A scrub jay darts out from underneath the maple tree and emerges onto the peak of the adjacent cherry tree.  He flaps his indigo and royal blue tail feathers in unison, shakes his head north, south, west and swivels ninety degrees to glower with his puffed up chest toward the east.  A moment later another scrub jay drives out of the maple, down to the garden, and with a zig and a zag, retreats back to the tree carrying a thin, long twig.  The male, distinguished by the narrow white stripe over his eyes, surveys the land for new predators and, once satisfied, zips under the dripping mass of green leaves.  

I realize I have been mesmerized and have not moved since this display began.  I begin to water jog slowly, and quickly reach a consistent rhythm.  The clear water laps around me and seeps in and out of my flotation devices as I scan the theater, my yard, for more action to observe.  This scenario would repeat many times over the next four days as the jays built their nest and I did PT in my tiny therapy pool. On good days, I noticed these events as invitations to breathe deeply, marvel at the mystery and feel the beauty in my life.

Because of the nest, my partner Sherry and I decide to put off pruning the maple tree until forever, and I cease my annual rumination on how the maple’s flowing leaves shade our vegetable bed. Finding the bird’s nest precipitates a full cure, though not the one we have been waiting for.

On a late afternoon after I watch both the adult birds fly out, I looked to see if a nest really exists. I still have delusions, but I learned that the scrub jay nest is not one of them. It is tightly woven with deep and steep walls and sits firmly between hugging branches. I wonder if the eggs are already laid and If the 16-19 day incubation period has begun. Scrub jays are altricial: once their eggs hatch, the young birds stay in the nest for the next 18 days or so. They are born void of feathers, dependent and unable to move much. As I read this information in my dog-eared bird book, while lying flat on my bed, a sweeping shadow crosses my mind’s eye. An hour later, still in the same position, I understand the shadow’s message. I have something in common with these baby birds. I am void of feathers, I am unable to move much, and I am dependent, much more than I can accept at this stage of my fifty-five year old life.

Nine years ago the dominant form of art in my life was movement. Weaving on ice skates and stick handling with a puck were the brush strokes of my paintings. When I ran, making unusual strides and shifts to accommodate the terrain, I heard jazz loud and clear. My college basketball team was sometimes a well-choreographed and fast-paced ballet. Movement was how I reached calm, found balance, and experienced joy. It took a single moment on an otherwise remarkably normal day to interrupt this artistry and introduce me to a new and more complicated relationship with my body, with balance, and with joy.

The house was still and cold at 5:30 AM and the wood floors creaked as I walked to the kitchen. It was the last Friday in April 2002. I sat down to my bowl of hot oatmeal with almonds, flax and apple and readied myself to go to work. As a doctor at the UCSF AIDS Clinic at San Francisco General Hospital, I took care of patients with HIV/AIDS, collaborated with them on their own healing journeys, taught and mentored as much as possible and did my share of administration. I worked with uplifting and brilliant people, surrounded by exciting ideas, exchanges and compelling projects, all day and often in the night. I felt deeply content, inspired daily to be the best doctor, advocate and teacher I could be. My work offered an abundant opportunity for both service and science; I had long found my calling, my colleagues, and my professional home.

By 6:30 in that evening I managed to have enough patient matters tucked in and I decided to spring loose from my ever expanding pile of work. I rode my bicycle to the yoga studio and arrived in time to slip into place just before the class began. Sherry’s face lit up when I arrived, and then she gave me her very seductive wink. I lit up and winked back with far less acumen but equal intention. After a few deep breaths I felt my pulse start to come down. I radiated heat and sweat from the bike ride; I was warm and ready to begin. A substitute emerged, saying that our beloved instructor Margaret was not well that day. The fifteen regulars exhaled a disappointed murmur.

I stretched upward with a deep breath, then my chest expanded symmetrically and my arms splayed downwards as I released the air. By the time the class was half over, I could see that the sub was visibly frustrated with my limited skill and how I modified multiple positions to avoid the torn cartilage in my left knee from locking. But I was having fun, so I moved to be out of her visual field. From the very back of the room, I enjoyed observing Sherry’s graceful moves, lean spine, and her strong arms. I bent towards my toes and unexpectantly felt a flash of pressure in my spine and thick, dense heat marching down my lumbar spine and left leg. I laid down in the back of the class, my mouth and my face contorted as I silently but strenuously cried “NO!” Sherry sensed something was off and came back to check with me—and instantly sensed something was very wrong. Sherry put my bike on the rack and packed me into a flattened front seat. On the short drive home I told her that I didn’t think I would ever be going to another yoga class.

Discordant notes of wrenching back and buttock pain, severe spasms, electric shocks, burning nerve pain and muscle weakness joined my somatic lexicon that very weekend. I didn’t know for certain which anatomical parts I had injured in my spine, but I did sense that something big had shifted and I feared that nothing would ever be the same in my life.

One of my favorite teaching axioms has always been, “Denial is the most powerful physiologic mechanism.”  Despite the worsening pain, I decided to delude myself into believing that I would be better within a week or two, and continued appropriate conservative treatment with physical therapy. My symptoms worsened significantly; six weeks dragged by and we realized we needed to take a deeper look and understand more about this “injury.”  I then entered the spinal industrial complex, and a new patient was born.

The first four years, I remained outwardly confident and inwardly questioned whether we would be successful in restoring me to my pre-injury state, or somewhere proximal to it.  Having turned towards orthopedic science previously for a hand fracture, a troublesome accessory foot bone that had become injured, and the repair of two knees with torn cartilage, I had the perception that with a knowledgeable doctor, things would go well. I underestimated the treatment complexities of spinal problems even though I knew them well: A small irony was that I had been teaching the UCSF medical students and residents about the diagnosis and management of spine disease since 1996.  I forgot, of course, that denial is the most powerful physiologic mechanism, especially when the medical issue is your own.  

The hot sun pushed through my living room window and transported enough bright light to warm the pale yellow walls into a safe, golden yellow afternoon den.  Up until then, I had only observed this serene and peaceful transition on a weekend, but here I was on a Wednesday afternoon, recovering from an open far lateral discectomy, my first spinal surgery.  I had finally found a position that was tolerable and I was dreamily debating with myself about whether I should get up and go to the bathroom or just stay and relish my new pain free position.  In that moment, I absorbed how suffering people might lie down in the snow and slowly convince themselves to stay and die happily.  Everyone was at work except me and Allicat, and she, being a cat’s cat, actually thought I was home solely because she preferred it that way.  

After the discectomy, I recovered quickly, and returned to work in twenty-eight days.  For the next ten months I rehabbed with ferocious passion and developed an even stronger core.  But, here’s the thing: I still couldn’t sit very long without serious pain in my spine and electric agony down my left leg.  The sitting problem worsened and then another part of my spine became affected, manifested painful symptoms, and then progressed.  No doubt about it-I was back in spinal hell.  As before the discectomy, I sought help, I researched my options thoroughly, consulted widely, debated and questioned all the treatments.  This entire scenario would repeat, multiple times, over the next eight years, as my functional status declined.  

It was a sunny and warm day, early in the spring, and mounds of snow were melting around the edges of a mountain meadow.  Here I was: I felt wonderful.  I was in my favorite black running shorts so I started running fast. I noticed that I had no pain, and I ran faster.  Still no pain. I became giddy and felt so comfortable that I sprinted through the center meadow.  Toward the end of the meadow, I lifted off the ground, flying a few inches above the meadow’s fragile floor. I awoke to Allicat’s inverted claw gently stroking my cheek.  I was confused and then desperately sad to be back in my hurting body. I tasted the dream all day, clung to it in my less busy moments while washing my hands and stethoscope between patients.  

Everything in my life felt threatened-my happy marriage, my content professional world, my sense of humor and, of course, my physicality.  I vacillated between the raw anguish of the reality and my desire to place it all directly into my denial/suppression file.

Though I’d been able to return to work, I now did all my work standing, including while talking to my patients, and I regularly apologized for standing while they sat.  I missed being at eye level, and they did, too.  However, over time, something shifted in the exam room.  Although my patients had always experienced my compassion and love for them, they now saw me as vulnerable, despite my best efforts to hide, deny, and minimize my symptoms.  My patients could see my spinal disease and identified that we were both experiencing pain and illness. I had joined them in the universe of suffering, and our relationship was enhanced by it.  In an unspoken way, my illness dissolved a boundary between us.  

As my spinal disease progressed, I could do less and less.  After eight years I wasn’t able to drive, I couldn’t sit more than twenty to thirty minutes a day, I couldn’t stand up for longer than ten to fifteen minutes at a time, and could do so only four to five times a day.  I was in a significant amount of pain, all the time.  All this meant limited contact with my patients, work life, and the entire world outside my own house, which profoundly affected all my most significant relationships and especially Sherry.  

Sherry and I have lived more than half our lives together.  As peers, athletes and activists we have loved, struggled, laughed, collaborated, hiked and guided each other through our late twenties into our middle sixties.  We have built and solidified the love and experiences of decades into something tangible that we both come to for nourishment and refuge.

Despite the beautiful relationship I have with my wife and amazing family and friends, I still became physically isolated from work and all my familiar haunts and habits.  I had always appreciated solitude and reveled in it.  However, this was a lot of unplanned solitude with limited mobility, a package, I know I didn’t order.  Over time, all of my important relationships have become savvier about how to love and laugh in this new conformation.  

I now know I have a yet unnamed connective tissue disease that caused the breakdown of the cartilage tissue in both my knees as well as the five discs of my lumbar spine and some in my thoracic and cervical spine.  Both the cartilage and the spinal discs normally have a great deal of collagen; they both function to separate and protect the bones above and below them and permit safe movement in the spine and knee.  Most likely, some key protein in me is missing, a simple omission with profound consequences.  

My feet used to anchor me to the Earth; I was fluid, lithe, athletic.  All these years after that chilly quiet morning in April, 2002, I am wobbly, my feet hurt and I am prone to bumping into things.  As a rule, nerves don’t genetically like being compressed for more than a few months; my L-5 nerve was compressed for over seven years, and now harbors an irreversible grudge that effects my left leg and bottoms of both feet.  All day I feel the current of three NYC subway lines trudging through my feet, intermittently dropping yellow sparks.  The outside of my left leg and my thigh host a colony of one thousand sensory bees that sting, prick and burn without fatigue.  After four spinal surgeries and much cobalt and chromium artificial disc hardware, my time spent upright has improved.  With crutches to guide my feet and unload my spine, I can triple my upright and walking time and stabilize my gait. Balance is more syncopated for me now, and my movements have taken on a profoundly changed artfulness.

The inbound and outbound flight patterns around the scrub jay nest remain busy while I watch from my outdoor theatre—my therapy pool. The scrub jays have been collecting and saving food, and within the next few weeks, baby scrub jays will arrive. In the pool with the floatation devices I am freed from gravity, truly weightless and my spine is unloaded; I am thriving. I keep hoping to find more ways to suffer less.

During these long years, I’ve found that if I was hoping and organizing to the nth degree how I would become all better, I wasn’t living with reality. Living in the future, I was missing some of the more difficult moments, but I was also missing some of the joyful ones. I still do everything can to improve my condition, but when I arrive at now, surrounded by things exactly as they are, I become most alive. The present moment is so different from what it used to be but, still, I can feel it’s richness; it is nonlinear, tenuous and fluid peace that I keep renegotiating.