I was supposed to be a paramedic by now. As were many members of my class. We got stuck in this black hole of a lack of internships during and after our didactics and clinicals. That sucked enough. And delayed my internship by more than a year. But…
Did you hear me? IT FRIGGIN’ SUCKS!
My back problem has continued to progress and worsen, and the pain and increasing neurologic symptoms have gotten to the point that I can’t avoid surgery any longer. I had hoped that I would be able to finish my internship before surgery, then use my recovery time to study for the NREMT Paramedic CBT and Psychomotor skills. Nope. With pain sitting at a constant 4/10, with spikes up to 9/10 when I do something as simple as turn over in bed, or reach for something, it’s hard to be able to continue an internship. Especially in the back of an ambulance. You get tossed around a lot back there. You reach for things at odd angles. You stabilize yourself by hooking a foot under the gurney and hope you don’t have a turn coming up while trying to perform procedures on patients. It’s unavoidable. And one day… it happened. It was inevitable. We had a driver (a fellow paramedic/FF) who drove a little more “intense” than others. At one point, we all got tossed. He hit a spot in the road that just jolted us. By the end of my shift, I *HURT*. When I got home after work that day (I still have my day job to work), I laid on the floor, with my butt up against my couch, and feet up on the couch, Iceman on my back under me. For 5 HOURS. And meds weren’t touching it. 9/10 constant pain in my back, going down my legs. After several hours, and a few rounds of an oral narcotic (Hydrocodone), as well as diazepam, things came under control again. No, I’m not angry at him.
But from there, my pain ramped up slowly over my shifts.
I had started my internship in late January, and delayed my second shift while I had a round of epidural steroid injections, to try and keep the inflammation down and keep me as pain free as possible. That, and a damn strong non-steroidal anti-inflammatory drug (NSAID – Think ibuprofen, just a lot stronger) can keep things at bay for a long time in some people. For me, not so long. It did help. But the incident I described above just hastened the inevitable. The overt instability of my lumbar spine creates a constant grinding of bone on bone, pinching of nerves by bone and intravertebral disks. Which causes more inflammation, which causes more instability… and on and on.
What really did it for ME was the need to be on narcotics many nights in order to reduce the pain enough to be able to sleep. My internship is 48 hour shifts at a fire station. Can’t take narcotics on shift. Not happening. I won’t be under the influence when treating a patient. No way. No negotiation. I won’t even drink alcohol within 12 hours of a shift.
At the same time, my preceptor noticed that as my pain levels increased, my learning decreased. When you are in more pain that your patient… it’s not good for either patient or provider. She noticed I was having increasing issues with patient assessments the way she wants me to do them. Which is a good way. Different for me, but a good way. And I tried. I really, really, tried to get it down. But with this much pain, it just doesn’t stick. Procedures are no problem. Just integrating the big picture while trying to tell my back to shut the fuck up is damn near impossible.
My preceptor and I agreed that I need to postpone my internship until I can concentrate and be the paramedic my preceptor knows I have inside of me. It hurt to hear it, but I knew it already. At 384 hours, I could have been tossed. But my preceptor didn’t toss me. She talked to my school, and explained that the delay in my internship starting (by situations outside of my control – not my back), coupled with my back problem, put me behind the curve, and she felt that I need go back to school after surgery and receive some remediation, to get me REALLY READY to knock the 100 or so remaining hours out of the park, and prove that I am a competent paramedic. She doesn’t understand why the school didn’t bring us all back periodically to refresh us. I agree. I just need to put everything together again in a good package. And my preceptor wants me back with her. My instructor told her that would happen. The crews at the stations she works at know me already, and know my strengths and weaknesses. They want me to succeed. I take that as a big positive. And if needed, she offered to let me do reduced hours (i.e. not a 48 hour shift, perhaps 12-24 at a time) to complete it.
Deciding on which procedure to have was done last year in consultation with my neurosurgeon. We discussed at length the different options, and he felt my best option was this type of fusion. And I agree with him. I don’t need an open TLIF. There is very little reason for anyone to have single or double-level fusion done that way any more. For some reason, orthopedic surgeons like to use the open procedure more. I have a lot of “spondy” friends online, including a few local here to me, to talk with. They’ve helped me to learn a lot. And I’ve done a lot of research myself, questioning my neurosurgeon about certain newer technology, the pros and cons of each, and why he chose the Infuse implant vs the Titan, for example.
So, on Wed, April 30th, I am going to have a minimally invasive transforaminal lumbar interbody fusion (TLIF) (Youtube animation: https://www.youtube.com/watch?v=rpqPXLvgwDE). Put simply, they will remove my screwed up disk at L4/L5, place implant(s) in there, along with bone putty, my own bone from the pars bodies they remove, donor (cadaver) bone, and possibly BMP (a protein that can enhance fusion). This is planned to be a single-level fusion, but a double-level fusion is a minor possibility, depending on what he finds when he gets in there. Hopefully, when I wake up, the intense pain and sciatica will be gone forever.
Pre-op appointments and labs are done, including a repeat MRI and x-rays. They show what I know already. My slip increased since the first ones were done last year when I was diagnosed. Not a lot, but obviously enough.
I expect to be in the hospital 3-5 days. Might come home sooner, but that all depends on pain control. No NSAIDs AT ALL for at least 3 months. Considering I use Toradol for migraines… this may be difficult, but not insurmountable.
Recovery starts as soon as that night or the next morning (depending on when I have surgery, and how well I do post-op), with them getting my happy ass out of bed for walking. And walking, and walking, and more walking for the next month. Did I tell you I’d be walking? Then up on a stationary bike, more walking, additional PT (dynamic and static stabilization, strengthening, etc). From there… hopefully a month later, riding my bike on the bike trails. Maybe. That will depend on healing. When I am not walking (or sleeping for the first few weeks between walks), I will be studying. I feel it is a good use for the time. Sick/Not Sick, EMPACT, my paramedic textbooks, Youtube videos, tabletop scenarios, you name it. No getting down on the ground with pretend patients, though.
One thing is for certain, no EMS until I am fused. This is going to be hard. Damn hard. It may suck more than the pain I am in now. I love providing EMS. Working EMS keeps me sane, and has literally saved my life. I may be able to be a supervisor during my recovery (Like 2-3 months out), but no hands-on care until my neurosurgeon says so. No argument here.
Want to see a model patient? Come watch my recovery. Everything, and I mean EVERYTHING is on the line right now. Not just my paramedic internship and future as a paramedic. My ability to provide EMS. My ability to walk without pain. Or even walk at all is in jeopardy if I don’t get this fusion done. Honestly, this surgery
bothers me scares the living shit out of me. But it is my only chance at getting my life back. And I WANT MY LIFE BACK, DAMMIT!
My last EMS shifts will be this coming weekend. It’s hard to stop. It really is. But I have to. I have to let the neurosurgeon put me back together. To make me a member of Club Titanium. The rest will happen as I let my body heal. Then I will come back. Stronger. Physically, and mentally.
I have so many friends willing to help me, I am overwhelmed. Thank you. I can’t thank you all enough before, during, or after. So I am starting now. THANK YOU. THANK YOU. THANK YOU. I may get bitchy, grouchy, want to do more than I should, not want to do anything. I know you will all be there to keep me in check.
So for now, I am a paramedic postponed.