Medicine in the (Post-Apocalyptic) Wasteland: 1 / ?
Hey everyone. I get so many asks about post-apocalyptic scenarios that it’s I’m going to build you a series of posts, dealing specifically with medicine after the collapse of civilization.
Yes, this borders on sci-fi. Yes, a lot of things will be very different in your story, depending on the hows and the whys and the social structure that exists after the apocalypse. Things will also be incredibly different based on when your story is set, because things will likely collapse in a particular order. So your story is going to change a lot depending precisely when you’re writing about, in relation to The Catastrophe (of whatever type).
The difference between this and sci-fi asks is that there is very much an area of medicine devoted to this type of care. It’s called Austere Medicine, AKA Wilderness Medicine. It’s studied. There are resources. There are people who work in villages that may not have had an apocalypse, but have limited funds, access to power, access to diagnostics, access to drugs, and they do it every day of their lives. This is sci-fi with modern parallels. This is interesting.
For the purposes of this article, we’re assuming two major problems: no / extremely limited electricity, and no / extremely limited gasoline.
That first one throws out most of modern medicines. Hospitals. Surgeries. MRIs, CT scans, even the humble X-ray goes by the wayside. Providers have to go back to doing medicine with their hands and with their ears.
Oh, and a lot of people are going to die.
Enter Dani Disaster.
She’s smart, but moreover she’s
resourceful, and she can think outside the box that modern medicine has
tried to put her in. Maybe she was a doctor, or a nurse, or a paramedic.
Now she’s a healer, a Jane-of-all-trades of medicine. She barters for
what will help people in the short term, and shakes her head and sighs
when she realizes she can’t help a lot of the people she used to be able
One thing I want to mention is that Dani will definitely
want to keep someone around, preferably an intimidating, armed someone,
to protect her. Because people will want things from Dani; everything
from begging her to fix their dying-of-something-she-can’t-fix husband, to demanding she be personal medic to the Warlord King (or whatever brute is rising to power in your world).
The First 6 Months
Most people don’t have more than a month’s worth of their medication on hand. Even most pharmacies would run out of the most popular life-saving medications inside of a month or two, assuming they aren’t simply raided by bandits. And in a world without gasoline, the odds of restock are very, very low.
That means no blood pressure medications, no blood thinners, in an ever-increasingly-stressful world. That means no insulin for diabetics, no immunosuppressants for those with autoimmune diseases, no antiepileptics for those with seizure disorders, no antibiotics for septic patients. No pressors to give and no pumps to hang them on. Even IV fluids, literal salt water, will run short.
I will be straight up with you all, keyboard-mashers: a lot of people
will die in the first 6 months of an apocalypse, and I’m not even
talking from the fighting. I’m not even talking about starvation. I’m just talking about chronic illness. Heart attacks. Diabetes. Blood clots. Strokes. I’m talking about the elderly, who can barely make it a block to the store. I’m talking about serious respiratory patients who need steroids and who have serious trouble walking distances. Cancer patients won’t get chemo, or radiation, or maybe even food. Patients with HIV will run out of antivirals, and then run out of T cells, and die from the common cold.
There are going to be a lot of deaths in the first 6 months after the apocalypse, friends, and it will be ugly as hell.
Remember that for most of human history, the lifespan was about 40 years. In a world without organized medicine and the pharmaceutical processes to make medicine,
there’s precious little that can be done to expand the lifespan.
Congratulations: You’re the Surgeon. And the Infectious Disease
doc. And the Midwife. And the Wound Care Specialist. And the
Anesthesiologist. And the…
Look, healthcare is a wide field, and no one person is going to be good at everything. No one person is actually interested in everything, either. There is no one type of healthcare provider who can do everything, although Emergency Medicine docs probably come the closest; and before The Thing That Happened, Dani may have been an ICU nurse, tweaking ventilators, or a paramedic who’d never thrown a stitch before, much less amputated a badly gangrenous leg.
What I’m saying here is, there’s a learning curve for the actual technical things she’ll need to do, in addition to re-learning how to do everything with nothing. And some of it might be way, way outside her wheelhouse, especially at first.
Six Months to Five Years: The Rise of Dani Disaster
If Dani is lucky, and she gets to the raiding of pharmacies early on, she’ll stock up. On anything she can get, of course, but especially on three things: antibiotics, analgesics and sedatives. Why? Because they’re what will save lives and be useful as hell for trading. Here’s why:
Antibiotics: infection will probably be the single group of preventable deaths that are worth looking at, from a supply-vs-life-years-saved perspective. A single course of antibiotics will save someone’s life, but a diabetic will need insulin, every day, for decades. Also remember that with system breakdown comes water supply breakdown, which means a return of diseases like typhoid and cholera and diptheria and polio.
Antibiotics are an art all of their own, but frankly, they’re boring. Broad-spectrum antibiotics will be most useful; including amoxicillin/Augmentin, Cefaclor, Keflex, Levaquin, erythromycin or clarithromycin or azithromycin, Cipro, or doxycycline.
Oral antibiotics are going to have benefits over IV antibiotics, for a number of reasons, mostly portability and ease of administration; IV-only drugs haven’t been listed here. Some meds may come in a form that can be given IM; this may be helpful for conditions that severely upset the GI tract (and thus prevent people from absorbing them, because the pill will either go up or down, depending.)
The thing you have to realize is that in austere medicine, common things happen commonly. No one cares if your patient has a pulmonary embolism, or a cool dysrhythmia, because with complex conditions, one of two things are going to happen: They are going to get better, or they are going to die. Heart attacks, a major focus of modern medicine, are essentially untreatable without the risk of dying.
Instead, the most important things Dani will be treating are things that, in the developed world, should be handled in urgent care clinics: gastroenteritis (the shits) and broken bones and infected wounds and yeast infections. A friend of mine went to Haiti after the quake, and within 24 hours she could diagnose a yeast infection by the way a woman was walking.
Diflucan. She will need LOTS OF DIFLUCAN.
(It’s worth noting that Haiti was very hot and very humid, which is where fungi like to grow; other areas may see other climates, and thus less yeast infections.)
Analgesics: If she’s smart, Dani will take anything she can beg, borrow, or steal. Common, over-the-counter meds like Advil/ibuprofen and Tylenol/acetaminophen/paracetamol, and pill opiates like Vicodin and Percocet and Morphine and Dilaudid. All of these have their place, but mostly this is a “whatever I can get” sort of a thing.
If Dani is really smart, she will go out of her way to find every bottle of ketamine in whatever hospital she raids. We’ve talked about ketamine before, but it’s worth mentioning again, in that it can be used to sedate the crazy, ease pain, or put someone under for short surgical procedures like an appendectomy or amputation. (It’s also a single agent; it controls pain and causes sedation. It doesn’t act as a paralytic, but hopefully she won’t need one).
Lidocaine in a Big Fucking Bottle is optional but beneficial for topical procedures, wound care, suturing, etc.
However, all of these things will eventually run out, no matter how judicious she is about using them. And that’s when we get to….
Five Years Plus: Back to Herbalism It Is
There are a lot of allopaths–those who practice Western medicine–that believe herbalism is complete and utter horseshit. I am not one of those people. A lot of medications have their origins in natural remedies and plants, and herbalism is how we treated, well, everything, for quite some time.
The poppy plant begat opium, which begat laudanum, heroin, morphine, and fentanyl. The foxglove plant (digitalis) begat, Digoxin, whose actual name is digitalis. Curare is one of the original paralytics used for surgery. The list goes on and on.
Now, an allopathic education doesn’t typically lead to an in-depth knowledge of medicinal herbs. But fortunately, there are these lovely things called books, and there are, in fact, some really good ones on this topic.
My personal medical-herbalism reference is James A Duke’s The Green Pharmacy (Amazon link, but available everywhere; not an affiliate link). The author ran the medicinal herb research at the US Dept of Agriculture for a good long while, and the best part about his book is that it is organized by disease (so you don’t have to read about 5,000 plants to find one that treats allergies), and he grades his evidence base for each recommendation. However, there are also field guides to medicinal plants.
Once the allopathic meds run out, Dani Disaster is going to become, basically, a witch doctor, without the witchy aspects. (Or with, depending on her faith and whether or not she practices the craft; no one is judging here.)
She’s going to have a garden of medicinal herbs, and she’s going to learn to prepare poultices and teas and tinctures and creams. Basically, she’s going to bring an allopathic ideology back to herbalism, preferably with some form of evidence base. Willow bark tea is going to be a Big Deal™, because willow bark tea contains an active ingredient very similar to aspirin.
But she’s also going to have to be, in part, a home chemist. If she does enough research she can learn how to make her own ethyl alcohol, aka ethanol, aka boozeahol, but this can be used as a disinfectant and antiseptic. (Hell, in a pinch regular ol’ wine can be used to clean out wounds, apparently.)
She can also learn to make her own bleach, her own IV fluids (0.9% Normal Saline, anyways), her own oral rehydration solution (aka Pedialyte / Gatorade), and perhaps even her own ether, which is a crap anesthetic but better than nothing.
That’s It…. For Now
This is just a small snippet into the world of austere medicine. (Be careful with Google searches on this topic; Doomsday Preppers are very, very scary and their websites can be… uhhh….. ill-informed.) There’s still plenty more to talk about, so stay tuned for more posts! (I’m especially drooling over the idea of writing a post on the ethics of medicine in the austere environment–stay tuned!!)
(Essentials in bold if you’re money-tight, but I would seriously consider everything on this list. Obviously don’t buy what you already have)
Button Up Shirts or/and Zip Up Hoodies (easier to put on & take off due to being unable to lift arms up)
Comfy sweatpants (easier to pull them down/up & take them off and they’re comfy^^)
Slippers or flipflops (easier to slip on and take off, which saves bending over)
Hats or Beanies (to cover that gross hair in the first week without a shower)
No perfume, no colour, sensitive skin soap. (To wash with for the next few months after surgery. ‘Simple’ is a good brand. Otherwise avoid using shower gel for 6 weeks)
Arnica Tablets (taken to help with the bruising a week before & after surgery)
Bio Oil & scar treatments (Can be applied once scars are dry and healing)
Vitamin C (Boosts immune-system and thus recovery)
Ginger tea (NOT GINGER TABLETS) (Help to stop any feeling of sickness)
Baby wipes / Wet Ones (To help keep your body clean until you can shower)
Laxatives (If you have trouble taking a shit - especially if you take Codeine)
First Aid Kit (just encase! You will be given some spare gauze and stuff though)
Paper Tape (For the dressings post op. Though you’ll get a roll after your post op appointment to put over your incisions)
Dry Shampoo (Helpin’ that hair look slightly less gross!)
Neck rest / travel pillow (Comfort when traveling back from hospital and travel in general)
Straws (makes drinking much easier & requires less arm movement)
Extra Pillows (Place these under your knees and under your head/back to elevate you while you sleep on your back! It helps)
The Food Doctor (Healthy ready meal alternatives, can be found on Amazon)
Green Tea and detox teas
Plenty of fresh fruits and vegetables
Plenty of water
Healthy home made frozen meals ready to microwave (Makes cooking quick and easy but still healthy)
Healthy snacks to munch on (like nut mixes, dried fruit, yogurt bars etc… rather than junk food. Your body is healing, help it along.)
Move everything in the house to being in reach
Make sure you have a primary carer for the first week, especially the first three days because it will be hell on your own.
Find a couple of films and series you wanna watch in the first week
Pick out a couple of books to read
Tidy and clean your house/room a day or two before surgery (Makes everything simple and easy to move around in, also a more positive and clean environment to be in while recovering)
Change sheets and wash any clothes you wanna wear etc before
Prep your bed so you can sleep sitting up slightly, lots of pillows help!
Physical and Emotional preparation:
Eat healthily in the months leading up to surgery - Plenty of fresh fruit and veg - BALANCED diet at least two good meals a day - Plenty of water - Cut out processed foods, high sugars and salts - I recommend looking into ordering recipe boxes if you’re tight on cash/struggle to make healthy meals yourself every day. - Smoothies are a great time for 5 a day - Snack on dried fruits, nuts, yogurt biscuits instead of junk.
Stop smoking asap. Seriously, stop. Doesn’t matter how long until your surgery, the sooner you quit the better all round - surgery is a great motivation to quit smoking. Vape pens are a good alternative, be strict with yourself. Try to stop vaping in the month before your op or go down to 0mg of nicotine if you still need the feel of vaping/smoking. Do not vape or smoke for 2 weeks before your op. You’ll lose ur nips.
Stop drinking alcohol at least one month before, in my opinion giving yourself as much time away from it is much better to help detox your body and get healthy (alcohol is generally shit for you so cutting down or stopping is pretty good anyway, and surgery is a perfect excuse!)
Exercise. Pushups and flies will help to develop your pectoral muscle, bring down the breast size and help the surgeon place your incisions. Crunches, sittups, squats, and various exercises will help to keep the rest of your body fit and speed up your recovery (you’re gonna be recovering and potatoing for a while, get your body in a better state so it heals well and quickly). Cardio, jogging on the spot, starjumps and knees-up, gets your blood flowing, helps to get you nice and healthy for the op and recovery. Look up exercise routines on youtube!
Do a lot of internal reflecting and focus on your mind as well as your body. You need to psychologically prepare for surgery and that doesn’t happen over night. It’s also very difficult to do this, I really struggled to. It’s perfectly normal to feel scared, nervous, or feel like it’s a big deal, it’s a huge deal. You’re losing something that’s been there for a long time, you’re going through major surgery, and you’re finally getting something you’ve been awaiting for a long time!
Try not to have an ideal vision of what your chest will be like, don’t expect anything, try not to compare it to other chests, especially cis male chests. The first time you see it, it’ll look pretty rough, take it in slowly, learn to re-accept it as your own. It can take time to learn to love yourself all over again, but welcome your new chest with an open mind.
Tips and General Advice:
Make sure you have all your questions and concerns written down before your pre op appointment to take with you - if you have any more later or forgot to ask something, call the hospital or your surgeon’s office to ask them. Otherwise ask on the day of your op if it can wait that long.
Write down all the tips and advice they give you even if you don’t think you’ll forget them.
If you can, take a cheque in for both payments to the surgeon and the hospital on the day of your pre op appointment. This will give you plenty of time if there’s a problem with the payment and is also much easier than stressing out a few days before. Otherwise make sure you pay a week before online, so if there’s a problem you’ll have time to fix it.
Don’t underestimate or overestimate how big this surgery is, how much
time you’ll need or how many thing’s you realistically need to buy/prepare.
Obviously it would be better to overestimate as it’ll leave you more
prepared, but there’s some things you just won’t need/need to do. Think
carefully about yourself, your situation and how you deal with pain and how you like to
be comfortable. If you forget anything you can always get it later on! So here’s some tips for that:
- Write a detailed list and slowly check through it cutting down on things if you think you’ll need to. See what you can use in the house and what you’ll need to buy. Be minimalist if you’re trying to save money.
- Make sure you have plenty of time booked of work/school/uni, if you go back early it’s much less of a problem than being back late.
- Really take the time to research what you’re about to be put through, speak to others who’ve been in the same boat and realistically think about how you will actually be affected and how you will actually feel after surgery. This will help to stop you from having unrealistic expectations of your physical appearance and capabilities, your mentality after the op and to help stop yourself from become lazy.
- Again, honestly try your best not to expect anything of your chest, try not to worry about how it will look, how the nips will be, whether the scars will be straight or narrow or whatever. Be ready to have to learn to accept your new chest however it looks. Be ready for a huge emotional change. Don’t brush off these kinds of things, they’re just as important for your healing as everything else on this list.
Follow @jamie-pyro for non-binary & trans related info and to follow my personal experience and progress as a non-binary transmasculine bean!
“He fights your fight. Lives your life. I don’t give a @#$% what you call him, you’re his father.” - Green Arrow to Batman, Green Arrow/Black Canary #5
I’m actually warming up to the Rebirth redesigns, kinda. I mean, it’s weird that Robin has more red than Red Robin and I think I’ll be forever mourning Nightwing’s finger slips but ya know… Drawing Cass fighting is. so. much. fun.
My stim toy and sensory collection and where to get them. I have entirely too many but I’m perfectly okay with that.
Photo 1(top to bottom, left to right)
1. Pluto plasma slime (target)
2. Sensory bucket of beads (beads from Michaels, not sure about the bucket)
3. Ear defenders (dicks sporting goods)
4. Green chewable chess piece pencil topper ( @stimtastic)
5. Black lotus chewable necklace (stimtastic)
6. Red mushroom chewable necklace (stimtastic)
7. Purple bat chewable necklace (stimtastic)
8. Gender fluid pride chewable necklace ( @bitterautistic etsy shop, on mobile so I can’t link it)
9. Green tangle Jr (stimtastic)
10. Tangle Jr therapy (stimtastic)
11. Key chain measuring tape (home depot)
12. Green squeeze critter (stimtastic, he popped but I still love him)
13. Jellyfish yoyo (stimtastic)
14. Purple felt (walmart)
15. Flex puzzle (target)
16. Green hot wheels car (target)
17. 2 edamame key chains (amazon)
18. Red and blue fidget cube generation 2 (box lunch)
19. Eni puzzle (stimtastic)
20. 2 stretchy skeletons, green and orange (these were decorations at a Halloween party my mom had at work so she grabbed a couple for me)
21. 2 fidget spinners, green and galaxy (galaxy- amazon, green- walgreens)
22. Bike chain (I stole this one from my brother)
23. Blue boink fidget (stimtastic)
24. 3 stickbot figures, green, red and pink (target)
25. Nut and bolt (home depot)
26. Crazy Aarons thinking putty (candy store)
27. Copper snake twist necklace (stimtastic)