CHAPTER TEN
JANET
Let us not weep for those who have gone away when their lives were
at full
bloom and
beauty. … who shall say whether those who die in the splendour of
their prime
are not fortunate to have known no abatement,
no dulling
of the flame by ash, no slow fading of life’s perfect flower?
- Helen
Keller.
Mrs.
Janet Jones had been a patient for some five years when I became
alarmed during a routine consultation. A delightful woman and the
wife of my old friend Jack, after whom I had coined the phrase “the
Pisa sign” for a spinal antalgia, Janet had been in a severe car
accident in her youth and had been thrown out of the car,
fortunately sustaining nothing more serious than a fairly nasty
whiplash.
Annual congresses are often quite dull affairs but, that year, I had
been stunned by the professor of radiology at a local medical school
who had given our profession a wonderful series of lectures on his
research into whiplash. Quite indifferent to safety belts, I
had been shocked when he reported that, of the one thousand cases
included in his research, many of whom had died, only five had been
wearing safety belts. Many of the others had been thrown through
the windscreen or out the door, doing their bodies and heads
terrible, irreparable damage. The memory of Princess Di was still
fresh in our memories.
‘I
was lucky, I suppose,’ Janet said to me one day. ‘I suppose I
should be grateful that I’m not in a wheelchair. But it’s good
business for you,’ she said with a twinkle in her eye. ‘One man’s
meat and all that.’ My patients enjoy pulling my leg.
Janet had been more fortunate than some. Nevertheless, the only way
she could cope with the pain in her neck, and the headaches, was a
monthly ‘grease and spray’. An English teacher of note at the local
high school, long hours of marking took its toll.
I
always looked forward to Janet’s visits. She was something of a
maverick and we had wide ranging conversations on politics, religion
and whatever else took our fancy. Corporal punishment was one of
her favorites. ‘Spare the rod and spoil the child,’ she quoted to
me one day.
‘I
always find it fascinating how you atheists are quite ready to quote
from the Bible when it’s convenient!’ I retorted, remembering how a
particularly nasty teacher had caned me in front of the whole
class. Janet was not at all religious but she still held to many
old fashioned ideas.
‘I
don’t know why you men are so cowardly about physical punishment,’
she went on. ‘In any case, I can be far more cruel with my tongue,
when I’m in a vindictive mood, than you ever could be with a cane.
We need to banish hellkites like me from our schools, not caning!’
Although I couldn’t see her face, I knew Janet was teasing me, but I
didn’t let on that I had no idea what a hellkite was. But I could
guess. Her reputation as a much loved, but firm, teacher went far
beyond her school.
‘Well it’s true that I once chose six lashes on the backside rather
than being grounded for a whole term,’ I said, remembering the day
when I had been foolish enough to take a bottle of hydrogen sulphide
gas from the lab into the school dining room. I may have fooled
some of the staff sitting at the high table that the beans we had
for dinner were having their effect, but not the science teacher. ‘I
deserved it and, believe me, I never tried that one again. But there
again, that thrashing must be what caused my warped personality,’ I
grinned at her.
‘There you are,’ Janet took her opportunity. ‘You also really
believe in caning. Some of the kids have become impossible since we
abandoned corporal punishment, and everybody suffers from their
abuse, especially the other children who do want to learn. They also
have rights you know. And don’t think for one moment that you are a
kinky chiropractor just because once you were fairly disciplined.
Something much more sinister brought that on,’ she went on with a
laugh.
‘Janet, I want you to purchase a lectern to do all your marking. I
have a patient who makes one at a very reasonable price.’
‘A
lectern! Only priests use lecterns. I’m a teacher, not a priest.’
‘Ja, well it’s high time you learnt a few things from priests. In
this instance, how to save your neck. A lectern takes the stress off
your neck by tilting the books.’
‘Well, call it something else. A tilting desk, perhaps?’ she said
with a smile.
And
so went our sparring as I was easing the knots out of her neck in
preparation for an easy light adjustment of the subluxated axis bone
that caused many of her headaches. Lying face down during much of
the consultation, out of eye contact, many patients feel free to
talk about personal and private topics that they need to get off
their chests. Every chiropractor is something of a shrink, too.
‘Are you angry with me, today?’ Janet asked one day, as I was
working on an active trigger point in her trapezius muscle, using
the Nimmo technique I had learnt many years ago from an elderly
chiropractor. ‘You’re being a proper misogynist.’
‘Misogynist? What’s that?’ I asked. Janet often used words that were
beyond my vocabulary, not to impress, but simply because she was a
true scholar.
‘I’m not
telling you. You will have to look it up in the dictionary,’ she
said with a laugh.
I walked through to my private office where I dictated my reports
and pulled out a copy of the Shorter Oxford dictionary. A moment or
two later I was back with Janet. ‘It’s not true!’ I said,
indignantly. ‘I like to hurt men just as much as women!’
‘Okay, then you’re just a plain sadist.’
Janet’s
neck had lost the normal curve, the lordosis as it is called,
due to a partial rupture of a stabilizing ligament in the neck.
Almost invariably this finding is associated with chronic neck pain
due to the change in the posture of the head and neck, particularly
if a patient works with her heads tilted forwards, such as marking
books.
Unfortunately Janet also had one very serious vice. A heavy smoker,
she puffed away at every opportunity, particularly when marking
scripts and, as the years passed, her blood pressure began to rise,
slowly at first, and then 
more
rapidly as she began to put on a middle-age spread. One of the
great difficulties of becoming too friendly with patients is that
they often will not take one seriously when one has serious things
to say.
‘Janet,
your blood pressure today is 158\102,’ I announced one day. ‘You
just have to stop smoking, otherwise you will be taking pills for
the rest of your life.’ I also had quite a successful acupuncture
program for smokers but, try as I may, Janet would not even consider
it.
She just laughed at me in her infuriatingly disarming manner. ‘Then
you had better send me to my GP.’ She had that manner of women who
know how to get their own way and I was quite unable to be stern
with this charming woman.
‘Why is it you are so insistent about my smoking?’ she asked, one
day, angrily. ‘Why is it so important to you?’
‘Smoking has a devastating effect on your body, Janet. It cuts ten
years or more off the average smoker’s life.’
‘But how? I mean I know about the risk of lung cancer and emphysema.
But is there more to it than that?’
‘That’s only the tip of the iceberg, Janet. The worst part is the
effect on your blood vessels. Because cigarette smoke releases so
many toxic chemicals and carbon monoxide, the arterial walls become
hardened and weakened by a process called atherosclerosis. There
really is a high risk of heart attack and stroke. Do you want to see
your grandchildren grow up?’
‘Oh, shut up Bernie. You’re just using scare tactics on me,’ and she
stormed out. It was a good few months before Janet consulted me
again.
Another few years went by. Janet came and went. Another set of
x-rays confirmed the onset of arthritis in her neck, the inevitable
deterioration after trauma but she continued to respond well to
treatment. Her blood pressure was reasonably well controlled by the
medication but, on occasion it rose alarmingly, such that I
periodically declined to adjust her neck. I had by this time
stopped nagging her about her smoking. We had both accepted it.
Then came the fateful
day when Janet declared that she was getting a new kind of
headache. She had recently become quite concerned about her chubby
appearance and had joined a group of joggers. Everything was fine
except for the fact that she got a dreadful headache whenever she
went running.
‘It’s right
here, Bernie,’ she said, pointing to her temple on the right hand
side. Quite different to the sub-occipital region where her “neck”
headaches settled. A careful examination revealed nothing, except
for a possible change in the optic disc in her right eye. Not one
of my fortés,
I thought that another opinion would be in order. An initial
referral to Janet’s general practitioner proved quite pointless:
‘Dr. Raaff just tore up your letter, Bernie. And really, aren’t you
fussing about nothing? It’s only a headache.’
I was confident of my clinical impressions and was in a foment of
anger that he had so lightly dismissed my concerns. Afterwards, it
seemed inconsequential when compared with Jack’s explosion of fury.
The doctor was fortunate not to be disbarred.
I was
determined not to be intimidated: ‘We’ll wait a few weeks Janet but,
if you’re not improving, then I am going to make an appointment with
Mr. Hyde.’
‘How did you know,
Bernie?’ It was a call out of the blue from our local neurosurgeon,
Jonathan Hyde with whom, inevitably, I had quite a few dealings.
‘Know what?’ I replied, not at all sure what he was talking about.
‘That Janet Jones’s headaches were so serious? I examined her
thoroughly and, other than that possible swelling of the optic disc
I could find nothing. Even that was very marginal. But because you
were worried I decided to do an angiogram. I don’t like doing them.
I’m afraid Janet has a huge aneurysm in the Circle of Willis. We
are going to have to operate and frankly its risky. It will have to
be a team affair at the Westmeade Brain Centre.’
An angiogram is a now less frequently
used test, as it is mildly dangerous with a two percent rate of
morbity. An iodine-based dye is squirted into a catheter inserted
into a blood vessel in the groin from where it is guided into an
artery to the brain, which is then x-rayed. I later saw the
pictures. It looked as though Janet had a ping-pong ball right in
the centre of her head, where the blood from all the arteries to the
brain collects in the so-called Circle of Willis. It is a very
sensitive area of the brain and right adjacent to the optic chiasma
where the optic nerves cross on their way to the brain. On further
questioning and examination it had been discovered that two new
pairs of spectacles bought recently for blurred vision were not
because there was anything wrong with Janet’s eyes.
Janet was going blind because of the enormous bulging artery
pressing on the optic nerve, and so she elected to go for the
surgery. She knew the risks but she couldn’t handle the thought of
being without her sight and, in any event, the aneurysm could burst
at any time. I phoned her the night before she went into hospital.
She was optimistic and chatted on gaily: ‘I am going to be a good
girl from now on, Bernie. Sign me up for those needles of yours,
when I come out. I really want to give up this nasty weed.’
I
was just dropping off to sleep the next night when Jack called.
Janet had died in surgery. During the autopsy they found two more
aneurysms. Cerebral aneurysms occur almost exclusively in smokers
and heavy drinkers. Janet was a tee-totaller. A wonderful,
generous, fun-loving woman, Janet had lived life at full speed, and
was undoubtedly in every way a fulfilled woman. But she died twenty
or more years before her time and left behind a desperately sad
family, and never saw the lovely grandchildren that I had the
privilege to treat years later.
