Sunday, March 15, 2009

toward medical entitlement and mutante maneuvers

At the rheumatologist’s office (a clean white edifice Ikea-like in Pacific Heights with Arabic- looking inlays against the lobby walls) the other day.

The same rheumatologist who is smart and brisk and always calls me to tell me my lab stats (she could just, after fulfilling her own responsibility to know, never bother to let me know—other doctors certainly operate this way). The same rheumatologist who reminds me that MediCal only pays her a quarter to see me (though she did do me the huge favor of keeping me on as a patient once I became to old to have my mom’s private insurance—and does not remind me of that). The same rheumatologist who sees me once every six months and reminds me that oh yes, some of her patients have had arthritis for as long as I have, but none have been as “devastated by it” as I. And the same rheumatologist who did not harass me when I freaked out two years ago and quit all my meds because I had gone on that trip about long term side effects that I know better not to go on anymore (she could have easily made me feel worse about ignoring all her advice that I needed to stay on meds) is still the same rheumatologist who asks me, once every 3 months, to raise my arms over my head, clucks and says, “Yeah, no movement there---do you stretch?’ seemingly oblivious to the fact that whatever limitations exist to my rotator cuffs set in oh, about 27 years ago, when my bones were still soft as a toddler.

Anyway, this is not about that rheumatologist, but about the other rheumatologists that work in her office. These two were tall, freshly Ralph Laurened young woman in heels, having a conversation in the hallway as I buzzed along in my scooter on my way out of the office.

The one dr. had her back to me while her colleague faced me. The first was telling the second about a recent dialogue she had with a patient. Her tone was loud and imperious:

And she wanted me to order an MRI for her. And I said You know, it is not really necessary. And she said well I just want to know for sure it is healed because I don’t want to waste another month in physical therapy. And you know, I’m just thinking to myself, You are the reason this country is bankrupt, because you insist on having your dr. order all these unnecessary tests. I mean, can you believe the entitlement?

I was coming toward them on the scooter. They were very tall in their heels. Sitting on my scooter, I was a few feet beneath them. Their lab coats gleamed white. I wore my kind of Amelie green coat, my little-bit much coat (thnaks mom) and little green cap that is getting kind of raggedy looking. They felt like the colonial humans and I felt like the what—hobbit? who had traveled to their land from far distances because they would agree to treat me.

I think the completely unselfconscious use of the word “entitlement” is what drove me over the emotional edge. My heart was racing. I rolled my eyes hugely, looked toward the dr. who had been listening to her cohort while facing me. She started to say, maybe in response to my forehead displacing eyeroll, “Well, I certainly believe everyone is entitled to medical care but….” and then she trailed off and her friend lowered her voice saying something like “I know but….” as if they had checked themselves and would commence talking in the same way, but quieter.

For an instant I considered, no not really considered—I twitched with this notion of going total Accion Mutante. A kind of Michael Moore re-does Sicko with the help of the Jackass crew. I mean, they did not know what was wrong with ME. Whose to say I did not have some sort of palsy,? And that might hand might spasm and that I might loose control of my little cart and that I might swerve and ram into the “entitlement” one. You know, and maybe she might break a Prada heel and have to go down to the 3rd floor for an X-ray, a little dose of radiation . May Be.

Anyway, I did nothing, but I knew, in another rational, calm part of my being, that I would be totally justified in approaching them and saying, You know, I heard your conversation and I think it is a very disrespectful thing to say given you are out in the hall way surrounded by people who need tests to know they are OK. And what could possibly be so wrong with getting any kind of confirmation to that effect, even Even for the people who are most likely all well and healed or stable for the time being. Insistence of every assurance of one’s health (esp. if it is a tentative or previously threatened health) is never entitled. And in fact, that woman who you just put the burden of the whole capitalist nation’s economic woes on is Not to blame. try the millionaires who run insurance companies and jack up the price of all medical tests by sheer bartering power. I knew I could do this, but I did not. Because I feared I would not be able to pull it off. I want a specific demeanor for that and I am just not there yet. I mean, I would have started crying or yelling because I was nervous. I need Jack Nicholson. Whom I love, Whom I think is an honorary Italian. I got the eyebrow-part down sometimes.

Postscript--Then last night, I went to the first in series of events from SFSU's Poetics and Healing Seminar. Barbara Tedlock's newest book will include case studies on alternative medicine--in this case, where shamanism meets Western medicine. i.e. ORs that require soul retrieval experts.

And, Eleni Stecopoulos, busy with getting the event started, sent down a very nice woman whom I had never me to make sure I knew I could use the elevator to get upsatirs

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