Thursday, June 15, 2017


Dr. Mechelle Lewis

Yesterday I visited the little Valier clinic that is supported by the Marias County hospital in Shelby rather than the Pondera County in Conrad, which is where Valier is located.  The Shelby hospital has had much scandal and struggle over the past years, and was even when I worked there briefly in about 2002.  Now they are finding a new balance in a time that is financially hostile to small prairie hospitals.  I was very pleased that there is a doctor at the clinic again rather than just a nurse-practitioner, though the latter are often perfectly capable for most problems.

I wanted a consultation with a real MD and I got one.  She even lives in Valier.  I do like her and the visit was helpful, but this is not about her.  We agreed to run a blood panel to see about this “lactate acidosis” issue and we’ll confer about the results next week when her clinic day comes around again.

This is about the paperwork that every hospital requires in the beginning.  The “new” questionnaire was interesting.  I wish I’d asked to bring a copy back home with me.  It reminded me of a federal questionnaire of some kind sent to Valier years ago.  It was fairly comprehensive and the mayor at the time didn’t like some of the questions because they were likely to offend the sensibilities of the town's self-image.  She retyped it and gave us all her redacted version to answer.  Much earlier, a high school counselor in Browning got into trouble for reporting the result of a survey of drug use among the kids there.  The parents were irate: they insisted there WERE no illegal drugs used in Browning.

To some, this medical questionnaire was very modern — possibly TOO modern.  It asked for me to identify my race and gave a list of possibilities, ordering that I only make one choice.  I checked “white” because I didn’t want to argue, but a hospital is a scientific institution.  It is scientifically established that there is no such thing as “race”.  The genetics of human beings are continuous and close enough together for reproduction, which is the definition of species.  We ARE a species:  those who are not human should consult the veterinarian rather than the hospital.

What the questionnaire was doing was confirming the reality of cultural categories, often based on prosperity and national values, that can be used to create and enforce stigma.  Yet, a hospital or doctor is ideally presumed to treat all who need help regardless of stigma.  This is pretty much fantasy since ability to pay for care is key.  What the questionnaire really wanted to know was whether I had insurance.  And the overzealous ICE enforcers are using medical facilities to find illegal immigrants.  Not Scots/Irish ones like me.

I was also asked for my income level and was surprised to see that there was a category lower than mine.  Usually I’m in the bottom category, defined by those at or below the legal poverty level.  But I’m actually an example of “Class X,” meaning that my education is not that of a poor person.  What medicine has come to be about is money, but originally it was about science, and — in the dimension of religion — about care, which is why it is associated with missionaries and nuns.  When the nuns began to sell their hospitals, that was a signal.

By far the “hottest” issues in human care over the last half-century have been those completely reorganizing what we know, think and do about sex, which is why I often return to the subject.  (The first child born from a ovum with a transplanted nucleus was just born, a three-parent child.)  This questionnaire wanted to know whether I were heterosexual, homosexual or bisexual.  I quipped that I didn’t know about that last, since I hadn’t had the opportunity to try both options.  

Actually — when I said I had come to believe that sex was a fluid phenomenon, changing according to the culture, to maturing, to opportunities, and other forces — the nurse looked blank.  (She’s a rancher and understands cows which do not have “fluid” sex roles, though they might be homosexual, in terms of trying to breed the same sex as themselves.)  Actually -- at 78 I'm celibate.  I didn’t ask out loud how much these options usually had to be explained.  A Hutterite patriarch was sitting in the room, waiting for care.  We’d exchanged pleasantries about the weather.

Nor did I say anything out loud when the questionnaire wanted to know how many lovers I’d had.   They rightly assumed that there were few enough for me to know the number, but that might not apply to everyone.  They didn’t stipulate their sex or preferences or whether I’d had to pay for it.  There was no attention to penetration or legal relationship.  There was no question about sexual abuse.  They wanted to know when I began to menstruate or when I passed through menopause, but I had to answer with question marks since both were so long ago that I can’t remember.

The postmaster tells me that at her last checkup in Great Falls the questionnaire she can to fill out had about twenty sexual categories, used the phrase "self-identify with", and included options she had never heard of.  

The doc was fine and I like her, but in her explanations, which were the standard basic info available on reputable internet sites like Mayo, she used the usual medical jargon of “most people” and “usual treatment” which are meant to be reassuring.  For Hutterites, being like “most of us” is a good thing, a high value that keeps order.  “Most” Valierians would “mostly” agree.  When I explained that I was interested in exceptions, she took it well, and understood that I needed a trained doctor who could tell — as present jargon goes — a zebra among the horses.  (“Call the Midwife” has an episode illustrating the days when docs prescribed thalidomide to “most pregnant women” with perfect confidence.)

I read a lot of medical research and am sharply aware of how fast it is moving and how diabetes, which was at the root of my worry about side-effects of Metformin, is — like most of the human metabolic disorders — expanding and morphing at a furious rate which was another reason I needed an MD to help me think.  

There’s also the issue of access to drug prescriptions.  I have never had an MD threaten to refuse prescriptions for which I had an established need, though nurse practitioners have done it twice.  I assume they wanted to control me.  They didn’t DO it.  Because of illicit drug use, we are in a time when medical prescriptions are scrutinized.

It was a great relief that the nurse achieved the blood draw on the first try with no problems.  She used a “butterfly” needle, if you’re interested.  Some nurses leave me with bruises up and down my arms because, they say, I have “rolling veins.”  I had just walked the few blocks from my house, so there was plenty of blood on the move in the veins.  

I haven’t raised the issue with the doc about working at animal control where they told those of us who handled animals, esp. ferals, NOT to give blood for transfusion to others because there were so many subtle microorganisms we would acquire in our blood, categories like rickettsia.  Prions were not identified yet.  I’ve had vaccination for rabies, but probably that Titer has gone down by now.  This is specialized thought, not what one would expect a standard family practise person to consider.  But then, ranchers handle a lot of animals.

My own body is for me always an absorbing project (jokes) and I do my best to keep my brain and behavior serving it.  It’s a great relief to have an MD at hand if I go out of my own control or if the price for being a living human is fatality.  Of course, if I die, it’s not my problem anymore.  (I have a friend who hates it when I end posts flippantly.  I'm teasing.  But it's for courage.)

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