It takes a lot of phone calls but by noon I have gotten somebody from the hospital and somebody from Dr. Ghaly’s office both to Fax orders to the agency. I covered all bases, not knowing who would produce the necessary prescription. Then Desta Anthony, nurse practitioner, shows up for our meeting, only forty minutes late. I’m in my hospital bed, she’s in my manual wheelchair, and my fine colleague—who is an out-of-state medical social worker—is on the phone. His job is to speak the language of conciliation, not to mention keep me from tearing her head off.
So we talk. Desta Anthony speaks double-speak, that is, every time she says something, she then doubles back and un-says it. She said I wasn’t homebound enough to qualify for her services. What does she mean by that? Well, she says, I can transfer from bed to wheelchair. Yes, I agree, I can do that. And I can walk ten feet, she says. Yes, I can do that, I say. So you’re not homebound, she says. WTF?
Using Medicaid transportation, it takes at least three hours to go to a doctor’s appointment. I tire too quickly to do that. The Big Guy from Grand Rapids chimes in with his twenty-seven cents, concurring that I tire too quickly to go out to the doctor’s. Desta won’t deal with the chronic fatigue issue; she drops it and changes the subject. We try to talk about the catheter. She says I don’t need it; it’s not medically necessary. The records that St. Joseph’s Hospital sent her basically state that I was given a catheter to get me to leave the hospital. Then Desta tells me that a catheter is not the proper way to treat insomnia. I drop the f-bomb on her and the Big Guy tells me to calm down. There have only been three men in my life who could override me, and he’s one of them.
Only an idiot would think that a catheter would resolve insomnia. How? And I am not using it to treat insomnia. I am using the catheter to prevent me from having to wake up to go to the bathroom, like every two hours every night for ten years. And I am outraged that this young woman would tell me an untruth. But we haven’t hit Desta’s main problem yet, which is that she needs to prescribe drugs. She cannot fathom any other way of relating to her patients. She must prescribe drugs. She affirms that was her dream, her reason for being, her goal and the definition of her success: she prescribes drugs.
But of course she doesn’t phrase it that way. What she keeps repeating, ad nauseum, is “How am I going to treat you medically.” It has reached the point where I no longer know what “medically” means, so after she leaves I look it up. The dictionary says “medical: 1. Of, relating to, or characterizing the study or practice of medicine; 2. Requiring treatment by medicine.” So it is all about popping pills! But, ah, no, there’s another definition coming up on the search:
Medically necessary care (MNC) is the reasonable and essential diagnostic, preventive, and treatment services (including supplies, appliances, and devices) and follow-up care as determined by qualified health care providers in treating any condition, disease, injury, or congenital or developmental malformation. . . MNC must take into account the patient’s age, developmental status, and psychosocial well-being, in addition to the setting appropriate to meet the needs of the patient and family.
This statement comes from the AAPD, which is either the American Academy of Pediatric Dentistry, American Association of People with Disabilities, or Aftermarket Automotive Parts Distributing. I figure it comes from the disabled people, but then I go back and re-read the middle sentence that I had skipped:
MNC includes all supportive health care services that, in the judgment of the attending dentist, are necessary for the provision of optimal quality therapeutic and preventive oral care. These services include, but are not limited to, sedation, general anesthesia, and utilization of surgical facilities.
The dentists, for God’s sake, have got it right! They can stand back and see the big picture and the whole patient in the context of the patient’s world. All the friggin’ doctors can see is their drug box: prescribe pills, prescribe pills, prescribe pills. And Desta Anthony and I are talking about two different things when we talk about what is “medically necessary.” I am talking about what will make me healthier; she is talking about what pills she can prescribe. Occasionally she says, “But what can I do for you?”
I tell Nurse Practitioner Desta Anthony that she can write the order for the catheter, likewise, write orders for a shower chair and wheelchair repair. She can order blood work. She can do the annual physical that is required to continue my home health care. She can remove the occasional splinter. (I am right-handed and last year I got a splinter in my right thumb. I asked every care provider in my world to remove it but nobody would. I finally had to go to urgent care and charge the taxpayers $60 to have a freakin’ splinter removed!)
And Desta Anthony says, “But how can I treat you medically?” She is not about healing; she is not about helping the patient: she is about prescribing drugs. I know that there is no way in hell I can work with this woman and see no point in wasting any more time, but the Big Guy from Grand Rapids is still trying to work with her. He is patient. He talks quietly, and tells her what good and wonderful things she can do to help me. He’s not trying to sandbag her; he’s trying to create a space in which she can bloom.
Desta can’t do it. She goes on to talk about my “noncompliance” in taking drugs in the hospital. When it comes to taking drugs, she says the chart they sent her says over and over again, “refused, refused, refused.” And then something becomes clear: I worked cooperatively with the doctors in the hospital. I took two doses of antibiotic and four doses of insulin. I did not stop taking them until I had negative reactions. Desta says that is not in the hospital’s report; it does not say any medicine was taken. (To be continued)