Anxiety and Me

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I did not become a spine surgeon by having anxiety.

A middle-aged patient was admitted to Queen’s hospital during my first year of orthopedic residency with low back pain and an anxiety disorder.  It was recommended that she have a psych consult.  “What was an anxiety disorder?” I had no idea what anxiety or an anxiety disorder was.  I had to go look it up.  In retrospect, it was curious that I was 28 years old and did not know the first thing about anxiety.

My identity was developed through accomplishments.  I found out in seventh grade that I could get good grades and had some athletic ability.  By the time I hit high school, I was on a straight A path and held it with few exceptions through college.  I graduated with a 3.85 GPA and was magna cum laude.  In medical school, I also graduated with honors and was nominated for the Alpha Omega Alpha honor society.  I did my first two years of residency in internal medicine in Spokane, WA.  I did well but was humbled by some of the impressive skills of my superiors and even peers.  I did my orthopedic training in Honolulu, HI.  My fellow resident Dan and I did a great job and were known as very hard-working, responsible residents.  I then did an orthopedic trauma fellowship in Sacramento, CA.  My final training in spinal deformity was at the Twin Cities Scoliosis Center in Minneapolis, MN.  It was considered one of top spine fellowships in the world at the time.

During my spine fellowship, I had two occasions where I became light-headed and had to scrub out of surgery.  Nothing like that had ever happened to me.  I had endless endurance and could stand through eight to ten hour surgeries without a problem.  In 1988, about two years after I began my Seattle practice, I started to sweat during surgery.  It seemed unusual.  However, as I tend to sweat anyway, I did not think too much about it. It became consistent and more profuse.  I often had to step back and have my forehead wiped.  I would wear ice packs on the back of my neck.  Although spine surgery sounds like a delicate operation, it is not.  There is a lot of strength involved in moving the muscles around the spine. This is particularly true when there have been multiple prior surgeries and a lot of scar tissue has formed.  What makes spine surgery very challenging is at multiple points in the case, you have to switch from a major muscular exertion to delicate maneuvers over nerves and the spinal cord.  It became very difficult to work at a slow enough pace to minimize the sweating.  I did not associate these symptoms with anxiety.

One night, I sat at my desk and looked at six hours of paperwork. I had a patient who had suffered a major post-operative infection in the hospital.  Another patient was a massive muscular 300 pound man and had gotten into a fight with the security at the hospital. The final icing on top–that day, I had just gotten served with papers for a malpractice suit.  I remember sitting there that night thinking, “Bring it on.  I am tough. I can deal with this.”

I had also had a friend comment to my wife about “David’s obsessiveness.”  I was shocked.  I had no idea what obsessive meant, but I knew the term didn’t apply to me.

In 1996, my marriage fell apart.  The details are not important.  However, I don’t think in retrospect any marriage could have survived the self-centered energy that I generated around me.  Divorces are always complicated, and it did bring a new level of stress into my life that I could not have imagined.  I again began to have difficulties sleeping and recurrent anxiety.  I still was sticking with counseling, but I was losing the battle.  By 1997, I had developed a full-blown severe obsessive compulsive disorder.

OCD is somewhat of a societal joke.  In the visual media, it is often portrayed in a light amusing way.  I remember one talk show as a kid where a person was interviewed who just spent his entire day every day counting pennies.  Everyone on the show thought it was peculiar and fascinating that anyone could do something like this for such a prolonged period of time.   More recently, there is TV show highlighting hoarders syndrome.

Some day, I am committed to writing my whole story about my descent into and out of OCD.  Briefly, it is the ultimate anxiety disorder.  It is a miserable experience that words are woefully inadequate to describe.  What the general public does not understand is the intensity of thoughts and imagery that drives these repetitive behaviors.