Wednesday, December 8, 2010
The Podiatrist loses control!
My x-rays and other tests were rolling in, but not really illuminating my condition. I had demanded some appointments with specialists. My Doctor refused me the service, "until I was done with physical therapy"; but I fought her and I got "the referrals".
"Referral" is one of those Orwellian words that insurance companies foist on
healthcare professionals. These decisions are not in the best interest of the patient.
I liked the Podiatrist right away, a ruggedly handsome liberal Sox-fan from Brookline. Speak my language bay-bee.
No one had be able to evaluate my x-rays yet. I knew what to expect when my film appeared on the screen. I'd seen this before: the Doctor or Nurse begins mousing around the border of the screen and asking me questions to verify my identity. The Podiatrist, went past the usual two or three; he turned to me.
"Are you named after your father or grandfather? Were they ever patients here"?
"Yes and no" I replied.
He was starting to scare me, staring at his computer.
"These can't be your x-rays, they're not the x-rays of a living human being"
Terror is a little like acid. And things were getting far-out.
"Those are my x-rays Dr, I recognize them"
He pulled at the sides of his hair and moaned "no,no,no". He rolled his chair back and around too quickly, like a kid. Covering his face with his hands, he jumped up and said, "OhmyGodohmyGodohmyGod".
This is poor protocol for an initial consultation I think.
Sometimes in life we have role reversal. I have encountered this many times with medical professionals and their administrative staff. This is another thing about twentyfirst century medicine Doctor Shows did not prepare me for; the patient never becomes the caregiver on TV.
I said "It's OK Doctor, just tell me"
"This is a perfect storm" he said.
Well obviously, I thought. I was starting to see colors.
He saw my cane (coffee colored aluminum with caramel and bronze swirls from Duane Read in Manhattan, to match my hats), and squealed "You WALKED from the parking lot?!"
"From my apartment ten blocks away" I confessed, I'm not proud of this. It was insane. The ground was covered in ice, even businesses in Chelsea do not shovel the snow out to the street. Before the "T" awarded me a travel benefit (on appeal), and when my friends couldn't chauffeur, I hobbled slowly down the side of the road. Intermittently seeing stars, I perspired through my clothes.
"How?" he pleaded, "This is devastating bone loss! You should be in a wheelchair!"
There was that word again. "Wheelchair". My primary care physician had chased me around with one trying to make my get in it. To the addict in me, the Oxycontin/wheelchair/carton of cigs lifestyle has a powerful allure. Hard to grasp if you don't get it; indelible if you do. Writing this down is my attempt to say the why and how of what happened. Perhaps this is ineffable.
Once again, I dismissed the offer to give up on my own mobility and roll off with the the bag of benny's and benefits in the silver chair.
"How" he said again. My wet socks and Crocks telling tales.
"Vitamin "R", I knew the answer. "Rage". The Podiatrist stopped and looked at me, hearing what I had said. My examination had begun in earnest.
The Doctor will see you now.
My bad feet, ankles and knees were catching up to me. My earliest memories are of my feet hurting. Everywhere I had walked, I had walked in spite of the pain. I can get angry enough to blow your house down.
"A perfect storm to sink my ship?"
"We don't see this kind of bone loss even in the third world..."
This was like a bad trip and I needed to come down now.
"The good news is you're finally here"
"I've been trying to get this referral for months" I chided.
"This has been going on for years, maybe congenital.."
"What's been going on?"
"Several things I think, you have a confluence of symptoms, that create a perfect storm..."
He couldn't say it, but I had always known. Joked about it all my life.
Although I was sober and drug free, I knew I was headed for a blackout. Oblivion is my default happy place, which sucks by the way.
We had been talking about one foot, not even the worst one. That's how the tests were allotted, the benefit meted out; only one foot was x-rayed and MRI'd. I knew whatever was wrong with foot one was wrong with the other foot and my hands as well. When the Doctor told me that amputation would stop the spread of osteonecrosis into the trunk, which is fatal, I knew that he meant my prognosis was quad-amputee. He continued to explain but I was gone from the room, only my body was present. My mind was not. I had stuff to think about.
That is no longer my prognosis :-) and the Podiatrist is one of my favorite Doctors. He has no filters, but he's hot.