Saturday, December 02, 2006

A Personal Note...

Some of you, through the course of careful reading and/or e-mail exchanges, have been aware that I have not been feeling very well for a few weeks now. I've been coughing 24 hours a day, a really nasty achy cough from way down deep in my chest.

The coughing was so bad at time, I nearly passed out. I couldn't lie down without coughing. I couldn't stand up without coughing. I couldn't sit for very long without coughing. If I yawned (which I rarely did, what with all the coughing removing the excess CO2 anyway), I coughed. If I stretched up to reach something, I coughed.

I haven't been sleeping very well, and while I never developed a fever, I never felt comfortable temperature-wise.

Now, I say this with all due respect, because I know of at least two doctors who read this blog, but....well....doctors are assholes.

OK, that's a bit unfair. The HMO system in this country forces them to be as superficial in treating patients as possible. We all should keep in mind that 95% of the times that we call a doctor because we're "ill," it's something the body can usually treat on its own, and we're really just calling to get relief from the symptoms.

So two weeks ago, when I showed up on my doctor's examining table, he poked a tongue depressor in my mouth, looked under my eyes, up my nose, in my ears, and pronounced that I had a sinus infection. Yea, he listened to me breathing, but since he hadn't heard me coughing during the visit, he assumed I was OK in my chest.

Gave me a prescription, and sent me on my way with the advice that if it wasn't better in a week, he'd refer me to an ENT. And in fact, that drug did help me that night, even tho I was still waking up coughing, I could at least breathe better than I had in many weeks.

A week passes, and while I had the initial bump in health, nothing was happening with regards to the coughing, which we both assumed was because of my post-nasal drip. I call and get a referral to an ENT.

Meanwhile, if anything, my coughing is getting worse, to the point where I have fits at night where I almost pass out, and certainly I scare the cat off the bed. I can't sleep comfortably at all on my bed, so I grab some pillows and go sleep on the couch, which for some reason I can get at least a decent hour's sleep on in between fits.

I see the ENT. He does even less poking around than my GP (same HMO, but this guy gets a higher fee because he's a specialist), and says its not a sinus infection but an allergic reaction. He switches my prescription to something else, and sends me on my way, despite my very detailed description of my coughing and hacking. He had his back turned, studying my chart and making notes. Or calculating his bill. I can't say, although they were damned quick to have a total when I walked out to reception.

I switch meds and things only get worse. Yesterday, I called him up and asked to see him again, because clearly this wasn't doing anything, and all I really want was a good night's sleep: my body can handle the rest, I'm sure. With that, because my cough has been getting worse and worse, I have a fit on the phone.

Gee...suddenly, I guess hearing his patient honk like a goose gets through to him...he recommends I go back to my GP and have a chest Xray, to see if I may have bronchitis or something like that.

I manage to get a six o'clock appointment, yesterday, Friday (and here, I have to tip my hat to my GP, so let me modify that "assholes" comment earlier...not only did he see me almost after hours, but he did it knowing his mother was in a nearby hospital, preparing to die sometime this weekend...many kudos and thanks, Dr. K).

Finally, someone takes a careful listen to my cough and my breathing, and drops a bombshell: I may have asthma.

For many people, asthma is a chronic-but-not-life-altering condition. For me, it could be yet another of life's obstacles to doing what I like doing, and what I was hoping to make a living at: scuba diving.

I obviously don't have all the details yet, so I can't make an objective judgement based on information available, but from what I know of asthma, it could potentially prevent me from diving if its not controllable. It's a little hard getting an inhaler into a regulator underwater, it seems.

I walked out of his office, three new prescriptions in hand (one for cough medicine, thank god!), in a daze. On the one hand, I'm kind of glad. I had thoughts it might be some form of fibrosis, and some people had mentioned pneumonia (which could be indicative of something else underlying it), and yea, living in New York City, and having breathed in the Trade Center fumes, thoughts that it could be cancer or mesothelioma danced into my head late at night.

On the other hand, it's asthma. It's that fat kids know, the guy you always picked last for football because he had to stop in the middle of a play to use his inhaler? And that fat kid thing is going to keep me from living out my dream of making underwater videos.

Well, fuck it. I can't sit and whine about it. I have to keep moving on in life, and deal with it as it comes. I figure things aren't as bad as I'm afraid they are, nor as good as I'm trying to convince myself they are. And that's OK. It wouldn't be my first dream that's been crushed and betrayed by my body.

But I do have to admit the entire experience has left me a little disillusioned with the state of the American medical profession. Neither of these doctors did anything wrong, both played by the rules of the game, but for the want of listening, really listening, to a patient...well, who know what might have happened?

I've been hacking for three weeks now. Who knows what kind of damage has been done to my vocal cords, and my voice? Right now, I don't have one to speak of. I used to have a beautiful voice, a voice that got paid so people could listen to it. An actor's main tool. His lifeblood is not in his vein but in his lungs.

We have the finest medical care in the world, if you can get it and afford it. But what good is that if we lose the one thing that makes a doctor a doctor: the ability to listen and empathize with a patient's sufering?

And I say this as an articulate American who visited two private doctors in their own offices. Imagine the kind of care a poor family is getting at a local clinic or emergency room, where they sit for hours at a time, waiting to be seen by a doctor who's juggling four other charts simultaneously, who may not speak perfect English and can't describe the symptoms being suffered?

And it shows. It shows in our mortality rates. It shows in our declining life spans (which peaked, not surprisingly, during the Clinton years). It shows in our obesity epidemic and in our asthma epidemic (which just added a new member last night) and in our exploding diabetes shows.

And it's shameful that we don't have a single-payer health care system that pays doctors a fair fee and allows them to practice medicine, not triage.

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