Jul 29

Reflections on Pain: Part 2

reflections on pain


I just finished a stretch of three months of full-time work due to my partners’ maternity leave. It was a tough transition to be honest, but I adjusted to the busier life within a few weeks. The worst part about it though, was about half way through I tweaked my back which is still quite bothersome today. I’ve had back pain before. I even wrote about my worst episode which inconveniently happened a day before I was to get on a plane. That was terrible, but after a couple weeks my back returned to normal, just like it had many times before.




This last episode is different in that, although it is better (and now tolerable), it has moved into a more chronic phase. The experience of chronic pain is a bit different than that of more acute pain. I thought I would share my experiences and thoughts with you.


I think it was caused by yoga, although I’m not certain. There was this particular workout I did that involved a lot of spine flexing and extending, going from standing to hinging to downward dog to upward dog, etc. The next day I felt it in my back. Not too bad, but enough. I ignored it. I’m actually not sure how it got to the point where it is now, but it evolved from not too bad into not being able to put my socks on or drive in a car for more than 30 minutes without crying.


This was during the last month and a half of a heavy work schedule and was actually worse than the work itself. I spent a lot of time standing, as I only had so much sitting in me for a day. Bending over for procedures was tough as well, but I’ve worked out strategies from prior episodes of pain I’ve experienced.



I kept waiting for the pain to get better, but if anything it got worse and moved to other places, like my groin and hips. I even got some numbness in my toes and feet which was concerning. It implied the nerves were being severely irritated, likely from one or more lumbar disks pressing on them.


My best positions were lying down and walking, neither of which is conducive to being a physician. After a few weeks of the constant pain, I was eagerly awaiting my return to part-time work. As I mentioned in a previous article, I sold a call week to decompress my schedule. Well, a couple months later I sold another one, but this time to try and give my back a break. The thought of working a long weekend shift and possibly having to come into the hospital multiple times at night was excruciating to think about. This turned out to be a great decision, as that weekend was particularly bad and I spent most of it lying down.


As the pain lingered on, for the first time in my life I started wondering about my disability policy, and just how bad  my pain would have to get to where I could no longer effectively work. On my bad days I considered going to zero time instead of half time. I considered the irony of acquiring a big pile of assets to live on, retire early, and then spend the rest of my retirement lying on my back in pain. Wouldn’t that be the ultimate slap in the face from the universe?


Freedom is Beautiful

I will take a slight tangent here to bring into focus how liberating financial freedom is. I know I’m sounding like a broken record here, but this lesson is sort of the central thesis of my writing. For most, the choice is to either work or starve. I see this every day. People come in who rely on their healthy bodies to make a living and find themselves injured or in severe pain and unable to work. They get MRI’s, injections and physical therapy and hope they can get back to it. If they can’t they are at the mercy of the disability and workers compensation system, which is not always precise with its allocation of resources. Often they are left with the dumpster fire of multiple unpaid medical bills, unemployment and depression in addition to all of their other problems.


There are people clearly disabled and unable to get benefits, and people that are clearly not disabled and scamming the system. The government is usually a poor filter and has an inefficient way to allocate resources, although there is not really a better alternative. It does the best it can. Narcotics and psychotropic pills are thrown around like candy and, more often than not, people just end up addicted to medications that don’t really help them much in the long run (although they believe they do because they feel worse when they try and stop them and go through withdrawal).


Ahem, Freedom

Anyways, back to financial freedom. The higher your degree of financial freedom, the less you have to worry about things keeping you from working and earning a living. In a worst case scenario I could just quit my job tomorrow and be fine. Even though relying on the 4% rule in early retirement has its risks, it’s not THAT risky. Quitting work beats struggling through severe pain.


If you are the typical physician household spending well above six figures, the truth is you have many levels of wasteful spending in your life and could cut back to high five figures with little difficulty after spending about a day and a half reading a few financial independence blogs. Financial independence by 40 or 45 is not easy for someone making a median or below average salary, but for a typical physician or other six figure career it is stupidly simple.


Yeah, yeah, I know. It’s impossible with student loans, club sports for the kids, leasing respectable cars, the 3500 sq. ft. house in the best school district, saving for college, etc. Life is one big decision matrix of opportunity cost. You can have anything you want in life, but not everything you want in life. Freedom has a cost. A 2300 sq. ft. house and used middle of the road cars will not change your life all that much, but they will result in much earlier freedom. You have a choice.


If you save half your income for 15 years and your body or mind breakdown for some reason, you are essentially financially free or nearly so. You have so many options at this point there simply isn’t much financial stress involved. You can focus your attention on the problem at hand rather than worry about the money. If you have no problems at this point and you love your job congratulations! You have won.


Thought Experiment

Pain and suffering causes one to think.  This is the silver lining. Discomfort expands the mind to reflect upon things which may not be considered when life is comfortable. As I reflect back upon my almost four years of working part time, I realize now how great the decision was for me. If I had raced to the finish line and continued working full time I would certainly have a much larger pile of assets, but I would still have this pain. Up to a point, more money does not make pain go away.


As I reflect back upon all those days I didn’t work, where I spent my time doing things I loved, and spent time with the people I care about the most, I realize how lucky I was to have them. Those days of pain-free freedom were much more valuable to me than a nicer house, car, clothes, etc. would have been. I don’t remember how I felt driving my 15 year old car or wearing inexpensive clothes, but I do remember going to the park with my daughter after school one day. I do remember going for a walk and having lunch with my wife on a random weekday.



I’ll be honest with you; if my back gets worse I’ll probably walk away from being a physician. I knew a surgeon with bad back problems and he couldn’t operate any more without severe pain. He could keep doing clinic if he wanted to because he didn’t have to stand for extended periods of time hunched over a body, but that’s not really what he wanted to do. He didn’t love seeing people in clinic, but he loved to operate. He was financially independent at that point so he walked away. That’s freedom. Freedom from doing something that no longer brings joy or fulfillment.


As I dig deeper into life I am realizing this ‘freedom from’ is much more valuable that the ‘freedom to’. The marginal utility of ‘freedom to’ drops precipitously after some rice, beans and a warm bed to sleep in. ‘Freedom to’ is just a story that no one but you and your ego care about.’Freedom from‘ is true freedom, true happiness, true liberation.


We shall see how this all plays out. I’m optimistic, but I also know the future is unknowable. I’m gonna go take some anti-inflammatories and do my physical therapy and reread my article on how to be the happiest person in the room.  Send some healing vibes my way. HP out.


Skip to comment form

    • b on July 29, 2017 at 4:31 pm
    • Reply

    I’m sorry about your back man. Unless you are 250 pounds, you are likely to get better, statistically speaking. It may not be on the timeline you like, but 2 weeks of NSAIDs and gentle stretching are a great combination. If not, there is no shame in talking to an honest spine surgeon. I’ve seen alot of patients who derive a great deal of benefit from ESI, sometimes indefinitely.

    1. Yeah I’ve contemplated ESI. In a moment of absolute irony I was actually doing an ESI on a patient with foot pain and numbness while simultaneously having foot pain and numbness. The NSAIDS worked well on the back pain, but have done nothing for the peripheral symptoms.

    • Karina on July 29, 2017 at 5:51 pm
    • Reply

    Sending healing vibes your way. I am unfortunately familiar with the effect pain can have on one’s life. My husband, a professional musician and luthier, was once at the point where he wasn’t sure he could continue doing either of these things because of a very acute onset of psoriatic arthritis. Being married to a physician and living very simply at least took financial worry out of the equation. Having access to healthcare and living in an age of so many biologic agents/immunomodulators also helped. He is doing well now, and despite occasional breakthrough pain episodes, continues building bad-ass custom guitars and making beautiful music. Fully acknowledging my bias, I still play his songs during longer surgical cases and even get compliments on music selection from my residents, which are of course taken with a grain of salt:)
    Anyway, thanks for sharing your story, and I hope you feel better. We will continue to follow HP advice and working towards early financial independence, as we are not quite there yet, but on the way. We are also grateful for all your other posts, and I even had residents read some of them instead of journal club articles, especially the one on meditation which was perfect for the first years in July.

    1. Wow, I am honored to be a part of anyone’s journal club. Thank you for sharing! Chronic pain is enough to deal with on it’s own and I consider myself very fortunate to not have to worry much about the financial impact. Glad your husband is doing well. It’s amazing what some of those newer drugs can do with respect to suppressing inflammatory arthritis.

  1. I feel your pain! I too experience chronic neck/back pain ever since I was in a bad car accident almost a decade ago. I love your reflections on pain. A little discomfort (or a lot) definitely puts life into perspective. I hope you feel better soon.

    1. Thank you, life is definitely more fun when not in pain!

    • Hatton1 on July 30, 2017 at 10:52 am
    • Reply

    I hear you on financial independence. At 60 I am developing osteoarthritis seemingly everywhere all at once. I guess I am surprised because I am pretty thin. So thank god I really don’t need my job. I only work 3 days per week and have quit OB. I would hate to have to roll out of bed because I had made stupid financial decisions

    1. Osteoarthritis is an interesting process. Whoever figures out how to prevent or cure it will be the richest person in the world.

  2. I’m currently only two years into practice, but I’m looking forward to being financially independent in another 7 years or so. I would really love to not have to ever worry about being able to support my partner and I if I were to be unable to work.

    1. Those 7 years will fly by 🙂

  3. Sorry to hear about your back. While I don’t know if age plays a role at all since you’re quite young, things like this will come to all of us at some point, and usually sooner than we expect. Many, many people are forced to retire because of health issues. Or they retire and realize they can’t be as active in retirement as they planned because they waited too long. I was just talking to a colleague who has been FI for a while and is excited to retire and rock climb and do crafts. Now she is having severe wrist/hand pain and may not be able to. Like most of us, I suspect she simply feels young and was in no rush. It’s very common to wait too long though! Just remember that surveys on life regrets show that waiting too long to retire is in the top 2. Retiring too early doesn’t even make the list and seems to only be a regret for those who had few savings.

    Your comment on ego being behind the “retire to” made me think. You’re right here. Maybe “retiring from” shouldn’t get such a bad rap. Just “retiring from” the long hours in my job is extremely appealing. But I still want to satisfy Mr. Ego with some fulfilling “retire to” activities as well. I guess I still have some personal development ahead of me until I find my Zen.

    Thanks for the post!

    1. I’ve noticed that as the ego attachment loosens, the distinction between “retire to” and “retire from” just turns into “retire”. Good topic for another blog post 😉

      Health is something we all take for granted until it is taken from us. When I have those moments of no pain, no tension, no numbness…it is so blissful.

  4. Will be sending you healing vibes/prayers. I have daily pain in my feet and lower ankle area. Has not been fun as I had grown to love running. But, I focus on what I can do which is running shorter distances and riding longer ones. I use a topical cream, Topricin and it has helped immensely.

    My wife suffers with chronic back pain. She sees a chiropractor and also uses the same cream. It moves the chronic to the tolerable range.

    We both do stretching and rolling for our affected areas and are able to remain quite active. So hope you will find a combination of things that can provide enough relief to still enjoy life.

    cd :O)

    1. Thank you Chris. I’m approaching my pain from many angles. I’m optimistic.

  5. Glad your maternity coverage stretch is over. Reading your first post on the subject made me upset by proxy. I can totally see how stepping away from the grind then going back in could be extra tough. Props for staying strong. Im in the process of stepping back, reading your experience makes me aware I probably wont be able to go back. It’s like flying first class too much, cant take coach anymore. (I dont fly first class btw but this is how I imagine no leg pain when flying to feel).

    1. That is a good analogy. The big question is should I continue to work so I can afford to fly first class, which arguable should be better for my back 😉

    • wolverinemd on August 2, 2017 at 12:10 pm
    • Reply

    It’s a cliche but it’s true. Money doesn’t matter if your health suffers. As late-50’s MD, I can empathize with your back pain. Until 3 years ago I was in fantastic shape, running 30+ miles a week, winning local races, lifting weights and biking. I stepped in a hole and tore my meniscus. Months of therapy didn’t help so I had “routine” arthroscopy which went well until MRSA set in. 6 months and 4 additional surgeries later, I was fortunate to keep my leg but my knee was completely destroyed. Now I’m able to walk about a mile until the pain sets in. Then one year ago, I woke with right sided low back pain, radiating to my foot. The pain was frighteningly severe. Then I developed foot drop. Narcotics didn’t help. NSAID’s helped a bit and gabapentin was also somewhat helpful. I missed 2 months of work, had 3 ESI’s, 2 courses of PT and could not sit for more than 2 minutes. Finally after 6 months I had a microdiscectomy and was able to sit again. I was really happy to return to work and be relatively pain free. Back pain is draining. I had many bad thoughts. I had planned on working until 65 but after all that, I’ve planned to retire in the next 18 months. I wish you the best in your fight against back pain. Keep walking, consider an ESI, gabapentin (I tolerated it well, some don’t) and even acupuncture. Surgery is mostly effective if there is a specific target like I had (an isolated herniation).

    1. Thank you for sharing your story. As you point out there is no such thing as a “routine” surgery. I feel for you and hope things get better for you from a pain perspective. I’m pretty against surgery, but someday I may get to that point. Hopefully not. Not sure if gapapentin helps with the pain/numbness, but it is the best sleep medication I’ve ever taken! It’s hard to understand what severe pain is like unless you have lived though it.

  6. Sending good thoughts and healing energy your way. Chronic pain is exhausting and messes with your mind. So glad you have your meditation practice to help maintain a healthy perspective.

    Hope that the PT is delivering some relief!

    I went through a long stretch of chronic low back/hip/abdominal pain a few years ago and found that Thich Nhat Hanh’s book No Mud No Lotus was a great supplement to my meditation practice.

    If there’s any chance that your psoas muscle is involved, this post of mine might be helpful:

    May you find freedom from pain!

    1. Thank you. I will check out that book. Pretty sure my back is the culprit, not the hip.

  7. Hopefully your back is feeling better by now. But if it is not, and mainstream conservative therapies have not been helpful, consider trying alternative herbal supplements such as Boswellia Serrata or SAM-e.

    • Natasha on August 30, 2017 at 6:11 pm
    • Reply

    Hope you are feeling better . Back pain is very debilitating ( I had terrible SIJ dysfunction for 4-5 months during pregnancy and had to pass my fellowship exam during that time . Could not take anything for it , either – had to stand up half way through last case and declare ” I have nothing else to add gentlemen” as could not sit anymore – you should see examiner’s faces :))) Passed it, too- they mush have felt sorry for me .

    It left me with a deep sympathy for my lower back pain patients and appreciation of good health when I have it . I think most of us take pain-free state for granted.

    Sending some healing vibes your way

    1. Thank you Natasha. Pain has given me more empathy and deeper understanding for which I am grateful. We only notice our health when it leaves us.

Leave a Reply

%d bloggers like this: