Schlink Attack: Mark's New Pet DVT

Our first two months in Astana have mostly been wonderfully mundane and reassuringly predictable with work, school, seeking new friends and setting up house. Mark and I drive to work early to avoid traffic and the kids walk to school. Ginsburg stays home and destroys books or whatever she deems worthy. We come home, walk the dog, workout, cook dinner, repeat. It's a wonderful combination of homeyness and repetition, especially given the launch pad we hit upon arrival to post. Four days after getting to KZ from Colorado, Mark flew to Tashkent to pick up his driving buddy (Mamed), Ginsburg, and our car for a 2,000 km, 48-hour road trip that involved uncertain border conditions, last minute surprise paperwork, and hefty fees (bribes) to get everyone here. Long hours in the car meant good company, storytelling, music and silence, and breaks in several Kazakh towns along the way. They drove past mountains and lakes, and endless steppe. It also meant eating too much beef jerky, roasted almonds, dried fruit, and coffee, and probably not enough water. Ominous circumstances (and hopefully lessons learned) because not long after, Mark's Astana re-welcome was interrupted with a hospital stay for a deep vein thrombosis.

Turns out, even in fit individuals, blood clots can happen to anyone and especially when circulation is diminished over periods of time. We suspect the clot started several weeks prior while in DC due to an upper respiratory infection that he caught in a classroom containing about 400 students. A day or two of feeling under the weather was followed by exercise intolerance at the gym. In Colorado, bike riding at 8,700 feet required Herculean stamina, but a cycling fanatic was gonna do what a cycling fanatic does - ride. Finally, after thousands of kilometers of flying, and bonus time in the driver's seat led to calf pain that he simply couldn't be stretched out or fixed with a dose of ibuprofen. It was the kind of pain he probably would have ignored had I not been insistent on bringing him in.

The doctor's visit led to a leg ultrasound, which led to a hospital admission, initiation of blood thinning medication, thigh high compression stockings, multiple lab draws, a couple of echocardiograms, and a CT, followed by more labs. No, I wouldn't be allowed to see him because doctors here follow The Protocol and do not allow deviation from The Protocol. They don't communicate nor collaborate with patients, insisting that visitors would stress him too much. He and I spent a lonely anxious night apart from each other with no answers and drained cell phones. By the time I was allowed to visit and ask his doctors some questions, I was met with resistance to knowing their plan beyond "more tests" and bedrest. In the US, once a clot is determined stable, the rest of the care is handled on an outpatient basis and bedrest in the meantime, medically unsupported. Doctors scanned his heart twice and found no signs of dysfunction, weakening, or pooling of blood. Labs and fluids were ordered to monitor a high normal creatinine level and eventually they performed a CT. The results showed clear lungs with exception to an old, chronic clot lodged at the end of a pulmonary vessel, suggestive of previous lung infection. In between the scant nursing care, he played video games, read, drank water, and took naps. We exchanged countless texts and memes. He doom scrolled and bought sweaters on sale.

After the fourth day, Mark's labs still looked great with nothing indicating that he'd inherited a clotting disorder. He was doing well on the medicine. Still, the doctors wanted to observe him for another week. Because, The Protocol. My request (demand) for open communication and allowing for US based standards of care, wasn't going to fly. It was at this time that I lost my mind, cried, and stomped around like a toddler - which finally caught their attention that we would not be ignored. Mark was as calm, of course, as he explained to them that American patients expect to have a say in their care, that we should be part of their decision making process. The doctors didn't agree. They knew best and anyone who defies The Protocol is risking death itself. That's exactly what they told us. In the end, as a compromise, Mark agreed to the initial 5 day stay instead of the 10 day one they'd hoped. On the way out, I apologized for losing my cool and they accepted it, hopeful they'd be spared further theatrics. I don't care if they thought I was hysterical - I will never stop advocating for him, or any other patient for that matter.

Recovery from DVT is fairly easy but it's also cheeky: exercise but not too much, stretch but not too much, drink water but not too much, wear compression socks but not too much... take medicine as prescribed, don't keep your legs crossed, and also... hopes and prayers because sometimes blood just clots. Mark feels great, though his leg does swell with abandon after exercise and is wary of tingling toes, a predictable and annoying side effect of having reduced blood flow to his lower leg. Recovery, annoyingly, is measured in months to years, if ever. Knowing Mark though, he will find a way to do it and in half the time because he's predictable in that way.

Lake Balkash, about 1/4 of the way through KZ.

The Balkash Town.

Getting to know each other's musical tastes.

Touring Astana with Mamed.

A male model and his dog.

After a fresh shower which scared the nurses to death
despite my being there. Or maybe it was because I was there...

Soviet IV. Kazakhstan is modern in so many ways, but not in others.
Medicine is still 30-40 years behind.

Sonographer making stern remarks to her colleagues who may or may not
have forgotten to restock the ultrasound gel. Fixing that error took over an hour.