First, let me establish that most of the pain is gone and I mostly have use of my left arm after a bad dislocation. Second, I'll tell you that I have never had physical therapy, knew nothing about it, and disobeyed my emergency room care givers orders. A Physician Assistant-Certified young man who has lived everywhere in a military context, he wrote me off as an old woman with resources instead of an overeducated solitary. He assigned me to go to a physical therapy business associated with the Great Falls Clinic Orthopedics in Great Falls. I live 80 miles away in Valier. I used to go to the eye doc at that clinic until my eye doctor died. Other eye docs left to be independent.
Thankfully, the full force of this winter had not struck when I fell. A woman I knew slightly, a former mayor of Valier, drove me down to Conrad. There are three county seats big enough to have more resources than Valier and all are about thirty miles away: Cut Bank, Shelby, and Conrad. I trade in all three.
I worked for the hospital in Shelby for six months, just before the place exploded over politics and most of the docs left for Great Falls where they organized their own clinic. Essentially, the political issues were changes in medicine over the years, state enforcement of supervision, MD's vs. DO's, and the general difficulties of small hospitals in remote places. Valier pays for a clinic run by the Shelby hospital once a week.
Last fall one of the docs who had left Shelby for Great Falls set up an adjunct clinic in Conrad. I moved to his care but soon he sold his practice. When I fell, I essentially had no regular doctor. This meant I had no access to the prescriptions I need because of being diabetic. Two women MD's had told me bluntly that if I weren't more respectful and obedient to them, they would refuse to write prescriptions. Next week I will go back to the care of a female doc I first knew at the Valier Clinic. Her only fault is being too far away.
My pharmacy is in Conrad. In prep for the doc next week, I gathered up the prescription bottles I had left and put them side-by-side. They did not agree in amounts of the pills or in dosage timing. In fact, all but the most recent called for Metformin 800er (extended release). The same pharmacy filled them all. They tell me now there is no such pill as Metformin in that amount. One label tells me to take 2 pills once a day, another says take the two pills morning and evening with meals.
All assume that I live my life like theirs or at least like some stereotypical magazine. For twenty years I've lived on a bare bones salary in an old house so I could write without having to sell, which would eat up half my time and energy. I blog, which most people consider not really writing. It just sounds funny to them -- they need prizes and publication and reviews. They believe that writing is some mysterious thing they can't do.
The truth is that I don't eat meals per se -- that is, I try to keep the balance we all learned after WWII (the food pyramid) in spite of daily challenges to everything we learned. (Butter, coffee, contaminated bagged greens) I try to go by the latest and most reliable science. I put everything compatible in a bowl and eat it walking around. it's not a pill cue.
I asked the emergency PA-C who took care of me for a prescription for Tylenol 3 (with a bit of codeine) and he was happy to do it, but I didn't know then that it can't be sent in the mail. I didn't want to ask the woman who had taken off from work to add the extra time for the pharmacy so I never filled the prescription. Finally, desperate for relief from a steady month of aching on aspirin and Advil, I ransacked my supplies. The newest bottle of Advil wouldn't open (childproof). Finally, I found a little stash left over from a tooth extraction decades ago. You're not supposed to keep them.
Shortly after I came back from emergency care I was happy to discover that the grocery store would deliver and the post office brought my mail if my meds arrived that way (we normally go to the PO). For the rest, I gritted my teeth.
Yesterday the roads were clear after weeks of being closed by feet of snow and profoundly cold blizzards. I felt I might be able to drive to Cut Bank, at least on the low traffic roads here. I could and I did. In one place water was crossing the road but a car ahead of me showed it was shallow, so I drove through. I had the addresses of two physical therapists and had talked to one helper on the phone.
The Cut Bank therapists will not accept me as a patient without being referred by a doctor, preferably signed up with theirs. Physical therapy is a subsidiary controlled by doctors, like prescriptions. Doctors, like writers, don't like using up time and energy on managing a practice so they hire people to maximize their profit and they make rules. Doctors, like writers, sub-contract peripherals. So my choice is to dump my known and liked doc, who hasn't seen my shoulder, in order to accept an unknown doc and commit to that practice.
Also, if I went to the nearer Cut Bank people, my insurance would be reduced. Luckily, not long ago the Shelby hospital bought the Emergency Clinic in Conrad, so I'm covered there. Only one Medicare insurance provider serves Montana. Last year, no one did. I have no idea who paid the bills but I only bought meds.
The fantasy about Valier is that it's a pretty little town where the neighbors take care of each other. The truth is everyone works, is raising kids who have demanding after-school schedules, or is as old as me, driving a vehicle as old as mine. During the day the streets are empty: we have become a bedroom community. Not only has the medical profession failed to keep up with many developments simply because no salesman pushes them, but also they have no awareness of the changes in the culture. The reality of life on the frontier is beginning to look like the 19th century.