I had just finished my second case of the day, a cervical fusion, when Chad, my PA got a consult to see a patient at Countryside Hospital.
Aaron Cook, 81 had been diagnosed with multiple myeloma, which is cancer of cells in the blood that accumulate in and weaken the bones of the body.
Chad had spoken to the nurse and was told, Mr. Cook was paralyzed in his legs.
An MRI of his spine revealed that the cancer had replaced most of the bones of his spine. In his mid back, the cancer had weakened so much of one of the vertebra that it crushed upon itself. As a result the bone and cancer cells were pushed back into Mr. Cook’s spinal cord causing his paralysis.
Given Mr. Cook’s age, his paralysis, and the appearance of his MRI my initial reaction was that there wasn’t much that could be done. I spoke to his physician, Dr. Reynolds, who told me Mr. Cook had initially presented with severe back pain.
But because the cancer was so widespread it was concluded by the oncologist and radiation specialist that any treatment would be palliative, which basically meant the cancer could perhaps be slowed down but not cured.
Dr. Reynolds informed me Mr. Cook had been in the hospital about ten days receiving radiation treatments to his spine. ‘The excruciating back pain that he had on admission had subsided’, he continued, ‘but now he was unable to get out of bed because his legs were paralyzed’.
I told Dr. Reynolds that it was unlikely anything could be done surgically to help Mr. Cook but that I would go by and evaluate him if he wished. He said that would not be necessary. He just wanted me to look at the films and let him know if there was anything that should be done.
As soon as I hung up I was called back to OR room #4 for my next surgical case of the day. I finished up operating at about 6pm, and after I dictated my surgical note and checked on my post-ops I thought about Mr. Cook. I knew I wasn’t expected to see him but I felt compelled to drive over to Countryside Hospital and see him nonetheless.
As it turned out I had performed surgery on Mr. Cook’s wife many years earlier so he knew me, and in fact, he was expecting me. As I talked to him about how he wound up in the hospital he told me that up until about 4 weeks ago he was just fine. He and his wife had gone over to the Florida east coast but because he ‘just didn’t feel right’ he told his wife they needed to cut their trip short and return home.
When I was given his history earlier in the day I just assumed he had been diagnosed with multiple myeloma several years ago and that now his MRI revealed the end stages of the disease. But he had just been diagnosed 10 days ago.
When I examined him, I discovered he was ‘paralyzed’ in his right leg but that the strength in his left leg was only mildly weak. I then discussed with him options and prognosis. ‘In most circumstances such as yours I would remove the crushed vertebra and replace it with a metal or plastic cage filled with bone’, I told him. ‘Then I would place screws and rods in the spine above and below the fractured vertebra to stabilize it’, I continued.
‘But because the cancer had affected so much of your spine, I can’t do any of that. And because of your age, I’m not sure you would survive such an extensive surgery anyway’, I concluded.
‘So, what does that mean’, he asked. ‘Well’, I said hesitantly, ‘I’m not sure you will ever walk again’.
Choked up, Mr. Cook said, ‘Oh my God, my wife is too ill to take care of me…’ Looking down at him lying in his bed, still in pain and unable to get up and walk, I was sorrowful, wishing there was something I could do, yet realizing surgery was too risky.
I told him I was sorry and that perhaps with continued radiation treatments, he still might get better, although I knew this was not likely.
As I stood at the nurse’s station writing my progress note in Mr. Cook’s chart, I felt compelled to look at his MRI scan again. As I flipped through the images I thought to myself, ‘there’s got to be something I could do that might help’.
I called Chris, one of my colleagues to discuss his case. He too, agreed that Mr. Cook at 81 years-of-age would never survive a major surgery. But perhaps if I removed some of the bone from the back part of the spine, he suggested, this would free up enough of the pressure on the spinal cord so that his strength might improve to the point where he could walk again.
I thanked him, hung up the phone and walked back into Mr. Cook’s room.
I told Mr. Cook that I had given his problem more thought and there was something I could do surgically that might help him. ‘However, while I cannot promise you it will be successful, I think it may be worth the risk’. Not surprisingly he was willing to take that chance.
I spoke to Dr. Reynolds and explained my plan who then agreed to have Mr. Cook transferred to the hospital where I would perform surgery in the morning.
Surgery went well and though the cancer had destroyed most of that particular vertebra I was able to relieve the pressure on Mr. Cook’s spinal cord. Over the ensuing weeks following surgery Mr. Cook gradually regained strength in his leg and began to walk using a walker and some assistance.
For me, Mr. Cook’s case reinforced to me the importance of several things. The first is that nothing replaces talking to and examining the patient myself.
Not only does this allow me to get a real sense of the patient’s problem but also helps me to understand the true impact of the illness on the patient and his (or her) life.
In Mr. Cook’s case I initially dismissed ‘out of hand’ that anything could or should be done surgically in someone who had widespread cancer. However after speaking to him I realized he was living a normal life just 2 weeks earlier. Not only that but his wife was very ill herself and there was no way she could take care of him.
So as I stood there leaning up against the counter at the nurse’s station, I felt a change of heart. Was it merely my sense of compassion… or was it an angel, or the Holy Spirit that inspired me, reminding me I was given my gift to help others.
And so, grateful once again for be able to hear that voice in my head, I did what I could to help Mr. Cook, and his wife.
“The wind blows where it will, and you hear the sound
of it, but you do not know whence it comes or whither
it goes; so it is with every one who is born of the Spirit.”
John 3:8


