Yesterday I went to see a new doctor—not my most favorite thing. It was only about eight blocks away from my apartment so I wheeled over, thereby saving you $53 in round-trip Medicaid transportation expenses. This is one good reason for you to pay for my power wheelchair—it cuts expenses. As I wheeled, my stomach started churning, informing me that I was facing a new medical practice, this one being Associated Medical Professionals of NY, most particularly A.M.P. Urology: I was going to get my catheter changed.
You will recall the history of this: Dr. Tucker, chief of hospitalists at St. Joseph’s Hospital, ordered the indwelling catheter so that I could get some sleep. Because of the nephrogenic diabetes insipidus, I’d been getting up to pee every two hours every night for ten years and I was pretty tired. Based on nothing more than uninterrupted sleep, my kidney function improved dramatically.
Prior to the advent of Dr. Tucker, a quarter-million physicians had refused to order an indwelling catheter because, first, they said it was not medically necessary. Sleep is not medically necessary? Oh my, my, my, what morons physicians be. And, second, that I would get a urinary tract infection. Yeah, but first I would get uninterrupted sleep, which is where most healing takes place, so what’s your problem? “We will not treat you appropriately now because it might make you sick in the future.” Yeah, and I might get hit by a truck tomorrow. Doctors always think they are great prognosticators; they are usually wrong. Deal with what’s in front of you, not something you imagine might happen someday.
So I got my catheter and the nurses from the Visiting Nurse Association (VNA) came and changed it once a month based on physicians saying that it needed to be changed every thirty days to prevent infection. Then the VNA nurse screwed up, management kicked me out without asking for my side of the story, I filed a complaint with the NYS Dept. of Health, which investigated and found the VNA to be non-compliant with regulations. Well, how about that?
So I moved on to getting my catheter changed at Dr. Tucker’s office until he and I had a parting of the ways, then I spent eight hellacious months shuttling between Iroquois Nursing Home and Crouse Hospital, which took care of the catheter changing business. Then—exit the Year of the Beast—I left Crouse AMA (Against Medical Advice) and went home.
At home, I had no one to change the catheter. On April 2, I went to the Syracuse Community Health Center where they referred me to Upstate Medical Center’s Nephrology Clinic. It is now July 15 and I’m still waiting to be seen there. Meanwhile, every month I go to Crouse PromptCare and they tell me they won’t change the catheter. Then they change the catheter and refer me to someplace else.
The first referral was upstairs to their own internal medicine office, which refused to take me because they don’t treat poor people, that is, they don’t accept Medicare and Medicaid. Why did we even pass the Medicaid law? Didn’t anybody think to ask doctors if they would accept it? They won’t, so why all the fuss and fury for a system that simply doesn’t work?
Crouse PromptCare’s next two referrals were to doctors who do a cash-only business. Seriously. My monthly income is $834 and physicians charge about $275 for first appointments. It’s about the money, people. Physicians do not treat the sick; they treat middle and upper class people who have money.
So now I am wheeling down the street to Crouse PromptCare’s latest referral, A.M.P. Urology, which actually accepts Medicare and Medicaid, and has real live physicians who treat poor people, not residents with 15 minutes of experience.
At A.M.P., I find four women who all do both admission and discharge, no waiting. I fill out most of the paperwork and when I refuse to sign away my rights on one sheet of paper, nobody gets excited or treats it as a big deal. Then I am escorted to the bathroom for a urine sample and thence into a second waiting room. I’ve been in four thousand physician’s waiting rooms but this is the first one that’s had external and internal waiting rooms. Then I get passed into a treatment room where a nurse does her usual thing and without getting stupid about it, e.g., in an Upstate clinic, the nurse asked me “How are you?” I replied “Tired” and she responded “Good.” She had learned to not pay any attention to anything a patient said.
But at AMP Urology, the staff members were not plastic people; they were real and they were paying attention. So the nurse and I went through the usual stuff and then she left the room. Shortly thereafter, she returned and winsomely asked me why I had an indwelling catheter. Good question. My answer was “To get some sleep at night. I put out a whole lot of urine.” That answer satisfied her and she danced away, presumably to report it to the physician, who appeared in a couple minutes: Dr. Sasha Pavlov, whose parents were Russian but, having grown up in Buffalo, N.Y., he was as American as peanut butter.
The first thing Dr. Pavlov tells me is that the catheter doesn’t need to be changed every month, just every six to eight weeks. He says that the infamous “studies show” that there is no down-side to changing catheters less frequently. In fact, doing it less frequently makes it less likely that you will introduce infection-causing bacteria. And speaking of infection, Dr. Pavlov doesn’t.
Always trying to be a helpful patient, I had brought a copy of my latest laboratory reports. Last week those reports caused the Good Doctor to say “Oh, my God” at least three times, and my-friend-the-physician to say, “Queenie, I am very worried that this is all going to blow up and result in sepsis.” The urinalysis reports nitrites, excessive red blood cells, bacteria, budding yeast and amorphous crystals. I have been running scared, using everything I know to get ahead of the infection that mayhaps be killing me. So I ask Dr. Pavlov about the urinary tract infection and he says, “What infection? Do you have pain?”
“No” I say.
“Do you have a fever?” He asks.
“No,” I say.
“Are you bleeding?”
“So you don’t have an infection,” he says. “What you have is an indwelling catheter, which causes colonies of stuff to grow but that’s not the same as an infection.”
“Bu-bu-but, the lab reports,” I stutter.
And, as Dr. Pavlov leaves the room, he says, “We don’t treat paperwork; we treat people.”
I wheel out into the sunshine, grinning. I do not have a potentially fatal urinary tract infection. I am perfectly healthy, if a little uniquely weird.
Good news, Chariot’s comin’
Good news, Chariot’s comin’
Good news, Chariot’s comin’
And I don’t want it to leave me behind.