the typical New Hampshire winter), helped clear my mind and kept me healthy.
It had been years since I’d a flu or cold, which is why Dr. Wu and I hadn‘t seen too much of each other over the four years he’d been my primary care physician. I liked his laid-back demeanor and credited him for having encouraged me to lose about 15 pounds a couple years earlier, after he observed that my blood pressure and cholesterol level were creeping into the high range.
After about five minutes of waiting there was a brief rap on the door of the examining room, and Dr. Wu entered.
“So, your left arm is still giving you trouble,” he said, reading from a laptop that he held in the crook of his arm, after we had exchanged greetings. “And you had an accident recently?”
OK, you’re on. Tell him about the accident and he’ll fix you up then. That’s what doctors do.
I recounted the mishap, and he asked whether I could lift my arm over my head.
I gave my arm a feeble lift until the pain in my upper arm told me to stop.
“Not even close,” I said.
“So we need to order an x-ray,” he said. “It’s probably a muscle tear and the x-ray won’t see anything, but the HMO won’t approve an MRI without it.”
I walked across the street to the X-Ray lab, where they took the pictures of my shoulder. My arm was too sore for me to move it much, so they had to position it on the plates. Then it was back to the office where I spent time tending to a few projects.
One of them was publicizing a reading honoring the 90th birthday of Richard Wilbur, a celebrated American poet and Amherst College lecturer. Wilbur had served in the infantry during World War II and his poems had appeared in The New Yorker for decades, during which he had twice been awarded the Pulitzer Prize for poetry. He was taller than me, and I’m 6’3”, and carried his solid mass up and down the stairs of Converse Hall twice each week with slow yet vibrant grace as he made his way to teach his poetry seminar.
A literary lion, in his 90s and he still plays tennis, I mused from my desk, and couldn’t help a snarky thought: I wonder if he dies his hair, though. He’d be a true medical marvel if that brown hair was natural.
It was cold and slushy outside, so I stayed inside for my lunchtime workout. As legs scissored back and forth on an elliptical machine at the college gym, I tried to gauge the pain in my left arm.
Is it worse or better than last week? Last week I could do this.
With my left hand, I gripped a handle that moved back and forth in synch with the two rimmed platforms that supported my feet on the machine. My arm pumped with the handle, and every time it extended, pain shot through my bone. So I kept my left arm close at my side, careful not to exceed its range.
Still I wasn’t too worried. I’d had some shoulder pain off and on for the last few months, but I was 46; surely these were simply the aches and pains of middle age. For the next 45 minutes I focused on working up a sweat, and tried to ignore the discomfort that lingered at the edge of my mind.
I finished my post-workout shower and was gingerly dressing myself in the college’s locker room, taking care not to tweak my arm as I threaded it through my sleeve, when I noticed I had two voicemails from Dr. Wu’s office.
Nice of him to call. Dr. Wu’s a good guy. He’s got some news about my arm, and he’s going out of his way to track me down.
When I called him back, he was with a patient, but he called me back later in the afternoon.
“Peter, the radiologist very clearly saw a bone lesion in your left humerus,” he said over the phone. “You need to come in tomorrow and get a CT scan and bone scan.”
Well that’s not exactly good news, is it?
“A lesion?” I asked, trying to sound unconcerned. “What’s that all about?”
“We don’t know exactly what it is, but the radiologist definitely sees something on the bone,” he said.
The next day, Katharina and I drove to Cooley-Dickinson Hospital in Northampton. I had spent the evening searching for lesion and bone online, and the results didn’t make for good sleeping. I was worried, but I also was hopeful that my scans would clear things up. After all, x-rays weren’t always accurate.
CT stands for computed tomography, and a CT scanner takes numerous x-rays of a body’s internal organs, creating visual slices that radiologists can examine. In my case, the scanner was taking images of my chest, pelvis and abdomen, while the bone scanner checked for bone density and construction.
The bone scan required a radioactive tracer injection to enhance resolution. For the CT scan, Katharina watched as I drank a vile tasting barium-laced “berry” concoction, followed by an injection with a contrast dye just before I passed under the donut shaped scanning machine.
Over the next several years, I would become very familiar with both unpleasant procedures, along with the unsettling, nerve-wracking anxiety that quickly settled in afterwards before the results of the scans were shared.