The 200-mile drive from Chicago to his home in Springfield, Ill., seemed longer than usual as James Weitzel tried, with little success, to relieve the dull pain near his right shoulder blade that had dogged him for months.
His family doctor had told the 20-year-old he had probably pulled a muscle or injured a disk in his back while hoisting cases of beer at the pizza shop where he worked. Over-the-counter painkillers hadn't helped, and Weitzel discovered that sitting on his hand while piloting his blue Cadillac down Interstate 55 made the pain less bothersome.
For days, he had tried to tamp down a recurrent uneasiness. "I had the sense that something [more serious] was wrong," he said.
Less than a week later, in early August 2016, Weitzel would learn that he was right when he awoke one morning unable to walk.
"All my friends were off at college, and I was at home trying not to die," Weitzel recalled of the months that followed. He has regained the use of his legs, but his life has been forever altered.
The pain started in the spring. After a few weeks, Weitzel consulted his family doctor. She told Weitzel it should improve with rest and the nonnarcotic anti-inflammatory drug she prescribed.
"It did a good job of dulling the pain," said Weitzel, who took the medicine for six weeks. Although diminished, the pain persisted.
In late June, he visited a chiropractor, who performed an adjustment to his back, manipulating his spine. The procedure proved useless.
In July, Weitzel drove 12 hours to northern Minnesota for an annual fishing trip with friends. A few weeks later, he headed to Chicago to visit his grandmother and attend a concert.
"The whole time in Chicago I remember getting IcyHot patches," he said. The over-the-counter analgesic patches did little to relieve the pain, which had grown sharper.
On Saturday, July 30, the morning after he drove home from Chicago, Weitzel said, the pain was much worse; he could feel it radiating to his chest.
Weitzel's parents took him to an urgent care center. An X-ray of his back revealed nothing amiss. He was given a prescription for another anti-inflammatory drug and a potent muscle relaxant. If the pain continued, he was told, he should get an MRI scan.
That night, Weitzel, who had attended a semester of college on a music scholarship, played the drums with a group at an annual party given by his next-door neighbor.
His mother, Lisa Weitzel, remembers telling her husband that their son's playing sounded uncharacteristically "off."
The next morning, Weitzel headed to the pizza shop for his eight-hour shift. He remembers feeling odd. His knees felt numb and his right foot felt as though it had fallen asleep. Weitzel managed to shuffle around the shop, but when he got out of his car at home, his father was struck by his odd gait.
"Geez, James, it looks like you have cerebral palsy," Weitzel remembers his father telling him. "How many of those muscle relaxants did you take?"
Only one, he told his father. His mother, worried that he might have mixed up the pills, told him not to take any more that night.
When Weitzel awoke at 6 a.m., he couldn't walk. Holding onto a wall, he managed to inch his way to the bathroom. His mother called the doctor's office and was told to take him straight to the emergency room.
"My dad had to carry me in," Weitzel recalled.
Doctors in the ER sought, with little success, to determine the cause of Weitzel's sudden paralysis. Twice they trooped to his bedside, had his parents leave and asked him whether he had used IV drugs. A needle-borne infection might explain his paralysis. Weitzel assured them he had not.
"The third time they started to do it, I told my parents, 'No, you don't have to leave,' " he recalled. " 'I'm not shooting smack — or anything.' "
As the day progressed, so did his paralysis. Weitzel's feet began to curl inward — Lisa Weitzel remembers medical students coming in to photograph the unusual sight. He became unable to urinate and he grew agitated. He told his parents he worried that the paralysis might affect his ability to breathe. His mother said she struggled to remain calm — belying her growing panic — to avoid further freaking out her son.
At around 4 p.m., he was taken for an MRI. Shortly after he returned to the ER, a doctor appeared.
The MRI had revealed the cause of Weitzel's pain and his paralysis: A large mass, roughly the size and shape of a man's thumb, was pressing on his spinal cord. The X-ray taken two days earlier hadn't detected it because the mass was located inside the spinal cord. Weitzel needed emergency surgery to remove the mass and hopefully reverse the paralysis.
The nature of the mass wasn't clear; it would be analyzed by pathologists.
"At first I was just happy to have an answer," said Weitzel, who had been given morphine to lessen his pain.
Lisa Weitzel remembers her son saying, "Great, get it out." She was terrified that her athletic son who loved barefoot water skiing might emerge from surgery as a paraplegic.
Spine surgeon Venkat Ganapathy was on call at Springfield's Memorial Medical Center when he received a call from the ER about Weitzel. "I remember him vividly," said Ganapathy, now director of orthopedic spine surgery at the University of Tennessee Medical College in Chattanooga.
Weitzel's situation was dire. "Time is of the essence for somebody who has lost the function of their spinal cord," Ganapathy said. "If the mass wasn't removed as soon as possible, James could be left permanently paralyzed." His age was also unusual: Spinal-cord problems in young people are typically the result of trauma, such as motor vehicle accidents. The cause of Weitzel's problem was unknown.
The three-hour surgery, Ganapathy said, involved painstakingly peeling off and removing layers of a gelatinous tumor shaped like the multiple florets on a head of cauliflower, without disturbing the spinal cord.
The spinal cord, he noted, "is a very unforgiving structure . . . the sheer act of trying to peel away a tumor can be dangerous," resulting in bleeding, nerve injury or permanent paralysis.
Ganapathy said that the operation went well. All signs of the tumor were removed. While the family waited anxiously for the pathology report that would tell them what it was, Weitzel began physical therapy to try to regain his ability to walk.
Three days later — after what Lisa Weitzel said "felt like an eternity" — pathologists reported that the tumor was an aggressive and fast-growing form of cancer: diffuse large B cell lymphoma. The malignancy typically affects men older than 50, not 20-year-olds.
"I was told I was the youngest patient the hospital had seen," Weitzel said.
The cancer, which grows rapidly, was not only compressing his spinal cord, it was also affecting nerve endings in other parts of his body.
One of the most common forms of lymphoma, a cancer of the white blood cells, B cell lymphoma is generally found in the lymph nodes or spleen. Weitzel's cancer was classified as Stage 1E — it had been found early and not in a lymph node and is dubbed extranodal. B cell lymphoma affects about 7 in 100,000 Americans annually and is fatal if not treated.
Weitzel did not have the typical symptoms of the disease, which include fever, night sweats and weight loss.
Treatment of B cell lymphoma typically consists of chemotherapy and radiation. Following the surgery, Weitzel underwent several rounds of inpatient chemotherapy, followed by 24 radiation treatments. He has been in remission since February 2017.
For his mother, the diagnosis was shattering for several reasons. "I'm so mad at myself for not pushing him to go to the doctor sooner," she said, and for failing to question the explanation of his back pain when he didn't get better. "This is a kid who never complained."
Her worries about her son's health, she said, were compounded by months of uncertainty surrounding the fate of the Affordable Care Act. The debate about repealing the ACA raged while Weitzel was in the midst of cancer treatment, when his medical bills totaled about $600,000. His mother worried that if the ACA was repealed, his coverage under his parents' plan could be dropped and he might become uninsurable. Covering children until age 26 and barring insurance denials for preexisting conditions are among the features of the law passed in 2010.
Weitzel and his mother say they are indebted to Ganapathy for his skill and assistance after the operation.
"That man saved my life," Weitzel said.
He is working full time at a new job — as a clerk in state court — and trying to put the past year in perspective.
He finds comfort in what one of his doctors told him: "This is a flip of a coin. There is nothing you did to cause it and there is nothing you could have done to prevent it."