Complexity

4/15/26 

     It was a rough night between my sadness at the news that Hampshire College, my alma mater and the place I met Kate S.,I s closing and my jitters about my appointment with the Director of Complex Spine Surgery today. At about 7:30am, I answered my phone and a heavily accented voice informed me that she was one of our clients, living in a shelter, and had no summer clothes. The list of clothing resources was at the office, so I promised to get back to her and made myself the strongest cup of Earl Grey I have ever had. 

     When I got to Mt. Sinai, the young man checking people in, who will hopefully never have a personal reason to know the difference, tried to send me to neurology rather than neurosurgery. Once I clarified, he said “8th Fl.” and pointed the way to an elevator. When I got out, I thought I was in the wrong place, because there was nothing but long grey halls in both directions with very little signage and the signage there was said “Neuro ICU” and “Neuro OR”. I definitely didn’t want to wander into an OR so I went the other way until I found a person and explained who I was looking for. I thought maybe she would send me to another floor, but instead she pointed back the other way and said “go all the way to those glass doors at the end of the hall and turn right.” I headed down the deserted hall, reminding myself that the whispers of exposed, naked brains were imaginary. 

    When I got to the glass doors, they said “Chair of Neurosurgery” and beyond them was a normal looking office with carpet and some plants, but when I turned right there were just some more nondescript doors with barely visible nameplates. I found Dr M’s name with two other doctors and opened that door. Instead of being faced with the usual receptionist configuration, I found myself in a small thrown together waiting area that consisted of eight mismatched chairs, a row of cabinets with three huge HP printers on top, a desktop on a table along with several boxes of gloves, and instead of an end table, a mini-fridge topped with magazines and a fake potted orchid. The walls were the yellowish grey of the yolk of a hard boiled egg, and most of the room seemed to be occupied by three cubicles which opened on the side to a kind of walkway, so that one wall of the waiting area was the back of a cubicle and nobody could see the patients entering. 

 

    I walked around to the opening of the first cubicle and found a sign with the doctor’s name, and a man on a telephone, clearly his clerical assistant. When he got off the phone, he handed me a clipboard of forms with the fading type of something that has been reprinted a zillion times and sent me back to the mismatched chairs to fill it out. 

    When I handed it in and sat back down, it dawned on me that everyone else had brought someone. On one side a couple was speaking Korean and on the other a woman in a hijab was chatting with her husband. Across from me, a mother and her daughter were getting agitated. “I’ve been waiting since 9:30am” she said out loud. “If it wasn’t so serious, I wouldn’t wait, but I really need her to see this,”. I was relieved by the female pronoun since it was 12pm. It got to be 30 minutes, then 45 minutes past my appointment. The Korean woman tried to call and request the records of her husband’s heart surgery from 1998 from somewhere but the secretary couldn’t understand her and they went back and forth about the doctor’s name, until finally the husband said something in his even stronger accent and she elbowed him. I so wanted to take the phone and explain what she was requesting like I would for a client. Eventually a staff member showed up and explained that they didn’t actually need those records which was fortunate because the person on the phone had figured out how long ago the records were from and was repeating that they don’t have any from back then. Dr M took the muslim couple, and I prepared to wait much longer, but it was only another quarter hour before he was ready for me. 

     Stepping into his office was like arriving in an entirely different building. It was large, spacious, freshly painted and had an expansive view. He seemed to have just moved in because the walls were bare, and two paintings were propped on his large l-shaped desk. A plant and a pile of odds and ends were stacked in one corner, waiting to be put somewhere. “I’ve seen your MRI before,” he said, in his Greek accent, typing my name into one of his giant screens. The picture of my spine came up on the other one, the hardware from my last surgery bright against the more muted tones of human tissues. He asked me a few questions, and then he pulled up another image of my neck – the previous MRI. 

     “Since I know it’s there, I can see the tumor on your old MRI,” he said, pointing. Side by side, we could both see how much it had grown, completely filling the space. “it’s right next to the artery, so if it keeps growing, it will compress the artery and cause a stroke,” he said. “And if it grows in the other direction, it will compress the spinal cord and cause paralysis.” Having made that definitive case for doing the surgery, he then went on to explain that the proximity of those structures were also the main risks of the surgery, along with the usual infection and bleeding and cerebrospinal fluid leak. “I’ve done this hundreds of times and only had a leak once,” he said. “We use microscopic sutures to fix it” – in fact, the whole procedure is done using a microscope. 

        Up to that point, it was what I had expected, but then he said, “the tumor is behind bone, so I have to take part of the vertebra off. And then I will stabilize it by fusing it to the next one with screws. But then because you had the two bottom ones fused already, this middle one will be alone, and that won’t work so we have to fuse all three.” Now we were talking about a much bigger procedure, more like the one I had in 2016 on my lumbar spine. “How big is the incision? “I asked. He held his fingers about 5 inches apart, the same as my lower back. “How long is the recovery?” “4-5 days in the hospital, six weeks in a soft collar.” 

    My last neck surgery was in July, once we were safely past the work chaos of pride month so I have spent a summer in a soft collar and it isn’t fun, especially since my office has no air conditioning and stained glass windows that don’t open. My house is not a lot better, with air conditioning in just one room. “How long is the procedure?” “Four to five hours, though sometimes we have been there much longer,” he said, his blue eyes meeting my own. He started thumbing through his calendar. “I’d rather not do June,” I told him. “I run an LGBTQ organization.” He nodded and kept paging through the little book.  

    “I won’t be able to get arrested,” I said quietly as the thought dawned on me. “What?” He was studying me quizzically. “Sometimes I get arrested protesting, and it can get rough. That’s how I tore my rotator cuff, an officer body slammed me in DC while we were interrupting the senate appropriations committee demanding funding for global AIDS treatment.” “I’m sorry that happened to you,” he said sounding a little shocked. “I mean, we know we could get hurt doing these things, but we fought to get global AIDS treatment back when people were dying, and access to experimental treatment and all these things.” “I remember when people with AIDS just died. And now, they have high blood pressure, they have diabetes, they have HIV, we just treat them. Thank you for doing that.” “Now we’re going back,” I said. “The money is cut off and people are dying overseas, and it will happen here too.” We realize at the same moment that we have veered off track. 

    He picks up his calendar and says “May 19th?” and I agree. “What causes these tumors?” I ask. He pauses a moment. “Sometimes a genetic condition but those usually show up at a younger age. Otherwise…bad luck.” “I’m an expert at that,” I say and we laugh. “The nerves have this material coating them…” he starts to explain. “Myelin,” I say and he nods. “Myelin is constantly renewing itself, and sometimes that causes tumors.” “Because one cell mutates and then they keep growing,” I say. “Yes, nerve cells don’t do that because they don’t divide quickly.” “If they did people would recover more and more quickly,” I say. He looks startled. “How do you know that?” he says. 

     It seems obvious to me but I have to say something. “They teach neuroanatomy in clinical psychology programs,” I tell him, although what they teach are the much larger structures, the pons and the brain stem and Broca’s area. He's still looking at me like there must be more, so I say, “My mother and my uncle were both disabled by spinal stenosis,” I said and he looked distressed at that idea. “My mother didn’t have insurance so she…” I trailed off. “And my uncle had surgery but back then they didn’t have the micro technology and so he wound up driving an adapted vehicle.”  He handed me a list of things to do – MRIs of my mid and lower back to look for additional tumors, a CT for surgical planning, clearance from my primary doc. 

     Outside the hospital it was an abnormally warm but beautiful day, the trees and bushes of the Upper East side all blooming in the sun and a light breeze. I got about a block away before I thought, “why is my life like this?” and started to cry while the brown and black nannies pushing white babies and people walking purebred dogs pretended not to notice.