This guy is driving out in the country and he comes to a field that contains a donkey and a sign that the donkey is for sale. The guy’s always kind of wanted a donkey, so he stops to talk to the farmer, who assures him that the donkey is a good one and will follow voice commands without a problem. So the guy buys the donkey, takes it home, and tries to work with it.
It won’t work. “Walk,” “whoa,” “stop,” and “go” have no effect; the donkey just stands there, so the guy takes the donkey back to the farmer and complains about the problem. The farmer reaches into the back of his pickup truck, pulls out a two-by-four, and smacks the donkey over the head with it.
The guy howls, “What did you do that for?”
The farmer replies, “First you’ve got to get his attention.”
One morning in the hospital I called four attorneys. That day four doctors came to see me.
First you have to get their attention.
Fifteen years ago the term “hospitalist” came into use. A hospitalist is a general physician who only sees patients who are hospitalized. My first one technically showed up when I was admitted to an inpatient med/surg unit, but the person actually working with me was physician assistant Jennifer Boland. Ms Boland was thoughtful, thorough, patient, and took a lot of time really trying to figure out what was wrong with me and what to do about it. She wrote the lengthy chart note that the hospitalist signed. After seven twelve-hour days, they went off duty for a week.
The next hospitalist was Dr. Parvaiz Naseem, who was on the case for three days and whose only memorable contribution was a discussion of his flower garden, which includes dahlias and marigolds.
On the fourth day of the second week, I got Dr. Sravanthi Ravulapati. While under her care I took four doses of insulin, had a bad reaction, and stopped taking it. Roughly speaking, it was an allergic reaction. I am allergic to all medications. Nobody knows why. Nobody will try to find out. It may be consequent to being poisoned by unmonitored lithium for seven years. Dr. Ravulapati said she’d never heard of anyone reacting to insulin.
I replied, “And you’ve never treated anyone who took antidepressants every day for twenty-six years, then stopped, or has been poisoned by lithium, either. You don’t know what kind of drug damage I may have suffered.” Dr. Ravulapati refused to accept it. She offered no alternate explanation for my reaction, ordered no tests to evaluate the problem, and refused to request consultations with any other specialists. She did continue to insist that I take the insulin that had hurt me.
So, as directed, in the morning I told the floor nursing manager that I did not want Dr. Ravulapati to be my physician anymore; I wanted a new doctor. That afternoon Dr. Christian Andrade walked into my room and told me he was discontinuing the catheter and discharging me to home.
I asked if he would listen to my side of the story.
When you make decisions about people without their input, knowledge, or permission then you have just created an adversarial relationship, which is exactly what Chris Andrade did. It is a doctor’s job to figure out what ails the patient and then make recommendations for treatment. It is the patient’s right to decide what treatment to accept. The patient has lived in her body every minute since she was born. She has information about herself that the doctor doesn’t. She knows what works best for her. The doctor is an informed advisor, not a commanding officer.
The doctor who makes decisions about a patient without ever meeting the patient is a fucking asshole.
Andrade, who appears to have been Ravulapati’s supervisor, had absolutely no knowledge of the home circumstances to which he was discharging me. I sleep in a hospital bed, travel in a power wheelchair, and have an aide two hours a day to give me showers and do my cooking. Andrade’s plan was to discharge me home without any food in the refrigerator, no way to get any, and no aide to cook it. And we’re not even going to talk about the Foley catheter issues except to say that before I got it, I was suicidal. He’s okay with me going back to that.
So Andrade and I talked, which is only to say that we both said words out loud. I kept saying, “You can’t discharge me with a glucose level of 475!” That led to multiple exchanges about the insulin, with me trying to bring the light of knowledge into the darkness of his already-made-up mind. Then we got to the real bomb. I said I had a bad reaction to the insulin and he said it was “psychiatric.”
No man calls me mentally ill and walks away with his balls intact.
Dr. Christian Andrade is not a psychiatrist. He is not qualified to make psychiatric judgments (and this was not a diagnosis; it was a judgment). No physician is legally allowed to work outside his specialty. Your gynecologist is not allowed to treat your bad heart and your cardiologist is not allowed to operate on your Achilles tendon and your podiatrist is not allowed to deliver your baby. But somehow every stupid son-of-bitch who graduated medical school thinks he knows enough to treat psychiatric illnesses. Every M.D. out there is prescribing tranquilizers and antidepressants that they are not qualified to prescribe. Most antidepressants are prescribed by primary care physicians. (To be continued)