Patient and Doctor?

This is something I wrote in 1/2004:

Low Back Pain
Act I

As I was sitting on the examination table with my legs hanging over the edge swinging slightly I reflected on what it was like to be in the patient’s role for once. I realized the patient part was one that I dreaded playing. My attire was indecent; a simple paper gown which chaffed at my mid-thigh just barely hiding my penguin patterned boxer shorts from view. I pondered how I would describe my ailment to my physician as I sat waiting, legs swinging, brushing my cotton sweat-sock covered toes on the berber carpeted floor. My family physician, Dr. Su, entered the room, greeted me, and quickly began asking questions. I immediately developed stage fright; I had learned the wrong lines. Fortunately, knowing what Dr. Su would ask, I was able to improvise most of my answers.
“What brings you in today?”
“I have low back pain.”
“How long has that been going on?”
“For 5 years now.”
“What have you done to treat it before?.”
“Muscle relaxants and NSAIDS. But it always comes back.”
“Tell me about the pain.”
I froze. I knew from experience that this question was important. What I said now would determine whether my doctor thought I had a kidney stone, a muscle sprain, a herniated disc, an aortic aneurysm or any of a myriad of other possibilities which I had not studied hard enough to even consider. The consequences were dire. If I misrepresented my situation I could end up in the operating room, or so it seemed. After a significant pause, I realized I had missed my cue.
I stammered, “It is a stabbing pain, but not really. Sometimes it burns, but not always. It is definitely achey. Achey and intermittent and episodic too.”
I proceeded to use all the words that I knew to describe pain and some that I had made up, but I could not really make the words match the experience. Fortunately, she interrupted me.
“Where is the pain located?”
Knowing the proper way to indicate the location of my pain I confidently extended my right index finger and proceeded to place it over my posterior superior iliac spine. I paused for a moment, enjoying the spotlight.
I told her “it hurts the most right over my P.S.I.S.” So much for the spotlight, I had blown it. I had slipped into the language of the physician forgetting my role as the patient. Dr. Su gracefully saved me from awkwardness by reciting her next line,
”Does the pain move anywhere?”
“Well, I sometimes have pain in my leg, but I don’t think it radiates.” At least not how I thought radiating pain radiated. Radiating pain is like lightning traveling from the root of the involved nerve out to its tiniest branches. “No, my pain does not radiate.” My pain starts in my low back and like a wick ignited by flame, travels slowly inciting the nerves to potentiate the perception of pain. Eventually the fire smolders down my antero-lateral thigh to my fibular head just below the knee where it flares up for an instant before extinguishing. The journey takes so long that I have always thought of the pains as separate in etiology, one originating in my leg and the other in my back.
“Where is the pain in your leg?”
With my finger still extended I pointed to my fibular head, remaining silent this time so as to avoid the embarrassment of my previous role reversal.
Dr. Su continued to ask me all of the required questions and I continued to answer them in the appropriate manner, trying not to stray from the facts that I had deemed medically important. Finally, it was time for the physical examination. The rest of the script was up to her.
After the obligatory auscultation of the chest Dr. Su proceeded to examine my back and legs. I lay on my back while she lifted each of my legs in turn.
“Do you have any pain when I lift your leg?”
“It hurts in my back but it doesn’t hurt at all in my leg.” No radiation, I thought. Little did I know that she had merely ignited the slow-burning wick that would ultimately set my lower extremity ablaze.
She finished the exam by demonstrating equal reflexes in both of my knees.
“Well, it looks like you have a muscle sprain. There is no radiation of pain, and the straight leg raise is negative. So a disc herniation is unlikely. You are pretty inflexible though. I think your inflexibility has resulted in poor resolution of the muscle injury. Let’s try some physical therapy for flexibility and strength training.”
I was relieved. The diagnosis I had hoped for. Muscle sprain. There was no herniated disc impinging on a nerve sending lightning bolts of pain along an anatomically determined tract that would eventually require a surgical procedure that was classically unsuccessful at relieving pain. No. Muscle sprain. This is the diagnosis I wanted. Knowing the nuances of the script, I performed so well that I received the benign diagnosis for which I had hoped. And so the identification of the herniated disc which was sandwiched between my fourth and fifth lumbar vertebrae bulging out into my spinal column was delayed, at least until the next act.