David was a patient during my earliest years in general practice: an otherwise fit man in his early sixties who needed an operation on his ear. The procedure went without a hitch but afterwards David noticed that he was markedly off-balance and he developed dreadful headaches. His description stuck in my mind: he said it was as if one side of his skull was being “squeezed and crushed in a vice”. He illustrated this with his hands, clamping and pressing them against his scalp as he tried to explain.
Initially, I hoped it was something that would settle spontaneously: side effects of the general anaesthetic or the painkillers, perhaps, or some deep bruising that would take a while to resolve. After a few weeks without improvement, I organised blood tests and examined everything my training suggested might be relevant. I drew a blank.
My ear, nose and throat (ENT) colleagues were similarly perplexed when he attended his six-week follow-up appointment. The surgery had been successful, they confirmed, and everything was well healed. They were at a loss to explain his new symptoms.
So began a tortuous process. The ENT surgeons approached the problem from every angle they could: head scan, X-rays, more blood tests, specialised tests of balance. Each flurry of activity was interspersed with interminable periods of waiting for the next outpatient review. Eventually, after many months, the verdict was delivered: they could find nothing wrong and could only suggest I refer David to a consultant neurologist.
A year later, David was no further forward. He continued to complain bitterly of the grinding headaches and the disequilibrium. The neurologist and an ENT second opinion had failed to produce a diagnosis. As so often with “medically unexplained physical symptoms”, the spotlight began to shine on the psychosocial sphere – were these symptoms an expression of emotional turmoil?
David was emphatic: he had emotional turmoil, all right, but that was because the bloody operation had left him in pain and no one seemed to have the first idea how to put him right. His relationship with the medical profession reached rock bottom and though I tried to support him as best I could, I began to dread seeing his name on my appointment list, so impotent did his case make me feel and so angry had he become.
Eventually, I moved to another part of the country, leaving my first practice and David’s insoluble symptoms behind. A decade later, I went in for dental surgery under general anaesthetic. Shortly after getting home, I began to feel giddy and off-balance and I developed headaches that felt as though one side of my skull was being crushed in a vice. I tried various measures but nothing helped. Memories of David inevitably came back to me.
In the intervening years, I had seen a number of perplexing musculoskeletal problems respond to chiropractic treatment where conventional medicine had reached a dead end. I went to discuss my situation with an experienced chiropractor and he knew immediately what had happened: the surgeon, in manoeuvring my head to get access to the back of my mouth while I was under the anaesthetic, had unwittingly deranged the alignment of the bones at the top of my neck. With a few manipulations, my debilitating symptoms melted away.
Since learning this lesson, I have seen several similar cases in which patients can date the onset of back pain or headaches and dizziness to receiving a general anaesthetic. Most doctors are mystified because there is nothing in medical training that teaches us that this kind of thing can happen. To a chiropractor, however, it’s unsurprising. If you haul insensate bodies from trolleys on to operating tables – if you twist heads this way and that while the protective neck muscles are paralysed by anaesthetic – you will very likely put vertebrae out of kilter.
Medicine is a lifelong education. The training that we get in our early years is only a starter guide. Life experiences (our own and those of family and friends), the patients we encounter and the stories we hear continue to expand and refine our understanding of the myriad ways human beings work and don’t work. As well as learning lessons from chiropractors, I have also seen startling results with homoeopathy, acupuncture and psychotherapy. Yet these kinds of approaches are frequently derided by conventional doctors, who reject them because they can’t be understood in our current scientific terms.
If there is one thing that can be said with confidence about our understanding of the human organism today, it is that, like all bodies of scientific knowledge, it will be shown to be woefully inadequate over the next 50 years. The provisionality and partiality of our knowledge should serve to keep our minds open to other ways of thinking.
I can now direct patients with anaesthetic-related back or neck injuries to someone who can help them. My regret is that I didn’t have this understanding when David needed help. I can still see him, clamping and pressing his hands to his scalp, trying desperately to communicate what he was going through but being met with the incomprehension and impotence of his physicians. That has been one of the defining lessons of my career and I try to remember it whenever a patient presents puzzling problems that defy a conventional diagnostic approach.