‘A crunch. A rip. Pain spread like a stain’: my life­time of back trou­ble

The Guardian Australia - - World News / The Long Read - Mag­gie O’Far­rell

It is one of those static, chill days you get in Ed­in­burgh to­wards the end of win­ter. Ice sheets the pave­ments and roads; no wind stirs the black­ened branches of the trees; the fallen fo­liage from the now dis­tant au­tumn is frost gilded and crisp un­der­foot.

I am swathed in mul­ti­ple lay­ers of merino wool, a scarf cov­er­ing half my face, and I am hold­ing my­self stiffly up­right on the very edge of a stool in a small and glar­ingly lit room. De­spite the wool, de­spite my mit­tens and sheep­skin-lined boots, I am un­remit­tingly, un­avoid­ably cold. Chronic pain, I am dis­cov­er­ing, is tir­ing, drain­ing, dom­i­neer­ing: it ab­sorbs all your en­ergy and fo­cus; it drives other thoughts from your head. My body seems un­able to keep it­self at a liv­able tem­per­a­ture, so pre­oc­cu­pied is it with the ex­treme dis­com­fort of my back.

In the room with me is a doc­tor from Aus­tralia and I am won­der­ing to my­self: how can he be wear­ing just a shirt un­der that white coat? Doesn’t he feel the cold? How can he be un­af­fected by this tem­per­a­ture?

I have just ex­plained to him that, three days ago, I leaned side­ways to move a counter in a game I was play­ing with my chil­dren and I felt a crunch, fol­lowed by a rip, and then a hor­ri­ble shift­ing sen­sa­tion as some­thing slid out of place in my lower back. Pain spread like a stain, out­wards and up­wards, and I have, ever since then, been un­able to move, sit, walk or stand with­out un­be­liev­able agony.

We are, he and I, gaz­ing at an xray sheet on a light­box. I’ve al­ways had a deep fas­ci­na­tion for x-rays: what a gift, what an un­ac­count­able power, to be pre­sented with the shaded, lay­ered im­ages of your in­ner work­ings, to be granted an oddly pre­scient glimpse of what you’ll look like in your grave.

Other x-rays have shown me my cra­nium, with its recog­nis­ably ridged nose, my chaos of teeth, pit­ted with the stark ge­om­e­try of fill­ings; I’ve seen the spread bones of my hands, the lin­ear metatarsals of my toes, the neat socket of my an­kle. But never this, be­fore now: the as­ton­ish­ing twinned halves of the sacroil­iac re­gion.

The an­tipodean doc­tor points out bones, joints, nerves, to help me get my bear­ings on this strange map of grey and white and black.

He says my left sacroil­iac joint has slipped out of align­ment, caus­ing my cur­rent state.

“And when did you break your sacrum?” he says, lean­ing closer to peer at some­thing.

“What?” I say, from be­hind my scarf. He re­peats the ques­tion, turn­ing around.

I tilt my head to look up at him and an in­vis­i­ble, an­swer­ing knife slices through my side. “I haven’t bro­ken my sacrum,” I mut­ter, winc­ing, tight­en­ing my hold on my­self. “Or at least … I don’t think I have. Have I?”

The doc­tor raises his eye­brows. “You don’t re­mem­ber?” he says.

***

The lower back is a les­son in sym­me­try, with the curved wings of the pelvis flar­ing out from the sacrum, which is cupped like an open palm and pierced with a line of paired holes. The coc­cyx curves up, be­neath, a ves­ti­gial re­minder of our simian ori­gins. On an x-ray, the area re­sem­bles a but­ter­fly or sil­ver moth, pinned to a dark vel­vet board. There are parts of the body which, taken in mag­ni­fied iso­la­tion, look strange or spindly or pe­cu­liar or uniden­ti­fi­able, but the sacral area is un­mis­tak­able and un­usu­ally beau­ti­ful. It is part an­gel, part lep­i­dopteran, part Rorschach inkblot.

The sacrum, the tri­an­gu­lar, pit­ted cen­tral bone, is a com­plex, mul­ti­fac­eted cog, per­form­ing numer­ous func­tions. It is cru­cial for load-bear­ing, sup­port­ing the en­tire spine above it, and for ac­com­mo­dat­ing the spinal nerves; it ar­tic­u­lates with the hip bones, con­nects with the fi­nal lum­bar ver­te­brae, above, and the coc­cyx, or tail­bone, be­low. Strong lig­a­ments con­nect it to the il­ium bones of the pelvis: these joints are Lshaped and ca­pa­ble of a small amount of move­ment.

In chil­dren, the sacrum is formed of five sep­a­rate ver­te­brae, which start to fuse into a sin­gle bone at around the age of 18. Women’s sacrums tend to be shorter than men’s, with more breadth and cur­va­ture, to al­low greater ca­pac­ity in the pelvis.

The term “sacrum”, which was coined by 18th-cen­tury anatomists, comes from the Latin name os sacrum, which means “sa­cred bone”. Be­fore the anatomists came along, the sacrum was also known in English as “the holy bone”.

All this anatom­i­cal and lin­guis­tic in­for­ma­tion is un­known to me as I perch gin­gerly in the doc­tor’s of­fice, as I watch him point to a tiny grey line, like a river seen from a plane, on one side of the sacrum on the light­box.

I can see what he means. There is ev­i­dence of frac­ture on the bone. I am able to see it. I also know that the x-ray is mine: I can see my name, re­versed so that the sur­name pre­cedes my ini­tial, in the cor­ner. But can I re­ally have bro­ken it and not known? How is that pos­si­ble?

I look down at my hands, a mi­nus­cule move­ment that causes a shiver of dis­com­fort from my shoul­der blades, down to the base of my spine, ex­actly where the line of frac­ture must be.

“I fell,” I say to the doc­tor, “on a mar­ble floor.”

***

What I don’t tell him is that we were on hol­i­day, in Italy. That one of my chil­dren had been very sick. That it was early spring, Easter time, and my job that week, as the mum, was to get the fam­ily back on track, to show them that we were go­ing to have a great time, de­spite ill­ness and stress and dashes to hospi­tal. I wasn’t ex­actly wear­ing a jester’s hat, but I might as well have been. I had an as­sign­ment from a news­pa­per to write about a gar­den of stone mon­sters, built by a griev­ing duke for his dead wife. Mon­sters or no mon­sters, we were go­ing to en­joy our­selves: I would make sure of it.

One morn­ing, I was with my chil­dren be­side a pond out­side the villa; my son was be­side me and my two daugh­ters were chas­ing emer­ald-backed lizards in and out of the rose­mary bushes. I had drawn up my feet and I was sit­ting cross-legged in a rick­ety gar­den chair. My son said some­thing – I for­get what – and I laughed, throw­ing back my head.

Bal­ance has never been my strong point. I am for­ever fall­ing side­ways, lurch­ing into book­cases or ban­is­ters or door­jambs. Turn­ing my head can cause me to top­ple over. I of­ten trip over things that aren’t ac­tu­ally there.

So I laughed, cross-legged in my chair, and what hap­pened next seemed to oc­cur in slow mo­tion. I saw the me­dian line of the pond edge, the box hedge, the eaves of the villa tilt. The scene of the wa­ter, my chil­dren, the tiles dropped away from me and I saw in­stead a flash of tree­tops, the ar­row­ing path of a bird. I heard the noise be­fore I was aware of the im­pact: a crash­ing thud in­side the bor­der of my body, trav­el­ling up­wards in a great sonic wave to­wards my ear canals.

The next mo­ment, I was supine, in a dif­fer­ent place en­tirely, as if I had dropped through a trap­door. Here I was on a level with mar­ble flag­stones, with feet, with the lip of the pond. It seemed sud­denly hard to breathe, to in­flate my lungs. I tried to roll side­ways, to right my­self, but there was a pain so enor­mous, so se­vere, at the base of my back that I couldn’t move. It was a large pres­ence, this pain, with ten­ta­cles and claws: it gripped me tightly in its clutches, it drove an iron fist into my spine.

My chil­dren were crowd­ing round me. I could see their san­dalled feet, the hems of their clothes. The youngest was pat­ting me on the arm, say­ing, “Mama, Mama.” Tears were stream­ing from my eyes and I could hear strange, hoarse, gasp­ing sounds.

“Get your dad,” I man­aged to say. It was hard to get up, to move: this I re­mem­ber, more than any­thing else. My hus­band tried to help me up, but each time he touched me, I screamed. The flag­stones around the pond, the in­stru­ments of my de­struc­tion, sud­denly seemed like the best place to be, to re­main. I would just lie here, curled like a prawn, on my side for the rest of the week. That would work, wouldn’t it?

Some­how they got me into the house, my hus­band and my 11-year-old boy. I re­call spend­ing some hours ly­ing on my front on a bed, al­low­ing tears to leak, in a driv­elly and di­rec­tion­less fash­ion, into some pil­lows. My chil­dren came in and out, awed and silent. My hus­band’s wor­ried face hove into view, com­ing nearer and nearer. “Do we need to go to hospi­tal?” he asked.

No, I mut­tered. The idea of go­ing any­where, of rais­ing my­self from this po­si­tion, of – good grief – fold­ing my­self into some kind of ve­hi­cle, made me want to vomit. It hurt to move my leg, to curl my toes, to turn my head, to brush a hair off my fore­head. It hurt to blink.

What I learned that day, be­fore I had lin­guis­tic con­fir­ma­tion that the bone I had in­jured was in some way “sa­cred” and “holy”, be­fore I had pored over pic­tures of it, oc­cu­py­ing the very mid­dle of our bod­ies, hold­ing up the spine, form­ing the ba­sis for the nerves to our brains, the move­ment of our legs, was that the sacrum is cen­tral to us.

It lies at our mid­dle. If we are wheels, the sacrum is our hub. All roads lead to it; ev­ery­thing flows from it. With­out it, that small, hand-sized bone, we can’t move.

In Italy, how­ever, I was mov­ing the very next day. I had no choice.

I had three chil­dren to look af­ter, one of whom was still un­well, a hol­i­day to un­der­take, an ar­ti­cle to re­search and write. So I did what par­ents have al­ways done. I took painkillers, I got my­self out of bed, I stood up­right, I hob­bled on.

I went to the gar­den, be­cause I had no choice: the stone mon­sters had to be seen, the ar­ti­cle had to be writ­ten. I re­call a cer­tain amount of dif­fi­culty get­ting my­self out of the car. I clung for a mo­ment to the hot me­tal of the roof, gulp­ing back a sob, and then stuffed bags of ice down my clothes. I was past car­ing what the chic Ital­ians around me might think.

I leaned on the buggy for sup­port as we pro­cessed around the path­ways, the seat of my trousers filled with a rub­ble of ice cubes. I peered up at the lichenous faces of the mon­sters who weren’t so very mon­strous af­ter all, but in­scrutable, mired in weeds and soil, their gazes di­rected above the heads of those who had come to look at them. “Are you all right?” my hus­band kept ask­ing me, and be­cause I didn’t want to alarm the chil­dren, I said: “I’m fine.”

In the cold room in Ed­in­burgh, I con­dense this story to its bare es­sen­tials. I tell the doc­tor that I fell, on hol­i­day, sev­eral years ago, and that ever since then I am prone to sud­den and acute in­juries from strangely lit­tle cause.

“Any prob­lem with my back,” I tell him, “seems to go straight there.”

The doc­tor nods. “Well, it would,” he says, tap­ping the x-ray.

“In­juries like that can be life-chang­ing.”

***

In my mid-20s, I lived in Lon­don, where I worked for a news­pa­per. It was a job that re­quired me to sit for long hours in front of a mon­i­tor, click­ing again and again on a mouse, scrolling up, scrolling down, zoom­ing in, zoom­ing out, over and over again, five days a week, some­times un­til mid­night. It wasn’t long be­fore my back seized up: I had pins and nee­dles be­tween my shoul­der blades and a numb­ness down my right arm. My boss, ner­vous about RSI ab­sen­teeism, sent me two floors up to see the com­pany phys­io­ther­a­pist.

She was the first in a long line of prac­ti­tion­ers on whose couches I would lie, face down, while they prod­ded and mea­sured and tested my back.

“My God,” was what she said as she pum­melled me with an elec­tric mas­sager. “You have the back of an 80-yearold. Of course,” she shouted, over the noise of the hellish ma­chine, “the prob­lem’s all com­ing from down here.” I felt her hand de­scend on my lower back.

“Some­thing’s re­ally not right in your lum­bar. Your SI joints move around too much – they’re hy­per­mo­bile. And your tail­bone seems kind of crooked.”

As with the Aus­tralian doc­tor who would x-ray me, years later, there was a lot I could have said in re­ply, but didn’t. At the time, I got up off the couch, my back feel­ing kneaded and al­most bruised, and went back to work.

I made phone calls, I chased copy, I dis­cussed lay­outs, as if it was a nor­mal day, but all with the sen­sa­tion that there was some­thing be­hind me, some­thing only I could see, neb­u­lous and malev­o­lent, some­thing I thought I had out­run, a long time ago, but here it was, back to haunt me, plac­ing its clammy hand on my shoul­der and say­ing, you

didn’t think you’d get away that eas­ily, did you?

The un­even cur­va­ture of my coc­cyx was caused by spend­ing up­wards of a year ly­ing on my back, in bed, as a child. My spine grew, of course, as would that of any eight-year-old, but it grew crooked, from the pres­sure of the mat­tress be­neath. I’d con­tracted en­cephali­tis and the virus was eat­ing away at my brain, a mag­got through an ap­ple, mak­ing lace­work of the neu­ral path­ways. Most of the last­ing neu­ro­log­i­cal dam­age was done to my cere­bel­lum, that part of the brain in­volved in move­ment and co­or­di­na­tion, but the virus also dis­man­tled many of the neu­ro­mus­cu­lar junc­tions in my spine and pelvis. Mus­cles in my back and up­per legs were left much weak­ened and fore­short­ened.

Don’t get me wrong: I con­sider my­self to be an ex­tremely lucky per­son. The doc­tors first said that I would die; when I didn’t, they said I wouldn’t walk again. To have re­cov­ered, to have found a loophole out of one of these des­tinies, let alone both, strikes me as the very best for­tune a per­son could ever have.

As as twen­tysome­thing jour­nal­ist, how­ever, it came as a shock to re­alise that I hadn’t left – couldn’t leave – all this be­hind me. At that age, you be­lieve your­self in­vin­ci­ble. You think the world will al­ways be like this, that a life of work­ing long hours and stay­ing out late and barely eat­ing and flit­ting from one rental flat to an­other is a per­ma­nent state.

Your teens, your child­hood, seem in­dis­tinct and dis­tant, in con­trast to the speedy Tech­ni­color of the present. What hap­pened to that child, that teenager, might well have hap­pened to some­body else.

What I hadn’t re­alised then is that parts of life come in and out of fo­cus as you get older. Events that might at the time have seemed to pass with­out con­se­quence may re­turn with great im­port; some­thing you thought you might have shrugged off or come through can al­ways rear its head again, very much the way a virus can lie dor­mant in your sys­tem.

The truth is that my sacroil­iac re­gion is a part of me that could tell a long story, should any­one wish to hear it. It is my synec­doche and also my equiv­a­lent of Achilles’ famed heel, which didn’t make it into the magic wa­ters of the Styx. I had avoided an early death, I man­aged to find a way out of a life of in­ca­pac­ity and de­pen­dency. In my teens and 20s, I fled from this knowl­edge; I wanted to put as much dis­tance as pos­si­ble be­tween my­self and that ail­ing, im­mo­bile child in a hospi­tal bed. I ran away from her, as fast and as far as I could, but my sacroil­iac area, my lower back, was al­ways there to re­mind me that I could do no such thing, that she is me and I am her. There will be no es­cape.

It is of course a very, very small price to pay. So what if my coc­cyx curves too much to the right? So what if my pelvic lig­a­ments are too loose and the mus­cles con­nected to them too tight or too weak or at­ro­phied or what­ever it is they are? So what if I had to wear what the ob­ste­tri­cians called a “truss” through­out my preg­nan­cies, to hold the bones of my pelvis to­gether? So what if I broke my sacrum and didn’t re­alise? I can walk, I can grip a pen, I can lead an in­de­pen­dent life, and that’s more than the neu­rol­o­gists ex­pected for me.

***

As I sit star­ing at the healed frac­ture on my x-ray, as the doc­tor guides my hand to the cor­re­spond­ing place on my lower back and I feel, yes, a tiny cal­ci­fied lump, a frozen pea be­neath the skin, I am struck by the strange­ness of it all. We think we know our bod­ies, these shells of blood and mus­cle and tis­sue and bone, but they lead lives of their own, they keep se­crets from us. We in­habit them but they re­main un­know­able, elu­sive, brave, car­ry­ing on with the busi­ness of liv­ing, de­spite our ac­ci­dents and choices and in­cur­sions and fool­ish­nesses.

I leave the hospi­tal walk­ing slowly and care­fully, with short­ened, hes­i­tant steps, the gait of a woman wear­ing leg irons. Cross­ing the car park, I am filled with an un­fa­mil­iar and ab­surd de­sire to apol­o­gise to my back. I had no idea, I want to say, I didn’t re­alise, I didn’t know. I edge my way over wet tar­mac, nav­i­gat­ing the banks of cleared snow, and think, for the first time: we can’t go on like this.

This is what I have learned about liv­ing with pain: you need to be care­ful that your base­line for what’s ac­cept­able doesn’t sink too low. There were days, af­ter my fall in Italy, when I found my­self think­ing, well, I can’t turn my head to the left but it’s fine be­cause I can still turn it to the right. It’s too painful for me to sit down, but if I just bal­ance my lap­top on a desk, a card­board box and three dic­tio­nar­ies, and if I stand in front of this wob­bly zig­gu­rat, then I can keep work­ing. I can’t bend down to tie my laces but, hey, I’ll just find some slip-on shoes.

Some in­juries are life-chang­ing, the doc­tor said, and so I have duly changed my life. These days, a year or so on from my x-ray, my sacrum and I have reached an equi­lib­rium of a very ten­ta­tive and hes­i­tant na­ture. Our re­la­tion­ship is un­am­bigu­ously un­even: the sacrum is in charge and I am the will­ing, rev­er­en­tial sup­pli­cant.

I am filled at all times with a du­ti­ful re­spect for the holy bone and pay reg­u­lar obei­sance to it. I do what­ever I can to keep it happy. I rub scented oint­ment into it, I ap­pease it with hot packs. I have spe­cial cush­ions to ease its com­fort, all over the house; I take one with me when I travel, for hard and un­for­giv­ing sur­faces in trains or planes or air­ports. In the man­ner of a cat meet­ing a dog for the first time, I will eye up a chair be­fore I will com­mit to sit­ting in it. I avoid any that are too soft or too hard, or ones that re­cline too much or are shaped like a bucket. Any­thing that might tip back­wards doesn’t even get a sec­ond glance.

I don’t cross my legs, I don’t lift any­thing heav­ier than a bag of flour, I don’t row boats, I have to tell my daugh­ter that no, I can’t carry her, no mat­ter how tired her legs are. I even forgo the plea­sure of sledg­ing.

Like a re­li­gious fa­natic, a me­dieval mys­tic, I pros­trate my­self for my sacrum, on a mat, at least three times a day. I have a se­ries of 12 ex­er­cises, “for sacral sta­bil­ity”, the sheet says. I move through them, al­ways in the same or­der, with mute, pi­ous reg­u­lar­ity, once in the morn­ing, once at mid­day and once in the evening. I never miss a sin­gle one of these phys­i­cal nove­nas.

As I do them, mov­ing my legs one way, my arms the other, bend­ing and sup­pli­cat­ing my spine, I can hear my sacral joints click­ing, re­align­ing, set­tling them­selves, speak­ing to me. It is a word­less lan­guage, al­most as old as I am, and I am happy to hear it.

All Hail the Holy Bone by Mag­gie O’Far­rell was orig­i­nally pub­lished in Granta 145: Ghosts. Visit granta.com/ guardian for a spe­cial sub­scrip­tion of­fer with a 25% dis­count for Guardian read­ers

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Pho­to­graph: Puwadol Jat­u­rawut­thichai/Alamy

Pho­to­graph: Se­bas­tian Kaulitzki/Getty/Science Photo Li­brary RF

‘Part an­gel, part lep­i­dopteran, part Rorschach inkblot’ … the sacrum, or ‘holybone’.

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