Everyone says that I drive them crazy -- especially my wife. I never tell her she's beautiful or cute, even when I think so. Instead, I say she looks nice. She says her mother looks nice. I say nice is good, real good. Nice is good to me. What if she looks beautiful one day, then the next day she looks even better? I won't have anything left in reserve. You've always got to have something in reserve.

I see people with no reserve all day. That's why I became interested in becoming a pain expert to begin with. What's great about pain is that there's no bullshit. There's no need to spend time talking. By the time I see them, the patients have been given up on by everyone else. There's no meat left on the bone. I admire pain. It demands to be honored. There is no more basic fear than the fear of constant, unending pain.

L. came to my office complaining of pain in the left leg. She is all smiles. I think, this lady is goofy. When I examine her, I see that not only does she have pain but also can't walk very well because her leg has become so stiff. Both she and her husband are smiling like loons. I suspect a spinal-cord tumor and get proven right. I ask the neurosurgeon to biopsy her spinal cord and he does. After the biopsy, her spinal cord has even less reserve and so she learns how to catheterize herself, starts a bowel program and can't use her other leg so well. The biopsy comes back inconclusive. I can't believe it. I spend a lot of time calling the world-renowned pathologist and ask if he can't take another look at it for me. I call the neurosurgeon who says, "I think I got a good piece of it."

"Well, sometimes that happens," she smiles.

I put on a full-court press. I present her to my colleagues, take her spinal fluid, look at her skin, her lungs, her brain, and her blood. Except for an unexplained spinal cord tumor and pissing and crapping in her bed, she is perfectly healthy. Over the next few months her tumor doesn't get any larger, and I throw some drugs her way. Some pills to make her bladder and legs spasm less and some steroids to make myself feel better.

Her husband smiles excitedly and tells me he is so happy to have me. I have the urge to lock the door and keep them shut up forever so they don't get out on the streets. That's all I need, him beaming and her thin as a skeleton in her wheelchair with her tumor announcing to anyone within earshot, "See, look what a great doctor we have. We're so glad to have him!"

There isn't much more to do. Nothing has changed in months. I figure that she'll have a kind of life, but at least it will be hers. I hear from them every now and then. Prescription refills, requests for more physical therapy. They live about a hundred miles away and sometimes come for a fifteen-minute visit. We talk for thirteen of it and then I examine her. I try to schedule them when no one else is around. I'm still their favorite doctor.

One Friday her husband calls up. These symptoms sound different. I tell them to drive the hundred miles to the clinic. A scan shows a two-inch-wide tumor in the back of her brain where three months before the scan showed only brain. She is minutes away from dying from the pressure. Her husband runs up to me and pumps my hand a couple of thousand times and says, "I'm so glad you're here." Her eyes are jiggling around from the tumor and she has a headache, but she's happy to see me too. That night the neurosurgeon unroofs her skull. She starts to feel better pretty quickly. Several pathologists and oncologists from around the city decide that this is an uncommon, but not rare, tumor.

She has started her treatments and comes back today to see me. They are both beaming. Her legs are thin and blotchy red. There is no hair or flesh on them. Her toenails are a fright. She says, "Oh look, look!" She kicks both feet back and forth in her wheelchair to show me. Then she says, "Look at this." She pushes herself up hard, with her hands. Her feet and toes are pointed down because after the spinal-cord damage, her Achilles tendons have shortened and pull her heels up tight. Her face is big and round, a moon face because of the steroids. A layer of fine hair covers it. Her eyebrows are arched and her forehead is maximally wrinkled. She is all smiles and her still-jiggling eyes are pointing down to show me she is standing on the balls of her feet. She looks like a kid. A ballerina. Her husband is proud and looks at her feet, too. Then she sits back down and complains, "Oh, if I could just get rid of this big face."

"No," I tell her, "You are beautiful." 

Nicolas Wieder DO is a semi-retired physician who trained in Interventional Pain Management and who resides in Anchorage, Alaska.