Reflections on Pain: Part 2

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.

Progression

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.

Options

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.