Saturday, December 22, 2012

The Post-Apocalyptic Spine Doctor

Well, the Mayan calendar gently disappeared yesterday and contrary to the wild prophecies of some, the world did not end. Instead we all move forward into the holidays and greet the end of the year, comfortable in the knowledge that our own linear calendar renews itself in another collection of Pug Puppies pictures to hang on the wall.  In a week or so, we will gratefully return to our work, in my case seeing and caring for youngsters with spine problems.

Although the more rational of us did not really think the world would come to a crashing halt yesterday, all of us must at some time have stopped and thought, what if it does?  What if the world really does shut off on 12/21/12?  Combined with the natural introspection that always accompanies the end of the year, the extraordinary event gave me a chance to review and reflect on things personal and professional.  Among other things, I spent some time thinking about more than twenty years in the spine business - what have I learned and what do I think I (and we all) still need to learn before the next Mayan calendar runs out?

What I have learned:

1)  The child of the spine is more important than the spine itself.  This is a simple statement, but in a field that is so heavily techno driven, it is easy to become caught up in metallurgy and fusion levels.  But the reason we concern ourselves with spinal curves and back pain is because of the effect it has on the child who has the condition. Each child has her own response to what is going on with her spine so that I must refrain from making generalizations and follwoing cookbooks.  I must quite simply ask, "How do you feel about this?"  It is surprising how difficult it is sometimes to ask such a simple question.

2) We treat children, not x-rays.   It doesn't matter sometimes what the x-rays are telling us.  Some kids who are doing great may have very bad x-rays and vice versa.  It never behooves us to try to make an x-ray beautiful if the child does not have any problems in the first place, and it is especially important not to ignore a child's complaints just because the x-ray may appear normal.

3) X-rays are the 2 dimensional representation of a multi-dimensional problem.  Spine doctors try to learn this early when reading films.  From a technical standpoint, it means that I always have to account for the rotation of a spine, the unseen throd dimensional plane of the x-ray.  But I have also understood that I must also be aware of the dynamic aspect of a problem.  An x-ray of the low back taken lying down may be much different than the same view taken standing up,  Also, as a child moves, the x-ray may change yet more profoundly.  Probably most importantly, the dimension that must be anticipated is that of time.   What will a curve be like in two years, five years, thirty?  How will the pain in a ten-year-old be when that child is twenty-five?  This is the hardest dimension to predict, of course, but it is the most rewarding by far.

4)  Families must be engaged in their children's care.  This is another simple truism, but you would be amazed how long it took the medical porfession to understand it.  This awarness has led, I think, to better education of parents and caregivers, as well as more involvement in the care and healing processes.  But moving forward there is still great deal of work to be done to fully engage and educate.

5)  There is safety and comfort in numbers.   There is no feeling, I believe, as scary or lonely as being a child who needs medical care.  For that child to be able to reach out to other children is of immeasurable value - if only in that it lets the child know that she is not alone.  Children will communicate with other children in a language that adults (even parents) do not share - about pain, about appearance, about social acceptance.

6)  Taking care of children keeps you young.   I don't know if this is a fact or just wishful thinking, but I cannot help thinking that the evanescent joy and radiant spirit of even a sick child, and especially the well ones, helps to keep my spirit whole.

What I need to learn:

1)  I must evaluate how best to educate the children and the parents who are in my charge.  Although I am proud of the programs I have already put in place, I think that there can be even more communication with children and parents, as well as other adults who come into contact with the kids in my care (teachers, coaches, etc.).  Venues like this blog can help keep people up to date with my thoughts, and are just an internet address away.  But other things, like outreach programs, Spine Camps, "town hall" type meetings, etc. will help immeasureably.

2)  To be both receptive and skeptical about new technologies.  The spine business is changing fast and new techniques and ideas are constantly being brought forth.  Some will have a lasting effect on spine care in kids.  Otheres are "passing fancies".  All are out there and our friend the internet makes them all readily accessible to patients and parents.  It is part of my job to be aware of the new things and to give them enough thought that I can give an educated opinion about them when asked.

3)  To include the patients and families in developing communication programs.  I am indebted to one of my grown patients for coming up with the idea of Backtalk, not only because the organization is so terrific, but because it showed me how I can interface with the folks I am caring for.  Moving forward, I hope to include more thoughts and wisdom from my young charges on these pages and to collaborate with them and their parents on up-to-date writings and educational/ fun programs about spine care.

So there in a nut-shell are the kernels of my 2013 professional New year's resolutions.  I resolve to add entries to this blog more frequently and to keep my mind and soul open so that I can have a constant supply of fresh topics to discuss.  I resolve to continue to be state-of-the-art with regards to technology, but to never lose sight of the humanity of what I am doing.  An most improtantly, I resolve to continue to love what I am doing and to derive joy and happiness from my interaction with patients and family, and with you my readers.

Happy and bright holiday and New Year's wishes.  Or as the Mayans might say, "Cha'an!"