Wednesday, February 1, 2012

Waiting to see the doctor


My gut hurts, I’ve got hemorrhoids.
It’s the first time I’ve had these ugly little bumps sticking out of my butt that make it feel like I’m sitting on my insides each time I sit down.
“Don’t spend too much time either sitting down or standing in one place,” the nurse advises me over the phone.
“Natalie,” I say, “I never thought you and I would be having this conversation.”
“I know, when you hired me to work at New Times did you ever think I’d be advising you on how to treat hemorrhoids?”
“Not exactly,” I said.
Natalie had been a reporter at the weekly alternative rag in San Luis Obispo, where I did a brief stint as the late Steve Moss’s managing editor. She was one of my first hires at the newspaper. She had classic good looks, was smart and could write a good story. 
I liked her and was pleased with her work but she wasn’t enjoying it. She found the work of a journalist not suited for her and decided to return to school and get a nursing degree.
I’m glad she’s my nurse. I know that I’m in good hands. She works at the Veterans Administration health clinic where I get my indigent healthcare as a veteran.
It’s a bureaucratic system that would probably serve as model for any the government might run in the future for other citizens unable to afford their own healthcare insurance.
I’m glad as heck to have it. But it’s a little slow and laborious. It could probably use a tune up. 
I know the system is overloaded. The place is always busy and the wonderful volunteers and staff who work at the clinic do the best they can to process all of the great needs they see every day. They are always kind and attentive.
It’s not the workers but the system that’s the problem.
I’ve called for two reasons, not just to get relief from hemorrhoids. 
I’ve also asked Natalie about little growths beneath the skin close to where a melanoma was removed from my lower back nearly 10 years ago. Melanoma, if left unattended and not caught early, is one of the deadliest cancers.
I’d seen Dr. Dingler about two weeks ago and he took a quick look, patted around my side, stomach and back, and said: “It’s probably nothing to worry about. If there are any signs of new growth or increase in size, give us a call back.”
I left that appointment feeling less than assured but figured the doc knows what he’s talking about. I’ve had two melanomas and I know better. The little bumps need to be biopsied, or I won’t relax.
“You’ve gotta be the squeaky wheel,” mom says, “that’s the only way you’re going to get the attention you need.”
“I know, mom,” I respond. I hate being the squeaky wheel when it comes to things that to me seem obvious: if a patient expresses concern, then care should be given.
I hate pushing people; I’ll do it, if I have to, but I won’t like it.
“Listen, Natalie, I don’t mean to second-guess Dr. Dingler, I just saw him not long ago but I’d really like him to take a second look, I’d like to be certain of rather than guess the nature of these growths. Is it possible to get a biopsy?”
She explained that a biopsy would have to be done through the West LA facility, about a four-hour drive into the car-crazed southland.
“Do you mean Long Beach?” I hadn’t known there was a facility in West LA.
“No, the biopsies are done out of West LA. Sorry, that’s the only facility.”
It’s not a problem. I can get down there. “How do I set up an appointment? Do I call them down there?”
“No,” Natalie said, “we have to put in a request. you’ll be notified.”
Sometimes I hate bureaucracies, but this is the only healthcare service available to me. I have to wait. I’ll give it a week. 
The second melanoma, which looked like a little hairy piece of veal that came off my leg, will be a good reminder to persist.
The best prevention is early detection. My experience with the veterans healthcare system, however, as glad as I am to have its service, seems to lag in urgency care that might prevent full-blown cancer.
My second melanoma, about seven years ago, put me in the doctor’s crosshairs; she’d have come to my office and dragged me in for surgery herself if I had tried to delay for even one more hour.
“Your biopsy came back positive,” the dermatologist, Dr. Tinkle, had told me on the phone. Her call came during the peak of a tight deadline, just as we were about to roll with the presses. “You need to come to my office right now, if you can.”
“I can’t get out of here until four at the earliest,” I said.
“Good, we’ll see you at four,” she said, and hung up.
She didn’t just do surgery, unlike the previous doctor who removed the earlier cancer from my low back several years before, who was a little bit rough; she, however, was an artisan and performed her work with amazing professionalism and deftness.
There’s no scar where she excised deep into the skin. I’m ever grateful for her precision and care.
“You need to get checked every six months,” she told me after it was over.
I did that for about a year, until I left New Times and my healthcare insurance lapsed because I couldn’t afford it any more. I haven’t seen a dermatologist in nearly four years.
I’m lucky to have access to a doctor’s care as a veteran, and I can usually get in to see a doctor as quickly as necessary.
But in this case, I wish there was a little more urgency, the kind expressed in Dr. Tinkle’s demand that I come to her office without delay, especially where time and early detection are of vital necessity in the prevention of full blown cancer.
My daughter was still young when Natalie worked for me as a reporter. I inform Natalie that Anna has graduated college and recently completed the MCAT for entrance into medical school.
“Well, good for her,” Natalie says, “now you can look forward to talking to your daughter about your hemorrhoids.”
“Thanks, Natalie. Thank you. I cant wait. I’m really looking forward to our next conversation.” §

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