For a Peek Inside

This tale was written years ago, filed, lost, found, lost again,  recovered again, and now posted here. For friends and relatives who often jump to conclusions, this is ancient history:
I am not sick.

medical emergency, doctor, hospital, testing, costThe small pick-up truck hurled along the winding, bumpy mountain highway, the tighter turns and bumpiest spots elicited increased groaning from him.  The driver looked away from the road just long enough to glance at him and ask, “Are you alright?”

He was curled up in the passenger seat clutching his belly.  He reached over and gently patted her arm, “Just ignore the screaming and wailing from this side and get us there as quickly – and safely – as you can.”

Eyes back on the road she steered through another curve and retorted, “If it gets too bad, I’ll just turn up the radio to drown you out.”

“Good girl.” 

He tried to stifle most of the sounds of discomfort, but the malady which sent them hurtling along this 35 mile trek to seek emergency medical help was incredibly painful and he found it impossible to remain stoically silent, especially as they swept through the turns.  A short time later his body had mercy on him and he passed out.

He awoke to the words, “Darn, missed it again.” As their truck executed a tight high-G turn, then another, followed by a gentler right hand turn and a slower pace.  He opened his eyes just as they passed the impressively beautiful building of Le Conte Hospital.  This was not their target, but it was comforting to know it was so close by.

He noticed that the pain he had been feeling was almost entirely gone, and immediately thought, “Oh, great: now that I’ve put us both thought this and we are about to see the doctor the pain goes away – Sorry doc, I’m fine now: I’ll come back if it returns.”  But he quickly dismissed the fear that it was a false alarm, knowing that this relief was resulting from a flood of endorphins – a natural form of morphine produced by the body to mask pain – probably released as he passed out earlier.  As they wore off, the pain would return.  He was not ‘fine’.

His wife slid the truck into a parking spot.  They climbed out and gingerly made their way inside the Urgent Care Clinic – a standalone doctor’s office touted as being a better solution for non-life threatening medical care than a hospital emergency room.

He found a chair and tried to get comfortable while Marie acquired the sheaf of paperwork and set about filling in the medical history forms.  Occasionally she asked him for information she wasn’t sure of and he answered in soft, measured words.  Yes, the pain was indeed returning, and he was using deep breathing relaxation methods to try to forestall its full impact.

In a mercifully short time they were ushered into a pre-screening room where a pleasant nurse went over the paperwork, asked many questions about his condition and recent history then took his basic vital signs.  When the interrogation was complete she steered them to a medical examination room where a television blared out some cartoon show.  Marie found a way to turn off – or at least cripple – the television so they could sit and chat quietly.  Not being accustomed to television, neither of them expected to be entertained everywhere they went and found most television programs to be mindless and annoying.  A little conversation, peppered with Marie’s delightful sense of humor, suited their purposes much better.

In time a doctor stepped through the door, introduced himself, and repeated most of the intake interrogation, followed by some poking, prodding, thumping, and listening through a stethoscope.  Then he stood back and asked, “How long has it been since you had your last colonoscopy?”

He looked at the doctor uneasily, “I … don’t think I’ve ever had one of those.”

The doctor raised an eyebrow, “And, who is your family doctor?”

“I don’t have one.”

The doctor shot him a look that screamed, “Oh, God; you’re one of THOSE!  A heretic who refuses to have regular medical exams and testing done.  Then comes in with one foot in the grave and expects us to undo years of neglect and abuse.  When will these people ever learn?”

Doug recognized the look and it raised his hackles.  He fought to keep the anger from his voice, “I am a very healthy person; it has been well over a decade since I’ve been sick or injured enough to require medical attention. “  He wanted to go on to explain that doctor’s offices and hospitals were the best places on the planet for a healthy person to get sick.  That sitting around in a doctor’s waiting room with a couple dozen people who are hacking and coughing or radiating fever for hours in order to assure himself that he was healthy made no sense.  But he didn’t; the doctor had doubtless heard that before, just as Doug had heard the usual retorts before: about how being proactive in health care was important.  Diagnosing serious problems early often made them successfully treatable.  He understood that, but also knew that even if they found a problem such as cancer or heart disease he could not afford to treat it.  He would benefit only through the knowledge that he was dying – and why.

A few moments of antagonistic silence passed as the two exchanged these telepathic thoughts.  Then the doctor continued, “Your symptoms indicate that you have Diverticulitis, that’s a disorder of the bowels where one or more small sacks or balloons form in the bowel wall and can become inflamed, causing your pain.  If treated early it’s not too serious, if one of those balloons bursts you can die of peritonitis quite rapidly.”

Doug nodded as he listened.  He had not thought of Diverticulitis.  He was familiar with it, but it had not come up in the days since the pains had started.  He and Marie had tried to guess at the cause by looking up symptoms for maladies they knew of that seemed to fit the profile.

“I need you to hop over to the hospital,” the doctor continued, “and have a CAT scan done, then come back here and we’ll see what it says.”

He sighed and stared at the doctor, thinking “Here we go … how typical.” But he said, “Is that really necessary?”

The doctor quickly came back with, “Oh, it’s no big deal; they’ll have you drink a fluid that will light up your insides during the test, you’ll have to wait a couple of hours for it to work its way through, but the scan is quick and painless.”

A bolt of bright pain lanced through his gut, he clutched at it and stifled a whimper.  The pain was returning with a vengeance now as the endorphins wore off.  Between the pain and his aggravation with the doctor he was not sure he could maintain a civil tongue.  He looked to Marie and said, “You’re going to have to help me here.”

She knew what he meant and stated, “He has no medical insurance; is the hospital going to hassle us over the high cost of such a test?”

The doctor’s eyes went wide in genuine surprise, “I have no idea!”

Doug thought, “I bet you don’t even know what a CAT scan costs do you?  It doesn’t matter to you because insurance always pays the bill, so you can funnel people into the hospitals diagnostic section willy-nilly and never give a second though to what kind of bills you’re running up.” But he knew; he had researched it for an article he’d written on the rising cost of health care.  In the USA a typical CAT scan would run from $700 to $2,500 depending on the body part being scanned and the geographic location of the testing facility: large city hospitals tended to be more expensive than testing facilities shared by several smaller hospitals.  Specialized scans could run as high as $6,000.  Le Conte was an almost new Hospital in one of the larger cities of the area.  The test would doubtless be on the pricier end of the typical scale.

Another lance of pain shot through him, he desperately wanted to explain, “I’ve been full-time self-employed for 12 years.  Health insurance for self-employed people runs around $400 a month even through a large group policy like the National Association of the Self Employed (NASE).  There was no way he could justify spending one third to one half of his monthly personal income on something he would so rarely use.  That would be $4,800 a year tossed down the toilet.  The State sponsored program, TennCare was considerably less expensive, but was no longer taking new applications.  For the past two years they had been tossing people out of the program to cut costs because insurance fraud had practically bankrupted the program.  A large part of this was people seeking potent pain meds that they then sold on the street.”  But instead he asked, “How sure are you of your diagnosis?”

“Given your symptoms, it’s pretty sure you’ve got diverticulitis.  Standard procedure is to confirm that with a CAT scan.”

“Is that required?”

“No, we can treat you empirically.”

“Empirically?”

“Yes, treat you based solely on the symptoms.”

“And would your treatment have side effects – would my toes fall off from the treatment if it is not diverticulitis?”

“Oh, no …” the doctor explained, “You’d go on a clear liquid diet and I’d prescribe antibiotics for the infection.  It can do you no harm.  It just won’t do any good if it’s something else.”

“Since you’re confident in your diagnosis,” he said with another wince, “let’s proceed empirically.”

“Alright, but I’ll want you back here in three days to see if it’s working.”

“Agreed.”

The doctor left to make out the prescriptions, a nurse showed the couple to a counter where they paid their bill for the day and were given their prescription forms and diet instructions.

They stopped to drop off the prescriptions at a pharmacy, then went on home.  She helped him get settled in bed, then went to fetch the medications.

Lortabs helped ease the pain.  The liquid diet flushed out his innards and allowed them to rest.  Medications fought the infection.  In time healing began.

The follow-up appointment was brief, just confirming that they were on track.  The doctor did emphasize a need to be on the rolls of a local doctor who could be seen when need arose.  That did seem a sensible precaution – even if he had no intent of going in every few months for a check-up.  He had heard of one local doctor who works well with those of limited means; working as a GP not as a pre-screeener for specialists.  He promised himself to make the connection as soon as he was capable.  Life, it seemed, would go on a bit longer.

And now, as a reward for having read all the way through this rather lengthy tale, here is a related treat: 200 Countries, 200 Years 4 Minutes: The joy of Stats.  It is informative yet very entertaining.

If the video does not show up for you, [Click Here]

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