Last week in the evening I developed a crushing headache in the right quadrant of my head, over my ear. There is no doctor in Valier. The closest is thirty miles away. I diagnosed myself via the computer: probably either a stroke (inside the skull) or a bad infection (outside the skull). It was late, the roads were “emergency only.” There is an ambulance but it was silly to risk their lives. Then there was the money. I did — nothing.
I was doing a lot of vomiting, which I hadn’t since I was a kid. When everything was empty, I went on dry vomiting. I also had major vertigo, which meant labyrinthitis — an inflammation of the labyrinth of the ear, which is what manages balance. I was too dizzy to stand up and walk without hanging onto furniture. I mostly slept and drank a lot of water. Since I was stress-intolerant incontinent, I was soon wet. I was so contracted that I ached.
The next day all was calm physically except for being dizzy. I began to eat a little. On Saturday it occurred to me that aspirin was a good idea and I began to take the recommended dosage. This was a major improvement. By Sunday evening I was almost back to normal. Since I had no visible signs of stroke — no distortion of face or disabling of limbs, no interruption of thought — I concluded it was an infection. This was not confirmed by measurements. I had a fever but couldn’t find the thermometer.
I had been warned again and again about cleaning out my ears with a foreign object for fear of infection. In the end, thinking carefully, I think that was the origin of trouble. Now I take that advice very seriously. It appears that I scraped through the incident— fortunately.
On Monday when I called the once a week clinic in Valier for follow-up, the receptionist, Rhonda, wanted to know why I wanted an appointment. Why is a receptionist entitled to know about one’s medical life? I know that in part it’s to estimate how much time you need, but somehow it has become a door-keeping issue for someone who only answers the phone and keeps the schedule. I told her I’d self-diagnosed either a stroke or a serious infection the previous week and wanted follow up. She made the appointment without asking anything more.
Pretty soon she called back to say that if I’d had a stroke or a serious infection they would not treat it in the clinic and I should go to Shelby, where the mother hospital is. She said this was the nurse’s opinion. She did not put the nurse on the phone — nor the doctor. She had not asked for my symptoms and would not have known their significance anyway. She was just going by rote — I should go to Shelby, not to the clinic. She assumed I was having a stroke or serious infection, as I claimed, but didn't ask why and could not distinguish between the two. She didn’t ask whether I were safe, if I had help, if she could call someone for me, or why the clinic and why now.
I was appalled and outraged that this kid just out of high school should tell me what to do with my life, NOT to come to the clinic. If I HAD been having a stroke (or even a serious infection) I could have died. For reals.
Let’s review. There were two more inches of snow last night. The Montana highway people were picturing continuing snowfall and showing yellow roads, which means snow and ice. Clear roads are green. I can barely drive my old pickup the two blocks to the clinic, IF I can barge out of the driveway. (The young women in the clinic have partners and new powerful cars.)
Rhonda accepted my self-diagnosis as real and immediate. In fact, the action was last week and I’m pretty much recovered, but she didn’t grasp that. She just wanted me to go to Shelby. She said the nurse suggested this. Neither one of them had seen me, had heard me give an account of my symptoms, and Rhonda has no medical training. Neither one of them has any notion that I’m an old single woman without family or a driver and neither takes into account the fact that my driveway has been plowed in, possibly more than I could break through.
The doctor was not involved, nor did the doctor call back later to see what the real situation was. I have never known a doctor who wouldn’t do that. So much for all the hospital’s declarations of caring and support. The doctor does live just outside Valier.
Rhonda had made me an appointment before she directed me not to use the clinic. I was so insulted by her attitude — fantasy and prejudice-based —that I called back and cancelled it. She was undisturbed by this, even though she had just believed that I had a condition too serious for the clinic to handle. “Have a nice day,” she advised blandly.
So this situation has three levels. The first is the most obvious which is as described above: a real life situation enough out of the ordinary to make these people into knee-jerk dispensers of "care" only to people they know and understand. If there is any variation from obedience and predictability, they are quick to escape.
The second is the question of health care in widespread rural areas and why it is so often off the mark. What happened to the old ideas of service to human beings and listening to what a patient might tell you? Instead it all revolves around the predetermined and righteous opinions of weakly qualified people. There is a demand to be present. This is what religion used to be like, especially in backwater small towns where people weren’t used to the idea of heterogeneity.
The third part is why I am so angry. In my head I am calling Rhonda, the nurse and the doctor some very nasty names. All through the ordeal I had thought I only had to hang on until local help arrived. Now I hope I never see them again and I’m resolved to go somewhere else for health care. This clinic is, it appears to me, a second-rate outfit. I have high standards for medical people. I’ve worked for this clinic's “mother hospital” (Marias Medical Center in Shelby, ward clerk in the nursing home portion) and watched them go through a sequence of scandals. Earlier I'd worked as a chaplain in an outstanding regional hospital (Rockford, Illinois) and saw how much they really cared and went the extra mile.
If no one ever cares, if no one ever nails them for brushing off patients, they’ll never reform. It OUGHT to be a crucial element of the community instead of sticking us with second-rate performance. Hospitals are no longer religious — they used to be run by nuns. But it’s only very recently that they’ve become unprofessional. Multiple kinds of degrees (MD, OD, Nurse Practitioner, Ph.D, Physician Assistant), many unproven modes, people only pretending to be doctors, and managers who are complicit — because it’s more profit.
As a side bar, several people read in my previous post that I was sick and called up to investigate. We're all old. None would listen to my symptoms. They heard or or two items and declared, "Oh, yes. Sinus." Or, "Of course. Miniere's." They were not reassuring. But they did not like my lay diagnosis of digging wax out of my ears. I still stagger a bit.