St. Policy.

Five summers ago, before we started our homestead, I was consulting for a friend who runs a small electronics factory assembling large custom RF systems out of an old shoe mill. The shop was hot, maybe 100°. After almost an hour trying to make a small change in a CAD drawing that should have taken me five minutes I realized something was wrong. I was confused, I could barely see the computer screen. I needed to go home.

I looked down the long windowed hallway outside the shop. It was a harsh smear of sunlight with no detail – windows, walls, whitewashed bricks were all dissolved together like an overexposed photo.

I made my way to my apartment and crawled into bed. The next morning Delphine called and asked how I was feeling. I said pretty much the same and she said she was taking me to the hospital.

policyI don’t like going to doctors. But twenty minutes later we were on our way to the emergency room (we’ll call it the St. Policy Trauma Center). We arrived and the triage nurse asked, “And why are we here today?”

I said I didn’t know about why she was there, but I couldn’t stand more than ninety seconds without getting nauseous and my vision was blurred. I was hypersensitive to light and I was having black stools.

She said, “You look like you’re down a couple of quarts. Maybe you need a little tune up,” and asked for my birth date.

Someone took me to an exam room. It was nearly noon. Two hours passed and not so much as an aspirin was dispensed to get me on my way. A nurse finally showed up with an IV kit. She asked for my birth date again. I guessed I was being admitted. I warned her my veins were hard to find. I’d make a lousy junkie.

“Oh, that’s okay dear. I’m very good. I’ll find one, don’t you worry.” She tied an elastic around my arm and slapped my hand. “Little pinch.”

In went a needle. I jabbed a finger from my other hand into my leg to distract myself. I hate needles.

The nurse slowly swept the needle in an arc under my skin looking for a vein. No luck. She pulled the needle out. “Let’s try the other arm.” Three more needle sticks, three more dry wells, three more apologies. I was getting nauseous.

“I’m going to find someone else to give it a try.” She left.

Over the next two hours five different gals took turns trying to locate a vein without success. Five times I announced my birth date. I looked at my arms and saw purple everywhere. It felt as if my arms were hunks of meat being tenderized one needle prick at a time.

Someone called IV Therapy. A half hour later a slightly chunky middle-aged woman with a gap-toothed smile entered the room. “I’m Kathy with a K. Your birth date?” She stared at my arms, poked a couple of times with her fingers. “We don’t usually like to do this but I’m going in here.” She pointed at the back of my hand, slipped a needle in, tested for blood flow, and covered everything with a clear bandage. “Done.”

A new nurse gave me a ride upstairs to a bed. I asked, “Any word on when I might see a doctor?”

“Later. For now just rest. I need to take your vitals. What is your birth date?” She rolled up a blood pressure machine, cuffed my arm, and pumped it up. It squeezed the various needle wounds I had been given earlier and made me wince. She slipped a temperature probe into my mouth and waited for a beep. “Ninety-eight point one. Blood pressure 124 over 65. Pulse a little high, 98.”

I sent Delphine back to her apartment. It had been a long day for her and she looked exhausted. As she left she said, “I love you.”

It hadn’t occurred to me until she said those words – but I loved her too. It was a new kind of love for me. Not the grinding trying to earn approval love that my ex-wife put me through for thirty-five years. It was a comfortable love, a feeling of partnership love.

A parade of nurses and aides came and went over the next few hours. Most were there to “take my vitals”, some checked my IV, and some hung new bags of this and that when something started beeping. Each person seemed nice enough – but they were mechanically following orders on my chart put there by someone or some thing I had yet to meet. I was in a nest of automatons – a medical Mechanical Turk. I still had not seen doctor. Everything being pumped into me or sucked out of me was based on lab tests some policy manual had dictated.

I napped on and off the rest of the night, periodically awakened by a blood pressure cuff or thermometer. I’d been confined there for the better part of day and still hadn’t seen a doctor – any doctor. What was I being treating for and by whom?

Morning. The smell of hospital food wafted through the air. Breakfast trays were distributed. No tray for me – apparently I was fasting.

A nurse showed up. “I’m here to take your vitals. What is your birth date?”

“I only have a couple of vitals left but you’re welcome to them.”

She smiled the funny kind of smile that said she didn’t actually get my joke.

“Any word on when I’ll be seeing a doctor?”

“Haven’t you seen Dr. D. yet?”

“I’ve been here since 11:00 yesterday morning and haven’t seen anyone.”

“I’m sure he’ll be by this afternoon. He’s very busy.”

And yet I was being treated. A couple of hours later the nurse returned for more vitals. I asked, “Any word on a doctor yet?”

She looked at my chart. “You’ll be getting an upper endoscopy first thing tomorrow morning.”

Upper endoscopy? I wondered what that was. The upper part sounded okay. But the end and the oscopy? I seemed to be on dozens of schedules that drove the hospital machine. It was the medical equivalent of drone warfare. I imagined a room of doctors in a bunker in Colorado Springs staring at monitors and working joysticks.

The food people knew I was not supposed to eat anything. The nurses knew when I was supposed to have my blood pressure taken. The pharmacy knew when to send up another bag of saline. The only thing that was missing was actual medical care. I was a Thanksgiving turkey in the oven – baste every twenty minutes, turn, check for doneness.

6:30pm a fortyish Asian man in a white uniform entered my room. He asked for my birth date. Everyone asked for my birth date. Was I being treated with astrology?

“I’m Dr. D.”

I say, “Glad to finally meet you.”

“So tell me what’s happening.”

I recited the history – black stools, dizziness, sensitivity to light. He asked questions. At last – someone who knew what he was doing.

“I scheduled an upper endoscopy for tomorrow.”

Ahh. He was the one. He left, perhaps to find a patient with a more compatible birth date. I prepared for a night of vitals and boredom. I was a kid again, back in a hospital crib hearing mysterious sounds, moaning, footsteps in the hallway. I hated it. I drifted off to an uneasy sleep, a half dozen wires taped to my chest pulling hairs out whenever I moved.

My night nurse woke me up. “I have to take your vitals and I have some meds for you.”

“February 8th.” I was groggy.

“Here is your Glyburide, your Lyrica, and your Ambien.”

“What’s Lyrica?” It sounded like something to help me write songs.

“It’s for your diabetes pain.”

“I don’t have diabetes pain. Why am I getting it?”

She read my chart. “Because you’re taking it at home.”

“I’ve never heard of it. I don’t take Lyrica.”

She glanced at the chart again. “So you’re refusing it?”

“Yes. I don’t want to take something I don’t need.”

She tossed the pill into the trash and wrote Refused on my chart.

“How about the Ambien?”

“What’s it for?”

“To help you sleep.”

“I was asleep. Doesn’t waking me up to give me a pill to make me sleep sound odd?” But now I was awake so I said, “Okay. That one I’ll take.”

She gave me a small cup of water and I swallowed the Ambien and Glyburide. I guess I drifted off after she left.

I awoke. The room was dark. I was confused. I slid out of bed and grabbed the IV stand holding bags attached to me through clear plastic tubes. I rolled it a few feet across the floor, got dizzy, and fell. I stood and grabbed the stand only to fall again. I couldn’t snap out of it. I tried to move toward the bathroom and fell again. The room was distorted. I wasn’t sure where I was. I fell again and this time jammed my finger on the floor. Nothing made sense.

An orderly turned a light on. “Why don’t you get back in bed and we’ll take care of you.” He helped me up.

I was exhausted and barely conscious of what was happening. The orderly rolled my bed out into the hall in front of the nurses’ station. He lifted up the sides of the bed and spoke to a nurse. She pressed a hidden button on the bed. “If you try to get out of bed an alarm will sound. Just relax.”

I grabbed a side of the bed to reposition myself and I set the damned alarm off. “Sorry. I was just trying to turn over. I wasn’t going anywhere.”

A nurse came to reset the alarm. The glaring overhead lights made sleep impossible. I was thoroughly confused and thoroughly exhausted. I asked, “Is there any chance I can talk you into rolling me back into my room? I’ll be a good boy, I promise.” There wasn’t. “I never do this. I feel as if I’m hallucinating.”

“It’s the Ambien. It happens a lot.”

I tried to shield my eyes from the light. Sleeping was hopeless.

Morning. I awoke in my room. Was it all just a dream?

Delphine arrived. I told her about falling and noticed that the tip of the nail on my right index finger was cracked clean off. Maybe it wasn’t a dream.

A couple of hours later I got a visit from Kathy with a K. “You’re going to need a PICC line. We insert an eighteen inch catheter into a vein in your arm and run it up towards your heart. It lets us draw blood and run IVs without having to find a new vein each time.”

A new nurse showed up and asked my birth date. She rolled me down to a room where my endoscopy would take place. Someone showed up and said he was my anesthesiologist. He did something with my IV and I woke up back in my room. Delphine was there.

9:00pm a nurse entered. “You’re scheduled for a colonoscopy tomorrow morning. You have to drink all of this by midnight.” She put a four liter jug labeled GoLYTELY on my table. “It’ll clean you out.”

“There isn’t a lot to clean out. I haven’t eaten anything for three days.” GoLYTELY – Holly Golightly? What would Audrey Hepburn think?

My nurse poured a twelve-ounce plastic cup of Holly juice and handed it to me. “Enjoy.”

I took a swallow. It tasted like baking soda dissolved in motor oil. It was certainly no Breakfast at Tiffany’s. Couldn’t they put grape flavoring or something in it?

Four liters of Holly juice. That was going to be a challenge. Every ten or fifteen minutes I poured myself another cup of misery and chugged it. Progress was slow.

An hour later I’d finished about half the jug. My nurse came in and looked at the container. “Very good. Some people have trouble getting that stuff down.”

“If I finish this jug can I have another?”

She laughed. Finally one of my jokes hit. “Yes. Finish that jug and we’ll give you as many more as you want.”

Around midnight Holly wanted out. There was a portable commode sitting next to my bed. I used it and pressed my call button for an orderly to haul the bucket out. I repeated that exercise once every twenty minutes for the next two hours.

Next morning I was rolled down for my colonoscopy. I awoke back in my room and saw Delphine smiling at me. She asked, “How’re you doing?”

“The closet is off the problem over the hill.”

She laughed. “You’ve been out for a couple of hours.”

“Up in the store of green salad over there.” I realized I wasn’t making any sense but I didn’t care. Words were simply leaking out of my mouth on their own. Maybe the Holly juice worked both ends.

“Did the doctor find anything?”

“No idea.”

A couple of hours later a nurse came in. “You’re scheduled for an ultrasound in the morning and maybe a CT scan after that. Has the doctor spoken to you?”

“I haven’t heard from anyone. Everyone’s writing things down but no seems to be reading any of it. This place is a giant machine with no one at the steering wheel.” I was talking to a very small gear in a very large clockworks and she probably didn’t like all the mechanical behavior any better than I did.

Day five. A nurse took me to the ultrasound room. After asking my birth date the technician said, “Lie down on the table flat on your back.” She squeezed some glop out of a bottle on to my belly and began rubbing me with a wand.

“Is it a boy or a girl?” I asked.

Without hesitation she responded, “Twins.”

Apparently I wasn’t the first one to ask that question.

Delphine was waiting for me in my room. A nurse entered to take my vitals. I asked, “Any chance I can have something to eat yet?”

She looked at my chart. “Sorry. You’ve got a CT scan.”

We waited. An hour, two hours, three hours. I still had no idea what was going on, hadn’t seen a doctor since my anesthesiologist fiddled with my IV bags.

A nurse showed up pushing a wheelchair. “It’s time for your CT scan but I have some bad news.”

“Oh?”

“We need to put a new IV line in your arm.”

“I thought that’s why I got the PICC line.”

“It’s policy. Someone from IV Therapy will be right up to put in the new line and then I’ll take you down.”

Kathy with a K showed up. She looked upset.

“I know you.” I tried to sound welcoming. “Why can’t they use the PICC line for this?”

“They can. It’s used all over. CT just hasn’t updated their policy yet so they want their own IV line.” She was obviously offended that her work wasn’t being used properly.

The first nurse wheeled me into the CT room. I’d seen the equipment before – on Star Trek. All Our Yesterdays. There was a six-foot metal doughnut with a fifteen foot sled arrangement that fed it. This was the Atavachron, gateway to other worlds. I said to the fellow standing next to the equipment, “Mr. Atoz I presume?” He ignored me.

I asked, “Do I get my choice of planets?”

Apparently he was too young for Star Trek. He said, “I need you to lie down on this table.”

I slid into place. Ten minutes later I was back in my wheelchair on my way to my room. My nurse said, “So you’re scheduled to be released today.”

“Really? It’s not that I don’t love you folks but it’ll be nice to turn over without pulling hairs out of my chest.”

My nurse returned an hour later with a sheaf of papers. “Sign here and here and here. This is your prescription for Glyburide, for Nadalol, and this one’s for insulin.”

“Who prescribed all this?”

“The Hospitalist.”

Hospitalist? Wasn’t that a John Wayne movie? “What’s Nadalol?”

“A blood pressure medicine.”

“But my blood pressure’s been about 125 over 60 every time you take it. I don’t need blood pressure medicine.”

She looked at her notes. “It has an off label use for reducing esophageal varices – the bleeding in your throat.”

“Bleeding in my throat? Ahh. Okay.” So I guessed I had bleeding in my throat. Good thing I asked.

She said, “I tried getting time with the diabetes people but their policy is to not leave their floor. Any questions?”

I had a million questions – like after all those tests had anyone discovered anything about my bleeding? I’d been in this place for a week without seeing a single doctor after saying hello to Dr. D. I hadn’t heard the results of any of the tests, had no idea what they’d pumped into me – but I wanted to go home. “No questions.”

Delphine brought me back to my apartment and spent the night in my guestroom – just in case.

I lay down in my own bed and marveled at how comfortable it felt. I was back among the objects of my life that let me do things like create software and TiVo out commercials on television. I gazed out my window at the river. It reflected lights from the factories across the water. The old brick buildings, occasional sounds of ambulances and fire trucks in the distance – it felt good to be back home.

Before they closed for the weekend I headed to my pharmacy with the prescriptions. The pharmacist said, “Without insurance you know insulin costs $220.”

“Per year?”

“For a third of an ounce cartridge. About a month’s dose.”

“Aren’t there some other diabetics in the country?”

“Twenty-five million.”

“I mean it’s not like one of those drugs to treat eight people who got bit by a left handed boa constrictor. You’d think maybe they could get by with a little less than $660 an ounce.”

“Do you want it?”

“I have no choice. I just got out of the hospital and they said I need insulin.”

“Do you know how much you’re supposed to take? The prescription doesn’t specify an amount.”

The prescription doesn’t specify an amount? Aren’t doctors supposed to decide this? If I told him I didn’t know I’d probably have to go the weekend without insulin and that made me nervous seeing how close I had come to kicking off. So I said, “Ten units every evening.” I thought that’s what I heard a nurse say when she gave me a shot, but I really didn’t want to have to find this Hospitalist. The truth was I didn’t even know what a unit was. I could test my blood sugar and add or subtract a few units if I had to.

The pharmacist handed me a bag with pills and a box of insulin.

Saturday evening. Time to take the insulin. I opened the box labeled Lantis. There were five small glass cartridges in a plastic holder. I took one out and tried to figure out what I was supposed to do with it. It was too big to swallow. I didn’t see any needle sticking out of it. There was no way to get the stuff into my arm.

I had no needles, no dispenser of any sort. I had to wait until Monday to fix the problem.

Monday morning. I called my primary care doctor’s office – the guy who I thought was paid to supervise my care. “I’m sorry, but Dr. B. is on vacation this week.” No help there.

I was still confused about why Dr. B. was called my primary care doctor. I hadn’t seen him in the hospital. Wasn’t he overseeing my treatment? Why didn’t he show up?

I went back to the pharmacy. “Hi. I was here on Saturday to pick up some insulin.” I showed the pharmacist the Lantis box. “I need to buy a dispenser of some sort to use this.”

The pharmacist looked troubled. “Let me check.” He started typing on his computer. Five minutes later he said, “It’s what I thought. We don’t have those dispensers. We just carry the refills. Your doctor was supposed to give you the kit. It’s free.”

“My doctor was the hospital.”

“The Hospitalist?”

“Yes.”

“Let me call.” He dialed, got put on hold a half dozen times, and finally reached someone. “The hospital doesn’t carry that brand either.”

I was at a loss. The pharmacist took pity on me.

“Let me try a few other possibilities.” He began dialing. An hour later he gave up. An hour. “Your primary care physician doesn’t use that brand. I’ve checked a half dozen places and no one has the starter kit for that cartridge.”

Why did my anonymous Hospitalist prescribe this particular brand of insulin? It was apparently 30% more expensive than insulin in little vials and needed some kind of dispenser that no one had. Did that brand give the best free Caribbean junkets? I was sent home from the hospital with no instructions and an expensive prescription with no dosage for something I had no way of using. If I’d hired someone to wash my car and they were that sloppy I’d fire them.

“Now what do I do? I need the insulin.”

“Let me try a friend.” He dialed and had a casual chat with someone. “If you go to Prospect Street about a block away and tell them I sent you they have a kit you can have.”

I went, they had one, I thanked them profusely.

A few weeks later I checked my mailbox and discovered a dozen bills from various medical practices I’d never heard of. Radiologists, physical therapists, anesthesiologists were asking to be paid amounts from $35 to $3,517. There were no explanations, no statements of what they claimed to have done. Just polite little bills saying Please pay $879. Make your check out to Amalgamated Medical Associates of Wherever.

As I continued to open envelopes I discovered I was even getting bills from other hospitals – places I was sure I hadn’t been unless they took me there while I was unconscious. Was it possible that Dartmouth-Hitchcock erected a hospital inside St. Policy’s building? Was there some section of hallway that due to an old deed belonged to Dartmouth? Why did Dartmouth want me to pay them $2,817? I had never been there.

Apparently giving Admitting my name and address triggered a tsunami of bills from accountants as far away as Texas. What exactly was it that this corporation or that wanted me to pay them for? For services rendered.

I imagined buying a car that way. You entered a dealership, signed on the dotted line, and every gas station attendant, spark plug manufacturer, and driving instructor within fifty miles sent you a bill for whatever their computer could think up.

The big difference was that at least you’d have a car for your trouble. I received four units of blood at a cost of $140,000 that computers across the country were now asking me to pay – four units of blood donated by someone for free. $140,000. I got every test they seemed to have time for. $140,000. What I didn’t get was any diagnosis, prognosis, or treatment. $140,000. Actual healing wasn’t in the picture.

I imagined nice Kathy with a K shrugging her shoulders apologetically and saying, “We at St. Policy may not cure you but it is our policy to make sure you leave here completely asset free.”

And that’s why I don’t like going to doctors. What a mess.

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