My Mother, My Nurse, Part 1

my mother, my nurse, part 1      9.2.11

A few years after Laurie's surgery. From left: Amy, Donna, Eric, Kerry and Laurie

Kids of nurses have it both good and bad. Donna remembers her middle daughter saying, “Try being a nurse’s daughter — it’s really fun. Unless you’re bleeding from every orifice, she doesn’t care.” Laurie did not bleed from every orifice but she definitely got her mother’s attention.

This is the story of my cousin’s curved spine, and the surgery that made her upright. I told it before, from Laurie’s perspective. Now it’s time for her mother’s side of the story.

The guilt of genetics

Donna happened to be an orthopedic nurse at a spine clinic when Laurie’s back started to droop forward. This may sound like an incredible stroke of luck but spine problems were a part of Donna’s life story. The first person she knew with a back like her daughter’s was her father. As Donna puts it, “I grew up with a hunched-over dad.”

Donna spent much of her childhood taking care of her father, whose spine had collapsed so far forward that by his late 60s, he could not take a full breath. He died of pneumonia at 69. When she saw Laurie heading in the same direction, Donna became acutely aware of two things: her daughter’s struggles, and her own guilt. “I knew she was exhausted. I knew she was in pain, and I hated it. It skipped my generation and got Laurie.”

After a while, Donna got tired of people telling Laurie to stand up straight. One evening, she asked her daughter to stand against the wall to see if Laurie’s shoulders and hips could touch at the same time. They couldn’t. Either her shoulders had to come forward to get her hips against the wall or her hips had to jut out for her shoulders to make contact.

The thoracic spine is the part that typically hunches over in front a computer. This thought alone makes me want to sit up straight.

You have a curved spine. Now what?

The problem was in Laurie’s thoracic spine, the section between her neck and lower back. If you slouch at your computer, (and who doesn’t?) your thoracic spine hunches over. As Laurie’s back got worse, she curved further and further forward. It was as if she could never fully stand up from the computer.Donna took Laurie to eight doctors. When I asked why so many, Donna said she was looking for someone who was doing something new. Kyphosis, the medical name for Laurie’s’ back problems, doesn’t always require surgery but when it does, the procedure is invasive, painful, and leaves huge scars. As a nurse, Donna knew this. As a mother, she wanted better.

Finally, Donna found what she was looking for. The eighth doctor referred them to Isador Lieberman at the Cleveland Clinic; he was doing something new. Around this time, Lieberman published a paper in Spine, describing how positioning a patient differently during surgery and making smaller incisions could correct kyphosis with less overall trauma to the rest of the body. Since not having surgery wasn’t an option, this was as good as it was going to get.

Laurie’s day on The Rack

One thing that’s both fascinating and a little horrifying about talking with a nurse is the degree of gory detail that’s simply par for the course. Laurie describes her surgery in vague terms, as something she’d rather forget. Donna fills in the particulars. Before working on Laurie’s spine, Lieberman’s team had to deflate one of her lungs. They made a small incision in her side, collapsed one lung, then reached behind it to remove the spongy disks between her vertebrae. This part of the surgery left only a small visible scar. In a few days, Laurie’s lung would re-inflate and over time, the bones in her mid back would grow into a solid column of bone, but that would come later.

With a screw on each side of Laurie's thoracic spine, the surgeon pulled her upright using a wire.

With one lung deflated and ten disks removed, it was time to turn Laurie over. The team exposed Laurie’s thoracic spine. Compared to the small incision in her side, they now had to open up Laurie’s back to expose her spine from just below her neck to halfway down her back. This did leave a scar, a big one. The team put screws into both sides of each thoracic vertebra, ran wire along both lines of screws and attached thin rods on either side. For their final act, they pulled the wires tight and secured them to the bottom screws, pulling Laurie into a permanent upright position. In my mind, I picture a marionette. Donna compares the procedure to being on The Rack. Either way, Laurie gained two inches. “She went from 5’5-½” to 5’7-½”,” says Donna.

“I’m a walking Ace Hardware”

The procedure took nine hours. When her parents finally got to see her, Laurie was in recovery, on a bed surrounded by x-rays of her spine, a learning opportunity for medical students.  The sight made her father’s legs go weak. “Eric took one look at the x-rays and did the bended-knee thing,” says Donna. A nurse had to take Laurie’s dad out of the room, leaving Donna and Laurie alone together.

“Laurie looked awful. She had a chest tube to allow her collapsed lung to re-expand. She had an NG tube in her nose, and an IV in her jugular vein. She was pale and sedated. But as I got closer to the bed, she opened her eyes and looked at me. I asked, ‘Laurie, how are you doing?’

“Laurie said, ’How do you think I’m doing? I’m a walking Ace Hardware. Don’t bring any magnets into the room.’ Then she closed her eyes and wouldn’t speak to me.”

Next: How Laurie recovered and Donna got certified in pain management.