The Third Third

The doctor can see you . . .

A recent copy of the “Dallas Seniors’ Guide,” more a Yellow Pages for Geezers in Big D,  contains, among its many, many ads for “carefree living,” a Medical Diary and, next to it, a calendar.  How fitting, as everything about this booklet suggests the elderly (our parents -- not us -- but we’re next) can fill their days with doctors’ appointments.  How quaint.  How depressing.  How awful.


I know, a little, whereof I speak, having just come off a couple of months of too much medical care, albeit care that I appreciated as much as I resented needing it and the time and energy it consumed.  Tests for this, check-ups for that, new specialists, more tests, physical therapy, and more.  And, in the end, none of the definitive answers I would have liked in answer to the question of what-went-wrong; but, happily, assurances that, basically, I am a very healthy person and I can now get on with my life.  Amen.  But the point here is that you cannot “get on with your life” when you are running among medical campuses scheduling endless appointments.  It’s just so darned inconvenient.


My initial awareness that this was “not about me,” (as my grown children are inclined to tell me about most things these days), derived from being awakened in the hospital at 4 a.m. for an EKG.  Now, mind you, I was on a constant monitor on the cardiology/telemetry floor of the hospital; I couldn’t take a single breath that wasn’t charted.  “Why are you here now?” I asked the technician, trying not to bite off her head.  “Because the doctors come in early,” she said, “and they want all the test results ready-and-waiting for them.”


Ah, yes.  In some realms, i.e., in the hospitals, the doctor is still king, his underlings toe the line, and his subjects, er, patients, are powerless but to comply.  The model applies somewhat more gently outside the hospital, too.  But it comes down to this: no one’s time is more valuable than the doctor’s.  So, it’s just too bad for you patient patient (or in my case, impatient patient), that even a simple phone call to set up an appointment takes forever.  The recording “Your call is very important to us.  We are busy helping other callers, and your call will be answered in the order in which it was received” makes me crazy.  I talk back to it:  “If my call were really very important to you, you would answer it, fool!!!”  But then when, after 5 or 10 minutes, I finally get through to a person, I have to make nice because she (usually she, but sometimes he) is at that particular moment in time, the Admissions Committee to the elite school (of thought) that this is the doctor you want to see. Can you get an appointment?  Only if she can find room in the doctor’s schedule.  After an attack of tachycardia which landed me in the hospital and scared the bejesus out of me, the cardiologist (to whom I was referred by my internist, mind you), couldn’t (wouldn’t) see me for two-and-a-half months!  I tried cajoling the scheduler, I asked my internist to intervene, and I could not prevail on this doctor to grant me a mere moment of his time.  I said something imprudent like “I could die before I get to see him,” and, actually, no one cared.  This can make you sick.  


Then, when you do finally get an appointment with one physician or another, you are asked to come anywhere from 15 to 30 minutes early to fill out the same paperwork you filled out last week, or last month or whenever, information which is now efficiently stored in their electronic records anyway.  Why not just ask for updates?  I don’t know,  but the message is again, that my time doesn’t matter; someone figures I might as well spend most of the morning filling out forms and watching Fox News or listening to other patients’ cell phone conversations in the doctor’s waiting room.  And they wonder why my blood pressure is elevated when I finally get in to see the doctor, well no, not the doctor yet, first the medical assistant or the nurse who have to tee everything up for The Master Practitioner.  At this point, I am asked to wait again.  Naked. 


Even parking is a pain:  $3 for every doctor’s visit that must be paid either via a machine no one really trusts or understands (and I am always behind the person who puts his ticket in the credit card slot or vice versa) or to a person in a guardhouse after waiting in line for several other cars to exit.


I remember first feeling this combination of anger and impotence when I accompanied my sister to chemotherapy treatments 20 or so years ago.  At the time, I wrote to the medical center’s chief of oncology with “constructive suggestions” that I observed might preserve an individual’s dignity, provide an ever-more-elusive sense of control, and enhance healing in place of the pervasive you’re-sick-and-we’re-doing-what-we-can, one-size-fits-all, soap operas on the TV, metallic tasting juices in the fridge, and worse protocol that was currently being observed.  He acknowledged that they could do better -- and would.  But, 20 years later, when I accompanied my friend Jan to chemotherapy, her “appointment time” was absolutely meaningless; she had to wait until a space opened, until the drugs were ordered and then delivered from the pharmacy, until the infusion specialist who titrated the treatment was available, and for countless other reasons having more to do with how the hospital “did things” than with real patient care.  Jan begged me not to fight it on her behalf; she used her inherent likability to get what she really needed from the nurses and found it much more effective.  And she pencilled in most of the day for chemo when it came up on the calendar because, she said, that’s just the way it is.  I still think treating patients as people with meaningful lives to lead outside of the infusion lab -- with the dignity of privacy and respect for their time and preferences -- would be a more healing enterprise than treating all those people with cancer -- which is dehumanizing and terrorizing enough -- as pieces on the medical care factory assembly line.


A relatively brief spate of doctors’ appointments such as I experienced and the concomitant frustrations aren’t going to kill anyone.  In fact, it’s probably going to make me ever more mindful of my decent health and more conscious of taking care of it.  It also, however, makes me dread growing frail, feeble, sick and old; I don’t want to need a calendar to schedule my doctors’ appointments and my doctors’ appointments alone.

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