“Not an Exact Science”: A Story of Facing Fear (Part two, the exciting conclusion)

(Continued from last time…)

“Okay. I’ll just get the Yellow Fever shot as a precaution.” I attempt to smile, but it looks like a grimace. I hover on the edge of crying but swallow it down. Don’t be such a wimp.

”Right, well, then you’ll need to get the Measles, Mumps, and Rubella shot at the same time. That one’s a live vaccine as well,” said the travel clinic doctor. I look at her with moist eyes. “It’s better to get live vaccines together, actually, because your body thinks it’s under a major attack and works harder to make strong antibodies.”

“Fine.” I look at my coat hanging on the door.

“So today we’ll do the Influenza – since you haven’t had your flu shot yet this season – and the Yellow Fever, MMR, and the first of your Hepatitis A and B Twinrix series. Then you’ll come back in four weeks and get the Tetanus booster, Typhoid vaccine, and the second Twinrix. In six months, you’ll get the last Twinrix injection.”

Oh, and then there’s the pills. For malaria, I am offered three choices: a once a week pill (potential side effect, major intestinal distress), a once a day pill that’s cheap but may cause “unusual dreams,” nightmares, and hallucinations (“these pills are good for college students,” she says, and I presume she means because they are cheap rather than because of the hallucinations), and an expensive once a day pill that has relatively few side effects. Bingo.

“In terms of altitude sickness, well, I have to inform you that in severe cases, there can be swelling of the brain and unconsciousness, leading to death. The only remedy is to get down off the mountain. And then there’s the kind, which is basically fluid gathering in the lungs [slowly drowning, in other words]. Again, the remedy is to decrease your altitude. Then there’s the kind of altitude sickness that involves a nasty headache and nausea and extreme tiredness. That type you can treat with medicine, but the pills are a diuretic. You’ll have to be careful to drink plenty of water.” Then she stopped and looked me in the eye. “Oh, and I need you to promise to take one of those before you leave the country to see how you react.”

“Fine.” One way or another my life is over. Time to just accept it.

“I’ll also call in a prescription for Cipro. Oh, and now for the bad news [she actually said it that way]. I hate to say this but the possibility of food-borne illness is high, so no salads while you’re there. Fruit with heavy rinds, peeled, is fine, though.”

I laugh. Oh, that’s the bad news, huh?

She continues, “If you still have intestinal issues when you return from your trip, give us a call, and we can see what kind of parasite or bacteria you picked up and treat it.”

She leaves and the nurse enters. Then it hits me. I have a one in 250,000 chance of getting seriously ill if I let them inject that Yellow Fever vaccine into me, and I don’t even know if I need it. OH MY GOD, what am I doing?? I spill the beans to the nice nurse. “I’m not sure about having the Yellow Fever shot. I just don’t know!”

The doctor pokes her head into the room and suggests, “Can you call someone?” Yeh, like a shrink! But what she means is for me to find out about whether we will be going anywhere below 8,200 feet on the wrong side of that line on the map.

I almost literally jump out of my seat. “YES! I can call someone.” They leave me. I try to breathe deeply and only manage a stuttering of air puffs. Any second now I am going to lose it….

I start thumbing through my daytimer and soon realize that I do not have the Project Director’s phone number. I call my husband at work and on his cell five times. No answer. I flip through the daytimer some more and find my English Department colleague’s home number. Julie can get me that Director’s number, I think. I also know she might be my lifeline. Five minutes later, I have the phone number that I need and a helpful factoid: One out of 250,000 women die in childbirth each year. Somehow this comforts me. I had a baby and didn’t die; ergo, I will not have complications due to the Yellow Fever vaccine either.

The Project Director isn’t in when I call. But it’s okay. I have decided to get the Yellow Fever vaccine. Enter nice went-to-Cambodia nurse with three syringes. I tell her that I am going to follow the original plan after all and get the troublesome Yellow Fever shot over with. She throws away the Tetanus booster, which I will now take in four weeks, and leaves me alone again to go get the Yellow Fever and MMR vaccines ready. As she leaves, she hands me the laminated warning sheets about the vaccines I am about to have injected into my quivering body. I decide I’ll only look at the Influenza one and the Hep A and Hep B.

My husband calls me back, and I tell him what’s happening in a confusing, shorthand jumble. “Ask me a question I can answer,” he pleads.

I tell him it doesn’t matter anymore, that I made up my mind and will take the vaccine, and if I die, well, I die. There’s a one in 250,000 chance I will have a big problem on my hands if I get the vaccine, but life’s a calculated risk…

“Oh! You said 250,000? I thought you said 250! Honey, one in 250,000 is nothing. Don’t worry about it.” I am number-challenged, and he knows it. The doctor pokes her head in at that moment, and I say goodbye to the hubster.

Doc accepts my decision to go with the original plan and manages not to look perturbed at her problem patient. I apologize for the fifth time, and as she walks away, she says, “No problem. I just want you to be comfortable with your decision.”

This strikes me as funny, and I grin. But she has left already. I know that this trip is, in large part, about getting un-comfortable.

The nurse returns with a revised form, and I initial after every shot. The sheet says I “refused” the tetanus shot, so there’s evidence forever in the halls of medicine of my cowardice. (Since I changed my mind and said I WOULD take the Yellow Fever injection, then she had to say I refused the Tetanus, which will be given next time. If you are confused, just imagine how I felt at the time!)

She rubbed my arms vigorously with alcohol. Then she stuck me four times, one live and one dead vaccine in each arm. Rather than fleeing the room at this next point, however, she sat down and talked with me about her service trip. I’m sure she noticed my face and the welling tears. (NO, not from the stinging of the shots. I’m not that much of a baby. It’s imaginary tragedies that worry me, not actual events, which I seem to be able to take in stride just fine. And that’s the crux of my problem, isn’t it? My strength and my weakness is my imagination.) She said that I’d need to wait for a half hour just to make sure there was no initial adverse reaction. Nice lady. She kept me company for fifteen minutes, reminding me in such a natural way of why I was going through all of this.

That’s when it struck me, in fact — the irony of my freaking out about getting vaccinated when our group was traveling to these remote villages to install solar panels to power vaccine refrigerators so people with no access to such luxuries could live a safer life.

I left the doctor’s office after my allotted time. I was fine, of course. I made appointments for four weeks and for six months at the desk with the lady with the lovely hair. She smiled and wished me a good evening. I continued to backtrack, going downstairs to the pre-registration check-in area, where I was shown into a cubicle within five minutes, and a cheerful, positively bouncy, young woman handed me a “release to be treated” form to sign. I laughed to sign such a document after having just submitted to four injections upstairs. Then I saw it. A quotation that I think may end up being my whole trip’s epigraph … you know, the quote that appears in italics at the beginning of a book or story?

“I understand that the practice of medicine is not an exact science, and that most procedures and treatments are associated with benefits and risks.”

Yup. That about sums it up, doesn’t it? I need to quit looking for guarantees. Life is not an exact science. There are benefits and risks associated with most of the things we do that are worth doing. The trick is to “just keep your eyes on the people.” I signed the form.


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