By Anne C. Woodlen
(*Part of on an ongoing discussion about the state of the art of medicine and how we see needs for structural changes. This essay gives you a peek into how our current system of partially socialized medicine actually works through the eyes of a person believing they are entitled to free care across the Board. Through her eyes, we can see the arrogance and snobbery of the system in dealing with the poor. This is our legacy that we leave for our children and ourselves. Since we do provide this service to part of our population, we maintain we can provide this and much more to the general population for far less cost by using hospital kits. Read this and see what awaits you if something is not done now).
I got a letter from the county Long Term Care Resource Center telling me that I had to have a physical. They pay for my home health care aides, so I called them up and said, “Why?”
“Because,” they said. “We were always supposed to be doing this but we weren’t, so now we’ve got to.”
So I called my internist’s office and made an appointment. The first available was in two months, on Nov. 6 at 2:45.
Weeks later, I went to a gastroenterologist. His nurse practitioner told me to come back for a follow-up in a month. The only time available was Nov. 6 at 10:45. This is not good because I travel by wheelchair in Medicaid transport. They’re going to want me to go from one appointment directly to the other and sit in waiting rooms for four hours in order to save the taxpayers the cost of taking me home in between.
Money is supposed to be spent to take care of poor sick people, of whom I am one, but what’er you going to do? If I don’t take the 10:45 appointment, there won’t be another available for three months. The health care system sucks.
So I accept the appointment, then, the week before Nov. 6, my psychologist’s office calls to cancel my appointment because he’s sick. The next available appointment is for Nov. 6.
Well, okay. The internist and the psychologist are both in the same part of suburbia, so I might as well blow the whole day with doctor’s appointments and get it over with. I schedule the psychologist for 12:15. Then I have to schedule transportation.
Medicaid transportation is seriously sucky. The county won’t put the necessary money into the system so that us poor sick people get the transportation that is federally mandated. We get the local substandard rides from hell. For starters, Medicaid makes us schedule our pick-ups for an hour before our appointments. This is to cover their butts in case the transportation vendor is overbooked and can’t get to you at the scheduled time. If the vendor does get you on time, then you get to spend an extra forty minutes sitting in the waiting room. Either way, you lose.
So Nov. 6 comes. My transportation vendor sends Bobby, who arrives at 9:45. Bobby is my friend and totally cool. We have a lengthy and happy conversation because Barack Obama has just won the presidential election and we are filled with hope that things will get better—not to mention that Bobby is black and it’s been a long haul from crackin’ heads in Selma, hasn’t it?
I get to the gastroenterologist’s office forty minutes early. There is no coffee shop in the building, so I wheel across the street to the hospital, where I get coffee and then go outside to sit. A few minutes of that and I’m ready to split. Sitting between two hospitals and a physician’s office building is, well, unhealthy, so I wheel a block over to the university.
I like the university. The university is cool. It does not suck, so I hang out for a while, then wheel back to the gastro’s office, where I am installed in a treatment room at 10:45. My blood pressure is 132/78, which is very nice, and I discover that the treatment table faces a small window. If I sit on the end of the table, instead of in the chair the nurse indicates, then I have a fine view of the azure sky and the far hills covered with late autumn foliage.
After half an hour of this, I am still sitting. The gastro has not shown up.
If you invite someone to your home for supper, then you should be there to greet them. You don’t go upstairs and leave your guest sitting alone in the living room for half an hour. I figure that it should be the same in the doctor’s office. It’s called “courtesy”—hospitality, niceness, a polite way of treating people. My momma and grandma taught me that. Apparently the doctor didn’t have a momma or grandma to teach him how to be nice.
Can anybody give me any reason why this experience can’t be nicer? After you’ve waited fifteen minutes, somebody should come tell you something. “The doctor is running behind but he’ll be here in about five minutes.” “The doctor had an emergency and may be a while longer. Can you wait or do you want to reschedule?” This is called “being nice”—being polite, being considerate, being respectful. I know the doctor’s time is precious. So is mine. Maybe not to him, but certainly to me.
I have scheduled transportation to pick me up at 11:15. I have a life; I have other business to attend to. I do not believe that doctors are gods and my life depends on them. There is only one true God and he doesn’t wear a white coat, and my life depends largely on me taking responsibility for getting a good night’s sleep, eating a healthy diet, exercising as much as I can, and talking to God about everything else.
At 11:14 I pull out my pen and write on the paper on the treatment table:
My appointment was for 10:45.
I was here—you weren’t.
I am leaving for another appointment at 11:15.
P.S. You’d better not charge Medicare for this.
As I am going out the door, the doctor comes in. “How are you?” he asks.
“I’m leaving,” I reply. “I left you a note.”
I go outside but my transportation is not there. It’s a nice day so I sit next to a fellow traveler and we wait. She is also in a wheelchair and awaiting pickup. She’s been waiting forty-five minutes for her vendor. We talk about Christmas in Florida—Disney World and fresh orange juice.
At 11:30 I call my vendor. They haven’t dispatched a driver yet.
At 11:45 my fellow traveler gets picked up and I try to call my vendor again. Despite repeated positioning and repositioning, I can’t get my cell phone call picked up. I go back inside to look for a land phone. The security station is not staffed.
I go back outside and finally get my call through. I ask when I can expect a pickup. All the receptionist will tell me is that a driver has been dispatched. I’ve heard this before. The driver may have been dispatched from hell and not be expected to reach me for two days, and I can’t get a straight answer to my question. I am garbage and I am supposed to sit and wait for pickup. So I wait some more.
At noon, the driver pulls up. I have only traveled with Tom once before. He was sent on a pick-up after I’d waited two hours. I was not in a good mood.
The driver gets out and wanders over to me. He’s in no special hurry. He could care less that the pick-up is forty-five minutes late. He drives for Medicaid. The odds that he is a complete screw-up are extremely high.
With no particular enthusiasm or energy, he boards me and my wheelchair. He’s talking to the security guard, who has finally shown up. He and the guard both used to drive for the vendor twelve years ago. Tom quit and went to Florida, and now is back. The guard asks him about Florida, then asks him “What happened to the girl?”
Tom says, “Well, let me tell you about that.”
At this point I say, “My appointment in [suburbia] is in fifteen minutes.”
Tom viciously slams the door closed, gets in the driver’s seat, says “Fuck!” and then, “Are you trying to piss everybody off?”
No, sir, I am trying to get to my appointment on time. It is a therapy appointment. It starts at 12:15 whether I am there or not.
It is 12:20 when I get to the appointment, which is a good one. This therapist and I have been seeing each other for nearly twenty years. He is family.
After the appointment, I ask his secretary if she can go on the Internet and get me a map to my next appointment. It would be a very nice thing if I could wheel there without having to use Medicaid transportation.
She types in the addresses and gets a map that we both agree is wrong. She says, “Let me do it this way,” and starts to change pages.
I say, “No, just shift the map to the west and I’ll be able to figure it out.”
She gets out of her chair, orders me to sit in it, shoves some papers in the shredder, picks up her pocketbook and heads out. I ask her why she’s angry at me, but she stalks out without answering.
I do not understand what is wrong with people who work in the medical system. Why is it that as soon as you take a job in the system, you stop being reasonable and polite?
Wheeling to my next appointment would involve crossing a bridge that—to the best of my memory—has four lanes of traffic and no sidewalks. I decide I’m not in the mood to get killed, so I stay in the office and wait for my next pickup, which is scheduled for 1:45.
Precisely at 1:45 another driver shows up. Matt has never been here before but got directions from a driver who has brought me out here. We travel to the internist’s office, which is 0.7 miles away. I arrive forty-five minutes early.
By now I’m not in the best of moods, so I chow down on a Snickers bar, a classic Coke, and a bag of Fritos. Carbohydrates sooth the nervous system and mine needs serious soothing.
I go for a ride, wheeling up to a really strange circle of townhouses that has recently been built overlooking the medical center. It is a circle of about twenty garage doors. No front doors, no front yards, just garage doors.
I imagine her in a long evening dress and him in semi-formal attire. They are holding wine glasses as they greet their dinner guests in the garage: “Good evening! We’re so glad you could come. Welcome to our garage.”
The front doors are hidden somewhere behind the garages. If there is a “front” yard, it is hidden and inaccessible on the other side of the townhouse. The oldest houses have been here about eighteen months. Two of them are already up for re-sale. The newest houses, at the other end of the circle, are still under construction.
Having nothing better to do, I wheel over to the model, hoping to check it out. What I discover is that the front door is inaccessible. The sidewalk is flagstones set in large chunks of gravel. No way can a wheelchair navigate this. I seek to point this out to the two guys hanging on the pickup truck in the driveway. It turns out the contractor is the brother of one of the guys. Clearly, they don’t give a shit, so I wheel back to the medical center.
In my doctor’s waiting room, I find two other people—a man who says he’s already been seen, and a woman who is agitated. We agree that we know each other from somewhere but neither of us can remember where. I suspect it is from the days when I was a psychiatric patient. She apparently still is.
She says she traveled out here by bus. She has been waiting for her appointment for half an hour. There is only one return bus left; if she misses it, there won’t be another bus until tomorrow. I suggest that she should ask the receptionist what’s going on. She stands up to do just that when she is called in.
I need to use the bathroom. I go over to the door between the waiting room and the treatment rooms. It is locked. How nice.
I go to the receptionist’s window and ask. She tells me I have to use the bathroom in the hall. How very nice. The zillion dollars that Medicare pays my doctor doesn’t include bathroom privileges.
Moments after returning from the bathroom, I am called into the treatment room where the nurse checks my blood pressure. It is now 160/90.
The doctor arrives. We do the routine stupid meaningless stuff that will ensure that he can sign off on my home health aides for another year, then I ask him about ordering an unusual procedure.
Another doctor—who worked for him when he was the medical director of a hospital—poisoned me with unmonitored medicine. Consequently, I have a rare kidney disease that causes major problems. I think there’s something innovative that we can do about that.
My doctor doesn’t want to. “As there are things you are not comfortable with, so there are things I’m not comfortable with,” he says. Doc, get a life. This is an unorthodox problem that calls for an unorthodox solution. He finally agrees to call a colleague and make some inquiries.
I wheel out to the checkout desk and ask the secretary to call for my return transportation. It will take a while and I want to get the process started as soon as possible.
She tells me to use the phone in the waiting room. Yeah, right. Sure.
In the waiting room, I dial the number. It rings and rings, but no one answers. That is entirely unacceptable. The number is answered twenty-four hours a day. Something is wrong.
I dial the number for time-and-temperature. It doesn’t ring at all. What the fuck?
The receptionist says, “You have to dial 9 first.” You couldn’t put this on the telephone dial? You’d rather sit and watch while people go through this rigmarole day after day? What is wrong with you people?
I go outside. I wheel around. I pull some weeds in the flower beds. I go back inside. I sit by the directory and help a lost man find the x-ray department, which is known to me from the last time I had pneumonia. I talk to a little girl who is waiting for the elevator with her grandmother.
I call the transportation vendor. Nobody has been dispatched to pick me up. I go back outside.
A police car comes screeching in at Mach 2. I follow the cop inside, then hang back when he gets on the elevator. It stops at the second floor, so I take the next elevator and get off at 2. What could a cop in a hurry possibly be doing here? I wheel all over the second floor, peering through glass doors and entering waiting rooms, but find no sign of him.
I go back downstairs and discuss the matter with the man who runs the coffee corner in the lobby. He says cops come with ambulances. “Yeah,” I say, “but there’s no ambulance.” Then another cop pulls in, also in a big hurry. Acting nonchalant, I get on the elevator with him. When we get off on the second floor, he goes into my internist’s office suite. Wow! I wheel up to the telephone and act like that’s why I’m there and, as long as I am there, I call transportation again, this time dialing 9 first.
The receptionist tells me that Jeff has a drop-off in suburbia, then will be over for me. Yeah, right.
I wheel back outside. I am bored out of my gourd. Back and forth, around and around. I want to wheel around the back of the building but know I can’t get out of sight of the front door. Medicaid drivers tend heavily toward being idiots. If I’m not waiting in clear sight, they tend to do strange things.
Then the two cops come out with my acquaintance from psychiatric days locked between them. I know exactly what is happening here. Her doctor is committing her to inpatient psychiatric “care” and has called the police to provide transport. The only good thing about this is that she gets rapid transportation. I’m still waiting.
I call again and am told Jeff will arrive in ten or twelve minutes.
I wheel back in and chat up the coffee man. We talk about politics. He wanted to vote for McCain but Palin was a deal-breaker. I agree—the oldest elected president and a heart-beat away is this female with absolutely no substantial experience? We have a thoughtful discussion about what Bush has done right and wrong—mostly wrong—and what Obama might do right. We hope.
My ride comes. I have waited one hour and twenty minutes.
When I get home and go to call my mother, I make the horrible discovery that I have lost my appointment/telephone book.
Three lobbies, three waiting rooms, three treatment rooms, and four wheelchair vans.
I have no idea where it is, and I am totally screwed.
It’s just another day in American medicine, and can Obama actually do anything to change it?