{"id":4022,"date":"2016-12-27T17:14:43","date_gmt":"2016-12-27T22:14:43","guid":{"rendered":"http:\/\/www.allandouglas.com\/blog\/?p=4022"},"modified":"2025-04-21T01:56:37","modified_gmt":"2025-04-21T05:56:37","slug":"peek-inside-doctor","status":"publish","type":"post","link":"https:\/\/pineymountainfoster.org\/thoughts\/peek-inside-doctor\/","title":{"rendered":"For a Peek Inside"},"content":{"rendered":"
\n

This tale was written years ago, filed, lost, found, lost again,\u00a0 recovered again, and now posted here. For friends and relatives who often jump to conclusions, this is ancient history:
\nI am not sick.<\/p>\n<\/blockquote>\n

\"medicalThe small pick-up truck hurled along the winding, bumpy mountain highway, the tighter turns and bumpiest spots elicited increased groaning from him.\u00a0 The driver looked away from the road just long enough to glance at him and ask, \u201cAre you alright?\u201d<\/p>\n

He was curled up in the passenger seat clutching his belly.\u00a0 He reached over and gently patted her arm, \u201cJust ignore the screaming and wailing from this side and get us there as quickly \u2013 and safely \u2013 as you can.\u201d<\/p>\n

Eyes back on the road she steered through another curve and retorted, \u201cIf it gets too bad, I\u2019ll just turn up the radio to drown you out.\u201d<\/p>\n

\u201cGood girl.\u201d\u00a0 <\/p>\n

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.\u00a0 A short time later his body had mercy on him and he passed out.<\/p>\n

He awoke to the words, \u201cDarn, missed it again.\u201d As their truck executed a tight high-G turn, then another, followed by a gentler right hand turn and a slower pace.\u00a0 He opened his eyes just as they passed the impressively beautiful building of Le Conte Hospital.\u00a0 This was not their target, but it was comforting to know it was so close by.<\/p>\n

He noticed that the pain he had been feeling was almost entirely gone, and immediately thought, \u201cOh, great: now that I\u2019ve put us both thought this and we are about to see the doctor the pain goes away \u2013 Sorry doc, I\u2019m fine now: I\u2019ll come back if it returns.\u201d\u00a0 But he quickly dismissed the fear that it was a false alarm, knowing that this relief was resulting from a flood of endorphins \u2013 a natural form of morphine produced by the body to mask pain \u2013 probably released as he passed out earlier.\u00a0 As they wore off, the pain would return.\u00a0 He was not \u2018fine\u2019.<\/p>\n

His wife slid the truck into a parking spot.\u00a0 They climbed out and gingerly made their way inside the Urgent Care Clinic \u2013 a standalone doctor\u2019s office touted as being a better solution for non-life threatening medical care than a hospital emergency room.<\/p>\n

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.\u00a0 Occasionally she asked him for information she wasn\u2019t sure of and he answered in soft, measured words.\u00a0 Yes, the pain was indeed returning, and he was using deep breathing relaxation methods to try to forestall its full impact.<\/p>\n

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.\u00a0 When the interrogation was complete she steered them to a medical examination room where a television blared out some cartoon show.\u00a0 Marie found a way to turn off \u2013 or at least cripple – the television so they could sit and chat quietly.\u00a0 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.\u00a0 A little conversation, peppered with Marie\u2019s delightful sense of humor, suited their purposes much better.<\/p>\n

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.\u00a0 Then he stood back and asked, \u201cHow long has it been since you had your last colonoscopy?\u201d<\/p>\n

He looked at the doctor uneasily, \u201cI \u2026 don\u2019t think I\u2019ve ever had one of those.\u201d<\/p>\n

The doctor raised an eyebrow, \u201cAnd, who is your family doctor?\u201d<\/p>\n

\u201cI don\u2019t have one.\u201d<\/p>\n

The doctor shot him a look that screamed, \u201cOh, God; you\u2019re one of THOSE!\u00a0 A heretic who refuses to have regular medical exams and testing done.\u00a0 Then comes in with one foot in the grave and expects us to undo years of neglect and abuse.\u00a0 When will these people ever learn?\u201d<\/p>\n

Doug recognized the look and it raised his hackles.\u00a0 He fought to keep the anger from his voice, \u201cI am a very healthy person; it has been well over a decade since I\u2019ve been sick or injured enough to require medical attention. \u201c\u00a0 He wanted to go on to explain that doctor\u2019s offices and hospitals were the best places on the planet for a healthy person to get sick.\u00a0 That sitting around in a doctor\u2019s 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.\u00a0 But he didn\u2019t; 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.\u00a0 Diagnosing serious problems early often made them successfully treatable.\u00a0 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.\u00a0 He would benefit only through the knowledge that he was dying \u2013 and why.<\/p>\n

A few moments of antagonistic silence passed as the two exchanged these telepathic thoughts.\u00a0 Then the doctor continued, \u201cYour symptoms indicate that you have Diverticulitis, that\u2019s 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.\u00a0 If treated early it\u2019s not too serious, if one of those balloons bursts you can die of peritonitis quite rapidly.\u201d<\/p>\n

Doug nodded as he listened.\u00a0 He had not thought of Diverticulitis.\u00a0 He was familiar with it, but it had not come up in the days since the pains had started.\u00a0 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.<\/p>\n

\u201cI need you to hop over to the hospital,\u201d the doctor continued, \u201cand have a CAT scan done, then come back here and we\u2019ll see what it says.\u201d<\/p>\n

He sighed and stared at the doctor, thinking \u201cHere we go \u2026 how typical.\u201d But he said, \u201cIs that really necessary?\u201d<\/p>\n

The doctor quickly came back with, \u201cOh, it\u2019s no big deal; they\u2019ll have you drink a fluid that will light up your insides during the test, you\u2019ll have to wait a couple of hours for it to work its way through, but the scan is quick and painless.\u201d<\/p>\n

A bolt of bright pain lanced through his gut, he clutched at it and stifled a whimper.\u00a0 The pain was returning with a vengeance now as the endorphins wore off.\u00a0 Between the pain and his aggravation with the doctor he was not sure he could maintain a civil tongue.\u00a0 He looked to Marie and said, \u201cYou\u2019re going to have to help me here.\u201d<\/p>\n

She knew what he meant and stated, \u201cHe has no medical insurance; is the hospital going to hassle us over the high cost of such a test?\u201d<\/p>\n

The doctor\u2019s eyes went wide in genuine surprise, \u201cI have no idea!\u201d<\/p>\n

Doug thought, \u201cI bet you don\u2019t even know what a CAT scan costs do you?\u00a0 It doesn\u2019t 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\u2019re running up.\u201d But he knew; he had researched it for an article he\u2019d written on the rising cost of health care.\u00a0 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.\u00a0 Specialized scans could run as high as $6,000.\u00a0 Le Conte was an almost new Hospital in one of the larger cities of the area.\u00a0 The test would doubtless be on the pricier end of the typical scale.<\/p>\n

Another lance of pain shot through him, he desperately wanted to explain, \u201cI\u2019ve been full-time self-employed for 12 years.\u00a0 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).\u00a0 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.\u00a0 That would be $4,800 a year tossed down the toilet.\u00a0 The State sponsored program, TennCare was considerably less expensive, but was no longer taking new applications.\u00a0 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.\u00a0 A large part of this was people seeking potent pain meds that they then sold on the street.\u201d\u00a0 But instead he asked, \u201cHow sure are you of your diagnosis?\u201d<\/p>\n

\u201cGiven your symptoms, it\u2019s pretty sure you\u2019ve got diverticulitis.\u00a0 Standard procedure is to confirm that with a CAT scan.\u201d<\/p>\n

\u201cIs that required?\u201d<\/p>\n

\u201cNo, we can treat you empirically.\u201d<\/p>\n

\u201cEmpirically?\u201d<\/p>\n

\u201cYes, treat you based solely on the symptoms.\u201d<\/p>\n

\u201cAnd would your treatment have side effects \u2013 would my toes fall off from the treatment if it is not diverticulitis?”<\/p>\n

\u201cOh, no \u2026\u201d the doctor explained, \u201cYou\u2019d go on a clear liquid diet and I\u2019d prescribe antibiotics for the infection.\u00a0 It can do you no harm.\u00a0 It just won\u2019t do any good if it\u2019s something else.\u201d<\/p>\n

\u201cSince you\u2019re confident in your diagnosis,\u201d he said with another wince, \u201clet\u2019s proceed empirically.\u201d<\/p>\n

\u201cAlright, but I\u2019ll want you back here in three days to see if it\u2019s working.\u201d<\/p>\n

\u201cAgreed.\u201d<\/p>\n

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.<\/p>\n

They stopped to drop off the prescriptions at a pharmacy, then went on home.\u00a0 She helped him get settled in bed, then went to fetch the medications.<\/p>\n

Lortabs helped ease the pain.\u00a0 The liquid diet flushed out his innards and allowed them to rest.\u00a0 Medications fought the infection.\u00a0 In time healing began.<\/p>\n

The follow-up appointment was brief, just confirming that they were on track.\u00a0 The doctor did emphasize a need to be on the rolls of a local doctor who could be seen when need arose.\u00a0 That did seem a sensible precaution \u2013 even if he had no intent of going in every few months for a check-up.\u00a0 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.\u00a0 He promised himself to make the connection as soon as he was capable.\u00a0 Life, it seemed, would go on a bit longer.<\/p>\n

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.\u00a0 It is informative yet very entertaining.<\/p>\n