Pills and Piles


Today I spoke to a doctor about the blood clot in my leg (see Spider man). When the clot was discovered last December, I was put on a three-month course of blood thinners. Now, a month after not taking them anymore, we were to discuss whether I had to start again and take such pills for the rest of my life.

“Megan,” I began, for I always address doctors by their first name, “why can’t we check my leg?”

“Like another sonar?”

I get annoyed with doctors because you have to explain so many things to them.

“Yes, like another sonar. The clot was confirmed by sonar. Why can’t we check if it’s still there?”

She cleared her throat.

“By sonar,” I added.

“The haematology department doesn’t think it’s necessary.”

“And why not?

“Well,” she tried, “it doesn’t really matter.”

“It doesn’t matter that they think this, or it doesn’t help to check?”

“Uhm,” she hesitated, “there’s nothing to check.”

She had a point, I thought. “I see,” I said. “Finding a clot would falsify only one thing, namely that the pills worked. Finding no clot wouldn’t imply that I’m in the clear?”

“Falsify?”

Perhaps she didn’t have the point. “Megan,” I said, “let’s ignore sonar for now. The blood tests, I saw, showed no genetic markers for prothrombin. So the concern is based on incidence alone?”

“Yes,” she smiled, almost relieved. “You have no genetic predisposition to getting DVTs.”

“And?”

“That means that your body is not—”

“I get that bit,” I interrupted. “The concern is thus, what?”

“Well, you could have a clot again.”

“Megan,” I said, perhaps a bit gruffly, “I could sprout an olive from my upper lip.”

She frowned and didn’t say anything.

“I’m sorry,” I said. “There’s a probability attached to everything. Sometimes it’s zero, but it’s not zero for growing a spontaneous olive from my lip.”

She looked at the papers in my folder.

I tried again. “Has this haematology department done some assessment to determine that the risk is high enough to necessitate taking these pills for the rest of time, or are they just saying this to be safe?”

“It’s up to you in the end,” she said. “All I can give you is my advice.”

“And is that to take the pills forever?”

I could see that phrases like the rest of time and forever didn’t sit well with her.

“We could start you on Xarelto again and then assess things in a few months.”

“With a sonar?”

She smiled, which I took to be the end of our exploration.

“Can I think about it?” I asked.

“Totally. It’s your call, like I said.”

She stood.

“You know why I want a sonar?” I asked on a ridiculous impulse. “Doctors always see us when we’re down and out. We had piles, say. They saw the worst of us. But now we’re better. I’d like to call you up and say, ‘Doctor, my anus has healed wonderfully, thanks to the ointment you prescribed. When can I come and show you?’”

“I didn’t see anything about haemorrhoids in your file?”

“I’ll think about the Xarelto,” I said.




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