Saturday, June 9, 2012

Abscesses

     This week I had four patients with abscesses.
     In days of old abscesses were the mainstay of the medical profession.  A doctor would go by horse-and-buggy door-to-door to see patients and, mostly, lance abscesses.  There were abscessed gums and rectal abscesses, eyelid, fingernail, and throat abscesses. Any place in the body can develop an abscess, but the skin was and still is most commonly afflicted.  It was a gruesome business, and the doctor was anxiously awaited.  An infection rises up like a hot red sun under the skin and will not get better until it is opened, usually with the slice of a scalpel right in the center where it hurts the most.  Out pours the foul, wretched substance, the room smells like a dead possum, the sub-chambers of the abscess are squeezed and forced to expel residual pus teaming with bacteria, a dressing is applied, and the patient is fixed. 
     I don't usually see four patients a week with abscesses that need to be lanced and drained.  The treatment is not so different nowadays but the incidence of abscesses has gone way down because we use soap and clean water, and because most of us aren't working at jobs that tear and puncture the skin, leaving open portals for bacteria.
     I regard the experiences of my outer world as a mirror of my inner world.  This is not part of the medical model in vogue today, wherein patients have the illness, doctors do not; the illness is caused by an outer invader like cancer or bacteria whereas the patient is a poor undeserving victim; and disease must be attacked with military vengeance. 
     Therefore as I conducted my treatment of these abscesses I began to wonder:  What is festering below the surface in me?  What is being opened and drained?
     The first patient was a little girl whose parents said she kept getting boils.  This one was near her umbilicus, a symbol of the connection to the mother, the progenitor, a cord leading back to the origin of life.  A two-year-old cannot "buck up" and rationalize painful treatment.  She needed four people to hold her, distract her, sing to her, comfort her, stroke her hair, and suffer along with her through the quick procedure. 
     It's a two-year-old process, I thought.  My own abscess, my life circumstance, is two years old.  And I have needed help to bring me to the place where I can have it opened and drained.
     The second patient was a man in his 30's.  His wife had been pestering him to have a softball-sized mass on his back treated.  He said it didn't bother him much, being below the surface of the skin but she didn't like it and it was growing.  It took 45 minutes to drain, as there were compartments that tunneled into one another like secret chambers, so many that the nurse assisting me exclaimed, "We're never going to come to the end of it!"  Fortunately the entire thing wasn't abscessed, just the surface compartments, but I removed copious quantities of coagulated material cordoned off by a long-blocked oil gland as well as its entire capsule in order to prevent a recurrence.
     It's something I have been able to ignore except for the feminine, feeling aspect which pesters me to give it attention.  It's full of compartments that connect to one another and have been blocked off.  
     The third patient was a woman who had survived two breast cancers requiring bilateral mastectomies and today reported a "rising" in her armpit.  She didn't say so, but I assumed that her unspoken agenda and the cause for anxiety out of proportion to the pain of the abscess were her fear that the cancer was returning for a third time and might finally remove her from what she described as her fairy-tale life.  Instead of fear she talked like a running brook about her gratifying marriage, successful children, church friends, and enjoyment of her garden.  She laughed and touched my arm, and when I told her during treatment that this abscess had nothing to do with cancer she embraced me as though I had saved her life. 
     I need not be over-anxious.  The problem is unrelated to old suffering or affronts to my existence in the past.  This is a reminder of those times, but it is not the same.
     The fourth patient is, well, me.  I assume that the other three patients with abscesses are pointing to an accumulated mass of distress needing drainage in myself. Why should I assume this?  I do not live in a solipsistic world. Not everything that happens outside me is pointing to something inside me.  But some ideas and events are, especially the ones that repeat themselves or catch my attention.  We humans are pattern-seeking creatures, a trait accentuated in doctors.  Sometimes we identify a pattern outside ourselves, as when a series of similarly sick people might point to an epidemic in the community.  But sometimes the pattern, like a recurrent dream, is asking us to look within. 
     The abscess is a walled-off mass of toxic substance that cannot be healed except by release into the outer world.  It must be exposed.  Its contents, however sickly, must be seen and drained off.  For me this means writing little excerpts, as I have started to do here, about the accumulated mess of my profession, the state of medicine in the United States, and especially about how I have been attacked personally, in the line of duty, by the government and by people who are motivated by greed and envy.
     Since the "drainage" through bits of writing, exposed, on a blog has begun, I feel a little better.  The relief afforded by opening an abscess--a suppurating wound--allows for something new to form.  It is a mystery that the body should heal itself at all and that at a cellular level there are "knowing" forces which move an organism toward health.  The forces that led me to start a blog seemed ordinary, but the subtle message of my three patients' medical problems this week--there is an abscess, you have begun to drain it, this will move you out of a painful state--is extraordinary. 
     I am reminded of a basic principle in medical training:  If you listen to your patients, they will tell you what you need to know.  We listen to the understory of our patients' conditions.  They tell us how to cure them.  Their messages and prognostics are hidden in the seemingly inconsequential facts they tell us about the sidelines of their lives.  This is how we cure them.  And sometimes they tell us how to cure ourselves.
        

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