Charlie, one of the cats, was seriously ill and Lyme Disease (which was the designated subject for this post) went clear out of my head. It shall return. Meanwhile, I’ve been nursing Charlie, aka Houdini cat (who will literally disappear into the towel you think you’ve wrapped around him securely), reminding myself that nursing is a noble, noble profession. (That’s what you call professions that are bloody hard and nobody appreciates.) I’ll say one thing, taking a cat to the animal hospital does give one a quick lesson in the perils of for-profit medicine (my Visa may never recover) – especially in our risk-obsessed age where tests and scans trump individual history, personality and symptoms (human or animal). It also reminded me that one must be vigilant when faced with the ponderousness of Expertise.
In Charlie’s case it began with a neurological condition called Horner’s, an irritation of a nerve running down one side of the face, eye and down the neck and into the chest – not a disease but a symptom. Naturally Expertise immediately rushed to the worst possible diagnosis: lymphoma, or, in a pinch, brain tumour. (Do not pass ‘go’, just head for the hills.) I mildly posited inflammation or infection, probably ear related, particularly since Charlie’s had those before. But noooo.
Critical Care, human or animal, is rife with Expertise: grave, gravel toned and confident. Why? Because they have tech toys, that’s why. Cool devices and imaging technologies that purport to explain the mysteries of life. Even (ha ha) a cat scan. All of which push the patient into ever higher levels of care – because they can. Problem is, the patient often can’t.
I tried to hold my ground but it’s a slippery slope that one; the surer they are the more one caves, especially when they start to say, well, with cats elevated white blood cell count could mean X. I mean, what do I know from cat physiology?
So the cash register tinged and Charlie looked steadily worse. Of course nobody looks good in ICU between the ugly fluorescent light and the tubes but there’s something especially pathetic about a small furry creature sitting in a cage. And Charlie, well that cat could have taught Stanislavsky a thing or two about looking sad.
I kept getting calls to tell me things I already knew (he has a heart murmur). The last time I snapped, “I know. I have one too. Big deal.” That didn’t, naturally stop them from getting a cardiology consult. Bearing in mind that cats don’t hold still for much of these so need to be anaesthetized.
Finally, after every possible dire diagnosis had been ruled out, we came round to my original hypothesis: ear infection.
Don’t get me wrong. I have enormous respect for veterinary physicians. They study long and hard (far longer than human doctors) and by and large they are great. They deal with a diverse patient population who’s uncooperative and uncommunicative. And when I say diverse I’m talking species. And they need to make a living, I get that.
What they, and most of us, do not get however is that they are part of the culture at large and the culture at large is obsessed with the “science “ of medicine, leaving the art further and further behind. Watching Charlie work his way through the system reminded me of just how much medical focus has shifted away from the patient and towards disease, technology; towards what tend to be called “objective” results (versus the messy subjective ones patients bring).
I see this on a human level very time I go to the retinologist with my mother (that, by the bye, is a sub-specialty of ophthalmology). First, they get her to read the letters on the chart and are all impressed at how well she sees. Then they take their pictures and look grave: how could she possibly see that well with those terrible ridges in her retina? (To me they just look like the Alps.) Then they look puzzled. Scan says you can’t but you actually did see. What a gonzo dilemma. So, they go with the scan and give her the medication. Objective trumps subjective.
Question is, should it? Does it make sense for the patient to get lost in this morass of ostensibly objective ‘data’?
Not to my way of thinking. “Normal” – blood pressure, lipid level, whatever – is a best-guess average based on population statistics and what some committee has deemed appropriate. If you’re truly sick it shows up. C-reactive protein in the clouds – well, objective and subjective tend to match. Your joints hurt, you have some kind of inflammatory condition and the test backs you up. It’s that grey zone that’s problematic. Levels fluctuate in every individual, tests can be wrong (some more than others). Error rates in some tests are as high as 75%. But we forget that.
So, cat or human we are lumped in with the many-too-many – and our individual narrative gets lost. In Charlie’s case nobody believed this pretty little cat who had only been ailing for a week could possibly “just” have a madly inflamed ear affecting his balance and appetite. An infection is no picnic. But it’s not a brain tumour. And of course Charlie’s Oscar winning ability to look mournful didn’t help. This cat can look sad when he feels ignored; imagine how dreadful he looked when he was dizzy and queasy. It’s a gift. But it’s not diagnostic.
You need a proper history; the back story. The person with the disease is as important as the disease, said Hippocrates. Let’s say you end up in hospital with severe abdominal pain. It matters whether you’ve had this pain before, but less intense or of shorter duration. Sudden abdominal pain could be many dire things; a worsening of an existing problem is probably nothing that will kill you (otherwise you wouldn’t be in the ER in the first place). The clinical picture changes with the history. Someone has to factor it in.
Charlie’s doing better now. As for the rest of us – who knows. We may never survive the tech age.