Wednesday, September 14, 2005

The Doctor Do-Si-Do

The following post is based on actual events. Names have been changed to protect the innocent. Namely, me.

The first part of this tale has already been told. Intellectual giant tumbles down a dark staircase and injures shoulder. Spends the next 6 weeks sitting on his ass and gulping pills like Johnny Cash before he found Jesus. Surfaces only to post drug-inspired rants on his blog. Bores everyone, including himself. Now, to quote Paul Harvey, here is the rest of the story.

The day after It happened, I did what any normal person would do. I called my primary care physician, Dr. Innsbrook. Dr. I., a knowledgeable, thorough and personable M.D., has treated me for over ten years. I would trust her with my life, and that’s no pun. Unfortunately, my shoulder injury was out of her department, so she recommended a specialist. Since Dr. Innsbrook is always on-target, I took her advice. I made an appointment to see Dr. Cunningham, an orthopedist.

Dr. Cunningham could answer a Hollywood casting call for a “doctor-type”. He’s got the whole look working for him: bald head, little round glasses, white coat, academic bearing. His hands, regardless of the weather, are always ice-cold. His spits out medical jargon so complex, I can’t reproduce it here. Thankfully, he’s always willing to translate it into moron for me. Best of all, he keeps me stocked with painkillers.

While Dr. C. is a fine orthopedist, I don’t believe it was his first career choice. I get the impression that he would’ve preferred psychology.

“I’m scheduling you for an MRI, John,” he said during our first visit. “How does that make you feel?”

How did it make me feel? I didn’t know MRI’s from M & M’s. MRI is the abbreviation for Magnetic Resonance Imaging. I’ll let the Merriam-Webster’s Medical Dictionary define it for you: “a noninvasive diagnostic technique that produces computerized images of internal body tissues and is based on nuclear magnetic resonance of atoms within the body induced by the application of radio waves called also MRI.” I guess the MRI provides the doctor with a more detailed picture of the target area than an x-ray. To my deviant mind, it sounded like something you paid extra for at an Asian massage parlor.

“If it involves someone resembling Lucy Liu and a bottle of baby oil, I’m all for it!” I grinned.

“Okay,” Dr. Cunningham smiled back, “we’re talking the same language.” This is another odd thing he keeps saying. Odd, because his language is medicine and mine, as you know, is bullshit. Odd, because the MRI, to my surprise, had nothing to do with either Lucy Liu look-a-likes or oily rubdowns.

Have you seen “2001: A Space Odyssey”? Remember those scientists in those little cylinder-shaped things? The scientists we never see, because they’re in suspended animation until the spaceship reaches Jupiter? That’s what the MRI machine looks like. An MRI technician stretched me out on a conveyer-belt, covered me with a lead-lined blanket and rolled my ass all the way into that freaky “2001” cylinder. There couldn’t have been more than three or four inches of space in any direction. I swear, if anyone had started singing “A Bicycle Built For Two” I would’ve lost it. At first, I found myself lying in total darkness. Then, there was soft light and intermittent buzzing, not to mention my panicked breathing.

In these kinds of situations, you need a calm, reassuring voice to guide you. My MRI technician happened to be a young Indian man. I would’ve preferred a young Indian woman, but that’s beside the point. Many Indians have musical, lilting voices. And where but India would you find the sense of Zen-like tranquility I so urgently needed at that moment? At least, I figured, I had that thought to cling to.

“Hey, Twitchy!” called the MRI technician in his lilting, Indian voice. “Stay still or you’ll ruin the image! I’ve got an ass-load of patients to see, and no time for horseshit!” Just my luck. Indian voice, American attitude.

“Sorry,” I panted, “I’m just hyperventilating.”

“Well, don’t,” he said, which really helped. “Think of something nice. Like a field of flowers or a pretty girl.”

Aha! A bolt of inspiration hit me! Julianna Margulies and I were resting on a blanket in a field of Queen Anne’s Lace. I was shirtless and she had a bottle of baby oil. You can fill in the blanks. The tension ran out of my body and I breathed easily. Sometimes, it pays to be a perv.

Two days later, I was back in Dr. Cunningham’s office.

“How was your MRI experience?” Dr. Cunningham asked. See? Weird.

“Not bad,” I said, “if you’re a Stanley Kubrick fan. Thank God Julianna Margulies showed up or I wouldn’t have survived.”

Cunningham didn’t bat an eye. “All right, we’re talking the same language.” He scribbled on two pages of a prescription pad, tore off the pages and gave them to me. “I want to cover all the bases here. I’m sending you to the Pain Center downstairs for an evaluation. Then, you start physical therapy. The phone numbers are on those pages. See me again in a month.”

Another week, another examination room. Why are all examination rooms so damn cold, I was thinking, when in walked William “Refrigerator” Perry, the defensive lineman for the 1985 Super Bowl champion Chicago Bears. No, not really. Just a guy who looks like him. He’s NFL-big and NFL-round and wears a white coat that’s a size too small for him—even though it’s probably the largest size available.

“John,” he said, “pleased to meet you. I’m Dr. Weber and I’ll be doing your pain evaluation.” Why do these mammoth-sized guys always have such low, muted voices? This dude needed some Phlegm-B-Gone.

Okay, I’m not going to sass the Fridge. He kicked things off (ha-ha) by asking me for information.

“What medication are you on?” inquired Dr. Weber. “What dosage and dose schedule?”

This troubled me, because I assumed Dr. Cunningham recorded this data in my file, the folder Dr. Weber was holding in his giant paw. I had to think for a minute.

“Uh, there’s the big orange pill. I think it’s called Gabapentin and I take two of those three times a day. Vicodin, one tablet, which I take occasionally for any pain I might have between doses of the other one. Then there’s a little green pill, Elavil, which Dr. Cunningham has me take one of at bedtime, to help me sleep. I don’t know the dosages.”

Next, Dr. Weber asked me a question any orthopedic patient will soon commit to memory.

“How severe is the pain you’re feeling right now? On a scale of one to ten, with ten being the worst and one being the best, how would you rate your pain at this current time?”

“Before the painkillers, it was an eight or nine,” I said. “Since the meds, I’d rate it a three or four.”

Weber was writing something in my file. “What is a tolerable level for you?” he asked.

“One. If one is pain-free, then one is what I’m aiming for. What else, right?”

Weber didn’t respond. Unlike Cunningham, I guess he was happy being a pain evaluator, or whatever his official title was. He didn’t bombard me with questions regarding my feelings or experiences. Weber focused on my symptoms and used words like there was a charge for each one. Often, he just grunted or nodded when I responded. His evaluation of my pain? It was state of the art. Weber pinched and squeezed my right shoulder, saying “Uh-huh” at various intervals. Then he poked and prodded me along my shoulder and arm with an actual toothpick, while asking me how it felt. That was it.

I was putting on my shirt when Dr. Weber asked me a question that bugged me.

“Has Dr. Cunningham seen your MRI?” he said.

With all due respect to Dr. W., I found the question foolishly obvious. It was like asking me if birds flew or if Duran Duran was a crappy band. “I don’t know,” I said. “Why wouldn’t he? He ordered it.”

Dr. Weber mumbled something I couldn’t make out, then wished me a swift recovery.

Like a ship adrift on a pharmaceutical sea, I meandered through the next few days. Soon, it was time for physical therapy. A new, equally frigid examination room awaited me. I was dosing in a chair when the therapist entered.

“Morning Mr. Left! I’m Mr. Malph! Take off the shirt and lie face-down on the table. Your mug goes in that little hole at the top. We’ll have you all right in no time, Mr. Left. Get it? Right, Left? Just some humor to take the edge off.”

Hardy-har-har. Like I haven’t been hearing that crap for half my life. I did as he asked. Dr. Cunningham ordered me six weeks of physical therapy, three days a week, so Mr. Malph and I will become well-acquainted. Malph is short, no more than five-five. His fiery red hair is closely clipped, as is his chin beard. He has the compact frame of a gymnast. His tone of voice borders on shouting, as if he thinks I’m deaf. The things he considers to be jokes never stop.

“Mr. Left,” Malph yelled, as he kneaded my back like fresh dough. “Did you hear about the man who had the whole left side of his body cut off? It was awful. But he’s all right now. Hear that? All right!” He broke into a fit of hyena-like laughter.

What I dreamed of was a gentle massage given by a beautiful woman. What I got was a series of wrestling holds applied by Milton Berle reincarnated as a leprechaun.

Based on my experience with Weber, I was a bit wary of Malph. I saw him making detailed notes throughout our first session. At the end, I pulled him aside.

“Dr. Cunningham is my orthopedist. He sent me to you. Will you be faxing your notes over to him for reference?”

For once, Malph struggled for words. “Uh, I can if you’d like me to. Usually, I just keep them on file here. It’s the patient’s choice.”

You know, I’m not the brightest bulb on the wire. But I was gradually catching on. I was getting a funny little feeling that I didn’t like. It carried over to my next visit with Dr. Cunningham.

“So, John,” said the venerable doctor, poking and feeling my shoulder. “How did the pain evaluation go?”

That did it. The little red warning light inside my head was flashing now. “Don’t you know?” I asked him.

Slight pause from Dr. C., along with an anxious glance at the file he left sitting on the counter across the room. “Oh, c-certainly,” he stammered. “I wanted to hear it from you.”

Our culture has standard images. The compassionate parent. The teacher dedicated to learning, the cop sworn to uphold the law. Along with these stands the doctor, a devoted healer who knows and treats each patient individually. Leaving Dr. Cunningham’s office that day, I felt like I did the day I discovered Santa Claus wasn’t real. My father sensed this in the car on the way home.

“What’s eating you?” Dad said. “I haven’t seen you this depressed since Air Force Amy left the Bunny Ranch on ‘Cathouse.’”

“I’m not depressed, Dad, I’m worried,” I said. “I’m seeing two doctors and a physical therapist. I’ve trusted these guys with my health. It’s clear that none of them knows what the other is doing toward my recovery.”

“Well, don’t just sit on your duff waiting for these quacks to screw up. Call your sister, she’ll know what to do. Either that or get used to wiping yourself southpaw.” Dad reached for the volume knob on the radio. “Now, zip it. Limbaugh’s on.”

Dad was right. My sister had worked in nursing homes for several years. Before that, she’d been a candy striper in a couple of area hospitals. She’d learned a lot about the in’s and out’s of the medical business. I phoned her and told her what was on my mind. Sis was the picture of benevolence.

“Christ, what planet have you been on?” she asked. “News flash! It’s not like on ‘ER’ where the doctors hang out together and talk to each other all the time. They’re extremely busy, all too human beings with diverse schedules.”

“All right, but what am I paying them a shitload of money for?” I said. “So I can play messenger running between their offices, keeping them informed about my case?”

“Welcome to the 21st Century. It’s a self-serve world. If you don’t do it, no one else will. Write everything down, including names and dates. Have them fax all paperwork to Cunningham. If they won’t fax, go there, photocopy the papers and deliver them to Cunningham yourself. Then, you’ll have nothing to worry about.”

“Aw, that’s a pain in the ass!” I whined. I could never sing, but I can sure hit that high note when I’m crying in my beer.

“Right,” said Sis. “But you’ve got to do it. You have to be your own advocate. You have to ask questions, read all the fine print, take nothing for granted and make sure everything needed gets to where it needs to be. You have to be a fussy bastard. It’s the only way you can be sure they’ll give you the best care possible.”

It was hard, but I did it. I started a notebook in which I record names, dates and descriptions of what was done. I organized all my paperwork in a folder. I keep an updated list of the names, dosages and dose schedules of my meds. I made sure Malph’s notes were faxed to Cunningham. I hand-delivered copies of Weber’s pain evaluation to Cunningham. This pissed me off, because Dr.C.’s office is one floor above Weber’s. But Weber’s receptionist, due to “privacy laws”, refused to fax those documents. It meant a wasted half-hour brown-nosing the clerk in the clinic’s Records Department, but I did it. All of my info is now in my file in Cunningham’s office, ready and waiting. And yes, it was a pain in the ass.

But you know what? I’m not worried anymore.


Anonymous Anonymous said...

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3:19 PM  
Blogger Doggie Extraordinaire's Mom said...

First, I haven't laughed so much over a medical story in years... gosh, I miss being a nurse.

Second, I hate to burst your bubble, but I would be willing to bet that Dr. Cunningham's file on you is now so big that there is no way the good doctor will ever read all the information you provided, and will continue asking you the questions.

Third, if they care, I mean, if it's important to what they are about to do for your future, they call one another. They write letters thanking for referrals but they don't discuss your situation unless it's either hilarious and they want to laugh at you together, or if it might be important in determining the next step. Sorry. You're probably going to still get asked what everyone else is doing.

Thanks again for the laugh. I swear, I've been a patient of these doctors or their clones. They're all so damn similar.

8:12 PM  
Blogger John Left said...

Dear anonymous:

Thanks for your comment. Oh, and that 'helpful' link you're offering, to help prevent spam? It's spam, in case you did not notice.

Just thought I'd clue you in, bud.

10:28 AM  
Blogger Mona said...

Hi John,
It's been much too long since I've been doing my rounds...look at all the brilliant writing of yours that I've been missing. LOVE it. So, you're not worried anymore...but my question is, is it helping??? Too soon to tell? Thanks for sharing :)

1:03 PM  
Blogger Paula said...

Cute story! I love the MRI experience you described. American attitude is right... somehow health "care" is not always so caring these days. Funny at best and down right scary at worst, when you are dealing with multiple professionals and no one communicates. Good luck in your medical journey!

6:58 PM  

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