Tuesday, May 18, 2010

50,000 mile check-up and the density of doctors

Long-time readers (ye few, ye happy few) will recall my brush with cancer in 2007. (The curious can browse the archives in February and March 2007.)

Cancer is one of those gifts that keeps on giving -- to doctors, anyway. Even assuming the best possible outcome -- a complete cure -- once you've been branded with the Scarlet C, you have to submit to medical poking and prodding for the rest of your life just to make sure that the cancer has not returned.

Yesterday was my day to be poked and prodded.

Now because of the surgery I had three years ago, I don't have as much real estate to be surveyed as I once did. That means I could prepare for yesterday's entertainment in a slightly more civilized way than when I had to prepare for the full colonoscopy.

But only slightly.

Let's put it this way: When the Fleet comes into Norfolk, that's a happy occasion. When the Fleet comes in in my bathroom in the pre-dawn darkness... not so much.

We had to be at the hospital by 7:00, we were told, for an 8:00 procedure.

Long Suffering Spouse and I got there at 7:05 and I was snarling and grumbling all the way. Let's put it this way: Oldest Son is getting married on Saturday. If everything is fine and dandy, I don't need a test. And, if everything is not fine and dandy, I really didn't want to know -- and certainly not this week.

But yesterday was the appointed day and we presented ourselves at the main hospital registration desk and I composed myself as best I could. There's no reason to be rude to people who are just doing their jobs.

Even if their jobs strike me as incredibly redundant!

The hospital had to call me, at home, before the procedure to 'pre-admit' me. They could not talk to Long Suffering Spouse -- even though she's far better at remembering the details than me -- they had to talk with me personally. They called home when I was at work. They called home Saturday morning when I was communing with nature; they would not hold the line. Eventually, they reached me on Saturday afternoon.

I had to go through all the gory details of name, rank, serial number, insurance coverage, prior surgeries -- all prior surgeries, the nurse-interviewer stressed. Long Suffering Spouse chided me from the dining room when she heard me talk about a chest procedure that took place a long time ago. "That was 25 years ago," she said. "I know!" I said, "but this young lady says I have to tell her everything, going back to childhood." To my interviewer, I added, "This call is being monitored for quality control purposes."

Anyway, one might think that this rather thorough-going interview on such a wide variety of topics would suffice for a procedure that would take 15 minutes tops, and that only if I asked for full sedation.

One might think that... and one would, of course, be wrong.

My interviewer concluded with a stern admonition to bring my insurance card and identification (such as a driver's license) with me to registration on Monday. When we were eventually ushered into the interviewer's office on Monday, I had the cards at the ready. I put them on the desk. "Oh, I don't think we'll need these," said the registration person, consulting her computer screen for confirmation.

I can't imagine why anyone would insist on ID for this anyway. I know some people have paid substitutes to take college entrance exams. But why would I procure a substitute to take this test? How?

Anyway, I had just finished putting my cards away when the registration lady looked up again from her screen. "Oh," she said, "Blue Cross requires that we see those cards after all." I took them out again, trying to keep my grumbling sotto voce.

Having been duly registered, we were sent on to the GI lab. Now, I've been at this hospital far too many times in the past few years. Not only have I been there for myself, Long Suffering Spouse has also had a couple of procedures performed there. Once, both of us were summoned in the middle of the night because Long Suffering Spouse's mother -- then an in-patient -- had an episode that required our attention.

That particular hospital has been under construction since 1958. Most of the hospitals in this area are under constant construction. They're like dinosaurs: They keep growing as long as they're alive. If a Chicago hospital does not have an active building program it is probably about to close. Maybe it's this way elsewhere, too, but I only know about my hometown.

The latest fad for hospital construction is the new wing with all single rooms. This is a fabulous idea -- and long overdue -- and, at one time, at least, wholly at odds with the insurance companies' views. There were always private rooms, but most of the insurers would only pay for "semi-private" rooms. Semi-private means that there is another patient in the room, not that either of them has, under those circumstances, any privacy at all.

With all the construction going on over the years, even though I've been in many of the various rooms, the routes thereto have been constantly changing. We needed directions to the GI lab. The registration lady got them almost right. Fortunately, someone was at the end of the hall where we wound up who could guide us the rest of the way.

Once at the GI lab, after presenting my papers, I had more forms to fill in with another receptionist. "Did I know what test I was having?" No, I want it to be a complete surprise. You understand that Dr. M. will be performing this procedure? That's what he said anyway. I consented yet again and was directed to take a seat.

Long Suffering Spouse and I sat as far away from the flatscreen TV as possible. I don't think they had a flatscreen in this lounge the last time I was there. In fact, I'm sure they didn't. It's so intrusive. I don't mean to watch. I don't want to watch -- but it's really the only thing happening in the room. This one, at least, was set to CNN and not to some talk show. Perhaps if I'd come later it would have been set to Oprah.

I was almost done with my newspaper by the time I was summoned inside. Long Suffering Spouse brings tests to grade on these occasions. There are always papers for a teacher to grade. I'm not reading a paperback at the moment and I couldn't work with a TV on. I had bought the newspaper earlier, while we were waiting in the registration area.

Buying a newspaper is one way to get served faster in these situations. It's not that it makes the time go faster... how can I explain this? Can you remember back when smoking was allowed in some public places? (Yes, kids, at one time smokers were not officially treated as social pariahs....) I'd stand on the subway platform, waiting and waiting and waiting for a train. If I thought to light a smoke, however, within the first few puffs, I'd see the train headlight appear. In a waiting room, lighting a smoke would get your number called sooner. Not because you were puffing -- but because you'd have to stub it out upon being called. Buying a newspaper doesn't have quite as dramatic an effect on the wheels of fate -- but anyone foolish to light up a cigarette in most places now will probably be Tasered.

We were finally ushered into the inside waiting room. This was where I was to strip off my clothes, put on the lovely gown and shiver under a thin blanket waiting for the doctor to come. But first... there were more questions.

The nice lady at registration had asked some of the questions that the nurse-interviewer asked just last Saturday afternoon. Now the nurse in the holding area asked all the others. Again. I could see my answers on the computer screen in front of her as she went through the list. And, of course, I had to give my name again. Was it spelled correctly on my bracelet? Was my birth date correctly shown? Does the doctor take off points for spelling? I wondered. If not the doctor, then who?

Soon enough, though, with all this duplication of effort, it was nearly 8:00 and time for the show to begin.

I would contend that, inasmuch as this particular doctor was so much younger than me, he should be seen as no more than the juvenile lead in this show. I would further submit that I should be the leading man in our little drama. After all, it was my derriere and the secrets contained, *ahem*, behind that were the reason why we were all assembled this morning.

Except that we weren't all assembled.

The doctor was late.

He called, at one point, to say he was on his way. But that was somewhere around a half-hour after he was supposed to begin. And he wasn't there yet.

I watched a steady stream of people walk into the holding area, watched the curtains close around their cubicles, watched them open again and various medical professionals descend upon them, and watched them wheeled off to their respective procedures. I watched, too, as others were wheeled back. Some could leave sooner than others. I saw some leave. I saw some leave that had arrived after me.

But still... no doctor.

Finally, the nurse returned and said that Dr. M. was "five minutes away," and she wheeled me out to my room. This was where Long Suffering Spouse and I were parted. She still had her tests. I gave her my newspaper, which I had long since exhausted.

We got to the procedure room well over an hour after the scheduled time. My wife had promised to be back in school by now.

A new nurse was waiting in the procedure room. She and my holding area nurse conferred about the doctor's anticipated arrival and how backed up he would now be going forward. The new nurse said she'd used her unexpected time well, getting a lot done, but, she said, she was still peeved about something.

It turns out that this hospital provides 'flex-points' of some sort as part of the benefits package. These can be used, just like dollars, for any purpose that the employee wants. And this particular employee had decided to use her points on needed dental work.

And the hospital had called to challenge her on this. "That's a lot of points you're using here," she was told by the program administrator. "Well, yes," she replied, "but they're my points to use as I see fit." I gather she persuaded the administrator, but not without something of an argument. At this point, I ventured to speak.

"Let me see, now," I said. "We have a tardy doctor and an angry nurse. Maybe I should just leave now."

Both of the nurses thought that was very funny. It did relieve the tension, I suppose, but I wasn't entirely kidding.

Moments later, Dr. M. arrived, apologizing profusely and taking off his jacket. His flight this morning had been canceled, he said, and he had to make do with a flight on Southwest. His original flight would have landed at O'Hare -- minutes away from the hospital -- but Southwest flies only to Midway in Chicago -- on the other side of town. He had to take a cab at rush hour... and it took awhile.

"Where were you coming from?" I asked.

"Minneapolis," he said. "I was at a conference." Apparently, he had plans to head back in the afternoon, too. He snapped on his rubber gloves and began applying lubricant. Showtime!

* * * * * * * * * * * *

Everything went fine thereafter. I was a wimp and needed just a touch of painkiller to finish what needed finishing.

But now I was wheeled back to the holding area. I was fine. And ready to leave. And very late.

But the staff was concerned that my blood pressure was elevated.

Well, duh! What would you expect? I didn't want to be there, I was doing something unpleasant and -- in contrast to my younger days, before I had a bad diagnosis -- I have every reason to fear the outcome of these tests.

They gave me some apple juice and my blood pressure dropped 30 points. Then it soared again.

Fingers, hoses, air, water and a camera had all been pushed, as the song says, the wrong way up a one way street. There are consequences to these actions -- inevitable, regrettable and certain. And I certainly did not want these consequences to happen in my little bed. I needed a few moments in the little patients' room. But the staff was reluctant to disconnect me so I could attend to these increasingly urgent matters -- because my blood pressure was spurting.

Well, duh!

I prevailed, eventually. Upon my return, my blood pressure was lower, but still too high to please my minders. Even Long Suffering Spouse was counseling deep breaths.

My internist had been notified. He'd prescribed a pill to lower my blood pressure and suggested that they should monitor me for an hour to see if things settled down.

Another hour? My blood pressure spiked again. I took the pill -- though I could have easily palmed it -- my new attendant being focused, as she was, on the numbers displayed behind me.

I told her I was not going to wait another hour. I felt fine and I'd be leaving now, thank you.

"You mean you are going against your doctor's advice?" The nurse was young. I think she was shocked. Maybe I imagined it.

"You betcha. He'll get over it," I said.

I thought there would be all sorts of forms to fill out documenting my refusal, but they let me go without too much protest. The nurse did insist on wheeling me to the car, however.

I can't understand doctors. For smart people -- and they are all whip smart, in my experience -- they can be awfully dumb.

Oldest Son is getting married Saturday. I am in a cash crisis at work. My mortgage is unpaid this month. My receivables are high... my collections nonexistent. I have all sorts of extraordinary expenses associated with the wedding. And, on top of all that, I'm stuck at the stupid hospital, a couple hours late already, and the only thing they can think of is to keep me there longer to see how I respond? Apparently a medical degree can blind a person to the obvious.

I was far happier going home.

As for my blood pressure, there's nothing wrong with it that a check for $50,000 wouldn't cure. Sadly, that's not covered on my Blue Cross.

The good news is that I have two more years before I must be poked and prodded again. Maybe. Probably.

Now, on to the wedding!


Empress Bee (of the High Sea) said...

boy howdy can i relate to this medical stuff curmy! we have been doing this stuff since july non stop practically. the last check in at the hospital i asked her if she didn't already have my information since we are here as much as she is and she was not amused. oh, and they want your drivers license for the numbers on it in case you don't pay and they have to hunt you down like a dog. i know this because of son #1 and his, um. slightly non-responsible past in these matters shall we say...

smiles, bee

Steve Skinner said...

During my recent visit for a similar procedure my Dr. also got "backed up" so to speak and I waited nearly two hours in the holding room. Just as they were wheeling me into the procedure room a nurse announced that the emergency room was expecting a trauma so my procedure was put on hold. Back to the holding room for another 45 minutes; apparently, it was a fast trauma. Finally, after spending nearly four hours the show began and was completed in less than twenty minutes!