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“Ugly,” said my surgeon, shaking his head as he stared at an X-ray of my lower spine. An errant vertebra, so dangerously tilted that it resembled a bead about to break from its bracelet, was severely compressing my spinal cord — which explained why I could no longer stand up straight. The obvious solution was immediate surgery, but my book, Deep Water: The Epic Struggle Over Dams, Displaced People, and the Environment, was coming out, and I was about to start a two-month, twenty-five-event tour of readings and interviews. Having spent a year figuring out how to approach the subject and another four writing the book, I looked forward to the tour the way a gold prospector anticipates reentering civilization and spending his stash; the tour was my version of “Here’s what I’ve found.” My consequent reluctance to give up the tour didn’t faze my surgeon. During the tour, he said, he’d prescribe painkillers; then, when it was done, he’d operate. This sounded reasonable, conceivably even pleasurable, and I instantly agreed. Now I wince at the thought of the word that then occurred to me to describe the arrangement: painless.
The tour was as gratifying as I’d hoped. Just after the first event, a reading at the San Francisco Library in September 2005, I was startled to find myself crying, so unexpectedly satisfying was the bond of communication that seemed to have formed in the auditorium. Most people are used to thinking of dams as instruments of unmitigated beneficence, doling out extravagant sums of water and electricity merely by interrupting the hydrological cycle. But that interruption is multiplied by 45,000 dams at least five stories tall and more than 60 percent of the world’s 200-plus major river systems. To show people that that makes as much sense as blocking a similar proportion of our own veins and arteries is a complicated endeavor — now I’d found it was doable. Over the next two months, I learned how to explain dams.
The purest writers are said to derive the entirety of their professional satisfaction from the act of reading words and putting them on paper, sternly shunning publicity, Solzhenitsyn-like, but if that’s the definition of a writer, I’m not one. The readings invigorated me: they gave me energy and hope to write the next book. And as long as each reading lasted, I was oblivious to my dependence on Fentanyl, my painkiller of choice. Unlike the other painkillers I’d tried, Fentanyl is delivered via translucent patches that stick to the skin, which absorbs an evenly released stream of powerful opiate.
My spine had been operated on twice before, and I’d recovered quickly from both assaults. And with a blitheness that my wife attributes to denial, I assumed that this surgery, fourteen years since my last one, would be no different. This conclusion shielded me from anxiety as the surgery approached, at a cost of shock once the invasion was perpetrated. My earlier surgeries were garden variety, on my neck and lower back, but this time the procedure was radical. While I lay splayed on a table my surgeon described as a “rotisserie,” he first approached my spine from the rear, carving a vertical incision eight inches long, then decompressed my spine. Next, he turned me over and made a six-inch anterior cut, slightly curved to avoid my navel, and shoved my intestines to one side; that gave him room to scrape bone spurs from my spine. Finally, he flipped me again, realigned and fused three vertebrae, and attached them to titanium plates. All this took nine and a half hours. By the time I regained consciousness in the recovery room, my Fentanyl dose had been tripled and augmented by a chaser of Oxycodone, an opium derivative, and I felt not just pain-free, but euphoric. When a nurse asked if I knew where I was, I said, “Do you want the short or long version?” I found myself so uncharacteristically quip-happy that the nurses delayed releasing me to my room for the sheer fun of having me around. I understood their point exactly, and regretted leaving the recovery room myself. Now I know why: it was the last time I experienced anything resembling physical pleasure for a couple of months.
Unlike the bill it engendered, my hospital stay was unremarkable. (I invite defenders of the current American medical system to justify why, after spending four days in the hospital, my bill attained the fantastical amount of $232,000. True, having already dunned me for most of my surgeon’s fees, my insurer, just as fantastically, covered the bill — it’s play money, designed so that only the uninsured need take the sums seriously.) My pharmaceutical roller coaster reached its pinnacle near the end of my stay, and was poised as I left for its steep plunge. Strangely, back pain was the least of my problems; the surgery was a resounding success. But I was now at the mercy of drugs; nearly every sensation I experienced, whether painful or soothing, seemed induced by one drug or another, either as its goal or lamentable side effect. I kept a journal listing all the medications I was consuming and the exact time of consumption:
Saturday, 11-27
Roxicet 1 — 1:53 a.m.
Roxicet 2 — 6:07 a.m.
Prednisone 1 — 8:40 a.m.
Colace 1 — 2:07 p.m.
Roxicet 2 — 4:10 p.m.
Or I’d run their names through my mind until they sounded like a Latinate cheerleader’s chant:
Clonazepam Clonidine Cymbalta Colace!
Lactulose Lidoderm Lyrica!
Prednisone Proscar Tizanidine Triazolam!
Fentanyl! Fentanyl! Fentanyl!
My hands were constantly cold, no matter how warm the room. My bowels closed shop. I turned weepy. For the first time in my life, I found food repulsive — and if I forced myself to eat, I quickly grew bloated. My stomach, of course, was in the midst of reorganizing itself, having recently suffered its own version of resettlement. I rarely slept for more than an hour at a time, and did not once sleep for more than four hours a night. Seemingly against my will, I’d become a dissolute, watching TV at three in the morning, calculating the hours until the next pill, dreading the endless night. Now the bed became my tormenter, which I nevertheless occupied most of the time, as if it and I were partners in a horrific marriage. My real wife had long ago fled to another bedroom to avoid my nocturnal throes. Now she looked after me with abiding concern, constantly circling between pharmacy, supermarket, kitchen, and bedside, while depleting her own fragile resources with worry.
My conversations with her chiefly revolved around the properties of drugs, as I got to know the medications’ schizophrenic personalities. The surgery had jangled my lower spinal nerves, causing the skin of my left thigh to feel as if it had turned into molten shattered glass. For this I was prescribed a nerve pain reliever called Lyrica, whereupon my right foot swelled prodigiously and grew intensely itchy — I was allergic to the drug. Roxicet, two tablets of which I swallowed every four hours, produced jackhammer-proof constipation; the antidote, Lactulose, made me diarrhetic. Clonidine lowered my blood pressure. Some drugs did nothing at all.
After three weeks, my surgeon told me to cut my Fentanyl dose by two-thirds, and I found myself newly staggered, with barely enough energy to talk. But this first step in my opiate withdrawal lasted only a few days, and I consoled myself with the thought that the second step, elimination of the final twenty-five-microgram-per-hour Fentanyl dose, would be easier. It wasn’t. It takes two weeks to develop a Fentanyl addiction, and, to facilitate the book tour, I’d been taking it for three and a half months. Five weeks after the surgery, I removed the last of my patches, and began a descent into what my surgeon called a “one-in-a-thousand” case of drug withdrawal — which is to say, I’m exquisitely sensitive to opiates. “You’d make a terrible drug addict,” said the surgeon, and I lacked the energy to laugh. At night my legs cramped violently every twenty or thirty seconds, eliminating any prospect of sleep. In desperation my wife called a local rehab unit and located a nurse. She was full of understanding and interesting information — such as that the spasms are the reason withdrawal is called “kicking the habit” — but knew of no shortcuts. We consulted the surgeon, his young colleague, my GP, a homeopath, an acupuncturist, and a pain-management specialist, while sleep became ever more elusive. Clonidine was supposed to ease my spasms, but the only night I took it, nothing happened, and in desperation I ended up taking five pills instead of the prescribed two. Only the next morning was I informed that the quantity I’d consumed could have killed me. The GP, who’d himself worked in rehab, said baths in steaming-hot water alleviated the spasms, and on a few nights, I’d take desperate soaks at 3 or 4 a.m. I’d lie in the tub, for once not cold but abruptly far, far too hot, and I’d feel stunned by the procession of uncomfortable sensations, the speed with which all my bodily systems had shifted into idle. Then, as the opiates wore off, the pain they’d masked surfaced, and my thigh pain intensified. I turned gaunt and gray. By this time I was supposed to walk up to an hour a day to aid my recovery, but on most days I could barely muster strength for a single plodding shuffle to the nearest street corner and back, before returning to bed.
I’d covered the Vietnam War, navigated through rural India and southern Africa to write Deep Water, and grown used to thinking of myself as invulnerable. It was an illusion, of course, arguably useful, but now it fell away; I’d discovered my fragility, my approaching mortality. When a friend suggested I read a new, masterly biography of Stalin, I cringed at the thought of contemplating so much death. I was mortified by the thought that some day I might again become so pain-ridden that only opiates could provide relief, and I’d have to choose between addiction and intense pain. The future seemed newly foreboding.
And my health grew worse. On Christmas morning, I felt pain behind my right eye, which intensified as the day wore on. The next morning I received emergency laser surgery for a rare form of glaucoma called “plateau iris syndrome” — my irises had flattened, blocking the flow of fluid to the front of the eyes, potentially causing pressure to build until the eyes explode. The eye doctors hypothesized that Cymbalta, one of my many medications, induced the attack, a reasonable assumption since I’d started taking it only two days earlier. I stopped using the drug, but two weeks later, I experienced another attack (this time brought under control with eye drops), and more drugs fell under suspicion. What unnerved me was the irony of having plateau iris syndrome: my own eyes embody the lesson of dams.
Another month passed before I “came back,” as my wife puts it — before I felt well enough to resume my usual activities. She thinks I’d “left” five months earlier, back when I started the painkillers. It’s true that my life narrowed then, until all it contained was my pain and the drug that nullified it and the book tour that justified the drug — and of the two, the tour seemed the more powerful palliative. Nearly three months have now passed since the surgery, and my hands are warm, my breathing is unlabored, the future again holds promise. I understand that my bargain was Faustian, but I don’t regret it, not for a moment. By my definition, it’s what writers are willing to do for their books.
To read the articles in the May/June 2006 issue, click here.
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