Category Archives: Health Care

A Patient’s Perspective

“So how are you doing today?” asked the nice lady at the desk.

“Okay, I guess,” I answer, glancing at the clock. I’d got hung up getting out the door – the lady who was supposed to come to care for my wife while I ran to town was a few minutes late. We live 18 miles from the clinic and it’s harvest season, so I got hung up a few more times following tractors on the way. The rule is that if you’re less than fifteen minutes early to your appointment they cancel you, but I’d made it in time, thanks to a six-mile stretch of clear road where I could push our aging Toyota up to eighty miles per hour. It took three days of planning for me to be able to get time off work and find someone qualified to watch my wife so I could be here; another minute and I’d have lost the appointment.

“Birthdate?” she asked. I mumbled the numbers, keenly aware that the year I was born was a history subject to the lady. A natural introvert, this isn’t easy for me.

“Okay, have a seat.”

I wandered to the nearest open seat and obediently sat. I glanced around at the others in the waiting room. A few people sitting, staring sullenly at their cell phones. Some oldsters gazing inwardly towards the television that’s been stuck on FOX News since 1986. Children. Quite a few children. Coughing openly as they ran about the room… I’ll need to take my clothes off outside before I go back into the house when I get home.

My wife has an immune system disorder, so I need to be aware of these things. The last thing she needs is for me to come home and give her a cold. The last thing I need is to be here.

I pulled my phone out of my pocket and checked my e-mail – six new messages since I left home, all work-related, all urgent. I ignore them and glance at my texts. Three new texts, two work-related, urgent. One from my wife wishing me well.

I go back to the e-mails and start reading through them. I could feel my pulse rate go up – a customer isn’t happy with a design I’d done for them, and my boss wants a redesign done right away. I jot off a quick “I’m sorry, I’m at the doctor’s office – I’ll get this first thing when I get home” note, even though I’d told her yesterday that I needed some time off. I love working from home, but sometimes it’s awkward.

The second e-mail was another customer wanting a revision. The third was a message from the boss asking me to upload a file to the server. “I need this in ten minutes or we’ll lose the account.” The message was thirty minutes old… Gaaaahh…

My employer is very, very patient with me and goes way out of their way to accommodate my needs, but sometimes things at the office get a bit tense when deadlines loom.

“Chris? We’re ready for you.”

I pulled my gaze from my phone, blinked, and realized the nurse was talking to me. “Oh.” I hoist my carcass off the chair, drop my phone into my pocket, and follow her into the maze. After six or eight random turns we came to a scale. “Up you go,” she said.

Seriously? NOW? I’m wearing work boots, thermals, two shirts, a leather coat, belt, I’ve got about twelve pounds of miscellaneous crap in my pockets… But what do you do? “Well, looks like you’re up a few pounds,” the nurse said, writing down what looked like a four-digit number. “Well yeah,” I thought to myself, “last time I was here it was summer.”

“Okay, follow me,” the nurse said, resuming her course through the maze. Fighting the impulse to drop a trail of breadcrumbs I meekly trailed along behind her, hoping that I’d be able to find my way out later. “Here we are.” She opened a random door and ushered me into a closet.

I made my way sideways to the chair in the corner, wincing a bit as the nurse closed the door – the room was so small my ears popped.

“So why are we here today?” she asked.

“We?” I thought to myself. Out loud, “Well, because you told me to.”

“What?”

“Last time I was here you made an appointment for me and told me I had to be here in three months. So… here I am.”

“Uh… Do you have any complaints? Is there anything wrong?”

“Yes,” I thought to myself, “I’m here and I NEED to be home, that’s what’s wrong.” Out loud, “Well, I suppose my knee has been hurting a little lately.”

“Okay,” she said. “Let’s just get your blood pressure here…” The phone pinged in my pocket, my boss (I could tell by the tone). I took off my coat. My phone pinged again, the boss again, trying to text me again. I rolled up my shirt sleeve as the phone pinged a third time. The nurse cuffed me and pumped the doohicky… The phone pinged again.

“You’re running high,” she said.

“Yeah,” I thought, “I probably just got fired for not being at my desk.” Out loud, “Oh.”

“What medications are you on,” the nurse asked.

“I dunno, whatever the hell you put me on,” I thought to myself. Out loud, “Um… I take four pills, three in the morning, one at night.”

“Okay, I see you’re on Pskanipnadnapie, two milligrams of Snkapndmnapodsin, six kerfloogies of Kkdpaoasdfnkpa, and you take Sknasdfkdsnpp as well….?”

“Seriously, you’re the ones who gave me this crap, don’t you write it down?” I thought. Out loud, “Sure, that sounds about right.” I have zero clue what’s in those bottles – all I know is that one costs me three hundred and forty dollars a month and I don’t know what it does. I only take it half the time anyway – we need the money for my wife’s medications more than mine. It’s not like anyone cares enough to check.

“Okay,” she said, looking at her notes. “The doctor will be in in just a minute to check on your ankle.” Out the door went the nurse. My ears popped again.

I looked at my phone. I had to leave by 12:40 to to be here by 1:15 in order to keep my 1:30 appointment. Twenty-three minutes in the waiting room, five more in the closet, it’s 1:45 now. Over an hour. I checked my e-mail again. Another message from a customer wanting me to change a few words on their design and send them a proof by 1:45 so they could take it to their board. Crap. Feeling helpless I flip over to Facebook and wait for the doctor’s WiFi to connect. And wait. And wait. Nothing… I glance at the three texts from my boss – all I see is the word “NOW.” She must be way stressed, which is unusual, but there’s nothing I can do. Phone goes back into pocket.

I stare at the wall, my eyes idly searching out patterns in the drywall texture as my mind wandered. There’s so much that needs to be done – I haven’t had a chance to get to the dishes for days, laundry is piling up. The oil in the car needs changed about two weeks ago, I haven’t figured up taxes for the quarter yet. I have six ads to design, plus whatever’s in my e-mail. I know all I need to do to make that customer happy is swap out the placeholder photo in the third subcomposition, change the framerate to 24 on the main comp, add some motion blur on the logo… I just need to get home to do it. My phone pings again, a text from the caretaker. “Your wife just had a seizure, but I think I have everything under control.”

“So how are we doing today?” said the voice from the doorway. I tear my eyes away from my phone and look up. The doctor, eyes glued on her iPad, made her way into the room. “I see you’re having some problems with your hip? Oh, your blood pressure is a little high, let me retest that quick before we start.” She took her eyes off her tablet long enough to wrap a cuff on my arm and start pumping the doohicky.

pump pump pump PING pump pump pump….

“Ping.” I thought. “Wife just had a seizure.” I thought. “Think I have it under control” I thought. “If I don’t check that message in the next three seconds I’m going to explode,” I thought. My wife often has an asthma attack following a seizure, and sometimes she quits breathing altogether and loses consciousness — I hope things really are under control.

“Well, you’re running pretty high,” the doctor said. “I’m going to have to increase your medication. Have you thought about exercising?”

“What? No. What?” I glanced at my phone – the text wasn’t from the caretaker after all, but I couldn’t tell at a glance who it was from or what it said.

“You need to exercise more to keep your blood pressure down,” the doctor said, her eyes glued to the iPad in her hands. “I see you’re gaining weight as well.”

“Ping” said my phone.

“So what brings you here today?” the doctor asked.

“I don’t know,” I said. “You told me to be here, so here I am.”

“Oh. Well, how are things going? How do you feel?”

“Well, to be honest,” I said, “I’m not doing real well. My wife has severe medical problems, I’ve had to rework my life in order to stay home to care for her. She’s having seizures now, and sometimes she quits breathing. I don’t know how to cope with this – I can’t sleep, she can’t get out of bed except to pee so I need to do all the household chores as well as my job, her insurance cancelled her policy when she got sick, we can’t get her on Social Security – I’m falling apart. I don’t know where to turn.”

“Ping” said my phone.

“Well,” the doctor said without looking up from her iPad, “I’m not sure what to tell you about your hip, but you need to exercise more. That should help. I’ll increase your blood pressure medication by ten klagemeters. That should help. Is there anything else?”

“To be honest, my stomach has really been hurting lately, my knee really does hurt, I’ve been having headaches, I’m not sure if I’m exactly sane any longer,” I thought. But she’s just poking at that iPad, looking impatient. So I said, “No.”

“Okay, I’ll get that script for you for your blood pressure and I’ll see again you in three months.”

“Okay,” I said. “But what can I do about my wife? Can you tell me how to care for her? What can I do?”

The doctor glanced up for the first time, said, “Just do the best you can. And get some exercise. The nurse will show you out,” and left.

I sat for a few moments, trying to absorb the fact that two day’s planning, an hour and a half of time, and who knows how much money just got spent on the last two minutes, then “Ping.”

I fished the phone out of my pocket just as the nurse poked her head in, “Okay, just take this paper to the front desk, you’re all set now.” I fumbled with the paper, my coat, the phone, and eventually managed to limbo my way out of the closet into the maze. No one in sight – I picked a random direction and wandered until I bumped into the Money Lady.

“How would you like to pay today?” she chirped.

“I wouldn’t,” I thought. Out loud, “Huh?”

“Cash or credit?”

“I don’t care – here, I have a card.” I gotta get out of here before I explode.

“Ping” says my phone.

“Let me just look up your insurance quick… Okay, you have a fifty dollar co-pay.”

“Sure, whatever…”

*ping*

“Okay,” she said, “the doctor wants to see you again in three months. What time works best for you?”

Seriously? Like I know exactly what I’m going to be doing three months from today? “I don’t care, whatever.”

*ping* I can tell without looking at my phone – either I’ve been fired or my wife has died.

“Well, let’s see…” A pause. “We have an opening at one-fifteen on…”

“FINE! That’s fine. I’ll take it.”

“Okay,” she said. “I’ll just write that down on this card for you… Oh, my pen doesn’t work, just give me a minute and I’ll find another…”

*ping* went my brain – remember the *ping*

Out the door, finally. Three angry customers, one angry boss, a wife having seizures, a fifty-dollar bill that the insurance company will undoubtedly refuse to pay leaving me to foot the entire two-hundred and whatever dollars myself, it’ll be after three before I get home – and I’ll need to find a way back to town tomorrow to pick up a prescription for medication I don’t need and can’t afford… All so I could see the doctor for less than four minutes to talk about what she wanted to talk about instead of what was bothering me.

*ping*

Someday I need to try to find out how much the blood pressure medication company pays her. “Probably more than I do…” I thought as I drove my broken Toyota past the Porsche parked in the “Doctors Only” space.

It’s More than People Think…

“Oh yeah, there’s no doubt,” the doctor told me about a year ago. “Absolutely no doubt at all…” She looked down at the test scores for a moment, then back up to me again. “You definitely have ADHD. The results are clear — and by a very wide margin.” She then explained what the test’s results were and what they meant, but to be honest I don’t remember what she said. *ahem*

The psychologist and my family doctor worked together and soon I had a prescription for some tiny little pills. “You won’t feel any different,” the psychologist told me, “but others around you will be able to see a difference. And you’ll be able to get things done.”

And she was right. I didn’t feel any different. But the pile of work on my desk rapidly dwindled, I was able to clean and re-arrange the basement, other projects were finished… And of course I researched ADHD (Attention Deficit Hyperactive Disorder) a little at a time.

I wish I could “shut it off” like that.

I was surprised — it had never occurred to me that I might have ADHD. I mean, when you think of ADHD you think of the ten-year-old kid who fidgets and doesn’t pay attention. The jokes on the Internet, on Facebook, all reinforced that stereotype. The assumption that ADHD is just “not paying attention” is endemic. And erroneous.

ADHD is a real thing. They can test for it in a variety of ways. Scans show distinct differences in the brain activity of those with ADHD and “normal” folks. It’s NOT a made-up illness by any means. And it’s NOT just a matter of self-control or simply “buckling down and paying attention.”

Most people think that folks with ADHD either simply can’t be bothered to pay attention, or their brains are constantly whirling around in circles. That’s what I thought, anyway. And that’s how I felt — my mind was always flying around in a manic, unstoppable chase. I could never finish one thought before the next three interrupted. But the truth is a bit different… If you have ADHD, your brain actually kinda, well, falls asleep.

People with ADHD don’t produce the chemical (I think it’s dopamine, but I’m not sure) that “rewards” the brain when it stays alert and finishes a task. It’s a real, measurable, definable deficiency. The result of that is that, as I mentioned, is my brain basically stops a few times a minute. I could be looking right at you, engaged in the conversation, and have absolutely no idea what you just said… I wasn’t daydreaming — far from it, I was struggling very hard to stay involved — but part of my brain simply shut off. This is what earns us the “he’s just not paying attention” badge.

I just need more self-discipline.

What earns us the “squirrel” badge is how many folks with ADHD react when their brain kicks back on a few seconds later… Imagine being in a conversation with a friend. You suddenly realize you have no idea what has happened over the past few seconds, you just “wake up” in the middle of a situation. What does your brain do? It automatically looks at the most interesting thing in the area. I remember soooo many times I’d be talking with someone and realize I didn’t have the foggiest idea what was going on, and had no clue why my attention had refocused onto something else — the TV, the dog, a sparkly rock in the driveway, a squirrel… I just knew that I was lost and had just done something rude (or at least a bit odd).

So where does the “my brain is spinning in circles and I can’t shut it off” part of the equation come in? Well, when my brain blanks out for a few moments and restarts, it tries to tie the threads back together best it can, chasing around fragments of half-finished thoughts, trying desperately to remember all the details… Then the system crashes again, fragmenting the fragments and the brain scrambles around even harder and I’m trying to listen to what you’re saying and crash… A hundred thoughts, a bright light over there, someone’s talking, I don’t remember what was going on I need to pay better attention to what’s crash… Five hundred half-remembered thoughts floating around the conversation seems to be about dogs, I like dogs, did I remember to shut the lights off in the crash… Five thousand fragments in my mind I’m thinking about dogs and I don’t know why and what’s that light in the corner and someone’s talking and how am I ever going to remember what happ… crash.

It’s all my fault somehow.

I remember very vividly thinking so very often, “I need to throw beer at my brain until it slows down enough for me to think!” And I did. A lot. And it helped, some. Or at least I didn’t feel so frantic as I’d try to chase the million fragments…

So we covered the “Attention Deficit” part of “Attention Deficit Hyperactivity Disorder.” What’s with they “Hyperactivity” part of the deal? Well, people with ADHD learn coping mechanisms at a young age. Most folks have a reasonably steady supply of dopamine (I think that’s what it is) that keeps their minds alert and happy. ADHD people try to keep their brains awake in other ways. In children it’s often fidgeting, being in constant motion. “Very often if you take a hyperactive child aside and hold them snugly in a blanket, they’ll fall asleep in a matter of minutes. Even though they’re in a constant whirlwind of activity, they’re exhausted,” explained my doctor. “The movement, the motion is just their way of trying to stay alert, to pay attention, to learn. As long as they keep moving, their minds are calm. When they stop moving, their brains start to shut off, which causes the jumble of thoughts.” As people with ADHD grow older, their means of coping changes, often involving drugs, alcohol, risky behaviors… The adrenaline junkie who takes his motorcycle out on the Interstate at ninety-five miles per hour without a helmet, whose hobbies involve sky-diving or kick-boxing, might just be coping with ADHD, trying to keep the constant buzz and jumble of half-understood thoughts at bay for a few minutes.

It must all be in my mind.

My wife, Dagmar, bless her soul, has always, always had a problem that I do crossword puzzles at the dinner table. She believes meal time is a time to share our day, to talk, converse, interact. And she thinks I’m ignoring her as I idly peck away at the latest puzzle, and she often — understandably — will quit talking to me, get up and leave. The truth is, though, that by distracting my brain with the puzzle, I can listen and comprehend what she’s saying. If I put the puzzle aside and pay strict attention to what she’s saying, my brain will invariably shut down and start the cycle of fragmenting my thoughts… With the end result that she’s happy I paid full attention to her while I have zero idea what she’s been talking about and my mind is going a million miles an hour trying to tie things together and now I’m grumpy and confused. If I play my puzzle, I can listen, comprehend, understand, and do everything except engage. (It must be said, Beloved Wifey has learned along with me and doesn’t take such things personally any longer, and actively tries to help me.)

As a child I don’t know how many times I was scolded for reading at the dinner table. Same thing. Reading distracted me so I could, oddly, pay attention.

I tripped over this article earlier today (as I was trying to figure out why I’d recently fumbled a very important project at work), and was intrigued by how a few other people described having ADHD… “Like having fifty-nine televisions blaring in my head all at once. Medications turn off fifty-eight of them.” Another described it as, “Like driving in the rain with faulty windshield wipers. Moments of clarity along with lots of blur.”

The medication most often used to help those with ADHD may be a bit startling – amphetamines. Speed. Very, very tiny doses of speed… As it’s a controlled substance I need to visit my family doctor’s office every month to get a hand-written prescription that I need to take to the pharmacy — there’s no way of simply calling in a refill or having the prescription delivered. Even though the dose is tiny (I get no “buzz” or anything), it’s very well-regulated.

Does it help? Oooohhhh yeah!

I’ll take my “sanity pill” about seven each morning when I wake up. By seven-thirty I’m happily working away, able to do whatever needs done. But by one or two in the afternoon it starts to wear off and I find myself slowly losing effectiveness, getting more irritable as my mind becomes more and more cluttered, less able to follow simple conversations…

Yeah, okay, that’s actually pretty funny…

Generally by two in the afternoon I’m done being productive. I’ll switch over to tasks that aren’t very repetitive or don’t need as much concentration, often plugging my headphones in and listening to music or grabbing a beer to help keep my mind from derailing. If you call me after one or two in the afternoon and give me detailed instructions on something, chances are pretty good that I’ll screw it up… (I recently got myself into considerable trouble with a job this way – someone called late in the day wanting me to design something for them. A ten-minute phone conversation left me bewildered and confused, my mind racing a million miles an hour trying to remember what I was supposed to do… And of the entire conversation I only remembered one tiny thing. Loathe to call back the next day and admit that I had no idea what they wanted, I did my best, took a guess, and got it miserably and utterly wrong.)

I was hoping to wrap this article up with a fantastically concise recap, a wonderfully precise description of how it feels… But it’s 2:30 in the afternoon now. I found myself just moments ago standing in my Wife’s room, blinking at her, wondering why I was there, struggling to follow what she was saying, feeling irritable and angry that I didn’t know what to say or how to answer her question (as if I knew what she asked)… The Packers are playing, I think Atlanta just got a touchdown, the dog needs to go out, I’m not sure if we have enough coffee for morning, did I shut the lights off in the crash… I need to feed the dogs, the Packers are playing, I know my wife just asked me a question but I don’t crash… Did I feed the dogs? What’s the score? Why is that light flashing in the corner? Where’s my crash

It’s obscene

I didn't draw this, Martin Shkreli

Whomever drew this is a minor diety…

I know this is old news, but whenever I trip over the fact that in America pharmaceutical companies are legally allowed to jack up prices on medications that keep people alive by over 5,500 percent without warning… It kinda torques me off a bit.

Martin Shkreli is still an immoral, unethical, pathetic excuse for an American in my opinion.

 

Zero Point Zero One

So I had to go to town yesterday. I hate that. I dislike the interruption. I’m always much happier when I can simply, you know, sit still and work. Anyway… My toe hurt, so I had to go.

“You’re still losing weight,” the doctor said, staring at her iPad. “Fantastic!” What she didn’t know is that five minutes earlier I was standing on one foot on their official weigh station like a flamingo, my coat, shoes, billfold, keys, belt, phone, tablet, pocket change, and comb piled up on the floor beside me as I stared at the digital display with an intensity usually reserved for starting fires.

“Thanks,” I said. “Last time I was here I was still classified as ‘overweight.’ I needed to get those last two pounds…” Then the doctor asked about my toe and the subject of my weight was forgotten. (I don’t know what I did to my toe, but the toenail hurt like bejeezuz for a few weeks. The doc said I’ll likely lose the toenail as a new one grows in over the next eight or ten months. Ah well.)

As soon as I got home I checked my online portal. Sure enough, the clinic had updated my vitals. Right there it said, “Body Mass Index,” and listed a number. I did a Google search, “what is a normal BMI?” Click, click, click…

“Healthy weight: BMI is 18.5 to 24.9.”

My Body Mass Index?

24.89

I made it by 0.01%.

sweeeeeeeeet!

From about 2005 until fairly recently I’ve always hovered around two hundred pounds, occasionally bumping up to has high as two hundred ten or two hundred fifteen. I’m down to about a hundred seventy now, and have been holding there for the past few months. I’d still like to lose another ten or fifteen pounds, but it’s being stubborn lately.

A chart of my weight loss

Yay for me!