Published by Harper’s Magazine

It began with a loud pop. Though Austin Sell had suffered from severe back pain since childhood, on a clear autumn morning in 2011, not long after his twenty-first birthday, the pain became something much more frightening. He was chasing his younger brother through their mother’s yard in Great Falls, Montana, and his left foot landed in a crevice. His upper body buckled backward; there was a sound like “a bungee cord being snapped in two.” He could tell that it was bad, a kind of bad he had not experienced before. A few hours later, having tried heat and ice and Tylenol, Sell was sobbing and incapacitated; a piercing ache in his lower spine made it impossible to walk. A trip to the emergency room resulted in several morphine injections, a CT scan showing a slight disk bulge, and the assurance that he would be feeling better within four to six weeks.

Later that night, when his wife, Kelsey, who was pregnant with their second child, brought him home from the hospital, they hoped the worst was behind them. But it was just getting started. Soon the most innocuous movements were sending a shrill, lacerating sensation from his lower back into his groin, hips, and legs. “I was beside myself,” he told me. “The pain was out of control. I kept thinking, ‘Isn’t there something that can be done for this?’ ” So he proceeded again — and then again and again and again — to the emergency room. Instead of eliciting concern or further action, however, the return visits were met with annoyed suspicion. “I’m a big black guy with tattoos,” he said. “They accused me of exhibiting drug-seeking behavior.” Six weeks came and went.

It was not the first time Sell’s pain had provoked a skeptical response. His mother, Kathy Sell Mitchell, who raised Sell and his four siblings mostly on her own, recalls her hunched-over son confined to bed by a mysterious condition that struck randomly but persistently. It was just debilitating enough to cut short outings and playdates, but not to persuade his Medicaid-reimbursed pediatricians to take it seriously. No MRIs, no referrals to a pain clinic. He’s too young, they’d say. He probably has a low pain threshold. “The doctors would sort of blow us off — and I would just let them,” Mitchell said. “I wish I’d had the strength to say, ‘No, you really need to look into this.’ ” Instead, Mitchell did what little she could: with money she didn’t have, she paid for visits to a local chiropractor, gave her son ibuprofen and nightly back rubs, and drew him baths filled with Epsom salts and surrounded by small tea candles.