Tuesday, January 02, 2007

A Day at the Clinic

Ok, here's a typical scenario from Our Lady of the Damned. This is an almost verbatim dialog from one of my first appointments at the oncology clinic last September. The appointment took place four weeks after I was diagnosed with an aggressive lymphoma (from a supraclavicular lymph node biopsy) and two weeks before I started chemotherapy (yes, there was a six week delay). This was the first time I had ever seen this resident, Dr. A., who had just recently rotated into oncology.

English is not Dr. A's first language but, in spite of occasionally accenting an unusual syllable, she is easy to understand. Her bedside manner, however, is extremely cold, brusque, and unfriendly, and it may be that there is a cultural barrier to our communication. Also I believe there is strong pressure on the residents to keep clinic appointments well under ten minutes.

* * * * *

Dr. A: [walks into the exam room brusquely, without greeting me or introducing herself] Where is your port?

Me: What? I don't have a port yet. The surgery to have it installed is scheduled in two weeks.

Dr. A: [studies my chart] This is wrong. You should have started treatment already. I'm going to make an appointment to have a port installed this afternoon.

Me: This afternoon??? Um, I thought that it had to be done by a surgeon? In the surgery department? Operating room? Anesthesia? Kind of a big deal?

Dr. A: [walks out of the exam room without replying; is gone two minutes, then walks back in] The port will be installed in two weeks.

Me: Right. Listen, I have a few questions...

Dr. A: Are you die-ABB-uh-tick?

Me: Die what? Oh, diabetic. No. No I'm not. But I ...

Dr. A: How long have you had that brown rash?

Me: [????] Oh! You mean my freckles? Since I was a small child. My ancestors came from Ireland. But I have a question about...

Dr. A: Open your mouth please.

Me: Nnngh aahhh... About staging. When are the tests going to be done to determine what stage...

Dr. A: You are stage four. Take a deep breath please.

Me: Four. Ah. But how do you KNOW I'm stage four without any tests? There's been no PET scan, no bone marrow biopsy, no...

Dr. A: The cancer has spread. Breathe normally please.

Me: Spread where? How do you KNOW?

Dr. A: Your you-TERR-us is enlarged on the CT scan. Breathe again please.

Me: My what? Oh, my uterus. Yes, it is enlarged but it's benign. I had it checked last week. Did you see the results from my Pap test?

Dr. A: We do not communicate with the gynecology department. [walks out of the exam room]

Dr. A: [walks back in two minutes later] The cancer has spread to your liver. Take this paper to conference room 2 and...

Me: Wait. I know the CT scan showed foci in my liver, but without a biopsy or at least a PET scan how can you be sure that...

Dr. A: It doesn't matter, the treatment is the same anyway. Take this to conference room 2 to schedule your first treatment. [turns to leave]

Me: Wait! Can I talk to you about the pain? I have pretty severe pain in my sternum sometimes, where the mediastinal tumor is pressing against the bone? See how it bulges out? And I...

Dr. A: Yes, that is normal. Please take this paper to conference room 2. [turns to leave]

Me: Wait, just one more question. Shouldn't I have a flu shot before I start treatment?

Dr. A: Why do you ask this? We have never said such a thing.

Me: Well won't my immune system be compromised once I start treatment, putting me at higher risk for flu?

Dr. A: Yes.

Me: So can I get a flu shot here? Do you offer them?

Dr. A: You are free to do as you please. Now go to conference room 2. [walks out closes the door]

* * * * *

Yes, yes I did: I went straight home and cried.

Stay tuned, more true tales of the damned to come.


Anonymous Anonymous said...

Unreal. Nothing resembling compassion or even responsiveness. Oh Liz - to cope with all you're going through with such callous and untimely care is terrible. You are so right when you say that everyone should have access to decent, competent and compassionate medicine. That doctor sounds like an utter pig.

Are you able to take anyone with you to appointments? Sometimes having another person present can help force the jerks to respond. I don't know if it's even possible or whether you'd feel comfortable with someone else there but it might help a little.

10:42 PM  
Blogger Lymphopo said...

Sometimes I have taken my designated driver along with me, mainly just because I think somebody has to see this mess to believe it, how insane it is. But he tends to lose his temper and shout at the residents, or make hostile remarks, which really doesn't help matters. I find it easier to concetrate on getting through to them when I'm alone.

10:46 PM  
Blogger Ya Looblue said...

jesus-H-sebastian-God. that's incredible. i'd have run away screaming. it's stories like this that remind me why i almost became a doctor...to irradicate ones like THAT. *sigh*.
huge hugs to you...

10:58 PM  
Blogger Deb said...

Liz, er, Dr. Leda,
In hopes of not sounding like a shallow yaya dingbat, I'm sorry you're going through all this. I'm also ashamed to say I've been a member of the healthcare world for over 36 years, 26 of them as a RN. In response to my evergrowing urge to scream at work because of the wrongness of the healthcare delivery, I held you in high esteem, and tore out the lawn 4 years ago. I've since planted 75 roses at last count (decided I didn't need to count, it was the pretty colors that pleased me, not numbers). I enjoy my garden so much these days that I don't even want to go to work.

Despite your mounting misery, your honesty, psychodelic prose and wit shine through. Your true self comes forth, no matter how crummy you feel or how greatly you're mistreated by the system. These words seem so shallow as I read them, but know there's one fed up nurse here scooping compost (shit)on roses as I imagine your collective residents and tumor cells being buried by the stench!

11:00 PM  
Blogger Deb said...

This comment has been removed by a blog administrator.

11:01 PM  
Blogger Deb said...

One more comment...I got hired by the ONLY oncology clinic here in Olympia, WA and worked for just a few weeks when I decided I couldn't work for a doctor-owned clinic who refused to take Welfare patients or those without great insurance or big bank accounts. It made me so mad, I've spent the last year telling people to make the drive to Seattle, hoping these guys go bankrupt.

11:20 PM  
Anonymous Anonymous said...

Like we used to say in the early years, it is just the drugs. It is what you think, it's not you. LIVE, you wienerbrain. LIVE!!!! F@#k 'em all. xoKittyG

12:41 AM  
Anonymous Anonymous said...

aw Liz, nobody should have to go through that, that's just terrible. TERRIBLE. You deserve so much better. Everybody deserves better.

1:55 AM  
Anonymous Anonymous said...

I sit here and can't even think of words to express the disgust, outrage, just overall yechhhhhh that this person is, and this sentence didn't make sense, but you probably get my drift. White, blank, helpless rage, is the feeling. I'm sorry you had to be exposed to/assaulted by that resident. No human being deserves that treatment. Idiot.

another susan

6:33 AM  
Anonymous Anonymous said...

I was there on several occasions. This is really only the tip of the proverbial iceberg, I swear it. Every visit is yet another lesson in efficient failure. Sounds like an oxymoron, doesn't it?

Like the rest of you, I can't wait to read Liz's spin on it. She has a way of putting all down in her most colourful way, yet making us all laugh a little--even if that laugh is out of complete frustration.

9:39 AM  
Anonymous Anonymous said...

Jaysus, Liz. I'm glad I found you again, I've been thinking of you and checking in with Young Master Finn to see how he and the family are doing.

I work with the "medically underserved", which is a polite way to say folks that ain't got a pot to piss in. I wish your story wasn't a common one. I wish to Dog it wasn't. I wish I could zap you out of there and make someone do the right thing for you and do it with a smile on their damn face and compassion in their heart. I wish.

10:22 AM  
Blogger Alto2 said...

Regardless of your insurance status, you have a right to be treated with respect and dignity. I am assuming Dr. A is a resident. As such, she reports to an attending physician who is responsible for her evaluations. When you're up to it, march yourself into the office of the Director of Medical Residency for Our Lady of the Damned and file a complaint against Dr. A. Language barrier be damned; there is no excuse for rudeness. If Dr. A can't communicate effectively in English, then she needs to take a speech class.

Further, the next time you see Dr. A, even if it's in the hall, pull her aside and chew out her happy ass.

10:38 AM  
Blogger Trasi said...

I have to commend your efforts in not wasting any time chewing these people out. I think the recommendation to go to the Director of Medical Residence as alto2 suggests is a good one. You clearly know how to communicate your information/point without it coming out amidst venom and spitting. And as we all know, being chewed out by someone is never "motivating" towards change. It just gives the chewer a sense of release, but no positive change. No matter how unjust and uncalled for their actions are, you are so right to realize that it's usually not a situation of intentional "neglect" as much as it is a function of the "system" where they are measured by their low minutes per patient ratio in an effort to make the hospital efficient, and not money-losing. If this weren't so, likelihood is, such hospitals wouldn't exist at all, and there'd be no treatment even available. It's a sad state of affairs. However, the rudeness with which Dr. A cuts you off is not even necessary to make her numbers. Facts are facts, as sorry as we all are, and as unfair it is for anyone without insurance to afford treatment, and how ideally we'd love to have it available for everyone, that isn't how we as Americans have collectively voted and what we've supported doing with our medical system throughout the years. It is what it is. Best thing to do is make of it what you can, and hopefully you will have caught it in time to spare your life. And the rest of us can put our votes where it matters most, and support reform in that system toward a more socialized medicine system, if we think it is that important. All my best to you. Thanks for sharing your stories with us.

1:59 PM  
Blogger belledame222 said...

OMFG. Unreal is right. do these people go to school for Advanced Degrees in Assholism? i'm so sorry and sickened. strength to you.

6:58 PM  
Anonymous Anonymous said...

I couldn 't agree more with what Trasi wrote.

9:28 PM  
Anonymous Anonymous said...

Holy Guacamole. That is unbelievable, and I am so sorry that you had to deal with someone with a stupid attitude problem.

I was having a dinner-table conversation the other day with some American friends (I'm not American): basically, the USA has failed to recognise that people have a human right to healthcare. It's a right, not a privilege. It was certainly an interesting discussion, because 75% of those around the table had this clear sense (and stories of woe) that the whole USA healthcare mess is wrong, fundamentally wrong, but they hadn't conceptualised it as a rights issue until I did. Americans, for reasons that have never been clear to me, don't see economic and social rights as 'human rights'. But they are rights, among them is healthcare (or so says the International Covenant on Economic and Social Rights). Having the language of 'violation or infringement of a human right' is a powerful thing, and I'm not sure why it isn't more widely used in this context in the USA. Once you utilise that language, it clarifies what most people know to be true without really knowing the language with which to express their outrage at the situation. Sorry, that's not very articulate but I hope you know what I am saying: getting at the right language for the situation is crucial, in my opinion.

One of the students I studied with, wrote her masters dissertation on the USA's failure to provide healthcare on anything like an equal basis for all, being the single biggest human rights violation in the western world.

There is plenty of material the right to healthcare out there, and I think that the situation sucks, hard, and will continue to suck until people are mobilised enough to stand up to fight for their RIGHT to healthcare in the USA, and that starts with conceptualising it as such.

One of my more shocked moments was when I discovered exactly how much the current insurance premiums are: crippling. Fucking hell. It makes me so angry.

11:35 PM  
Blogger Unknown said...

I just found your blog a week or two ago, when it was mentioned at (I think) The Gimp Parade -- glad they mentioned you, and of course wish you didn't have any reason to write in the first place!

I get a wonderful wicked pleasure out of seeing your rejection of being described as a trouper... I was born with rather creatively designed innards, and came to the conclusion at some point that it must actually mean "survivor of medical f**kups" or "trained to hate Jell-o" because the whole courageous thing sure can't include me, either. Not unless being the sort to have meltdowns at basic bloodwork in the teen years counts. ;)

You said in an earlier entry that you figured all public teaching hospitals were like that... I really, really wish you felt well enough to relocate, because the one I grew up in isn't like that at all -- here's their cancer-center site. (Though I'm sure they have a few Dr. Resident Asshats too... My theory is that there's a secret "affirmative action for asshats" program to make all the other docs look fantastic.)

I hope things go well tomorrow, and you recover from it quickly!

3:33 AM  

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