DOCTOR, DOCTOR

When I was working as a clerical specialist for the City of Portland in the Nineties, I was told I had the best insurance in town, thanks to the union.  Fat lot of good it did me.

The front of my thigh burned, ached, sometimes dropped my knee out of service so I nearly fell.  I went to the doc.  The first one, a renowned cardiologist trying to finish out a career distorted by the invention of camera catheters that could be threaded inside the heart.  No more need for heart by-passes.  The second was a Japanese rheumatologist who joked but had no answers.  The third one was a pathologist.  He was very severe.  The fourth one was a female GP who put her hand on my knee and advised me to take Advil.  The fifth one was a joint specialist who took an X-ray of my knee while I was standing up and showed me that there was a piece of cartilage missing.  “Nothing to do about it,” he said briskly.  “The knee fails when the remaining cartilage is in the wrong place.”

Walking down the hall, I was going to a meeting ahead of my boss.  He said mildly, “I think your right foot and leg are twisting.  It’s likely plantar fascliitis.”  He was a runner.  I looked up plantar fascliitis and saw he was right.  Tearing of the tissue on the bottom of the foot.  Quite common.

The cure was simple: wrapping the ankle and arch in a stretchy bandage.  The foot was rolling because of the weakness of the knee.  The thigh pain was from the thigh desperately trying to keep my knee straight, so I put an elastic sleeve brace on that, too.  Cured.  Today everyone knows a lot about plantar fasciitis.  Cures and supports are featured in those grandma catalogues full of little gizmos.

More recently I woke up on a Thursday morning as though someone had smashed a baseball bat into the side of my head just above my ear.  I was so dizzy that once I managed to stand up, I couldn’t move without clinging to the furniture.  It hurt a lot.  There was no chance of driving, partly because of the dizziness and partly because the roads were closed or emergency-only.  The little village clinic was closed  (One day a week operation.)  I hurt quite a lot so I took a couple of aspirin (which I never do) and went back to bed.  

Soon up and vomited the rest of the day until there was only dry heaving.  Up, aspirin, down, a few hours of sleep, repeat.  The next two days were weekend, blizzarding.  On Monday I called the clinic to make sure they were open.  It’s only two blocks away.  The receptionist demanded to know why I was coming.  (They all do that so they can estimate the time for scheduling.)  I told her either a stroke or a tumor.  She told me those were too serious for the clinic and I should go to the main hospital, thirty miles away.  I once worked there.  I don’t trust them.  My pickup is old and faulty.  Being on the road was more dangerous than most afflictions.

In the end it was an ear infection.  Self-diagnosed and healed by time, except for still staggering a bit.  I’m thinking.  The turnover at the clinic is fast enough that if I stall for a few months, there will be a new staff.

It’s easy to speculate that since the sponsoring hospital is in some other county’s seat — a hospital with serious problems from aging staff, old-fashion policies, problematic docs and insufficient funds — that this is the source of the problem.  But it’s much broader than that — even world-wide.  Consider my eyes.

At seminary my right eye became infected so I went to U of C emergency.  I was treated by a young woman about to graduate.  Her supervisor was overbearing and indiscrete.  He kept talking about how much money he would make if he were in private practise.  He insisted that the woman test my eye for glaucoma (irrelevant), grabbed her hand when the instrument was touching my cornea and scraped a shallow wound.  I was billed $100 in spite of insurance.  I wrote the most vicious letter I could compose and did not pay, but the damage has followed me ever since.

Three Montana opthalmologists have treated me in recent years.  All three were in the same practise and all three have left to become independent.  The first found holes in my retina and closed them with laser fusion.  These holes may have been caused by bad circulation from overuse and swelling but were refused treatment in Canada as imaginary.  The treatment worked and there has been no trouble from that.

The second was a doc famous for the number and swiftness of his lens replacement surgery.  When I turned out not to have enough cataract to operate, he lost interest.  The third I consulted for itchy, burning, crusty eyes, alarming and serious enough for me to force my way onto his schedule on an emergency basis.  He could find no cause though we considered even eye shadow with sparkles.  Then after a few years he announced that I had ocular rosacea AKA dry eye syndrome, well-known in this computer age because of failure to blink enough.  “Use eyedrops,” he said.  No prescription.  It's in those grandma catalogues.

Part of the problem that prompted leaving was that the practice was run by a management administrator who compelled short predicted exams and removed those traditional clerk assistants who sat by a small lamp in the dark and took notes dictated while the doc looked.  This manager compelled the docs to use a computer instead.  Since these docs, unlike management, were not computer savvy, there were two results.  One was that they were so preoccupied with managing the computer software that they failed to look at the actual eyes.  The other was that they omitted to record some things to save time and trouble.  Like all software, the entry points didn’t always fit the reality, since they weren’t developed by opthamalogists.  But the measures increased profits.

These technical effects on the observation, diagnosis and treatment of delicate matters are part of what undermines confidence in a once profound profession, that of healing, which is meant to be a human interaction rather than a prescription.  Another part is the income disparity which has attracted people concerned only with money.

These matters verge on morality, which is a part of seminary training for religious service.  Management is also looking for opportunities there.