from 1991 until 2013, when, in his mid-
fifties, he performed that last case. Like
many surgeons his age, he wasn't educat-
ed about the detrimental health effects
surgery could bring. Still, he was always
keen to stay fit. "I did a lot of core exer-
cises every day, and my lower back is
perfect," he says. "But I never even con-
sidered [an injury to] the neck until all of
a sudden, there it was."
He then paid more attention to table positioning, tried to avoid pro-
longed awkward positions, operated more slowly when possible and
took microbreaks to stretch or pause. Although often "any extra time
seemed a luxury, so you just pushed through [the pain]," he says. "It
seemed like in order to keep your income relatively steady as time
went on, you had to do more and more cases."
In 2004, Dr. Levin developed two herniated discs in his neck from
degenerative overuse. He blames it on the rigors of operating. "The
twisting and bending and contorting, trying to see things in the pelvis,
caused a lot of strain and abuse on my spine," he says.
Dr. Levin then experienced pain in his left arm and suffered two
more herniated discs, with one causing nerve pressure. Physical ther-
apy and medications mitigated that pain. "Then one day I did three
very prolonged, difficult operations, three or four hours apiece," he
says. "I remember struggling, and I was pretty tired afterward." He
awoke the next morning to "unbelievably intense, incapacitating pain"
in his right arm, which required immediate surgery.
Three months later, he was back at work, but soon experienced pain
in his left shoulder, which revealed more disc issues along with nerve
impingement. Reluctant to go under the knife again, he reduced his
A P R I L 2 0 2 0 • O U T PA T I E N T S U R G E R Y. N E T • 3 5
"A lot of us are
breaking down."
— Peter Nichol, MD, PhD
