Put my back out this week. I gotta tell ya – my back is my Achilles heel.
How I did it was quite ridiculous. I happened to read a letter in The Herald stating that “antidisestablishmentarianism”, 27 letters long, is the longest word in the English language. “No it’s not!” I cried out loud. “It’s floccinaucinihilipilification!” (28 letters). And promptly wrote a Mr Know-it-all rejoinder to the paper. I did make mention of “supercalifragilisticexpialidocious” (34 letters) just to pre-empt any “Dr Campbell needs to wake up and smell the coffee” retorts. It didn’t work. The word thrown in my face was pneumonoultramicroscopicsilicovolcanokoniosis (45 letters). This is the sort of mindless banter we descend into for entertainment during lockdown.
I wish I hadn’t embarked on this wild goose chase. I happen to have the Oxford English Dictionary, a vast tome and the last word in English usage, encapsulated in a single volume of considerable dimension and weight, which requires a magnifying glass to read (unless, as the daughter of a friend of mine demonstrated, you are 18 years old). It was while I was manipulating this unwieldy volume that something in the lumbar region went twang. Since then I’ve been wandering around like a half-clasped knife.
I did make a self-diagnosis – always a risky undertaking. This was what we call a “mechanical back”. Nothing to worry about. All will be well. I’ve lost count of the number of times I’ve experienced an episode like this. I associate it with poor posture and overuse of the computer. I experienced many such episodes during my career as a GP but I always managed to drag myself out of bed (supposing it took an hour) and crawl into work. Our physiotherapist would glance at me and say, “It’s gone out again, hasn’t it?” and she would give me an instant treatment which was balsam, at least for as long as it lasted.
In hospital, the orthopaedic surgeons hated getting patients with acute back pain referred from the emergency department, because, by and large, they weren’t going to investigate them or operate on them, but merely give them tender loving care. They would end up blocking a bed. Now you might say TLC is not part of the orthopaedic remit. I couldn’t possibly comment.
But I was always very careful with patients with back pain, both in the emergency department and in general practice. I would go over them with a fine tooth comb, looking out for the dreaded cauda equina syndrome, the missed diagnosis that appears with bleak and monotonous regularity in the pages of the medical defence journals. 99% of the patients had mechanical back pain. I would lie prone on the surgery floor and demonstrate the exercises aimed at restoring the lumbar lordosis. Physician, heal thyself.
I have a notion that we doctors don’t really understand back pain. After all, if we did, we might be better at fixing it. It’s a bit like dyspepsia. We used to think we knew what caused gastric and duodenal ulcers, and we performed heroic procedures like vagotomies and pyloroplasties and Billroth 1 and 2 partial gastrectomies. Then, remarkably recently, an Australian physician showed that the causative agent was Helicobacter pylori and all you really needed was a week’s course of antibiotic. Now if John Buchan, Lord Tweedsmuir, had lived in the antibiotic age, he wouldn’t have had to endure a lifetime of tummy ache. Then again, we wouldn’t have had his creation, the American magnate policing the world on a diet of white fish boiled in milk, John Scantlebury Blenkiron.
But to return to pneumonoultramicroscopicsilicovolcanokoniosis (an occupational lung disease, I presume, of volcanologists), it occurred to me to prolong the excruciating newspaper correspondence by coining a biochemical formula of the sort that can be more or less endless, like 2,3,dihyrdopolybenzoicethyleneglycolicorthopentocyclopentanobisblablabla….ene. Or again, a German loan word. The Germans have this great capacity for conjoining and amassing syllables. They do it with numbers. 5,723,927 is fünf Millionen siebenhundertdreiundzwanzigtausendneunhundertsiebenundzwanzig. Pithy. But in the end, I let it go, maintained a dignified silence, shut down the computer, and went for a walk, which turned out to be far more therapeutic.
Now I read The Herald letters column and look out for the daily political diatribes from a well-known corpus of correspondents, guaranteed to make me splutter into my cornflakes. The world is awash with anger. Then my back starts aching again. Maybe lumbago isn’t mechanical at all. Maybe it’s all in the mind.
It doesn’t do to splutter into one’s cornflakes. Far better to read in an open-minded state of calm. You never know; somebody might write so persuasively as to make one change one’s mind. “I beseech you in the bowels of Christ,” said Oliver Cromwell, “consider that you might be wrong.” But if not, and you are compelled to write back, better to do so respectfully, than to carp and snipe. I saw a letter from a Diehard Remainer taunting the Brexiteers about the stinking fish on the lorries at Dover. “Brexit going well?”
Ha! That’s antidisestablishmentarianism’s floccinaucinihilipilification.
Time for another walk.
jamescalumcampbell 