ANNUAL CHECK UP OF WHOM?

Previously, on July 3, 2014, I blogged about Joni Walton, Physician Assistant covering the Valier Clinic these days. The post is called “A Simple Test” and it was a crabby one.  I was hard on Joni.  But they got me -- the test for acid lactosis that was supposed to be covered by Medicare cost me $100.  

So today -- and this is also supposed to be an annual checkup paid for by Medicare -- she had backup.  Sherri Marchand Smith, who is now a professor of nursing like Walton, is qualifying to be a physician assistant.  Married to a former cop, long a resident of Chicago where she worked with what she frankly calls “ghetto hospitals,” she clicked with me right away.  There were still problems.  There are ALWAYS problems.  It’s the way life is.  No blame to these women except that they are going along to get along.

Top of the cell tower

The worst problem is that the Valier clinic has phone and email service so bad that they have to use two different services.  Joni says that sometimes she can NOT get simple phone calls to Valier numbers to work.  (She is good about calling people.)  I asked if she had complained to 3 Rivers -- yes.  Also, the management of the Shelby hospital, Marias Medical Center, has called 3 Rivers to complain.  I asked whether the new cell tower next to the grain elevator (so the elevator won’t create a transmission shadow) had made a difference.  No.  

The checkup was to be guided by a questionnaire on a laptop.  In order to use it, the machine had to be attached to a long extension from across the hall that prevented the door from being shut tight.  It worked, but prevented confidentiality.  I wasn’t asked to undress or even take my socks off, but what if I had come in to be tested for HIV-AIDS?  Or a pelvic?  Not impossible.  I joked that I was pretty sure I didn’t have ebola and was not pregnant.  They asked whether I drank, smoked or chewed, but never asked whether I used illegal drugs.  (I’ve considered DMSO when my arms were aching.)

I was asked whether I had a smoke detector with a battery (no, because the house is so small that the toaster sets it off) or a carbon mono detector (yes), if I had a night-light (no), whether I had eliminated all fall hazards like throw rugs (no). They wanted to know whether I wore my pickup seat belt.  Didn't they realize that if I said no there was a $50 penalty?   By that time I was indignant, saying these invasive questions would take a court warrant to get more information about my private home and car.  Not content with supervising our bodies, the medical and insurance community is moving on to our environments.  This was not a checkup about my body at all  -- it was some bureaucratic inquisition meant to generate statistics.  And marketing opportunities.  It's consumer research.

Where's that lover?

About one quarter of the way down this official Medicare questionnaire I became impatient and challenging.  They wanted to know the date of my last pap smear.  (Sometime in the Eighties, maybe.)  To derail them, I asked why they didn’t inquire about my sex life.  Did they assume that such an old tubby woman wouldn’t have one?  They laughed and said they didn’t even want to know!  But in minutes we were discussing senile vaginas, the advisability of using previously-owned ben wah balls, Kegel exercises, vibrators (there’s a new one that looks as though it were designed for Batman, a thick black rubber circle with batteries inside intended for the male appendage.)  THEN we were laughing for sure.  And they forgot about seat belts.

The previous PA had doubled some of my meds, but I had just ignored her. This time Joni halved some of my meds.  Fish oil and vitamin D are now at the top of PA Walton’s Magic Meds list.  I was told to double what I already was taking on my own initiative.  (This would mean about $25 in new med costs, none reimbursable.)  When I pushed up my sleeves for the blood pressure test (the numbers are now allowed to be higher), my arms were inspected for melanoma, but not the rest of me.  Nurse Smith did a LOT of reflex tests, a peripheral vision test, and a little dance routine to test leg joints.  She looked into my ears and in my mouth, but not up my nose.  

We had a discussion of ear wax, the two kinds (Asian which includes Indians and is powdery, and European which is waxy enough to use as chapstick.  PA Walton claims that if you dig all the wax out of your ears, it lets insects climb in.)  She pushed Lipitor, saying it would keep my carotid arteries clear, but neither PA listened to my carotid.  Others have done that.  This time they didn't listen to my heart -- just lungs from the back.  They asked about wheezing.  Evidently the computer checklist was mostly about self-reports: don't look, just ask.

They wanted me to do a private at-home test for blood-in-poop that’s supposed to be much improved: no longer does one mail in the actual substance.  (Very few people ever did it anyway, and I'm sure the PO appreciated that.)  Instead one uses a sort of pregnancy test thing: wipe and look for a color change.  I wouldn’t accept it, so PA Walton tucked it into my book.  The book was “The Emotional Brain” by LeDoux and PA Walton declared her last “brain book” was comparing the male and female brain.  This led to a discussion of XX, XY, XXY, XYY, transgender, ambiguous sexuality, etc.  The idea of the male versus female brain as radically different, even in terms of halves, is now seriously challenged. Again.

But in fact, we had a considerable discussion of poop.  The two PA’s focused on constipation, which I assured them was inherited and related to hydration.  As children my sibs and I were subjected to various agar-agar glop.  The cure we liked was the one an old-fashioned doc advised where we stood in front of my mom while she scraped raw apple with a spoon (pectin) and tucked it into our mouths as though we were nestlings accepting insects.  Of course, there are always prunes.  Old-fashioned but it works.

Lion balls.

To derail these obsessed women again, I told them that my poop is “lion balls,” a technical term.  I assured them that when I was cleaning the cage of the lion that I helped to catch when I was an AC, I observed that -- indeed -- lion balls are relevant.  This was a female lion -- I don’t mean testicles.  Round poop.

PA Smith declared she loved me and wanted to hug me.  I reminded her that the new directives for med folks was that they should wash their hands before touching patients (neither of them did this) and that we should not even shake hands -- the preferred substitute is bumping elbows.  

We had a discussion of asking before coming into one’s personal space.  “May I put my hand on your shoulder?”  PA Smith was plainly used to working with the kind of people who are comfortable with physical contact.  Or comatose.

After PA Walton left to address the patient backlog that had developed, PA Smith and I, now unsupervised, began to compare emergency room stories.  She told about the guy who came in with a hatchet embedded in his back and I told about the guy who was shot in the forehead at just the right angle so that the bullet went around the outside of the skull but inside the skin and came out next to the entry hole.  We could easily while away an evening in a bar, esp. if her husband the ex-cop were there.  It was great, an upper.

Now I wait for the lab results.  They didn’t ask for pee or take my temp.  Just lots of blood which was reluctant to come out.  I didn’t throw up.  I don’t have ebola.  I am not pregnant.  If you ask nicely and you've washed your hands, we could bump elbows.  If that was a medical checkup I just had, it only revealed that I'm aging and insufficiently funded.  No one asked how I felt about that.  The questionnaire was not for my sake.  Now I'm wondering whether I should scrape up the money for a real physical.

"Bumping" -- not just rubbing elbows