Wednesday, June 8, 2016

My New Doctor(s)

70


Early into Nineteen Ninety, my Medicare coverage kicked in and I decided to get back on the doctor visiting path. As I had a friendly enough visit with a new doctor, 'Betsey', at the community health clinic I thought I might as well start with her and see if I could get her interested in my long term health problems. It was always a question of finding focus, I felt, rather than walking in and noting everything that was outstanding and unaddressed in my health issues. Two examples of things I wouldn't think of bringing up were the sudden brief bursts of fever I had been having, first once a day, then twice a day since the age of sixteen, and the recent lumps I had been finding underneath my skin. When I had mentioned the newly forming lumps to my mother she took a look at one on my arm and told me they were cysts, but then she became incensed and told me I couldn't have cysts as only women got them. Either way they didn't hurt and so I wasn't going to bring them up to my new doctor on my visit with her, I was just going to focus on my weight loss and intestinal issues.
The community health clinic had moved to a brand new building about a half mile from the forgotten stretch of the main road. Smelling of fresh paint and spaciously spread out, we now had to get to the front desk to be sorted out. When it was my turn in line, I noted my appointment and new insurance coverages and I was sent to the financial department to affirm my insurance and recalculate my co-pay. As my original co-pay had been a couple of dollars given my tight income versus expenses, with the insurance coverage, my visits were going to be effectively free. Then I was sent to the west wing of the building to the waiting area where I got to announce myself again to their reception desk and note my appointment time and with whom. I was asked to wait in the open concept waiting area which featured the first televised endless loop of a medical infomercial I had ever seen.
My name was called and I was lead back to one of the many doors and asked to sit in an exam room. My temperature and blood pressure where taken and I was told to wait for a bit until the doctor came. Betsey was young compared to most doctors I had ever met, perhaps just under ten years older than me, and she came in with a smile which was a huge improvement to many of my recent experiences. She asked why I was there and I told her that I would like to review my years worth of weight loss and she gently assured me that she had been told it had all been looked into and nothing had ever been found. While she may have been told that, I told her that hadn't been the case and pointed out the fructose intolerance and fat malabsorption diagnoses I had gotten when Premier Medical Center had looked into my health two years earlier. I had given copies of those records to Michael when I had first come here including a follow-up Qualitative Fat Analysis that had affirmed the findings. She was flustered for a moment by my confidence and started looking through my file to find those pages in it. And no one has ever treated you for these? She asked with a touch of surprise. No, was the answer. She said that, while avoidance was the only option for the fructose intolerance, she could give me a prescription for 'fat enzymes' which I could take before each meal and it would break down any fat in my diet into more easily digestible forms. That sounded good to me and she wrote the prescription for it and asked if there was anything else. I decided to take this minor win and not bring up any other items at this time. I was out and directed to the on-site pharmacy to get my prescription filled.
It happened to be at the far end of the same building and after my time in line, the pharmacy filled it and, while my appointments were now free, the prescription took-up the money I had brought for my presumed appointment co-payment...
After the first month of taking them, I was surprised that the first thing I noticed was that the lumps that I had been finding all over my body in the preceding months had all vanished by the second week on the fat enzymes. Had the lumps been some form of fat that was broken down by the enzymes? I wondered. While I hadn't noticed anything diet wise from taking the enzymes, I decided to stick with them as they had done something beneficial for me. A quick follow-up appointment with Betsey to confirm I'd like to continue with them and then back to the clinic's pharmacy where they told me they only had a few left and then I'd have to take a different type of fat enzyme after those were used up. They called back to the clinic area to have the doctor approve the change in the script for the different pills and, annoyingly enough, I had to pay a double co-pay, one for the partial bottle of the first type of pills and then again for the partial bottle of the other type of pills to finish up the month. I tried to argue as my money was precious but they assured me that, as it ended up being two different prescriptions, I needed to make two different co-pays.
Back at the apartment I finished the remaining original pills in nine days, then started the other pills only to have an allergic reaction to them. It was like my red food color #3 reaction where the insides of my body itched terribly and all I could do was take a cold shower to numb my entire body down until it finally went away on its own. These new pills did have a number printed on them in red, but I couldn't imagine how that little bit of red coloring could cause such a whole body reaction. Still, before returning to the clinic and complaining, I wanted to be sure it was the new pills and waited for the second day of taking them. The next day I had the same reaction and called up the clinic to make an appointment about it, I didn't take any more of the pills until I heard what the doctor had to say.
Betsey agreed that it was probably an allergic reaction to the new pills and I shouldn't take them any more, I had hoped to return them and get my co-pay back but was told that wasn't how it worked. Betsey looked through the Physician's Desk Reference in the room and confirmed that the pills did have red food color #3 and then looked at the page for the original enzymes I had been taking and we looked through the list of ingredients to find nothing in there to which I had a known allergy. She decided from that point forward she should always have me review the PDR with her for my future prescriptions, to be safe. So the question was, how could I continue to get the original fat enzymes as their on-site pharmacy was no longer going to carry them? Given my finances, getting them at a regular pharmacy at full price was out of the question, but Betsey did find out that, not only did they have a partnership with the other hospital in town, they also had a partnership with Preimier Medical Center in Denver where I could go and get the prescription from their discounted pharmacy. But I'd have to see one of their doctors to clear it. She had the front desk call and make an appointment there and I was given a slip of paper with the appointment time and date.
Walking out of the clinic with this good news, I then realized I no longer had a car to drive to Denver with, nor a driver's license so borrowing a car wasn't an option either. What the hell was I going to do?
It occurred to me that there might be a national bus line that passed through town on their way to Denver and I looked into it and found one had gone out of business, but the other was still running. Calling their local number to find out their schedule the bad news was: While they did have a bus that could get me there in time, it left for Denver at six fifteen in the morning. The local buses would not be running in time for me to get downtown to the national bus terminal. While I could buy my ticket over the phone, I decided to buy in person once I got there and my new question was how...? I couldn't afford a taxi, it was too early in the morning to ask friends for a ride, so the only answer was to walk from my apartment to the downtown area in time for the bus to Denver. Gauging the distance and the speed of my emaciated shuffling, I figured I'd need to have at least two hours to walk there, plus another thirty minutes spare time in case I was slower than I thought as well as to account for the time it might take to get the ticket once there. So I set my alarm and was out of my apartment a three forty-five in the morning in my winter coat as I began my long walk to the downtown area.
Rather than stay on the grid of the main roads, I had found a more direct, diagonal route to the bus terminal taking neighborhood streets. As I was already use to nighttime walks in fields and neighborhoods, this was not a big change for me except in the length of time walking. There's something comforting walking through a neighborhood at night, everyone tucked asleep and you drifting by, entertaining yourself by admiring their yards or house decor. About halfway through the walk, it became a challenge and I sat on one home's retaining wall to rest up for a bit as I had planned time for it. Unfortunately, once I was on my feet again, I realized I'd need another rest stop before reaching the downtown area and forced myself to at least make it halfway further before I did. After another few minutes resting on a street side bench, I was again on my feet and swore not to stop until I reached the bus terminal. I actually did, twenty minutes early, and I was the only one needing to buy a ticket so I didn't spend any time in line, just burnt through two months worth of pizza and music money to afford the round trip ticket. The tickets were good for the route without any date or time specified so I didn't have to worry about what time I had to be back at the national bus terminal in Denver.
The ride was comfortable enough and let me sleep, but I wasn't prepared for all the side trips we took making the just over an hour trip into a two & a half hour trip. Once in the city, I found the Denver bus that would take me to the main office of the Denver bus service and there figured out the routes I needed to take and they even gave me a discount pass for having a Medicare card. I finally got to Premiere Medical Center with forty-five minutes to spare, but then had to go through their financial department given my new insurance coverage. By the time I reached the clinic waiting room they were actually waiting for me but fortunately I wasn't going to miss my appointment as the financial people had called to let them know I was there.
Fortunately, too, the doctor I was to meet was another new face and I didn't have to worry about seeing the less than pleasant people I had met there before. This doctor was even younger than my new doctor back home, he was a resident there as part of his training and asked what brought me here. I told him about the prescription issue and asked if I could get the one that I wasn't allergic to, from them. He looked at the prescription slip from the community health clinic and decided ''there was no harm in it'' and called their own pharmacy to see if they carried it. They did and I was given their prescription slip and sent down to the pharmacy in the basement of the complex. When they saw my address, they asked why I had come so far. I explained how the local clinic's pharmacy no longer carried it and so I was sent here and briefly noted the process of getting here. The doctor had written the script for a month but the pharmacy called him up and asked him if they could change it given my circumstances.
I had to stand aside as they filled scripts for other patients until the doctor called back and approved the change. Rather than give me thirty pills for a month, they were going to give me the wholesale supplier bottle of one hundred pills to last me a bit over three months. I told them I didn't know if I had enough money for a co-pay for something that large, but they told me there was no co pay, I could just take it. It was the biggest pill bottle I'd ever seen in my life, but I didn't worry about it as I had to rush and get the local bus back to the national terminal in Denver with the hopes of getting back to my town before the local bus routes closed for the day.
I didn't.
Arriving a bit over half an hour after the local buses had stopped, I couldn't face walking all the way back to the apartment and instead used the bus terminal's payphone to call Daina. The bus terminal was closer to the south side of town so it made sense to call her. She was happy to pick me up and, as I had hoped, she offered to take me out to eat on the way back to my place. I got to tell her of my very long day and she told me of her school day. She wondered why I hadn't asked her for a ride to the bus terminal that morning but when I noted the time I had to be there, she realized she didn't want to get up that early, herself.
The next time I'd see my new in-town doctor, Betsey, it'd be for something different.





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