A central character in Ken Follett’s novel ‘The Eye of the Needle’ is hurt and weak, but rouses himself with this thought: ‘It was important not to permit oneself the psychological attitudes of the invalid’.
I read that sentence twice. And then a third time. It meant something to me personally.
I suspect all Follett had in mind was that the injured character galvanised himself into readiness to fight. He wasn’t thinking that all ‘invalids’ have the same psychological attitudes.
But what he wrote took me back to a critical moment in my mid-thirties.
I’ll begin my story when I was 18. I was a trainee journalist working in Edinburgh, when one day I felt back pain and by the next day could hardly move. My doctor prescribed pain killers and bed rest. Two days later my parents arrived to persuade me that I couldn’t just lie in my one room bed-sitter, unable to shop or prepare meals, and they’d take me home with them. I agreed, but I might not if I’d realised their plan was that my bed would have a wooden board over the mattress. Back then, that was the accepted wisdom for people with bad backs. Drugged and desperate I lay on that board, but it made my pain much worse. Eventually they had mercy and removed the board, and slowly I got better.
That was only the beginning. I had similar struggles through my twenties. Some chronic pain was always there, then every few years it would become severe and everything would stop for a few weeks. Mostly I kept going through university studies and church ministry, and even played scrum half in my college’s rugby team.
Then came my mid-thirties. By then I had been a full-time pastor for some years, and Alison and I had four young children. We’d had a wonderful experience planting a new church in Livingston, not far from Edinburgh. Now I’d been called to become pastor in the north east Scotland city of Aberdeen. Getting ready for that change involved long journeys, extra meetings, and final get-togethers. Life was busier than I ever imagined it could be.
A week before our move my back gave in. The pain was immense. Any movement was agony. It didn’t matter if I stood, sat or lay down; every position was bad. My doctor prescribed strong medication which dulled all my senses. Friends gave up their bedroom for me. Not just to let me lie there day and night, but so Alison with her friend Kathy could pack up the home we were leaving. One evening I was eased into our car, the seat reclined, and with kids in the back Alison drove us 130 miles to Aberdeen. There I lay on a thin mattress on the floor. Somehow I managed to attend the service where I was inducted as minister of the church, and even preached. Then I went home, and lay again on the floor. A few days later the top orthopaedic surgeon from the hospital arrived to examine me, and promptly admitted me to hospital. I was put on traction, and for two weeks I just lay there.
Then, with pain slightly eased, I was sent home and my back slowly improved. About two months later than scheduled I began my ministry properly at the Aberdeen church. Good things happened during the following weeks. But my back was not stable. Pain worsened, and again I was taken into hospital. This time they carried out a diagnostic imaging test – a myelogram – which involved a contrast dye injected into my spinal column. That allowed the medics a much clearer view of what was happening around my spinal canal than standard X-rays could give. But my body reacted negatively to the dye, causing more pain and keeping me in hospital for another two weeks. During that time I was measured and fitted for an upper body harness – metal bars sheathed in leather with tight straps to hold my body in the right posture. The idea, I was told, was that I’d be unable to move in unhelpful ways, and thus let my back heal. I felt almost unable to move in any way, except by making penguin-like rigid motions. But at least I could go home.
That was two days before I was to conduct a wedding. The couple had sat by my hospital bed while I prepared them for the service. On the wedding day I unbuckled and removed my harness almost as the wedding march was being played, and put it back on as soon as the service was over.
Over the following months and for a couple of years I was better. Life was good. The ministry was being appreciated.
But the debilitating pain was just hiding. It returned with a vengeance. This time I met with a neurosurgeon who recommended an intriguing operation called, I believe, ‘Chemonucleolysis of Lumbar Disc Herniation’. An enzyme would be injected into my bulging disc which would dissolve disc material and thus release pressure on the spinal nerve. Only a needle would be used, no scalpels. It all sounded good. I went into hospital the day before the operation. The neurosurgeon came to explain that my body would never have encountered the enzyme before, so its reaction couldn’t be exactly known. My body could go into shock which, in rare cases, would be fatal. That wasn’t comforting. Before the operation a small access port was inserted into my arm, ‘in case we have to give you urgent treatment later’. I knew what that meant. The procedure was done while I was conscious but face down on a special operating table. When they were finished no-one moved. I had to lie still, and the medical team stood around me for ten minutes. No-one said they were waiting to see if I would die, but I suspect they were.
Did it work? For about six to nine months I did feel better. But not significantly after that. I found out that they stopped performing the operation two years later, perhaps because of risks associated with it, but mainly because the long-term results weren’t great. Which, unfortunately, was my experience.
Something like normal life kept happening around these hospital stays and operations. Congregation numbers grew so much we had to move to a larger building. Our children were growing up. Alison began studies towards a health science degree.
What I didn’t care for was that I’d become known as the pastor who began his ministry in Aberdeen as a hospital patient. Whenever I met people they asked ‘How’s your back these days?’ I appreciated their concern but wished for anything else as the opening line of conversation.
Then a deeply unwelcome possibility intensified in my mind. ‘Here I am, aged in my late thirties, constantly immobilised by back problems. Doctors and well-wishers can do no more than urge me to protect myself. Maybe this is how life is always going to be.’
That last thought – that this might be how my life is always going to be – was deeply distressing. I’d always believed I’d get better. Perhaps my back pain would simply go away. If not, then surely there was some more or less invasive treatment that would cure it. No other kind of illness in my life had been permanent. I always got well. And I’d assumed that would happen with my back pain. I wasn’t yet 40-years-old. Life couldn’t always be like this.
But it could. Well-meaning friends and medical professionals (surgeons, general practitioners, physiotherapists) were telling me to manage my back carefully. They were urging a defensive strategy – a ‘do no harm to yourself’ way of living. I mustn’t exhaust myself, or work too hard, or sit too long at my desk or in meetings, or lift anything heavy, or drive long distances. I should always insist on comfortable seating, and avoid strenuous sports or hobbies. While never having to dig the garden sounded good, the implications of the rest were dire. But perhaps it had to happen. I’d have to accept my life ahead would be significantly limited.
I can’t explain why, but I woke up one day knowing I wouldn’t accept it. I couldn’t be that person if there was any option not to be that person. There were still many directions in which my life could go. Was I supposed to delete half the options, leaving only what was ‘safe’ and undemanding? Were outdoor sports like hill climbing and golf – good not just for my physical health but also my mental health – just to be abandoned? Would I never throw a frisbee or play tennis with my children? Would I not lift them up and hug them? Would I consign Alison to carry all the shopping, or take luggage out of the car, or move the furniture around? I wouldn’t. That day I decided that as long as possible and as much as possible, I’d live life to the full.
And, as best I can, I’ve done that. As a family we’ve climbed Ben Nevis and Snowdon, the highest mountains in Britain. I became a single-figure handicap golfer. I’ve travelled and preached from the Shetland Islands (110 miles north of the Scottish mainland) to churches along the south coast of England. I’ve been in dozens of countries including Ecuador, Peru, Brazil, Congo, Angola, Uganda, Pakistan, Nepal, Bangladesh, Thailand, North Korea and Indonesia. I wasn’t supposed to take long plane rides. I wasn’t supposed to journey over arduous terrain. I wasn’t supposed to hike up steep mountains, sleep in rough quarters in remote and dangerous places, and sit on the floor of jungle huts listening to stories of persecution and hardship. But I have done these things, and consider each one an immense privilege. I’ve tried to be a help and a blessing to those I’ve met, but have received back twofold anything I was able to give.
None of that would have happened if – using Follett’s line – I’d permitted myself the psychological attitudes of the invalid. If I’d settled for a highly protected, uneventful life, everything would have been different.
So, has the pain gone away over those years? No, not at all. It’s still the same pattern, manageable most of the time but then critical for periods of several weeks.
But now I do have a better understanding of why it happens.
One of the very painful phases occurred while we lived in America. My doctor prescribed powerful painkillers and directed me towards one of the most eminent orthopaedic surgeons in the Chicago area. He and I met, and before deciding on a course of treatment he sent me for MRI scans. Afterwards I consulted with him again. He put the images on screen and began: ‘Have you spent your whole working life doing manual labour?’ I laughed, and explained I hadn’t spent any of it doing manual labour. He apologised, but said, ‘When we see a back like this, it’s almost always someone whose life has involved heavy physical work over many years.’ He took me through the images and pointed out three herniated discs (commonly called slipped discs). Their pressure on spinal nerves would cause severe pain. And that wasn’t all. He added: ‘You can’t have a back like this and not have arthritis throughout’. I waited for some good news, perhaps a surgical option that would put me right. But there wasn’t one because, he said, no operation would give meaningful benefit. All he could do was recommend physiotherapy and a sensible use of pain medication.
Everything that doctor told me had been true about my back throughout my adult life. No accident had caused it, he said. It was just how my back was. And, in a sense, I’m okay with that. I’d never before really understood why I had ongoing chronic pain with bouts of acute pain. The new knowledge was helpful, and I’d continue to be positive and do everything I should and could.
Is that realistic for everyone? After all, what does a ‘positive approach’ mean for someone severely disabled, such as a soldier who’s lost his legs? That’s a very different situation to mine. I could live life close to what would be normal for someone without a wrecked back. The person who’s lost both legs has much greater challenges to overcome. But that doesn’t mean life must then be lived under a permanent shadow. Good and positive things can still be done.
As a child I read and re-read the story of Douglas Bader. He’d become an RAF pilot but crashed doing aerobatics, almost died, and had both his legs amputated. He fought hard to regain his strength and with artificial legs regained his flying qualifications. But the RAF forced him to retire on medical grounds. Then World War II began. Experienced fighter pilots were in short supply so even Bader with his tin legs was accepted. He won air battles above the Dunkirk beaches and in the Battle of Britain. In 1941 he was shot down over German-occupied France, and made a POW. Several times he escaped but was recaptured and eventually sent to Colditz Castle. After the war he held senior posts in the oil industry, played golf to a high standard, and was awarded a knighthood by the Queen.
Very few can be like Bader. A biography was written about him, followed by the film Reach for the Sky. Why? Because his story is exceptional. But his positive approach to life doesn’t have to be exceptional.
Every blog piece I write is intended to have at least a little wisdom. What’s the wisdom here?
I hope it’s this. I don’t actually like Follett’s reference to ‘the psychological attitudes of the invalid’. It’s far too sweeping. But I came close to permitting myself to think all ambitions had to go, that I could do nothing of significance, and life would have to be lived defensively and dependent on others. If I’d surrendered to those ‘psychological attitudes’ then, in some sense, I would have become an invalid.
That surrender doesn’t have to happen. There is another way of living. I know people who’ve done great things despite great challenges, and I’m privileged that some of them are my friends.
If, in any way, this account of my health journey helps you lift your eyes to better horizons, to greater possibilities, then there will have been wisdom here after all.
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