Wednesday, November 11, 2009

Medical (Mis)Treatment

We love to talk about freedoms and liberties in America. We fight for it, we love our freedom, we cherish it, it’s our highest ideal and wish death on whomever attempts to threaten its existence. But man, I never feel more deprived of this freedom than when I attempt a very routine visit to the doctor’s office, in this day and age!

Now, I have been a patient pretty much all my life. I know, we all have been, at some point, but I mean, I have been forced to be a conscientious, very loyal and regular one. And trust me, I am no hypochondriac nor do I get great enjoyment out of it. I go out of necessity. So, you may call me jaded, also – go ahead. I still want to say a few things about our medical (mal)practice.

Lately, it’s more restrictive to go to the doctor’s than it is to fly, which is hard to believe some days. Every time you go in the office, there some new restriction. And while some restrictions are meant for your safety and accuracy of service (like, fast before labs, wear no jewelry before you go under, wear tennis shoes on the treadmill, etc), others are complete bogus infringements to your time, honor and wallet. Complete disrespect for you, as a patient, or as a human being.

You have to provide an insurance card for every visit - why?- if there were no changes from the visit from yesterday, I am not sure; you have to provide a photo id, or else you’ll not be seen. I wonder how many people impersonate someone else, and know exactly the name of the doctor to see, the time to be there, the name and date of birth of the patient meant to be seen. Hhmm …

We’re so afraid the governmental health insurance plan will be “too bureaucratic”?? Are you kidding me? Our very own doctor’s office has bureaucracy down pat! Think of all the forms you fill every year, over and over again! The amount of data they have on you: everything from your address, social security number, credit card account, names of the closest people to you, and their phone number and these have nothing to do with details on your body and your health and condition!

And how about all those copies of all those insurance cards, about 20 times every year?? All that paper trail in a day and age when we’re all paranoid about stealing identity and saving everything encoded and password protected on computers so it won’t be accessible by human eyes?!

Then, on every wall inside all the little waiting rooms you’re a prisoner in, signs warn you vehemently: “Don’t call us for the lab results. We’ll call you. In two weeks”, “We will charge you anywhere from $35 to $55 for each form you need us to fill out” – and then, they have the gall to tell you why: “because insurance companies don’t reimburse the cost”. It’s all about the bottom line, isn’t it??

And that brings me to the other issue: I feel blood sucked and robbed blind every time I walk in there – and that’s to put it mildly. I would invoke violent sexual acts here, but class keeps me from doing so.

If I hear one more person telling me “well, doctors have to pay those huge student loans, so, that’s why they charge so much” I am going to puke! Ppphhhlleeeaaasee, people! Do they also have to live in million dollar homes? And go on a Mediterranean cruise every summer? And marry their only daughter at The Biltmore? And drive BMW’s and have several vacation homes?! I am sure they don’t have to do all those things, but well, they do. I don’t see them living in regular folk condos and shopping at Wal-Mart to pay the loans they got themselves into, willingly, either. And I am not saying all this because I am jealous, God no! But somewhere, there has to be some justice and some middle ground between people losing all they’ve got to get healthy and people providing healthcare and getting ever so richer that it’s blinding to the rest of us. I know capitalism isn’t a fair structure, but the gap is widening every single year. It’s hopeless!

And I don’t know about you, but I have a problem with paying the same amount of money to see a Harvard educated specialist and his Nurse Practitioner! Practitioner or not, she is a nurse! I am sure their “student loans” don’t compare! They can’t, possibly!

And that brings me to the next point, of the quality of care. In the heated and very actual debate of governmental health care system we’re witnessing today, we all hear about “the quality of American healthcare”. We pay the buck, but we’ve got the best! Again, if someone tells me that one more time, I’ll regurgitate!

Let me give you just a for instance from a recent visit. I meet with my general doctor for my six month follow-up. I get about 15 minutes every 6 months of his very expensive time, to look at my recent blood tests, and send me to some more specialists in search for a cure. No, he doesn’t provide the cure, he directs. 15 minutes.

So, this last time: he’s in the room, after 30 minutes of me waiting, of course, for about 2 minutes, while the phone on the wall rings. And … he answers it. It turns out, someone from the hospital paged him, so he can answer a question about a patient of his who is admitted. So, I am on the fence: I am not sure whether to be mad, that he’s using MY time to answer another call, or happy, that he actually cares about his most sick patients and doesn’t send their calls into voice mails, and answers them right away. Still a little uncomfortable. When he’s finished with the call, he doesn’t remember what I was saying, and picks up another train of thought, completely unrelated.

Now, I am mad.

I reiterate, and he nods, and approves. And doesn’t say much. When, I notice he reaches in his pocket and pulls out a black “genuine leather”, black case. While I am talking about, oh, unimportant things like my heart, my overall health, my lack of sleep, and lack of appetite, he’s fumbling to open the case and he does open it: it turns our his IPhone vibrated just then, and he has to look at it. And he doesn’t answer it, but he scrolls and reads an email or a text message on it, while chuckling to himself. (!!!??????!!!!). I am talking. He stopped acknowledging.

Finally, he changes directions and topics on me.

Now, I am madder!

And at the end, off he ships me to the specialist! Gets from me (+the insurance) his fee for his New York taxi on his trip for Thanksgiving, and off I go. And this is a doctor that was recommended to me by another doctor I like, as being “a good listener”!! I rest my case.

Another example of “pristine” health-care comes from a nurse. She coaches me for an approaching test, and she tells me I need to stop my medication before the test for 48 hours before the test, evidently because that’s what the manual for the test tells her. I assure her that this is not possible: the medicine comes from the pharmacy with a big, red label telling me I cannot skip dosages, not even ONE, and if I do, I have to head to the first pharmacy for a dose, or contact my doctor immediately, or else I am in trouble. She swears to me that’s what I need to do: stop it cold for 48 hours! Then, she “gets caught” by the doctor that she misinformed me, and calls me back: “well, because your dose is so high, and you need it in order to function, stop it for 24 hours at the most and take it immediately after 24 hours – don’t skip more”. Well, thank you for not killing me there, Ms. Nurse! Much obliged. I wonder what would have happened if that doctor was distracted for a moment by the phone email … Fortunately, he was the specialist, without an IPhone! It’s all the luck of the draw, isn’t it?!

I could write books (as in plural) about misinformation from the doctor’s office – everywhere I have been in two states. Tests done uselessly, just to get the money: why is a pregnancy test necessary or else the visit doesn’t continue, when you have not had sex in a year, pray tell? So, I am not believing one iota of this “amazingly qualitative American healthcare”. I can’t. Because in 11 years, I have not seen it. I have lived the non-quality, superficiality, and abuse of it, yes. Every visit provides that!

I am not saying that all doctors are like that. And that all practices are like that. I have met honest to God doctors who care about the patients, and will do anything for their wellbeing. Doctors who love what they do more than the mansion they live in. I have had a doctor, here in America, that risked being fired and was brought to face the Board of Directors because she was seeing me for free, while I had no insurance and had a very severe condition that needed treatment. She was supplying me with samples of the medicines I needed to be able to survive. The two doctors I most respect for their attention to their patient and for their love of the trade, quit working for a regular practice and are now working for Health Serve. So, because I am not homeless, I can’t see them anymore! But those are the doctors I bow towards and respect. Not the ones with the villa in Palermo! And unfortunately, those are fewer and fewer, and regular practices the general public has access to have them as extreme rarities. I can myself count three out of probably 50 I have seen in 11 years. That’s not much!

And this was also not meant to bash all the American doctors. I know for a fact Canadian, and German and Romanian doctors have their faults too. But they were not the topic here. For the sake of (some kind of ) brevity, I have addressed here solely my experience with American doctors. After all, those are the ones most of you are more familiar with.

And just our own American comedian tells us, “just for once I want to tell the doctor: you know what: "I am not ready for you, yet!” Now, that would make it fair, don’t you think! That would make it equal, fair and free for all. But it’s not the way it is, unfortunately!

And for some comic relief in (what I see as) a desperate predicament, enjoy the video and remember: “there is a little bit of arrogance in the medical community, I think we could all live without…”.

Tuesday, November 03, 2009

Who Needs a Comedy Club?

Three notes on observing people on a mid-week day off …

Maybe it’s because my parents never did it, or because they strongly discouraged it as rude and inferior behavior; or maybe it’s because I have too good of an opinion of myself and I am mortified if someone would do this to me, but it really bugs me when people admonish or pettily pick on their kids, partners, friends, or employees in public! I think, just like my parents do, that this is rude and uncalled for. Everyone, no matter how big their faults, has a pride and an ego. Only “things” don’t have pride nor ego. People do! To make a point out of trashing that ego means lack of respect and inability to find class in your own public persona. Means cowardice. And weakness, in my book. At any rate, you would not get my respect if you do it. There is no respect to be given where respect is lacking on your part.

But I digress.

So, I have a new bagel lady. And she is really lucky I absolutely love bagels and her store is ever so close to my house, because otherwise I would have stopped shopping there a while back! It’s always uncomfortable when I go in. She yells at all her employees, in a rude, and loud tone, although they all seem fine and respectful to her, the job and the customers.

So, today, I walk in and there is a new guy behind the counter. She is running the cash register, and helping two other customers, while he’s trying to make my bagel. I know he is new, and I can tell he is nervous. Big guy, his gloves don’t fit – makes me go “Aaawww. Poor thing!”. I ask him how he is, and he answers politely: “I am great! Just great! I have never had a bad day in my life! I am always fantastic!”. I am dubious.

She’s running the other two orders and screaming (and I mean “scream”) from across the room at my guy: “Josh, what is the young lady having?!”. I have not even told HIM what I am having, since he’s not ready yet. And why she would need to know before she takes care of the other two customers she has on her own hands, is beyond me… He ignores her.

She bellows: “JOSH, I said …!!!!! $4.50 for a refill, Sir. Oh, you want a dozen bagels too?! JOSH, you hear me???”. Forget about the fact that she’s interrupting her own customers who are trying to check out, she is more worried about Josh knowing what my order is going to be. He is trying to pay attention to me, and my order and I commend him for it.

I order, I walk to the cash register, shaking, almost, and she switches her attention to me. She is one of those people who walk into a room and completely fill it to the brim with her own emotional weight! She is loud, completely unaware of her own boundaries, and bossy. That last one is a polite understatement on my part.

She keeps shaking her head talking to herself loud enough that anyone can hear, appalled that “Josh” is ignoring her when she is asking him what “the young lady” is having. As if “the young lady” was deaf and mute ?!?

So, I say, pointing at my sandwich: “cream cheese sandwich, please.” Now, she is plowing into my emotional space:

“What do you want to drink, hon?”

“Nothing, thank you”.

“Oh” – she doesn’t look at me. Just raises eyebrow. “Really??”

“Really”, I say with a grin.

I hold my money out, when I see the price on the register.

“You want a bag for that?”
”No, thank you”.

“Oh” – shakes her head, looking at the register, again, not at me.

“You want your receipt for $2.50?”


She finally looks at me:

“You want me to shut up?”

I smile and don’t answer.

She laughs and answers her own question, looking at me finally: “Yeah, I guess you do!”

I put my change in my wallet as she is yelling at Josh again: “I cannot believe you absolutely ignored me while I was asking you what she wants. I mean, goddammit, what the hell is wrong with you, Josh?!”.

I guess he was getting ready to have the very first bad day of his life, I thought.

I had to go to my attorney’s office today, for this and that. The legal assistant is another one of those folks who just explode in a room. Heart on her sleeve, no secrets – this woman is. Your brain is on instant freeze around her – she’s that fast and loud, and … random. Her cell phone goes off, and she answers it, as I wait for the lawyer to see me at my appointed time.

I can tell it’s an emergency, as her voice starts raising more than usual (and trust me, that’s hard to picture, as her voice came raised from birth …), and her eyes start popping with “Oh, my Lord! Oh, honey, calm down! Oh, let me get him in here …”- in the fastest and thickest drawl you have ever heard.

Attorney comes in, as she’s telling him, almost out of breath (reminds me of Aunt Pitty in Gone with The Wind, asking for “her salts” whenever anything exciting happened): “Oh, it’s my friend, Wendy! The police officer is there to arrest her. He said she ain’t paid the court fees! But we paid them. A while back”. She hands the phone to the attorney. He goes into his office with it against his ear, while she’s fretting and looking for the receipt to prove to the officer that Wendy has paid her court fees.

I hear the lawyer say, politely: “Good day, officer. Officer, this was settled a while back, and we have the receipt from the Court House that we paid …” and his voice disappears in the office … The assistant is telling me about Wendy’s legal trouble and how lame the justice system is, and how “they cain’t keep track of nothin’”, and he comes back in the room, handing the phone to her: “Hey, Wendy is being wanted downtown for a hit and run, that’s why she’s being arrested. I know nothing about that. Here you go”. And hands the phone to her. She is quiet for about half of a second, which is an eternity for her – trust me! And then she tries to explain it to me while grabbing the phone from him and trying to appease Wendy.

But I stopped listening, and I follow the attorney into his office. He’s shaking his head: “It’s always somethin’!”.

I believe him.

At the post office today. Long line. The funny man, the postal worker, is there today. He is like a stand up comedian! Every time he is in there, there is not one straight face in the room! Sometimes, you might not be in the mood for lame jokes, but if you’re in there for more than 5 minutes, he will say something to at least make your frown go away for a second! You cannot help it. He’s helpful, fast and funny. Very, very funny! Kids and old people adore him, mostly. But other folks, too. I’d pay some days to be there a whole shift to listen to him! Talk about a man who’s never seen a bad day! Either that, or he can fake it well.

So, today was a busy day, for some reason, so I was there for about 10 minutes. A mom comes in to pick up her mail at the mail box, which is at the other end from the room with the registers, but her 7-8 or so year old son comes in the room with the postal workers and the line, JUST to say hello to the funny man. And the conversation goes as follows, which made my day, for some reason.

“Psst! Hi, Ralph! Just saying hey!” (the kid says, in almost a whisper)

“Oh, hey, hi, there, buddy! How’s school going?”

“Horrible! I am not learning anything.” – the kid says promptly, with a bored blink and a hand gesture to indicate lack of absolute everything, while hugging a couple of books to his chest.

After an unusual moment of silence from Ralph, who always, and I mean always has the right answers, he goes:

“Well, you’ve got to stop knowing more than the teacher, bud!”

“Yeah, I guess! Good to see you, man!” – the kid walks away with a shrug.

Sometimes, I just adore kids! As for grownups, well … again: you be the judge!

Sunday, November 01, 2009

What’s That?!

falling leaves

hide the path
so quietly
(John Bailey - Autumn, A Haiku Year)

Someone’s tripped over the buckets of paint up in the sky again, and they spilled them. All, on the trees, painting them red and yellow, and rust and orange and purple…

Half of the town is dressed in orange – and some of the kitchens. Pumpkin pie, and dips and frosting on the cupcakes for yesterday’s parties.

Smiley orange faces are grinning from lit porches, awaiting laughing and carefree children.

What’s that, I wonder? That spot, on the skin, right above my shoulder blade?! Oh, a dry patch! Must apply moisturizer to whole body again. A (not so) friendly reminder …

Touching the grocery cart and opening your car door reminds you with a jump - literally: metal things shock fake fiber sweaters. They must be …

The nose gets cold when mornings open the doors to a new week. Must grab a jacket. Brr! – that chill in the air.

The Produce section at the store reeks of fresh, ripe muscadines. Fresh new cider is pouring in wine glasses at wineries.

The yard is finally quiet. The outside A/C unit is silent. Gas bill is up.

Headlights shine in the night on wind chasing large oak leaves like stray, hurried cats, into a run to nowhere.

It’s snowing leaves again. All over town. It’s windy. Quiet. Melancholy.

The dimmer switch is on again. The light in the afternoons is softer, ever so quiet and silky. Not sharp anymore. “The sun has lost its gusto” – mom says.

The cats sleep in again. They cuddle.

The swish in the trees is back. And nightfall comes faster. Time for soup and warm biscuits again. And all the harvest candles to be brought up from closets.

It’s fall. Another year’s getting ready to pass into yesterday …

Click on the picture for more Greensboro fall pictures