Tag Archives: arrogance

Almost Alike: A Medical Cautionary Tale

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Blue medical bracelet with a medical symbol in white and the words "Adrenal Insufficency" on a metal plate.

Medical bracelet that says “Adrenal Insufficiency”.

I’ve been thinking about medical stuff a lot lately, so apologies if my posts tend towards the medical for a little while.  It’s what happens when you suddenly realize how lucky you are to be alive, and how close you came to death.  My father’s cancer has me thinking about life and death and medical care a lot, too.

In my dealings with doctors, I have found that they like the solutions to their problems to be neat and tidy.  In particular, they want there to be one diagnosis that explains all the symptoms they’re observing.  They want their patient to have that one diagnosis, and if their patient shows signs of more than one thing, it fouls up everything the doctor wants.

Case in point:  I had this neurologist at the headache clinic.  I told him that they strongly suspected my mother of having myasthenia gravis, or hereditary myasthenia.  Both are neuromuscular junction diseases that cause specific muscles to wear out quickly as you use them.  So for instance my eyes start out tracking the same object fairly well, but as time goes on, they drift outwards leaving me seeing double.  I had told my neurologist all about this, and about other muscular problems I’d been having.

I don’t remember why myasthenia came up, but I told him I was going to start on Mestinon, a medication that treats myasthenia.  His response was swift and a little annoyed:  “It’s not going to do anything.  I don’t think you have myasthenia.” 

“Why not?”

“Because people with myasthenia have trouble with specific muscle weakness. You have generalized weakness.  It’s not the same thing.”

He explained it as if I didn’t know this.  But he also explained it as if I hadn’t told him time and time again about the specific weakness, that was separate from the generalized weakness.  As if I hadn’t told him things were more complicated than he was expecting.

He offered to run an EMG but told me the results would be negative because “You just don’t have myasthenia gravis.”  I declined the testing.  I don’t like to be tested under circumstances where the doctor has already determined what the results are going to be.  Plus, I’d just been through an invasive procedure that left me in horrible pain for weeks, and I didn’t feel like being poked and prodded again.

But I did try the Mestinon, and it did make a difference.  It was subtle at first.  I could walk around my apartment without falling.  My eyes tracked things better, and for longer, before the double vision kicked in.  It was things like that.  The more Mestinon we added, the better those things got.  So it seemed my headache doctor was wrong, and there was something real about the effects of the Mestinon.

But in other areas, I was getting weaker.  In fact, as far as I could tell, I was dying.  I was hesitant to tell anyone this fact, because it felt like a fairly dramatic thing to announce.  But I’d known terminally ill people who had more energy than I had at times.  And I have instincts that tell me when something is going badly wrong.  Something was going badly wrong, and it went along with that more generalized muscle weakness.

I’ve already told the story of how I got diagnosed with severe secondary adrenal insufficiency.  And that’s what happened.  They found no measurable evidence of cortisol or ACTH in my blood.  When they flooded me with ACTH, I made cortisol, but not as much as expected.  Meaning my pituitary gland is not making enough ACTH to tell my adrenal glands to make cortisol.  And this was the reason for, among many, many other symptoms, my severe muscle weakness that affected my entire body.

I went into treatment for adrenal insufficiency and everything seemed to be looking up.  No longer bedridden.  No longer required to use a wheelchair for anything.  Not that I minded these things so much when they were happening, but it’s nice to be able to get up and walk up and down a flight of stairs when you want to.  It feels good to be able to exercise, after six years of bedrest.  Dexamethasone makes me feel alive again, instead of waiting for the next infection to kill me.   I feel strong, and sturdy, and robust, in a way I haven’t in years, and my friends sense the same thing about me.

The only problem?  Not everything went away.  I still had weakness in specific muscles.  I’d been referred to a new neurologist at the same time they were testing my cortisol.  This neurologist never pretended he had any answers.  He was simple and methodical in the way he worked.  He would come up with a list of every possibility, no matter how remote, and then he would run tests for every possibility.  This made me trust him in a way that I didn’t trust my migraine neurologist.  So I let him do any test he wanted to do.

Many of the tests, he came in and did them himself, which is unusual for a doctor.  Usually they delegate that stuff.  He did a regular EMG that turned up nothing, and I thought “See, my mother didn’t have an abnormal EMG either, so whatever we have isn’t going to show up on tests.”  Neither of us showed up as having the antibodies, either.  I began to think this was going to be one of those things that we never solved.

Then he called me in for something he called a single fiber EMG.  He was going to stick a wire into my forehead and measure something about the muscles.  I remember that on that day I had a lot of trouble even holding my head up on one side, and that I was seeing double.  He stuck the wires in, made me raise my eyebrows and move my eyes around.  There were a lot of electrical noises.

At the end of the test, he told me he wanted to see me as soon as possible because the result was abnormal.  The muscles were firing asynchronously. 

I didn’t know what that meant, but a week later I was in his office being told that I probably did have a neuromuscular junction disease after all.  Probably myasthenia gravis, possibly a much rarer hereditary form of myasthenia.

And to think that literally a couple weeks before I got the single-fiber EMG, my regular doctor and I had been discussing whether I really needed to be on Mestinon anymore.  We thought maybe my only real problem had been the adrenal insufficiency all along, and that my response to Mestinon might have been some kind of placebo effect (even though I don’t seem very prone to that effect even when I want to be).  Even I was starting to fall prey to that idea that a diagnosis is just one thing.

Right now, we don’t really know what exactly my diagnosis is.  We know for certain that I have secondary adrenal insufficiency.  And we are pretty certain that I have a neuromuscular junction disorder, and the most common one of those is myasthenia gravis.  (I’m just going to refer to it as myasthenia gravis for the rest of this.  Because it’s shorter than saying “the thing we think is myasthenia gravis maybe”.)

But the important thing — the thing a lot of doctors miss — is that there is not one diagnosis here.  There are at least two diagnoses, possibly more.  This is not the first time, and it won’t be the last time, that I’ve had doctors miss something fairly obvious because they thought that the simplest explanation is always a single diagnosis. 

I still remember back when I was dealing with three different diagnoses that affected movement in different ways:  Adrenal insufficiency, myasthenia gravis, and autistic catatonia.  And any time we’d try to bring up a symptom of one of them with a doctor, they’d bring up a “contradictory” symptom from a different one of them, and that would mean that… it couldn’t be myasthenia gravis, because sometimes I froze stiff instead of limp, because I also had autistic catatonia.   And it went on like that for years, where every condition I had was ‘contradicted’ by some other condition, so many of the doctors refused to see the complexity of the situation.

Sometimes that resulted in situations that were almost funny, but other times it could turn deadly.  There was a time I was hospitalized for aspiration pneumonia connected to gastroparesis, and my doctor refused to treat me for anything other than the pneumonia.  So I had collapsed in my bed after vomiting so much that all the muscles involved had gone limp and I was starting to have trouble breathing.  In retrospect we think it was the start of an adrenal or myasthenia crisis, and that I belonged in the ICU.  But at the time, the hospitalist simply refused to treat anything that wasn’t pneumonia.  So I had to lie there totally immobilized, delirious, and hallucinating, wondering whether I was going to survive, for days on end.  All because a doctor was only willing to think about one condition at a time.

Over the years, I’ve picked up an impressive collection of diagnoses.  Many of them are based on symptoms and my response to treatments.  But some of them are based on hard-core medical tests like high-resolution CT scans — things you can’t confuse for anything other than what they are.  I’m going to list the ones that  were diagnosed by those hard-core medical tests, and understand I’m listing them here for a reason:

  • Bronchiectasis (high-resolution CT scan)
  • Frequent bowel obstructions (x-ray)
  • Central sleep apnea (sleep study)
  • Obstructive sleep apnea (sleep study)
  • Early-onset gallbladder disease (ultrasound)
  • Exotropia (eye exam)
  • Gastroparesis (gastric emptying scan)
  • GERD – reflux (barium swallow)
  • Esophageal motility problems (barium swallow)
  • Dysphagia (barium swallow)
  • High cholesterol (blood test)
  • Hypermobility syndrome (Brighton criteria)
  • Myasthenia gravis or related condition (single fiber EMG)
  • Secondary adrenal insufficiency (cortisol test, ACTH test, ACTH stimulation test)
  • Urinary retention with spastic urethra (urodynamic testing)

So this is fifteen different conditions right here, that there is no possible way that I don’t have them.  They’ve been tested for, the tests are valid, there’s nothing unusual about the tests I was given, they exist.  I’m diagnosed with a lot of other conditions, but even if we pretended that those conditions turned out to be misdiagnosed because some of the diagnosis was subjective… I’m still left with fifteen conditions here that are very much real.  Some of them are more serious than others.  But many of them are difficult and complex both on their own and in combination with each other.  (Also, many of them went years misdiagnosed because doctors refused to even test me for them, believing that a person with a developmental disability or a psych history couldn’t possibly be telling the truth about their own symptoms.)

Now imagine you’re a doctor, and I’ve walked in your door, off the street, with no medical history.  And I’ve got the symptoms of all of these fifteen conditions.  Some of the symptoms are severe enough to be life-threatening.  And your very first instinct is to try to find one condition that accounts for all of these symptoms.  You’re going to be looking for a very long time, and you’re going to be lucky if I don’t die before you figure it out.

Of course, it’s still possible that there really is one condition that explains all this.  Or at least, a small handful of conditions.  There are many genetic conditions that can cause problems all over your body, and they can be notoriously difficult to pin down.  But for the moment, we’ve had to diagnose all of these things separately in order to get a handle on how to treat them. 

It may be there’s some genetic condition that causes neuropathy (my mother and I both have symptoms of autonomic and sensory neuropathy), which could in turn cause the gastroparesis and esophageal motility problems (and dysphagia, and other things that aren’t listed above), just as one example.  But right now we don’t have that information.  Right now we just know I have gastroparesis, and that it doesn’t play well with reflux and bronchiectasis, and that if I hadn’t gotten a feeding tube in time it probably would’ve killed me.  There could also be something behind the adrenal insufficiency, but that damn near did kill me a number of times before we even knew enough about it to put me on dexamethasone. 

And that’s why it’s important that medical professionals not restrict themselves to a single diagnosis when they’re looking at what’s going wrong with someone.  If you see symptoms that look contradictory, then you ought to be wondering if you’re looking at more than one condition at once.

If there’s one thing I have noticed, having been in and out of hospitals for a long, long time… it’s that my roommates are usually people like me.  They’re people with multiple medical conditions all at once.  They’re not textbook illustrations of a single condition in all its pristine glory.  They’re a mess, just like me.  Like my roommate who had both Lesch-Nyhan and myasthenia gravis (and was a woman, which is rare for someone with Lesch-Nyhan in the first place).  They really treated her like crap, too — they wouldn’t believe a word she said about herself, unless they could verify it from some outside source, which they always did, but still never trusted her.  Sometimes I heard her crying after they left.  At any rate, I can’t remember a single hospital roommate who had only one condition, unless they were in there for a routine surgery.

Which tells me that those of us who end up in hospitals on a regular basis, at least, are people with complicated medical histories.  Not people who just have one simple thing that can be figured out.  Which means that no hospitalist should ever do what one of mine did and say “I’m only treating the pneumonia, nothing else matters, no matter how bad things get.”  I’m really passionate about this issue because I’ve seen how close to death I’ve come, how many times, just because everyone wanted my body to be simpler than it was.

Maybe the problem is that we train doctors too much on textbooks, and on the people who most resemble textbooks.  We don’t want to confuse them with too much, all at once.  So they grow to look for the one explanation that will explain it all, instead of the fifteen or more explanations that will explain it all.  And in the meantime, their patient could die while they’re waiting to get properly diagnosed.

And that’s the part that worries me.  I’m very lucky to be alive.  My doctors know I’m very lucky to be alive.  And I have a pretty amazing team of doctors.  I have a great GP, a great pulmonologist, a great neurologist, and a great endocrinologist.  These are doctors who are willing to listen to me when I know more than they do, but also willing to argue with me when they know more than I do, it’s the perfect combination. 

My GP has been here since I moved to Vermont, and he is known in the area as one of the best doctors around.  We have our disagreements, but he always explains his decisions to me, and I always explain my decisions to him.  We respect each other and that makes everything work.  He has done his best to stand up for me in situations where my social skills have caused problems with other doctors.

My pulmonologist is amazing.  She always anticipates situations where I’m going to face discrimination, and she’s always ready.  When she knew I was heading for a really bad pneumonia, she had my lungs CAT scanned to prove the pneumonia was there, because she knew nothing less than that would get me admitted to the hospital.  And even then it took all she and my GP could do to get me into the hospital and keep me there long enough to get me a feeding tube.

I’m new to my endocrinologist, but he’s clearly really good too.  He’s been helping me through the first stages of being diagnosed with adrenal insufficiency, including things as difficult as when to stress-dose and how much.  He’s given me the confidence to figure out on my own the amount of steroids I need to give myself in physically or emotionally stressful situations.  That’s a key skill you have to have to avoid adrenal crisis, and I think I’ve finally got the hang of it.

My neurologist is also new, but he’s clearly highly competent.  There’s nothing flashy about him or anything.  It’s not like he has some kind of flashy swagger like you see on TV shows.  He’s very quiet.  What he has is the ability to be mind-bogglingly thorough.  He listens to everything you have to say, he asks very careful questions, and he takes very careful notes.  Then he thinks up every possible condition that could result in the symptoms you have, no matter how rare or improbable it seems.  Then he figures out which ones are the most important to test for first.  And then he pretty much tests you for everything.  If there were two words for him, it would be methodical and thorough.  And it’s paid off — we now know I have something similar to myasthenia gravis, even though all the signs were pointing away from it for awhile.  Like my GP, he’s one of those doctors that other doctors hold in very high regard.  I can tell by the way they talk about him.

I wanted to make a point of talking about these doctors, because the point of this post is not to bash the medical profession.  These are people who have saved my life.  These are people I have built a relationship with over the years, or am in the course of building a relationship with now.  I’ve had plenty of truly awful doctors, but I’ve had a surprising number of truly great ones as well.  Most are somewhere in the middle.  But the great ones are the ones I owe my life to, many times over.  They have done things for me that, I am sure, they have never even told me about, and probably never will.

But all doctors, no matter how great, need a reminder that medical conditions don’t come in neat, orderly packages the way the textbooks make them sound.  Most disabled people and people with chronic illnesses have multiple conditions, not just one.  Often, these conditions have symptoms that can seem to contradict each other.  And even when there’s one overarching condition that causes all of them, there’s a good chance you’re going to need to find all the smaller conditions before you can put the puzzle together.  Many times, finding all the smaller conditions is a matter of life and death.  People simply can’t wait around to find the perfect most elegant answer when we’re going into adrenal crisis or myasthenia crisis on a regular basis.  Maybe there’s a reason I have adrenal insufficiency, and maybe one day they’ll find it, but for now I need to be on dexamethasone so I don’t die in the meantime.

“I’m the only one who can take care of you properly.”

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“Do you want a full bed bath?” she said. “I'm going to be gone for a full week, and I know you won't want anyone else doing it for you.”

Uh-oh. I made a mental note to ask her other clients if this meant whatbi thought it meant.

I usually don't get an entire bed bath at a time because it wears me out. But that wasn't the issue. I have very sensitive radar for certain warning signals from caregivers. It's a survival thing. And I freak out a little at any hint of “You need me, I'm the only one who can take care of you properly.”

The weird thing about it is she's not even that good at her job. I mean she gets the basics done. But she does a lot of things that seem little and aren't, if that makes any sense.

Like she scrubs too hard, which causes pain and, for people with fragile skin, injury. She isn't able to control where she puts her hands. By which I mean she seriously thinks she's staying within certain bounds and she's not. Which means she gets lotion on my hands instead of just my wrists, which makes my eyes burn when I rub them later on. When she washes my vulva she goes all the way back to my anus despite attempts to stop her, which can cause infections. She can't aim properly when putting anti-fungal cream on, so my skin still burns when she's done. And no matter how many times I tell her to do otherwise, she tries to pull a towel out from under me before I have my pants on. Which can result in Desitin getting all over the bed sheets. She’s also one of the ones who inadvertently claws my vulva and thinks she doesn’t have fingernails.

More worryingly, she can be borderline abusive. You know how people slam cupboard doors and bang plates onto the table when they're angry? She does that to people. It's painful and alarming. She scrubs you even harder, slams your body around, and is generally rough with you.

Even when she's not angry she can be worrying in this department. On days when I'm unable to respond to her or move well, she treats me like I'm an object, not a person. And she can do the same things when in a hurry. It's like we are just things to her, not people, and the more severely impaired we seem to her, the more we are objects.

And she does a lot of things primarily for her convenience. Once she forced someone I know to stand up rather than get the bed bath he needed because it was slightly easier for her, and it exacerbated the injury that put him in bed to begin with. she didn't appear to care.

None of these are the attributes of someone who we all miss when she's not around. Let alone someone we feel we couldn't do without.

But her statement worried me a little. So I asked around. It's handy at times to live in a building where a lot of people have the same caregivers. Especially the people who bathe us, like her. They tend to be shared among more of us because they only come for the duration of the bath and any other personal care they provide.

Anyway, it was not hard at all to find someone who confirmed my suspicions more than I ever guessed. It seems that she has written it into her will that her pets are to be killed when she dies, because nobody could possibly care for them like she does. That's more of a warning flag than I wanted.

People have an obligation to our pets. And part of that obligation is to do everything in our power to ensure that they will have a good life if they outlive us. I know that Fey will miss me greatly, and I hope that she will not try to starve herself if I die. But I have plans set up for AnneC to find her a home or, as an absolute last resort, to take her in until she can find her a home. I would never have her killed just because I was dead.

To kill your pets when you die is selfish and reflective of a really disturbing and warped take on the world. Part of that take on the world is almost always “Nobody could take care of them like I do.” Which is also a huge part of the mentality behind a lot of animal hoarding and other abuse.

It works the same way with humans. “Nobody could take care of you like I do” always results in messed up behavior towards the person in question. It can range from minor abuse and neglect, to murder.

Parents who think nobody but themselves can take care of their disabled children are disproportionately represented among people who murder their disabled children. They often don't seek out help to take care of their children, and don't plan for a future when they are not around for their child. This means that even if they don't kill their child, they're setting them up for the awful situation the parent sees as inevitable after their own death. It becomes a self-fulfilling prophecy. Whatever they believe, this is not love.

And caregivers who think this of their clients can be just as dangerous. At minimum they abuse their power over us. They may try to get us to see other caregivers as not very good. Even when they're better than the person in question. They frequently treat us like things, because to see someone in this way is to fundamentally see them as a thing. And at worst, they too can kill us.

I know a disabled guy who dated a nurse who had this attitude to her patients. He believes she was an “angel of mercy” serial killer who killed several of her patients. (Such serial killers are far more common than the Jeffrey Dahmer types, but receive little attention from the media or law enforcement. Their victims are only disabled people, after all.) She frequently talked about killing all her pets and everyone else who depended on her before she died. He realized she saw him in this way, and got out of the relationship fast.

I don't think that this caregiver kills her clients or anything. And I don't think I'm in any serious danger of more than being treated like an object by her, or else I'd never allow her in my apartment. But knowing this about her means I can be on my guard for more serious warning signs in case she does anything more disturbing.

But in general. Any sign of “Nobody can take care of you like I can” should put you on your guard. It nearly always results in something bad, and sometimes results in catastrophic abuse or neglect, or killing.

Feline Ethics, Part 2: Avoiding Arrogance

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This is the second in an ongoing series of posts about feline-human ethics. The first post is Dealing with cats, part 1: What is Respect? The current post is on the topic of avoiding arrogance. The post that’s currently planned as the next post will be about the power humans hold over cats.

Human arrogance towards cats frequently goes two apparently opposiite directions.

1. Cats are like miniature humans in every way. They understand every word of what we say, are motivated by exactly the things that motivate us, and if they don’t respond exactly how we expect another human to respond then they are just being stubborn, callous, cruel, manipulative, etc. Any attempt to say otherwise relegates cats to the realm of dumb animals.

2. Cats are totally unlike and inferior to humans. They do not understand a single word of what we say, cannot love, cannot reason, are not self-aware, etc. They see us as food sources and nothing more. Any claim otherwise needs to be rigorously proven in a laboratory setting, and is probably a misunderstanding of basic instinctual behavior.

The first approach is arrogant because it comes from a tendency to view the world, and especially cats, as a reflection of humanity. So it views respecting cats and seeing them as human as if these two things are synonymous. The second approach is arrogant because it views certain traits as exclusive to humans (or at least to “advanced” animals). It also, like many false ideas about cognitive disability in humans, views it as “scientific” to start from the assumption that cats lack certain abilities and demands absolute proof of the presence of those abilities before it will believe in them. Whereas for “normal” humans the preesumption is that we have those abilities.

From my standpoint those views are two sides of the same coin. The idea they both stem from is that humans are superior in certain ways. It’s just that one solves the problem of respecting cats by giving them traits identical to humans, and the other just doesn’t bother respecting cats and assumes that only humans have traits that are common among many species, cats included.

Often someone who holds one of these beliefs will assume that the other belief is the only other one possible, so that if you doubt one you must believe the other. If you doubt the first one someone will think you believe cats are nothing like humans and are overly wedded to the biases of many scientists, and if you doubt the second one someone will believe you’re engaging in overly sentimental anthropomorphism.

When most people think about cats, they see them as having a life that is simpler than our own. A little life that can be contained inside the bigger concepts that humans have. Emotions are like ours but fewer of them, thoughts are like ours but less complicated and not as many, and so forth.

This is not a useful way to look at the lives of cats. They are not miniature humans, and they are certainly not like humans but with certain aspects blunted, removed, and simplified. They are cats. They have their own complex way of relating to the world and each other. They have their own emotions which they feel according to their own values. They have things in common with us, but it’s dangerous to assume either identicalness or that they are just limited versions of us.

So when you think of cats, have some humility. Understand that there are more aspects to their way of doing things than humans can even perceive, let alone understand. This doesn’t make cats innately mysterious, it just means that we are working with different bodies, sensory organs, and brains. Even humans with the best sense of smell have nothing on cats. Our visual system is set up totally differently, not only can we not see in low light levels but our perception of motion is nothing like a cat’s. These are not little differences, they shape cats and humans into very different beings. As humans trying to understand cats, there are just flat out things we will only comprehend the vague shape of, and others we will never guess.

Be excited over these differences rather than trying to think of cats as inferior or even simpler beings. This is not to diminish what we have in common either, just an attempt to avoid making them into lesser beings just because they are different ones.

It is also important not to think of yourself as a Cat Expert. If all the stories you tell others or yourself contain phrases like “good with cats”, “a way with animals”, etc., then you are headed in the wrong direction entirely. You may have an affinity with cats — I have always found them easier to relate to than humans — but the moment your self-image depends on being right about all matters cattish, you are doing the cats a grave disservice. Because once you enter that frame of mind, you will begin to delude yourself and forget that you can make mistakes. The moment you forget that you can make mistakes, you are able to do great harm to the people you base your ego on understanding. And ‘people’ there includes cats.

Whenever someone meets Fey and begins by saying they are ‘good with cats’ or similar, I try to convey enough watchful alarm in my body language for Fey to pick up on it and get on the alert herself. (Such people never notice this body language in either one of us.) Some things I have seen such people do:

1. Grab her and find a way to hold her where she knows she can’t fight. At that point she gives up (but looks terribly uncomfortable) and they tell me, “See she likes being held after all if someone who is good with cats does it”.

(I have even seen mention of that one in a better than average book about cats. But most cat books don’t mention it or other ethical issues at all, except sometimes to reassure humans that whatever decisions they make for cats are the right ones.)

2. Try to do whatever I just told them not to do. If they succeed in doing it without provoking a major response, they assume she is okay. If they do provoke a major response (hissing, spitting, tail lashing, ears back, clawing for instance) they go “awwww what a cute playful little kitty cat” and make me want to go at them with my claws out.

For example, Fey has some kind of condition affecting a particular nerve going to her back right leg. The vet said she had never seen a cat so thoroughly indicate that the problem is a particular nerve and not others. I tend to tell people to avoid her entire back end. On good days she will initiate touch in that area, on mediocre days she will allow touch but stiffen and look uncomfortable, and on bad days she will indicate pain in every possible way and defend herself by any means necessary.

Some really egotistical people will, upon explanation of this, proceed to grab her by the exact body part that hurts in order to try and prove they are Special People Gifted With Animals who can touch her there without provoking a response. And even if she responds by mauling them, they Dont Get It. At all. No matter what happens, they especially don’t get that causing another living being intense physical pain on purpose to prove that they are a special good kind of human only proves that they are an especially terrible, insensitive, and cruel kind of human who ought not to be allowed within a mile of a cat.

(I have also seen these sorts of people at the animal shelter. Fortunately they get thrown out pretty quickly because, among other things, if an animal scratched someone they have to be put in isolation for a long time which is horrible for the animal and everyone wants to prevent it. And because the people who work there actually care about animals.)

3. Read all sorts of bizarre and obviously false things into her behavior because they just can’t possibly handle the idea of not knowing what some action on Fey’s part means. Which in turn leads to really pissing her off eventually.

4. Use their “knowledge” about her as an ego trip or power play with me or other people.

5. Do any or all of these things to me as well, because lots of people who view themselves as Good With Cats also view themselves as Good With Autistics (or sometimes Good With Nonspeaking People). And they especially love to do it in situations where I can’t do anything about it. Such as get me in a situation where I can’t respond well and then harangue someone for ‘upsetting me’ or something when nothing of the sort has even happened.

Viewing yourself as Good With an entire category of people opens you up to massively egotistical mistakes that lead you down the road to outright physical and emotional abuse. It doesn’t matter if everyone around you comments on your gift with cats, your way with cats, your being a cat whisperer, whatever. I ignore such comments if I get them. I have a close relationship with a cat. Not special powers. You should never ever let praise go to your head. No matter who you are, your ability to make grievous mistakes when trying to understand another species is an absolute given. Until you understand this, avoid cats.

And if you have either thought “This part of the post doesn’t apply with me because I am too good with cats to make serious mistakes,” or if you respond to other cat lovers admitting to serious mistakes by either thinking or uttering “I am so good with cats that I could never make that level of mistake”? That goes double for you. I have a deep and rewarding and loving two-way connection to Fey that is more detailed in our understanding of each other than any other relationship, human or cat, that I have ever had. And we both make mistakes and have misunderstandings every single day. If you think that doesn’t happen you are fooling yourself and setting yourself up to harm the cat.

The other direction arrogance can go is in assuming there is no actual harm in making massive mistakes because it’s just a cat. Or worse, that because the cat can’t tell anyone what you do, it is really okay. I have only ever got one person to admit that last one. But as someone whose ability to communicate in standard ways can come and go, I have watched what I thought were decent people transform into assholes many times the moment they thought I was either unaware or unable to tell anyone what they had done. And if it was bad for me it would be worse for cats.

I don’t really know what to say to all that. I know people who think if someone purportedly can’t understand what’s happening then cruelty isn’t wrong. I know some peopleonly care about being caught doing wrong, not about doing wrong itself, because such people have done awful things to me when I either couldn’t tell anyone or wouldn’t be believed if I did. But I know that each time people play out such attitudes on cats, the cats suffer.

Cats also suffer when treated like humans in cat suits. They end up being punished in ways that feel like a random attack from nowhere for no reason. People do things that are polite to humans but terribly rude to cats. And cats also suffer when people assume that things like love are too human for cats to fathom. Working across species is even harder than working across cultures in many respects, it’s hard to know what’s exclusively human and what we share with other animals. And there are things we may never know.

The best way to approach learning about cats is with a combination of respect and humility. Know that you’re going to mess up, but don’t focus on it so hard that you don’t even try. Be alert to signals that the cat doesn’t like what you’re doing, and don’t laugh them off with “awwww aren’t we feisty today”. Treat the cat as an individual and conscious being that you are getting to know, not as a human or a mindless automaton. Keep your ego out of the way. And above all, be aware that despite differences in species, you are dealing with someone (not something) who is capable of feeling love, physical and emotional pain, anger, joy, fear, and many other things. Treat them accordingly.

Fey on my bed

The photograph is of Fey, a grey cat with ticked fur and some white markings. She is lying curled up on a foam mattress on top of a hospital bed tilted slightly upward. Her face is at the top, in profile. You can see the dome of her eye, with a large black pupil underneath, her eyebrow whiskers pointed straight up, and a big triangular ear pointed directly at the camera. The focus becomes fuzzy towards her tail, which is curled up and around. You can also see the shiny bedrail with some notebooks behind it. The mattress she is laying on is yellow memory foam with a pale green bedsheet part on and part off it. The foam is roughly the same shade of yellow as her eye.