It was a shock to open the exam room door and shake hands with Joshua N., age 18. He reached up and pulled back a shock of stringy, coal-black hair. “It’s okay,” he said. “I’m used to the staring.” By skootching his bottom to the edge of the exam chair and extending his arms onto the arm rests, he was able to accommodate the curvature in his back and level his head. I met his eyes. We shook hands. I recalibrated and quietly asked him how long ago his back pain had begun.
“Maybe four, maybe five years ago.” His voice was silky and low, like a jazz radio host. It seemed disconnected from the frail young man in front of me. “A pillow?” he asked. He shifted slightly and grimaced. “Do you have a pillow you can put under my butt? Maybe another for my back? Chairs and I don’t get along so well.”
I reached into a lower cabinet and grabbed two pillows. Joshua N. half-stood, and I slid one pillow beneath him and placed the other low against the back rest. With half-closed eyes, he exhaled slowly and settled into the chair.
“So anyway, I saw my family doctor first. I guess we were living in Limington [Maine] then, and he didn’t know what to do with me. Eventually, he sent me on to orthopedics. The films didn’t show much back then. I mean, I didn’t have this f***ed-up, crippled look I do now. Orthopedics gave me some exercises and some pills. They basically said that I had a bad back, and I would have to learn to live with it. I got to the point that I stopped going to school. We lived two miles out on a dirt road, and the bus ride just about killed me. So I helped out around the house with my younger brother and sister, picked up kindling outside for the fire, learned how to cook—you know, tried to keep busy.
“I’ve been living on ibuprofen. It doesn’t help much, but when I run out, especially in the morning, I can barely move. They tried indomethacin a few years ago; I remember that by how much it messed up my stomach, but I guess that was better than the ibuprofen.”
“Have you tried anything else?” I asked.
“Last year, we moved up north to be closer to my mom’s family. She tried to home school me and took me to a lady who gave me a lot of herbs and vitamins. What a waste. Oh, here, the medical clinic gave me these two weeks ago.”
