My Physical

questionAfter waiting in waiting room, then in examination room and being grilled by his assassin of a nurse, good doctor showed up. He was a serious looking guy. He acknowledged my presence without even looking up with a curt node. He kept on looking at his papers with an expression of concern. I had a feeling he was trying to find some imperfection in my perfect physiology.

He had the kind of personality that will even find a way to ruin a twin delivery with something like, “Congratulations you have twins but they ate their 3rd sibling.”

He just kept on looking into these papers. Occasionally he will mumble an “hmm” or “oh”. What could it be that this great scholar had found out simply by looking into these papers? Finally he looked at me. He gave me a kind of quick look over that a customer gives a piece of meat at a deli.

I tried to break the ice by pointing out that his kids are very adorable. He looked somewhat puzzled. I pointed out to the picture on the wall. He told me they are not his children. It turns out that this was a UN poster for hunger among children. The kids were of 6 different races as well. I apologized sincerely. I am sure he thinks I am some kind of a smarty pants. I made a mental note of putting my glasses on next time.

He asked me a whole bunch of questions. They all would be considered a serious violation of me and my privacy if he was not a doctor. Their obsession with bodily fluids, cavities and orifices is second to none. He kept on asking me if I have seen blood in one or all of these areas.

Then he gave me the good news that I will have to undergo a lot of routine screening. I will be screened for diabetes, cholesterol, kidney disease, liver diseases and anemia. If I want he can check my prostate “good old-fashioned way”. To leave no doubt in my mind about what the “good old-fashioned” way was, he raised his index finger. I told him I don’t know what this particular organ is supposed to do but I am sure it is fine.

After this he went to give me a whole lot of advise about things which you are supposed to know by the time you come out of high school. Only in US, a doctor will be considered a “good doctor” by insurance companies for talking about it for 15 minutes and then checking 200 boxes and writing 4 pages about it. The advise went something like this:

Eat greens, wear a seat belt, stay hydrated, get enough fiber, exercise, lose weight, don’t text and drive, don’t eat and drive, don’t drink and drive, don’t fall asleep and drive, look for blood in urine/stool/spit/sputum, don’t have a seizure and drive, don’t drop dead while driving, get vaccines, take Aspirin, eat fish and have safe sex with strangers. I told him I am married. Is he advising me to have sex with strangers as long as it is protected? I also told him that my wife might not approve of it but if it is something life saving then what choice do I have? He corrected himself and apologized for not realizing that I was married.

To be continued…

I

Visit to Doctor’s Office-Weight Loss Series

After spending some quality time in depressing surroundings that is a doctor’s waiting room, my name was called. I was ushered to an examination room. Calling it a room was fairly generous. It was the size of a vertical coffin. If that alone did not make you claustrophobic, they had all other angles covered.

The interior of coffin was done in shades of suicidal gray and deathly pastel. The overhead lights were those bright fluorescent types that they banned even in former USSR. There were all kinds of artsy posters on the walls. This eye-catching artwork had a practical purpose though. It warned that you could have colon cancer, breast cancer, prostate cancer and few other types of cancers. You ignorant soul might not even know about it. All you have to do is to ask your good doc for screening for these things. He will arrange for all your body orifices to be probed thoroughly so that this cancer will have no place to hide. They also had a very serious looking guy pointing a finger at you and asking, “have you had a colonoscopy”?

You could also have diabetes, high blood pressure, depression, mini stroke, diverticulosis, abnormal cholesterol or heart disease. You might have low testosterone, low estrogen, low bone mass and anemia. On a different note you could also have heart failure, kidney disease, hepatitis or skin cancer.

It also reminded reader that you should inform doctor if you don’t feel safe at home, had unprotected sex or have suicidal thoughts. Especially if you had suicidal thoughts after having unprotected sex. Because let’s face it; HIV is fairly manageable now a days.

The nice Nurse was an old-fashioned, old world nurse who still had the head thing and all. She did not believe in smiling or laughing. She handed me one of those nightmarish hospital gowns that open in back and never have all the straps in place. I made the regular lame joke that generally I am paid for this kind of thing. Either she did not find it funny or she wanted to put me right in my place. She gave me kind of the look that a Mummy (Egyptian type, not your own) gives you when you crack a joke.

I told her that I do not see the need to put this garment on, as I am here for a quick physical only. Apparently there is nothing like a “quick physical” and doctor would prefer me in this “thing”. She left the room and I did change into the “thing”. Just to make this an unforgettable experience, they even had a mirror in the room.

With my last shreds of dignity snatched away from me, I decided to make most of what I had been given. As a token of my protest against this objectification of my body, I decided to keep the socks on. I really cut a fairly depressing figure in this flowery loose robe. A knee-length robe with socks is never going to make you front cover of GQ. I decided to take the socks off. The reflection in mirror was even worse. I put them on again. But then I was worried it would add weight, I took them off again.

Nurse is back. She took my weight and all the usual stuff that they do. She told me I have great veins. I thought it was a compliment till I realized that she was planning to draw some blood. With her demeanor I was not sure if she would use a syringe or simple suck it out of my veins. I told her I am absolutely healthy. But doc would still want to check my cholesterol and thyroid hormone levels. I have already waited close to 45 minutes in waiting room, 25 minutes here, filled out my life story in all kind of forms and this healer is nowhere to be seen.   To be continued…

Physical prior to Physical Trainer.

As my physical trainer is hell bent on getting me to see a doc prior to initiating my exercise, I had to call and make an appointment. One of the things that strikes you when you visit a doctor’s office is how healthy people are. Not a single person in waiting room looked sick to me. in fact they all seemed to be having a jolly good time. Some of them seem to have become friends by waiting long periods of time in same doctor’s office over the years. I can smell an occasional romance blossoming amid walkers and under the sweet smell of chlorhexidine, hand sanitizers, death and dementia.

The other thing is amount of information they want. Your name, gender, DOB, address, Insurance, ethnicity, religion, spouse’s name, emergency contact etc. This is followed by next layer of welcoming material. These include forms about status of your health. This is a masochist’s dream come true.

Do you feel safe at home? Do you own a gun? (What if I own a gun and still do not feel safe? Are they going to get me an army tank?). Do you wear seat belt? Are you sexually active? Do you have STD’s? Have you noticed any blood in your saliva, stool, urine and sputum? (Some elderly couples seem to do this as some kind of a trip down the memory lane). Do you feel threatened at home or work? Do you use drugs? Have you had sex with another man? (No, but if doc suggests it then I might give it a thought). To be honest, I stopped reading the questions after first few and just circled the whole page and wrote a big NO.

As there is always a long wait, they have quality entertainment. There is a TV which seems to run only lifetime channel. There are some magazines with such exciting titles as “beautiful home”, “home and garden”, “retirement” and “golden sunset” (which apparently is even further down retirement road and for someone who is seriously considering dying). They have flyers about retirement communities, diapers for incontinent, potty chairs, colostomy bags at discounted prices, straight catheters, walkers, canes, special shoes and god knows what else. If you did not have depression before you come here, you sure are going to walk away with one.

The other problem is that some of the folks who are here seem to consider it as a social event. As soon as you sit, they start chatting up. They will say two polite things and after that it is all about their own health. They all believe in uniqueness of their complicated cases and challenges they have presented to medical world. I have a hypertensive on one side whose BP is not being controlled by collective might of American healthcare, pharmaceutical industry and three different pills. He seems almost proud of this. This dude apparently has to come in twice a week for just a BP check. He has been on every category of medications. Either he develops side effects of his “man parts” not working or it does not do anything. I told him may be he should just give up. Life is very over-rated and death is a golden sunset. I handed him the magazine with same title.

There is a lady who is talking to another lady about her Insurance problems, weed problems in her garden, husband losing memory, frequent UTI’s, not being able to sleep and her daughter living way too far. She is gifted (or cursed) with a high pitch voice that can drive you homicidal, suicidal or both. I honestly believe she should not be allowed anywhere near a medical facility. I can also understand her daughter choosing to live away so far. How long do I have to be here?

John Doe- A Doctor for his heart

Image credit to http://www.tauindex.com

The first doctor to see me today is a Cardiologist. I immediately knew he was a Cardiologist because he had a Rolex watch and monogramed shirt. He also had a whole bunch of people following him. These were his students, assistants, in-training doctors called Residents and fellows. His assistants introduced him to me. Apparently no Cardiologist worth his salt introduces himself. In the meantime, he changed the TV channel so he can keep an eye on stocks.

Me: Do I have a heart attack?

Doc: It is quite possible!

Me: Well, I did or did not.

Doc: We will have to do an Echocardiogram.

Me: They already did one in ER. Besides they did an EKG.

Doc: The ER Echos are worthless. EKG is even more worthless. We need a new Echo. If that does not tell us, we will pass a tube down your throat and get better pictures from inside. If that still does not tell us, we will do an echo while doing a stress test. If that still does not tell us we will pass a catheter in your groin and look into arteries of your heart. If your arteries are blocked, you will need a stent put in to open those arteries.

This guy sure has a plan B,C, D and Z. I have a feeling that he will keep on looking till he finds what he wants. I asked him when will he do this test.

Doc: I will not be the person doing that. I am a non-invasive Cardiologist. We will have our Echo specialist read the Echo and if a Cathertization is needed, interventional Cardiologist will be doing it.

Me: Are you telling me I will need 3 different heart specialists to tell me if I have a heart attack or not.

Doc: But before that we will need clearance from your kidney doctor, lung doctor, Surgeon, Neurologist and Psychiatrist. We don’t want to take any chances.

After this he ‘”examined” me. He carefully placed his stethoscope on my chest in a manner such that his shirt sleeves won’t be ruined. He asked his students to listen. They discussed the “findings”. They kept on saying words like murmur, irregular and dilated. I asked him what is wrong. “Oh, it could be anything. We will have to wait for Echo results”.

He tells me my cholesterol is abnormal and will need to be treated with 2 different pills. My BP was low on admission but is high now. I will need another pill for that. I will need Aspirin and another medication of the same type. I will also need something that is good for my BP, heart and kidneys.

Me: But that is like 6 pills. I have never taken pills in my life.

Doc: Well, all these medications reduce your risk for heart diseases from 38% to 33% over next 10 years.

Me: You want me to take 6 pills a day for 10 years at age 82 to reduce my risk by 5%!

Doc: It is your choice. But it will be against medical advise if you don’t. If you are found to have heart disease and need a stent, you will need 2 more pills. That will reduce your risk by another 0.5%.

John Doe -in ICU (Let no man die)

ICUNow that a decision has been made that I will be admitted to ICU (though not as an ICU patient) another set of complex negotiations started. My nurse called ICU nurse who immediately informed her that they don’t have a bed. This led to higher level negotiations between ER nursing director, hospital supervisor and ICU director to figure out where to put someone who is “running around naked, trying to hump petunias”.

Finally I arrive in ICU after making a stop in CT scan where they scanned my head, chest, abdomen, pelvis and god knows what else, to find out “stuff”. Here a whole new set of people are going to take care of me. I am again connected to new tubes and wires.

They have some questions for me. “If your heart stops, do you want us to try to restart it by shocking it and thumping it. Would you want us to put a tube in your throat if you can’t breathe? Is it ok to feed you through a tube placed in your nose or abdomen. Would you want us to do things like mouth to mouth breathing”?

Finally a doctor called “Hospitalist” comes in because I am a “non-teaching” patient. He talks very passionately about the possibilities of various common and rare diseases that I might have. He summarized test results:

Your white cell count is normal which is “abnormal” in this situation. We will investigate further.

Your Hemoglobin is low. We will investigate further.

Your kidney numbers are abnormal. We will investigate further.

You have gallstones and surprisingly a gallbladder. We will investigate further.

You have “spots” on your lungs. You also have a prostate size of a melon. We will obviously investigate further.

Your heart enzymes are also abnormal. We will investigate further.

Now I need investigations to investigate abnormal investigation results.

We have assembled a team of experts to help you.

We will have a Cardiologist to look at your heart. We will have a Nephrologist for your kidneys. We will have a Pulmonologist for spots on your lungs. We will have an Urologist for that melon of a prostate. We will have a Neurologist for your fall and dementia. We will have a Psychiatrist because you were running naked and trying to hump petunias. We will also throw in a Gastroenterologist and a Surgeon for your gallstones. We will have a Hematologist for your normal “abnormal” white cells and hemoglobin.

We will also get a Physical therapist and Occupational therapist. I will get a speech and swallow pathologist. I will get a wound care specialist because eventually everyone gets pressure ulcer. So why wait, let’s start now.

“Is there any kind of doctor that I am not going to see”? Consider yourself lucky, you are a man. Otherwise we also have Gynecologists.

I again feel the full might of world’s most complicated, expensive and advanced medical system. I am very sure that nothing bad will happen to me with this dedicated team of experts. I am sure not a single organ will be left unexplored till they find “stuff”.

John Doe Part 3

Finally “they” have decided that I am too sick to be sent home. They can’t risk me running around “humping Petunias”. The doctor with apocalyptic face delivers this news with charm of a man about to hang himself. “We don’t know what’s going on but we need more  investigations”. “There could be so many things wrong with you”.

Now “they” are trying to find me a place to admit. They first call someone called a Hospitalist. He is immediately concerned. He felt that I am too sick to be admitted on a regular medical floor. He did not feel comfortable taking care of someone trying to hump petunias. What if he tries to hump other patients on the floor?

They call someone called Intensivist (ICU specialist). He immediately tells them that I am not sick enough to be in ICU. “Humping Petunias is not a reason to be in ICU”. My doc tries to make the argument that I am on an oxygen mask. The Intensivist though seems like a tough nut to crack. “Not the face mask again for god’s sake. You guys put a face mask on everything that walks in”. My doc mentions that Hospitalist does not want to admit me as I am too sick and they do not feel comfortable. “Off course they are not! Nobody is comfortable with anyone who wants to hump petunias. But guess what neither am I!” My doc called Hospitalist again who politely told him to shove himself. My doc called Intensivist again who told him not so politely to shove himself. My doc begged for some kind of resolution. Intensivist took mercy and decided to talk to Hospitalist himself. Finally a decison has been made!

I will indeed be in ICU but not as an ICU patient. I will be someone called an “intermediate level” under Hospitalist care with possible involvement of Intensivist if needed. My own medical complexity has started to impress me. Someone else walked in with another tube and took some more blood because “the doc wants more tests”.

Someone from billing department comes in. But they immediately inform her that “he is confused”. They are talking that I might have to be in ER for some time because ICU is full. Off course me being “confused” they don’t talk to me.

At this time I am enjoying fine hospitality of world’s greatest health care system…in ER, in a bed with my hands tied, a catheter in my bladder, Oxygen mask strapped on my face, officially “confused” and a Petunia humper. I am living the dream and as some of the urine sprayed on sheets, it is a wet dream.           To be continued…

John Doe-the might of American health care

My name is John Doe. Well, it is not my real name but that’s what my name is nowadays. But I am more than that. I am “room 512”, “elderly demented male”, “urinary retention”, “guaiac positive stool” and a FULL CODE. I am also day # 56, waiting for placement but not stable enough for D/C home. I am also a “Hospitalist patient” and a Cardiology, Oncology, Pulmonary, Nephrology, Palliative care, Physical therapy, Occupational care, Orthopedics, Psychiatrist and Infectious disease consult.

A few weeks ago, I was just Joe (“an elderly male living by himself”). As far as I can remember I was doing well and was in good health. One night there was a noise in my front yard and I came to check it out. I must say I was in my birthday suit. I tripped and fell over. The noise woke up my neighbor, who immediately called 911 for “ an elderly naked male making noise by falling down and possibly humping a bed of Petunias”.

Before you know I was surrounded by the brightest display of lights you can imagine. There were town police cars with blue lights, paramedics with red lights and fire fighters with even bigger red lights. We also had a local TV station with cameraman and anchorwoman to cover the breaking news of an elderly man falling down. Before I could utter a word, I was “secured”. I was trying to say something but with all the noise, lights and 1000 people asking questions at the same time, I am not sure if I got anything out. I still remember some of these questions:

Who are you?

Why are you here?

Why are you naked?

Are you a nudist?

Are you demented? (how is one supposed to answer this question!)

Are you protesting against Obamacare?

In the mean time a fresh-faced student nurse has poked my arm multiple times, looking for a vein, and declared that I am a “difficult stick”. While he was looking for a vein, rest of them were looking in my eyes, inside my mouth, listening to my heart and checking my pulse to make sure that I was alive (though they were asking me questions at the same time). Another heavyset student had both his hands on my chest, “ready to go” in case my heart stops. They had already taped my head to stretcher, fastened belts around my body and found out that my blood pressure was low but not too low. An explorer has discovered my rectum and a thermometer had been inserted. I tried to ask questions but they had decided I was “confused” and told me so politely. A kind nurse reassured me that it could be anything such as stroke, heart attack, low sugar, high sugar, infection, bleed in brain, infection in brain or possibly all these things together. Off course you can never rule out pneumonia, urinary tract infection, ruptured gut, TIA or something we don’t know all together. I could also have overdosed as “elderly often do”.

During this time radios were crackling. It appeared everyone was talking to someone on a radio. My neighbor came, held my hand and comforted me. He said” I will never judge you. It’s your choice if you want to run naked at night or want to hump Petunias”. The paramedics were calling various ER’s about “Naked John Doe found down”. The ER’s were asking questions like:

Is Naked Doe just demented or Psychotic as well?

Is he violent?

Did he say why he was trying to hump Petunias!

Does he just hump Petunias or all kind of vegetations?

to be continued…