The most inestimable merit is a complete appreciation of the usual.
The beginning of the mission
Ozzie was a longshoreman supervisor. The splinter that stuck under his thumbnail wasn’t ordinary. Dunnage is the lumber that lies around on wharves to support the loads of ships from around the world. All sorts of contamination accumulate on it, and the splinter went down to the bone. I had removed the nail, cleansed the tissues extensively, and asked him to return the next day because of the potential for serious infection.
Ozzie was on his way back to my office when his car was rear-ended by an Army captain racing back to his base at seventy-miles-an-hour. The crash was so violent, Ozzie’s seat was broken, and he was thrown into the rear of his vehicle. He arrived at my office by ambulance, and I sent him straight to the hospital.
There was no gross neurologic deficit, fracture or head injury, but Ozzie’s neck was virtually locked with his head thrust forward. The pain was intense and constant and became excruciating from any attempt to move his neck. As the spasm receded, I palpated an obvious and persistent exquisitely tender "walnut” size mass high on the left side of the back of his neck just under the skin. I put him into the traditional Sayre Sling-type cervical traction, ice packs, narcotics - the traditional care. Ozzie’s injury happened during the first few years of my general practice. I called in an orthopedic surgical consultant.
After nine days, his pain barely less, Ozzie insisted on being discharged so he could return to work. I begged him not to, and within hours he was back in the hospital, gray and on the edge of shock. Two more weeks in the hospital barely provided further relief.
The orthopedic surgeon pontificated that "since all soft tissue heals within two weeks, any complaint thereafter must be imaginary or faking." That one ignorant, arrogant sentence totally destroyed Ozzie’s legitimate lawsuit. I would hear those words repeated too often over the years. Amazingly, the orthopedic surgeon didn't have the slightest idea what I was talking about when I asked him about the "walnut," and no one else I referred him to did either, yet it never changed. How can someone normal not palpate a walnut just under the skin?
Later, he told Ozzie that if he still “thought he felt pain,” he could hang his head in traction at home. So trusting Ozzie suffered sitting up and shivering through many sleepless nights during that unseasonably cold winter.
Shortly after Ozzie’s accident, I received an announcement for a twenty-hour course in basic joint manipulation in half-day sessions for a week at a Los Angeles area hospital. Manipulation was ridiculed in medical school, but my former brother-in-law had attended osteopathic school after repeatedly being rejected for admittance to medical school so I’d heard the word ad nauseum. Some of my patients had told me they’d been helped by it, and by then I knew that something basic was missing in my teaching.
I tried the little I’d learned on Ozzie, but he couldn’t stand any motion at all. I tried everything I could think of. It was 1962, and a drug called Tubadil® was available. It contained curare, derived from an African hunting potion, the most potent muscle paralyzer known. It was mixed with peanut oil so it could be injected intra-muscularly. Each dose had to be meticulously measured and only increased by 0.1 cc, about 2 drops, from the previous dose while the critical response was watched for: at about 0.4 cc, the eye muscles started to become paralyzed and the eyes would wander. The next increase would paralyze the diaphragm and terminate breathing. Even when Ozzie was administered a maximal dose supplemented with morphine, any attempt to mobilize his neck was instantly agonizing. Nothing I tried helped except when I purchased a Neuro-Orthion traction table that clamps both the head and feet and immobilizes the whole body. It was the only way Ozzie could get some sleep.
Nine months after his injury, Ozzie attempted to return to work although I protested again. On his second day back, he was standing on a ship's deck guiding the winch, and, as he began to look up to direct the hook through a hatch, he blacked out. Ozzie started to fall into the hold toward the steel deck thirty feet below. Another stevedore barely caught him by his sheepskin coat and saved his life. After that he didn’t return to work.
Ozzie’s case was reviewed by Neuro-Radiology at UCLA because it was suggested he had possibly sustained a small fracture which had been missed. The suspicion was that a bone callous might be compressing his vertebral artery which travels through the vertebrae into the back of the brain, so when he had looked up, he might have crimped it, but none was discovered.
For fifteen months I watched helplessly as Ozzie lost about forty of his once vigorous one hundred seventy pounds. Then, one day he came to my office just to talk. He sat with Loretta, his wife, at his side. Always respectful and quiet despite his pain, he looked at me with an additional sadness in his now gaunt and haggard face. He was near exhausted, and this gentle man of strong Christian faith paused a little longer before he spoke, so I sensed all the more the gravity of what he was about to tell me.
"Doctor, Loretta and I are here to thank you for all you've tried to do for me. You were always there, and we're grateful. We've talked it over. I've decided. I just can't take any more of this pain. If there's nothing else to do, I’ve come to say good-bye before I take my life." Loretta's eyes hadn't blinked. Ozzie had done all that I'd asked and allowed all I'd offered. I looked at him knowing how truthful he was, and my gut tightened as I sat back in my chair and knew that I had no choice.
"Ozzie", I said finally, "there is only one thing I can think of that I haven't tried." The doctor who had taught the manipulation course had told me a story of a woman who had been disabled with headaches. There had been no injury. He hadn't found anything on examination, no restriction, no signs of localized changes of any sort, but on an unexplainable impulse, he had offered to manipulate her neck under general anesthetic. He claimed that she had accepted, and for reasons unknown she was relieved. It had happened in England.
There was little similarity. Ozzie's neck was virtually stuck. Under any circumstance, manipulating a neck under anesthesia when all protective reflexes are obtunded bears a considerable burden of jeopardy, but, additionally, with Ozzie, the exact nature of the pathology was not known. Any movement beyond established but undetermined boundaries could easily totally paralyze or kill him.
I had been manipulating for about a year. I’d had some dramatic successes that had astounded me even from the most rudimentary procedures that I had learned,but I had never done anything remotely like what I now contemplated; and there wasn’t a hospital in the United States that would allow me to do such a procedure. I had never administered a general anesthetic. I offered it and told them the fullness of the risks. I would have to do it in my office, and, if they accepted, I insisted on one stipulation: Loretta had to be in the room. Whatever happened, she had to witness it. They looked at each other and Ozzie nodded to me.
For three days I studied, prepared, and prayed. That morning, everything was surreal. I couldn’t speak. I looked at my family and knew I was about to jeopardize their livelihood, my license and my freedom, but I couldn’t allow myself to think about it.
I walked out the front of our home and across the lawn into the front door of my office. Ozzie and Loretta were sitting there waiting, seemingly calm, and, without a word, we entered the small room where I'd set out all the medicines and emergency equipment the night before.
Ozzie lay on the examining table along one wall. Loretta sat against the opposite wall only a few feet to his side. I started an intravenous drip, and when he said he was ready, I slowly injected Brevitol®, an ultra-short acting anesthetic into the tubing. As Ozzie sighed and his chin slumped, I softly placed my hands onto the back of his limp neck, and for the first time since the injury the walnut of segmental spasm wasn’t there. Ever so slowly, I began to rotate his neck, first to one side then the other, tucking his chin toward the curvature above his clavicles (collarbones). Surprisingly, after all that time, there was almost no resistance from scarring that I anticipated as the room was immediately filled with the loudest machine gun staccato of popping noises I've ever heard, even till now. Then I gently applied a series of transverse sheer forces at each vertebral level, as the POW! POW! POP! persisted.
Except for her widening eyes, Loretta sat pale and absolutely motionless.
"I don't know."
When apparently everything in Ozzie’s neck had moved and there was quiet, I began to sag under the dread heaviness of every passing second.
Ozzie's eyelids finally fluttered.
"When are you going to do it?" he whispered.
"It's already done.”
“Ozzie. Can you move your toes?"
"Ozzie, can you move your fingers?"
"Ozzie, can you sit up?"
"Ozzie, can you move your neck?"
Sitting and facing Loretta, Ozzie moved his neck painlessly through the full range of motion. Loretta sagged for a moment, and then she came to us where I was already holding Ozzie,my eyes wet, my gratitude limitless. We stood there for a long time our faces together and arms around each other, all tears flowing freely as we praised and thanked the Almighty.
I looked up and raised my arms and thanked Him again as I vowed that I knew He had put my feet on a path that I promised I would never deviate from. And I never have.
Ozzie’s neck began to tighten again a week later. There had to have been some contractures after so long. I more confidently repeated the procedure, and Ozzie obtained complete and permanent relief. He promptly returned to unrestricted work for six months when he had a mild heart attack and retired.
I examined Ozzie annually for ten years, when I again x-rayed his neck. We remained in contact through the fifteenth year. Never again did he experience neck restriction, or pain, or headache.
I treasure a letter postmarked September 30, 1976
"Dear Dr. and Mrs. Goodley,
Enclosed is a clipping from Long Beach. If we had known about the party I am sure you know that your names would have been on top of the Guest List. We had a very wonderful day. Our one Granddaughter by marriage said that if Dr. Goodley had walked through the door she would have kissed your feet. Her dad was one of your patients in Wilmington a Mr. Smith and you really helped him and put him back on his feet. He is now in Hawaii in a Travel business. Ozzie is still doing fine.
Ozzie and Loretta Hanson
The clipping, dated one day previously, reported their fiftieth wedding anniversary to which more than 150 friends and relatives had attended.
In the following few years, I repeated the procedure over a dozen times studying its applications. Half the patients were markedly improved. There were no complications.
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