Once Upon a backache

I stand up straight and arch my back upwards. It aches and so I lean my arms back and press them against my lower back. I breathe in and I note the equal even movement on both sides.

My patient last week was not so lucky.

For one thing, she would never have been able to arch her back up. Since birth, she had a deformity known as scoliosis, a lateral curvature of the spine. Understandably, that puts pressure on the lungs and ribcage, leading to restrictive lung disease. In her case when we examined her back her ribcage was pushed posteriorly and laterally. The right lung was almost collapsed.

There are signs we are taught to look out for upon inspection to assess if a patient is in respiratory distress: are they unable to lie flat? Are they sitting up and using their arms for support? Does it make their breathing easier? Are they using accessory muscles for respiration? Is there flaring of the nostrils? Is there retraction of the skin on the lower side of the neck with each breath?

With this patient, we only had to look once.


Before we are born a number of genes help to ensure that our vertebral alignment is correct (there's a reason you don't have your feet popping out of your head). One of the most prominent ones are the Sonic Hedgehog genes (And yes, that's really what they are called). They are responsible for directing and aligning the spinal in the correct direction.

For some reason, in some people, they fail.

I am breathing evenly and softly as I consider this. My breathing is so effortless I don't have to think about it or even thank God for it. But last week, I wanted to. For I could see the effort and pain that our young, dying patient had to make; her whole body seemed to gasp and lurch just to take one breath.

I was on call then. My call began with admitting her as a case of acute respiratory distress. It ended with intubating and placing her on the ventilator, a move that we knew would probably be futile as, clinically, her prognosis did not look good.


Here's the thing about being a doctor: when surrounded by too much misery, we start hoping and even Praying for miracles that never seem to come.  But if you are looking and reflecting carefully, you may realize the greatest miracle lies within. And as I inhale now and take in a deep breath, I remind myself that it important not to forget.

Because in a place like Civil, a public health hospital that reflects the dilapidated state of healthcare in our country, it is very easy to forget.