I hadn't been back from x-ray long and was starting to feel the all-encompassing drain that results from the shock and pain associated with physical trauma and the uneasy rhythms of the emergency department when the MD entered room #16 (easy to remember since it I was born on a 16th). His expression said it all, or maybe he was just reflecting my own fear back to me:
"So, the good news is, your cervical x-rays look great, so we can get you out of that neck brace. But, it looks like you may have fractured one of your thoracic vertebrae . . . "
This statement was followed by a (seemingly) long silence, and I nervously shifted my eyes from Mike back to the doctor, doing my very best not to show my total terror and ignorance about the potential meaning of such a tentative diagnosis. Finally, I spat questions at him . . . what does that mean, like long-term? what does it mean right now? what do we do now, next?
He remained clinically distant but his eyes still belied sufficient humanity to show he does not enjoy this part of his job. "It means we need to do more tests - an MRI or a CT scan - to see how bad it is. If it's an unstable fracture, it means surgery. If it's a complete break, it means surgery." There really was no best case scenario discussed, at least not in my recollection. Our memories must automatically block out all hope when offered worst case first.
Since it had been a central theme of my encounters with everybody since the fall, from my fellow riders to the first responders to the nurses in the ER, I finally just decided to ask the question I had been avoiding . . . so, right now, I still have feeling and mobility in all my limbs, in my fingers and toes; could that . . . go away?
I can't remember the specifics of his response, but the gist of it was, yes, in reality, there could still be spinal cord damage, and while it was unlikely, it was still possible that this could lead to some degree of paralysis. I just nodded and looked at Mike, hoping he retained the energy I lacked. The energy to ask any other questions, grateful I had my own personal, knowledgeable, wonderful advocate there to comfort and stand up for me. As soon as the doctor left, I collapsed into tears. A new nurse (I think?) came in, said I seemed out of sorts, offered morphine. Eventually, we headed up to radiology to do the MRI - which was much less frightening once I worked up the nerve to request some anti-anxiety meds. All in all, what on an x-ray appeared to be a new compression fracture of my T12 vertebra was an old injury, a broken back I never even knew about, never knowingly suffered the consequences of. I was discharged, given more information about what wasn't wrong with me than what was. The absence of x did not mean I was well, but well enough.
My anxiety lingered until the next morning, when my inner anthropologist kicked in and I began to think more as an observer than simply a participant. I have been studying health and anthropology for at least twelve years now and recently defended my dissertation in an interdisciplinary social sciences of health program. While in my research I focus on illicit substance use, my personal experience in the ER reminded me of the critical importance of turning an anthropological lens on the most familiar, perhaps the most mundane, areas of human experience.
The strangeness of my ER experience was highlighted when, the day after my visit, I saw my chiropractor for follow-up care and confirmation of the diagnosis. On his examination, Dr. H found that, well above the vertebra that had caused so much trouble the night before (T12), I actually had significant pain, most likely a sprain from the trauma of being bucked off a horse, hurtling six feet to the ground and twisting severely on landing. Dr. H asked, "Did they even touch your spine the whole time you were at the ER?"
Nope. Not once. The first responders did, but they were only looking for major deformities or obvious abnormalities. In fact, the MD I saw in the ER never actually touched me. It was all about nurses (who moved me on and off the backboard, who did minor palpations on either side of my spine, and who administered drugs and asked endless questions but did not always seem to wait for the answer, some responses that were recorded in my medical records I don't even remember answering). It was all about the techs who ran intensive tests with expensive equipment. In fact, my ultimate clearance was given by a radiologist whom I never even met, although he saw my insides when he read my images.
This type of experience - technology-focused, rather than human-focused - is increasingly commonplace, even characteristic, of today's typical encounter with biomedicine, not just in the ER. In fact, I have friends who hesitated to even enter a hospital to deliver their babies, for fear that the biomedical system would take on a life of its own, regardless of their wishes. Several months ago, my husband was diagnosed with viral arthritis, but this was only after seeing four physicians - the first three did not seem to get a sufficient sense of who he was to make an accurate diagnosis for this clinical anomaly.
What is lost when the context and culture of biomedicine so entirely remove the patient from the trauma/disease/injury? Like these friends and family, I was entirely disembodied from the subjectivity of my experience - my pain was a number on a scale from 1 to 10 (with 10 being the worst pain I'd ever experienced...but they never asked what I would consider a 10); my identity was "32 year old female, relatively healthy"; my diagnosis was written in body parts - in ways that may have diminished the diagnostic capacities of the team of highly technologically skilled care providers working on and handling my body.
While the high-tech field of biomedicine is probably better equipped to deal with acute trauma than any other ethnomedical system I know of, and I am endlessly grateful that I was able to reep its fruits, I am also wary of any system that treats the body as so disconnected from its wearer. Yet, at the time, as a patient, I did little to fill that gap. I was only able to identify my most severe, most "present" pain and by the end of the visit, I had become my spasming, sprained, possibly broken back. I had begun to envision my entire future in terms of that specific physical change and its potential consequences.
