The Pelican Brief

Grantham: "Do you want to talk about the brief"
Shaw: "Everyone I've told about the brief is dead"
Grantham: "I'll taked my chances"

― The Pelican Brief

A short bit of history regarding orthopedic surgery. It is becoming more and more clear that surgery is in my future and it might come through the services of an orthopedic spinal surgeon rather than a neurosurgeon.  It seems like the neurosurgery ship sailed last week while in Attica when I was turned down by that loser three times. At least come see me yourself, examine me, and tell me what you think personally, before you make a decision…dick.

I have some experience here, since a very similar situation with surgery arrived for me in 2013 when I got hit hard on the soccer field.  Rarely do I want to hit someone on the soccer field after a hard tackle, but after a particularly hard intentional impact on the field, I might be ready to take a motherfucker out. It takes a lot to give me to see red on the pitch which means typically when I do…I'm probably not getting up off the field to take that motherfucker out. I've probably been debilitated.   It happened once to my knee.  The asshole (We will call him Cristo) took me down from behind after I made an amazing turn on the ball, beating him, and clearly embarrassing him in front of his friends.  It's a mathematical certainty in soccer that if you beat someone with an ego, their response will be directly proportional to the ratio of their perceived skill level to the skill level of the individual who beat them.  Cristo believes he's the best player on the field. So imagine if he gets beat by an old guy.  You can imagine what his response might be.  What his response will be.  Its a mathematical certainty. And I was younger than I am today.

You don't have to believe me just check the record. Christo has more red cards then the Bellagio has stacked in an uncountable blackjack shoe. Hijack may try to count them but that's way too many goddamn cards to count…even for him.

Anyway Christo took my legs out and I came up swinging. Then just as fast, I fell straight to the ground writhing in pain. He had given my knee more of a knock than it had ever received.  I could no longer walk. Wow… that's a bit of drama license right there, with some foreshadowing. 

That knee injury happened in 2007 and ended my playing career for about a year. The second time I got hit  hard enough to see red happened in 2013.  I didn't hit the ground, but I immediately went to the bench. The impact came from the side, when this asshole played through my left shoulder, snapping my neck from left to right. I was pretty sure my neck was broken.  Playing on our team at that time was a close friend who is also a Doctor of Chiropractic medicine. This kid also played soccer for the University of Tennessee so he was/is an incredible athlete.   He saw what happened and when I got off the field he immediately examined me and determined that my neck was not broken…But I was in a lot of distress. After that night I wasn't playing for a while.  Thus begin my deep journey into true spine and neck injury and the potential fixes thereof.

The pain in my neck and upper cervical region…the spine being divided into four regions, cervical, thoracic, lumbar, and sacrum…what's up the no joke variety.  You've all had a kink in the neck that does not permit you to turn your head left or right, however this kink was accompanied with the pain of a pinched nerve. A few days after the hit while trying to endure the pain I woke up In the middle of the night with that nonlinear nerve pain that told me I'm going to the hospital or I'm jumping off the roof. 

This time when I arrived at the emergency room I could point to a specific moment in time where an injury occurred. They were more accepting of my pain and definitely tried to do something about it. My descriptions of the pain I don't remember completely but I'm pretty sure I use the phrase I'm jumping off the roof level of pain. Not whatever triggered the idiots and the current story to provide no shits for care whatsoever.  I definitely asked for an MRI and as I recall I did receive a small bit of pushback from the emergency room doctor.  Trust I believe overcame the doctors reticence. He believed me. He scheduled the MRI fairly quickly and I was being wheeled through the underground passageways to the room for the procedure.  Ahead of the procedure though I still remember when the narcotics hit my system.  I would have to check the medical record but I'm fairly certain IV delivered Dilaudid was the ticket and I remember neck pain fading away.  

My discharge from the emergency room the next day was complete with a recommendation for follow-ups with a neurosurgeon and a pain management clinic. Both of which I scheduled very quickly.  The pain management clinic came first within just a day or two and I was in to an office experiencing my first guided epidural.  Basically you're getting an injection of painkiller directly into you your spinal canal at the level of what they believe to be the injured disc or nerve or vertebrae. The complexity of the spinal column can not be appropriately represented in pictures and standing plastic skeletons. These are dry representations of what is a very wet human environment.  Everything in a spinal column is contained within a sack of spinal fluid. The nerves, the discs, and of course the spinal cord itself--the second most intriguing piece of evolutionary bio-engineering apart from the brain itself. What is this highway of nervous function? Is it an electrical wire? Is it a chemical pathway? Recent research into such things as the Vagus nerve has resulted in a whole new field of medicine that treats the central nervous system not unlike a computer's internet protocol based ethernet. Messages are actually sent with discrete protocol from organs in the body to be interpreted along the way along the way by other nodes.  These messages can be recorded, copied, and played back within your body on the same network.  In this manner signals from the Vagus nerve can signal your body to make certain adjustments. These observations have kicked off an entire wave of vagal nerve stimulators (VNS) that are available for a slight charge at the end of this presentation. 

Yes unfortunately the science is new yet the internet has already picked up on companies providing the hardware to do Vagus  Nerve Stimulation that has already reached for and received FDA approval.  I only bring it up as an example of future technology that could have vast implications in neuroscience. Let the buyer beware at this point in its development.

So I found myself driving into one of the medical centers in Northern Virginia for my first guided cortisone epidural.  The price for such pain relief at this point in 2013 was about $1,500 a session.  Nothing really different from any other doctor's office I had ever been to…a bunch of strangers sitting in a waiting room, in various and questionable levels of human suffering, trying not to make eye contact. COVID changed all that when we could wear surgical masks in those waiting rooms and hide most of our feelings.  

A guided epidural requires the doctor to insert a needle at the level of the offending pain inside of the spinal column. This means he's penetrating the sac of fluid that surrounds all of this mechanical and biological and electrical and chemical mystery. His needle is guided not so much to get to the right spot but to keep from hitting the spinal cord itself which would be a disaster.  There's a Goldilocks feel to it…You got to get it just right. The cortisone he will inject will surround the disc but it will go up and down in the sac as well as it flows out as a liquid would.  They include with this procedure an initial injection of lanacane, which is a pain deadening medication that works immediately. If they hit the spot there is a potential for the pain to be remediated almost magically. The cortisone steroid itself could still take 24 to 72 hours to have its therapeutic effect. 

Apart from the very strange feeling of a hypodermic syringe penetrating your neck region, I could feel the needle going in, this is not for the light hearted. When the needle penetrated my spinal column, Katy Perry's boyfriend had nothing on the fireworks that were going off in my neck.  

The difference however is that it was enveloping the exact region where the pain existed. The doctor said “a little pinch” what thefuck…which is a strange thing to say given the needle had already penetrated…and in went to lanacane. It was A

immediate pain relief as he pressed the medication into the canal. The cortisone followed,  the needles were extracted, and I was pain-free. This ladies and gentlemen is the miracle of modern medicine and of course the science of pain relief.  It works. Here's my check for $1,500 bucks. Thank you, thank you, thank you.

I was given the basics of aftercare and told the procedure should last for 4 to 6 months. Given the pain I had been in for 4 to 6 months sounded like a lifetime. Unfortunately in about 2 weeks I woke up in the middle of night and it was almost an exact repeat of the previous night in the emergency room…without the MRI. But they did give me intravenous Dilaudid and sent me free in the morning to head for my neurosurgeon and potentially the pain management clinic. I called my neurosurgeon’s office in the morning and was able to skip an appointment with him and I was heading straight to the $1,500 clinic for another injection of pain relief.  

Same procedure with the needle but this time a little less immediate effect, and unfortunately even with the cortisone within a week the pain had returned and I was back in the neurosurgeon's office with the previously reported left hand hook over my head indicating surgery. And in particular spinal fusion at the C5/C6 level. Now comes the rest of the story. 

Because I had gone to see the orthopedic surgeon about the cure for the pain, orthopedic surgeons are guys who like to do surgery. It's their bag. I can't fault them for it, it's like an auto mechanic who likes to work on a car, let's open it up and get in there.  What I didn't know is that orthopedic surgeons also have a side hustle. In many cases they own a secondary company that is in the business of buying the orthopedic parts that they actually install in our bodies.  Not going to go into the legal reasons for doing this because they have their own legal risks and ramifications of installing a foreign objects into human bodies with their own hands that have to be mitigated through all kinds of legal channels including threats to their livelihood through malpractice and the like. All of that leading to our healthcare costs to us and I'm very uncertain outlook for American healthcare in general. 

Nothing crazy about that in a capitalist society and everybody should be owning a company pushing the throttle up to take full advantage of profit, their own blood sweat and tears, to make a better life for themselves and their family.  I don't like it when exploitation begins to occur. I don't like taking advantage of people and I certainly the test taking advantage of vulnerable people. Even the best of us get the nasty taste of our own vulnerability when we can easily get duped into a social engineering scheme and stupidly give up personal information about ourselves before we realize we're telling someone we don't know just a little bit of information that they can use to begin their work with penetrating or bank account.  If I can be duped on the phone by a phony call from the electric company anybody out there can be duped on the phone…it was my greatest fear when my mother and father were still alive because they would take incessant calls. My dad, a great dick in his own right when talking to these assholes, was good about it until he started down that long path towards dementia. In this vulnerable state why wouldn't he give the friendly man his credit card number. Why wouldn't he give his nephew who is in jail and talking to him on the phone his credit card number. These low life scumbags they take advantage of the vulnerable deserve a special place in hell. 

But look, I'm about to launch into the seedy underbelly of the orthopedic medical industry, whereby arguably the top of the heap humans, who are some of the most agile and highly trained  professionals in the world can still succumb to graft, fraud, corruption, an exploitation.  I don't know how many ethics classes they take in medical school…but for some of these doctors they didn't take enough. 

Yes, my neurosurgeon approved a single fusion at the C5 and C6 and scheduled me for surgery, And that surgery would be done within a few days. I began the process of setting up pre-surgical appointments in the necessary things to do to be in place on the day I was to be cut. I also began seeking their second opinions which directly resulted in another surgeon explaining to me the need to fuse both my C5/C6 and C6/7 with some very sophisticated and new articulating hardware. 

This all sounded great until I was talking with another individual in his office about financing the surgery. Wait a minute, what about insurance? Oh insurance doesn't pay for this procedure…For this double spinal fusion I was looking at a price in about the $30K range.  Easily reachable, just like buying a car. And that's exactly what it felt like…I felt like I was about to be bumped up to see the manager after I was asked about the undercoating and top coat seal for the paint. 

I had my wits about me although pretty sure I was living in pain and probably on some oral narcotics during these appointments. But I knew I had more second opinions from other doctors to check in on. Including two of the more appealing ones which were orthoscopic surgery to just remove the offending parts of the herniated disc and of course traction itself. My soccer friend was screaming at me to come into his office to get traction before doing any of the surgery. 

Through a friend of a friend who was always willing to do favors I  got in contact with a neurosurgeon from out of town. We will call him Deepthroat. We talked on the phone. In a much older, highly experienced, and raspy voice he talked me through what he perceived as the corruption rampant in the field of orthopedic surgery.  If there's a surgical device to be implanted somebody has to make that implant. Somebody also has to put that implant into a human body. You can't just make an artificial knee without having a surgeon willing to insert that artificial knee into a patient. You can't sell anything without a sales force. The orthopedic surgeons become that salesforce for these orthopedic devices of every shape and size…

I'm just not talking about the device itself…the mastery of modern mechanical engineering representing the movement of a shoulder or knee, I'm also talking about all the stainless steel rods pins and screws and special purpose tools to make it all work.  There are a lot of companies out there that build the specialized equipment. There's every competition…and no real standards. Even something as simple as getting an implant in your jaw for a crown to hold your beautiful New smile comes with a screw by a certain manufacturer with a certain fit.  You have to have the exact screw you have to have the exact hardware or your tooth isn't going in. Deeper in the body it's all the same mess. Show up with the wrong tool and the wrong screw, You might as well be at the mechanic shop removing your spark plugs with an air hammer. 

So in order to create a salesforce of actual orthopedic surgeons who are vested in the business of buying and selling orthopedic hardware to insert in human bodies, surgeons are given a piece of the action. They can actually own the company that buys the hardware from these manufacturers and then sell that hardware back to themselves for the actual surgery.  

I once lived across the street from and orthopedic surgeon. I just figured he did well because don't surgeons do well? And really nice cars, but also a yacht, then what really got my attention was the King Air aircraft that he also owned.  Once you push into that league there is more going on profit wise then anything you can do with your bare hands. You can work 24 hours a day 7 days a week at a really high rate, the highest you can think of, But you're never going to be able to afford an aircraft without figuring out another way to garner income.  Do you have to have a piece of something bigger. 

As Deepthroat continued to talk to me he gave me some links to some lawsuits that were happening around the country. Good people, thankfully, have already discovered some nefarious shit going down, and along with help from the Justice Department, we're going after some of the most unethical of the unethical in this underworld. 

It's unimportant for me to name names and places to reveal what I'm trying to reveal about this. Companies that were party to these lawsuits had medical doctors involved and we're working out of various medical schools to recruit new doctors into into this highly questionable trade. 

Growing more more curious about my neighbor I did some research into his past. When I discovered that he attended the medical school implicated in some of these lawsuits my blood ran cold. I felt exactly like Sandra Bullock in the pelican brief when she realized the depth of the corruption she had just penetrated and realized her life was in jeopardy.  I shut down the computer, pulled the plug, and sat there staring at a black screen. I'm pretty sure I even looked out the window for any strange dark cars sitting at the end of the street. 

I wrote all this up in my typical fashion years ago with the intent to post it on the internet in my normal blog site.  I didn't do that. Instead I put everything in a folder that's still on my computer marked “The Pelican Brief”.  Now I find myself back in the same business of requiring medical care from the same profession. I am going to tread softly and deliberately into this area for my own benefit but I will keep my eyes open. Everyone should keep their eyes open.