Field Medicine

Our life, it seems, has been consumed by healthcare lately. In addition to the ever-growing vials of vitamins and woo woo fertility remedies on the kitchen counter, there are numerous antibiotics and ointments for our menagerie of pets. It’s been prescriptions and appointments nonstop, for human and animal alike. First because of the dying-of-Marek’s chickens, and more recently due to the development of a huge cyst by our curmudgeonly male cat, Marshall.

The cyst had been checked out by our then-vet a few months before. Despite its size, they suggested avoiding surgery as it was right where his leg connected to his body, a spot that would be difficult to heal. It didn’t seem to bother him, so this seemed like a reasonable approach.

Some months later the cyst burst, evidenced by a trail of fluid dripping from my now-suddenly-less-bulbous cat. We called the vet and they suggested we monitor it for a few days, as these things often heal successfully on their own. By the end of the weekend the wound had opened up like one of those renaissance paintings where Thomas is sticking his finger in Jesus’ wounds. It also smelled horrible. So – a clear emergency.

It was thing #3,655 to have gone wrong in 2021 and at this point we were almost numb to it. We trucked out to the emergency vet in Albany, who observed a mass underneath the cyst. The mass meant that the wound would not heal on its own. Mass – that word. We both knew what it probably meant, but pushed that away for now, to solve the immediate problem.

At this point it occurred to me that we have been doing this for years – managing complex medical issues through pet ownership. When we got chickens some part of me still had that fear, the one put there by naysayers of the farm life: that I wouldn’t be capable of making the hard decisions that come with caring for livestock. Everyone imagines themselves faced with shooting a horse, I guess. But it came easier than I expected. Every stray cat I nursed back to health in childhood, the birds that had fallen out of nests we cared for on the porch… it was all the same sort of thing. When I found one of the chickens stumbling around with a crooked neck (a classic Marek’s sign) I briefly considered getting the bb gun and putting her out of her misery. But something in her seemed to still show a spark of life, and I waited and gave her some yogurt to nourish her, or at least make for a nice last meal. The next day she flew down the hill, no worse for wear, and has been mostly well ever since.

And so for Marshall we did the same, solving each problem with cautious optimism. Surgery was scheduled for later in the week with the local vet. The morning of the appointment we drove him to the vet – only loosely ‘local’ since it was still an hour away – and left him there with the promise of updates during the day. The first call said the surgery went well. Then we got a second call – he had passed out, post operation. They weren’t sure what it meant. Maybe a stroke? We don’t know. They were giving him oxygen. Then later, yet another call. He is doing well and you can come and get him.

On the way there we started picking apart what it meant to take him home. What if he needs oxygen again? Well, we wouldn’t be able to give it to him. I didn’t sense confidence from them in what exactly had gone wrong. What would you do for a person? Well they’d probably keep him for monitoring. Therefore we made the snap decision to bring him from the regular vet to the emergency Albany vet for overnight monitoring. It was a slog of a drive, but this was our favorite cat, our special guy. And after the year we had, I wasn’t going to let another thing die on me without a fight.

Driving to Albany I could see he didn’t look good. I stared at his little pale face under the ambient highway light as we drove in resolute silence. And yet I was calm, as I always am during these sorts of emergencies. A head full of logistics and plans, problem solving, prepping my speech for the intake person. When we arrived we sat in the car and called the emergency line, explaining the situation. Once they took him in, the vets relayed that he was in critical condition and warned us he was not likely to survive the night. They could try, but they could not make any guarantees. We left him there, and asked them to do everything they could. Sometime after midnight they gave him a blood transfusion and he popped back, right as rain. He had simply lost too much blood in the surgery. They kept him for an extra day and sent him home, his surgical incision already beginning to heal. Without the transfusion, they said, he would have certainly died.

When I think on this I realize that I have usually given our vets the majority of credit for saving our animals. After all, they’re the experts – I’ve never held a scalpel or stitched a wound. But I share some credit, too – for developing an intuition for how things are going, and making it my business to know a bit about the condition and treatment. At least enough to make decisions. That one decision – he should go to Albany, he’s not stable enough to come home – came purely from the part of my brain that thinks in field medicine, the one that takes all responsibility for an animal. The one that cared for the broken wing’d birds and the skinny stray cats.

Medicine of the human kind has been another matter entirely lately. My approach to my own health has not always been so proactive. Being childfree and mostly healthy for my entire adult life, I’ve had a relationship with medicine usually enjoyed by ornery, rural, middle-aged men. That is: minimal. Annual exams are a waste of time. You go to the Dr. when something hurts bad. Diagnostics follow the policy of don’t ask, don’t tell. I once joked to Mr. Max that if they don’t work out virtual colonoscopies by the time we’re old then I’ll just skip it and die instead.

It was a good run, but now with trying to have a kid that golden age is over. After miscarriage number two, I was determined to approach everything differently, starting with investigating possible causes through testing. I ordered the works. I even opted for the genetic testing – something I was initially against. It’s a heavy thing to find out what awful diseases might lurk deep in your genes. Nowadays – nah, fuck it. Give me the exact time and location of my death. Trauma has a tendency to toughen you up in that way.

Well, to a degree. Disclosure: This part of the story contains some gruesome medical stuff that would’ve had pre-pandemic me clutching my pearls. So, if that’s not your jam you might want to mosey over to the archives and read a post about pizza box graphic design, or something.

You’ve been warned, so here goes: in addition to all the many, many blood tests, they do some other tests of your interior parts, including a biopsy. To give you a sense, it’s like all the bodily horror of a colonoscopy combined with a vivisection. The details of this test were told to me via a phone call wherein I was told to, “Do yoga beforehand, steel yourself. Take some Advil at home and it’ll be over quickly.”

Mr. Max, who had recently been lauded for being a ‘trooper’ through routine bloodwork, was aghast. “You need to have them give you something better than that. This is ridiculous.” I concurred – modern medicine should not resemble the plot of a dystopian Margaret Atwood novel.

So I called back and asked if they could offer a painkiller – something, anything more than Advil. I was hoping for some kind of sedation. It went like this:

Nurse: “Well, what’s the issue, are you nervous about it?”

Me: “Well, yes. I’m nervous about the pain of it.”

Nurse: “We can give you something for the nerves”

Me: “I won’t be nervous if I’m not in pain, so I think treating the pain would be what helps the most.”

Nurse: “I’ll talk to the doctor and we’ll see what we can do.”

As an anxious realist I’m fairly sensitive to the suggestion of neuroses, so I stewed over that for a bit after I hung up. The next day, she called back and said they would prescribe some valium, with a bit of a sigh. “You won’t be able to drive,” she said. Well, yeah, of course. Even over the phone I could sense the sentiment: “What a big baby.”

So the day before the procedure(s) – I was scheduled for two, the first only slightly less gruesome – we picked up my valium prescription. When I saw one single solitary pill in the big orange bottle I couldn’t help but laugh. “I better not drop this on the floor of the car,” I said to Mr. Max. That single, lonely pill — It felt pretty judge-y. And while I understand exercising caution with controlled substances, did they really expect me to immediately fall back onto a dirty mattress in a haze of addiction if they prescribed like, three pills instead of one?

The next day I popped that and the recommended did-I-read-that-right dose of Advil in the car on the way to the clinic. While Mr. Max assures me my speech was significantly slurred, I found the overall zonking effect of the valium to be underwhelming. My anxious mind still ticked away, albeit a little bit slower than usual. I’ve had more effective escapism from a single Boston bar beer on an empty stomach.

So we got to the clinic and he walked me in. I should also note that there are a million surreal things about these fertility clinics. One thing is that it’s standard practice to test you for every STI under the sun. (I delivered the results to Mr. Max as: “Hey husband of 20 years, good news! I don’t have chlamydia.”). Another thing is that the exam rooms are always dimly lit. I guess it’s because of the monitors for the sonogram, but it makes you feel like you’re in that last scene in Brazil where the main guy gets tortured. Which as it turns out is not that far from the truth.

The first test – well, it was extremely painful. 11/10, would not recommend. Also, it was not quick. My anatomy would not cooperate and multiple catheters were tried. At some point the distracting chatter of the nurse and Dr. turned to frustrated muttering and tool exchanges. Their irritated tone reminded me of myself, a few weeks back, attempting to drive fencing into rocky, shale-rich soil. It’s the tone you use when you thought something would be easy but it’s not. Nevertheless, they finally finished and I felt a rush of relief that it was nearly over.

The next test required a “less flexible catheter.” This did not bode well.

I endured as much of it as I could, picturing our dreams of having a family hanging in the balance. Other techniques were attempted. Upon a 3rd or so blindingly painful ‘try’ I screamed involuntarily. Now I will note that my first miscarriage involved 8 hours of labor, contractions and all, so I am no stranger to pain. This was simply not an endurable kind of pain. Despite my valium stupor, the field medicine side of my brain finally kicked in and I sat up.

“STOP.” I said. And they did, as they said they would at the beginning of the ordeal.

“What will we gain from this test?”, I said. “Because I need to decide if this is something I need to do because it is extremely painful and you guys are trying all different things that are not working.” (Although I’m pretty sure it sounded like “Whuzz will we gainz from this teest…” I am still proud of this moment.)

They explained the biopsy would show inflammation that would indicate an infection, and if so they would treat the infection.

“Okay.” I said. “Can we just treat that with regular antibiotics, assuming an infection is there?”

“Well, yes. We could do that.” As they said this it occurred to me they had probably already intended to prescribe antibiotics, given the traumatic nature of invasive test #1.

“Okay.” I said. “Then let’s do that.”

And just like that they acquiesced and starting quietly packing things up, as if they had been the ones who decided we were done. The doctor turned and said with a smile, “You did really, really good.” Which immediately enraged me, both because it was patronizing and also because it was patently false: I had just bailed out of a test I was determined to have. That maybe I needed. I wasn’t entirely sure I had made the right decision, it all happened so quickly. But that worry was still much, much weaker than my immediate desire to get dressed and run away as fast as possible.

And run away I did, back out to the parking lot and to the car where my husband was waiting. Flustered, I tried to explain how bad it was. I did, briefly, but without a lot of the requisite detail. Mostly I wanted to forget the whole thing, so we drove to a takeout place for lunch, and to take a walk at a local park.

But all day, and even days later, it was like I had never left that awful little exam room. It took some time to put distance between myself and that experience, to be able to think on it clearly. Letting go of my shame at not being able to ‘get through it’, I could finally see that it was just wrong. There’s a reason invasive procedures involve sedation and not just the suggestion of an over the counter painkiller. One can’t help but see analogies to all kinds of sexual violations, right down to the ‘you did good kid’ speech I got, and the big smile designed to prove to both of us that everything was fine. Things need to change with how these procedures are conducted and communicated, and that goes far beyond my single experience. (For a more expansive indictment of these practices in modern medicine, please see, The Silent Battle for Pain Relief During Invasive Gynecological Procedures.)

Ultimately this terrible experience revealed how much unearned trust I had been placing in those with authority. It wasn’t until that deep, blinding pain coursed through my body that I realized what I needed to do. I needed to approach my own health the same way I do with my animals. Cool, collected, calm… and most importantly, critical. That voice that shouted ‘STOP’ –  that’s the spirit of field medicine. The one that takes all the responsibility, all the blame, all the glory. The same one that defied my vet —  that kind-faced, experienced woman who said my cat was doing well, and to take him home. Instead I drove him to the next city, based on nothing but an instinct, and saved his life. 

I’m still waiting on tests to come back from Fertility Investigation-Palooza 2021, but all the blood has been drawn, all the relevant body parts poked and/or prodded. So now we sit and wait, and think. It’s a lot of uncertainty. But one thing I know with complete and total confidence: whatever decisions we make, they will be ours, and ours alone.

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