Dancer vs. doctor: one med student's struggle between her two worlds.

I knew what was coming. For months I had put off going to the doctor. As a dancer, I knew he wouldn't understand me. As a medical student, I knew the generic musculoskeletal exam he would perform and the findings (or lack thereof) that would steer his diagnosis.

I grabbed the sides of the examining table and braced myself--knuckles white, breath held, jaw clenched, abdomen tight, lump in throat, and body awkwardly leaning to the left to alleviate the pain on my right side.

Then, sure enough, the "urgent care" doctor said, "Well, obviously you've got to stop dancing."

I am very familiar with these urgent care doctors. These are the MDs who get an adrenaline rush from dire medical emergencies but are annoyed with patients who are not on the brink of death. They make patients wait five hours only to see them for five minutes. They eat the patient-oriented techniques I have been taught in medical school--NURSE (nurture, understand, respect, support, empathy)--for breakfast. Steel-guarded against tears and emotion, they speak only in medical-ese. I knew what was going to come out of the doctor's mouth the second he walked in the examining room. As a medical student I knew I was supposed to stay rational, factual, and professional no matter what, but my dancer's heart sank and my eyes filled with tears.

"No! You don't understand. That's like a death sentence for me. And I'm performing soon."

"Well, that's too bad--"

"But you haven't given me a diagnosis."

"You've got to stop dancing."

"That's not a diagnosis, I'm a medica--"

"Look, you've got to stop dancing. Dancing causes the problems. If you stop dancing, you'll lose the problems."

But to me, to stop dancing wasn't an option. His "plan" would cause more psychological problems than I was willing to undertake at the time. Dancing was my life--had always been my life--and was the one thing that kept me sane throughout the rigors of medical school. I had fought to maintain my dedication to dancing throughout my academic career, always juggling being a member of a dance company with being a full-time student. I had been told many times before that I had to stop dancing, and had proved everyone wrong. I was not about to stop now.

Since that doctor didn't provide me with any suggestions to alleviate the feeling of a dagger in my back and pelvis, I continued dancing. I know--I'm a terrible patient. Doctors generally are. I knew that the pain was far worse than a mere muscle strain, especially having been told in medical school, "Always be suspicious if a young person comes to you with back pain." But my stubborn head was stronger than my body. For a while.

The pain got worse. Every step I took felt like I was being plugged into a socket and electrocuted. I gave up running, using the elliptical machine, and walking on the treadmill. My right leg was numb and lifeless; I couldn't even go to the grocery store. I gave up yoga. I gave up Pilates. I dropped out of my spring performance. I gave up walking more than a few feet to my car, to school, and back to bed. Still, the pain got worse. And finally, at three o'clock one morning--after having slept no more than four hours in three days, and writhing in pain atop a pillow, then on ice, then on a heating pad, then on the hard floor, then over the exercise ball, then in the bathtub--only then did I give up dancing.

Granted, during those months of restricting my movement, I had also been cutting back on dancing. I took it easy in ballet class. I stopped doing fifth position and stopped jumping. Grande battements were out of the question. When the pain was excruciating, I sat out (in tears). I had been going from doctor to doctor, trying to find someone who practiced the patient-centered medicine I was being taught in school. I sought someone to listen, not just someone who heard words. I sought someone who didn't fall back on cookie-cutter diagnoses because my history was anything but cookie-cutter. No one had stopped to consider that a) as a dancer of 18 years, I have far more awareness of my body than most, hence am able to differentiate a normal dancer's ache and pain from an abnormal and worrisome injury; b) as a medical professional, I have enough scientific and clinical know-how to construct my own diagnosis and research the source of my symptoms; c) the generic musculoskeletal exam may not be sensitive enough to pick up injuries on a strong and limber dancer; and d) I had already rested, iced, and souped myself up with enough anti-inflammatories to give me an ulcer.

My chronic, progressive pain should have raised a red flag--or at least an eyebrow. But my message fell on unreceptive ears, even when I spoke calmly, factually, rationally, and in medical-ese. My physical exam lacked "organic" findings, so I was continually turned away with a vague, guessed diagnosis of tendonitis, overuse injury, or stress fracture. I was finally granted an appointment with a specialist, reportedly the guru of hip orthopedics at my medical school. I limped into his office, hoping to find my knight in shining armor, only to limp out as fast as I could after hearing him say, "I don't even know why you're here; it's all in your head."

Finally, five months after my initial symptoms arose a physician's assistant made the diagnosis: I had a complete tear of my acetabular labrum--the ring of cartilage that deepens the hip socket. If I ever wanted to dance again I needed surgery. The decision to have surgery was obvious; I could not fathom living without dance. Taking up cycling instead, as the surgeon suggested, was not a viable alternative.

On waking from surgery I received an even graver diagnosis: I had congenital hip dysplasia that had gone undiagnosed for 23 years. After 18 years of rigorous dancing, this underlying malformation had predisposed me to premature loss of cartilage in my hip socket. I now had three holes drilled in the socket, and my recovery time to dance again had stretched from six weeks to indefinitely. In my post-anaesthesia grogginess, tears plopped onto my icepack. My head pounded with one thought: "I was never meant to be a dancer."

My life as I had known it had been turned upside down and inside out. I had to relearn how to walk, let alone plie. But these physical ramifications paled in comparison to the psychological. Even though rationally speaking, I still had everything going for me in my professional career, I felt as though I had lost the core of my being. While the thought of never returning to dance was petrifying, what scared me the most was the fact that I would have to look within myself. I feared that I would find an empty shell of nothingness, save for a bruised shadow of what I once was. I feared that losing dancing meant being lost in my own skin forever.

Yet I found that despite being physically unable to move, I was still a dancer. I kept myself going after the surgery, much as I would if I had fallen onstage. The ability to put my best foot forward, with head high, shoulders back, and sternum up, in spite of the ravaging pain, had been instilled in me years ago in the most basic of ballet exercises: port de bras, promenade, and reverence. The discipline that I had called upon in mid-night tech rehearsals or early Saturday morning technique class pulled me through 18-hour days as I studied for the first step of my medical licensure exam. And the compassion that had been essential to my choreography and life onstage rendered me able to take care of those around me, even though I myself desperately needed a caretaker.

I won't lie. The past six months have been full of hard lessons, and I miss dancing. To this day I am still addicted to the sensation of stretching, the air time on a failli assemble, and the thrill of a perfect triple pirouette with a split second of balance before landing. Every neuron in my body, every muscle, tendon, and sinew is primed for movement at a moment's notice. But I needed this injury in order to cast off my safety net; to lose myself, then find myself again; to realize that my self-worth is independent of my physical capabilities; and to understand that dancing does not make you a dancer. A dancer is first and foremost one in the heart.

Mamie Air, company member and choreographer for Yale Dancers, and medical student at Yale University School of Medicine, is studying orthopedic surgery for dancers.