During the past year, I’ve done time in the worlds of human and veterinary medicine. My post-operative conclusion is that it’s a dog’s life.
Before surgery last summer, I’d had little to do with doctors. My annual feet-in-the-stirrups female plumbing checks, and an occasional visit to the dermatologist to have the barnacles scraped off my hull, were not overhauls but tune-ups. Lube jobs on the road of life.
I’d also rarely encountered a veterinary emergency before my weimaraner was hit by a car at the end of September. The annual parvo and rabies shots, the occasional teeth cleaning to inhibit bad doggy breath, and nail trimming to muffle that annoying click-click on a wood floor, are the comfortable routine of the family vet. The assistant pats Raymond on the head, the vet pokes her needle in, offers a double shot of treats, and it’s same time next year.
All that changed in 1999. After nine months navigating HMO hell and the pay-as-you-go plan, I’ve emerged on the other side a weary but wiser consumer.
I’ve played a summer season of phone tagsand endured countless Muzak tunes and monotonous repetitions of ”Your call is important to us“before securing the authorization number from the nurse of my primary care physician that will get me past the guardian at the gate of the specialist. I’ve dutifully returned to the office of my primary care physician to have blood drawn for certain tests that my specialist says I need, even though I’m standing next to a lab bristling with needles and vials in said-specialist’s office when she prescribes them. I’ve been blindsided by a four-figure bill for a procedure I underwent two months earlier because the specialist who performed it, at the recommendation of yet another specialist, was not my on insurer’s list of preferred providers for that procedure. I’ve experienced all this through the educative efforts of my HMO.
Most of all, I’ve learned that the primary component of HMO medicine is paper. Even though we live in a time in which the world is wired and hard copy is supposedly a vanishing artifact, there is still an amazing amount of the stuff around, most of it fattening the files of the medical practitioner.
In each office and admitting room, I sign in on a piece of paper, confirming that, in spite of severe provocation, I have not recently moved to a foreign (read HMO-less) country. Then I’m handed a clipboard and told by the harassed receptionist to fill out each page ”front and back.“
Pages of questions elicit what particular ills my flesh is heir to: heart disease on my father’s side, cancer on my mother’s. I confirm that I have had measles and chicken pox; deny the hepatitis-alphabet, or numbness of the limbs, or shortness of breath (pausing as I remember the 5K in 1995 that left me panting). I check ”No“ to goiter and gout, intermittent loss of vision, and alarming chest pains. I struggle to remember the first day of my last period, give up, and make up a date that will not sidetrack the doctor into a consideration of possible pre-menopausal symptoms.
I fill out my birthdate and my husband’s, my Social Security number, and blank on his. I sift through the plastic in my wallet, and put on my reading glasses to copy the tiny but lengthy series of numbers that will prove to some wary accountant my good credit rating. I affix my signature in three different places, affirming that my doctors may do whatever they think best, and that I’ve read the warnings explaining that whatever procedures I am about to undergo to save my life may in themselves prove fatal.
At the end of it all I have been reduced once again to ”Kreyling, Christine11/23/49,“ which is how I must identify myself for each subsequent appointment request. Then I cool my heels in each doctor’s office, wading through half of War and Peace, waiting to lay my eyesand hoping it’s not my handson an actual MD.
Raymond’s scenario played out, in contrast, as a minor miracle of minimalism. Because the dog’s regular vet could not deal with such a severe fracture, I found myself at the University of Tennessee’s small animal clinic. A brief admitting interview establishes the basics, sans authorization numbers. The only clipboard is held by a member of the medical team, who fills out the single page questionnaire.
After a preliminary examination, Dr. David Lidbetter, an Australian with a cadre of initials behind his nameBVSc, CertSAS, MACVSc, MRCVStells me that the gray Honda reduced my dog’s right rear tibia to the consistency of lump crab meat. He cannot bear weight on his right front leg either. One of his lungs is slightly punctured and oozing air into the surrounding body cavity; the administration of anesthesia for surgery at this point, therefore, would be ”like overinflating a tire.“
Lidbetter pats my shoulder as he tells me that it will not be easy to save my dog. He explains that he intends to put Raymond’s leg in something called a ”circular skeletal external fixator“a contraption of rings and rods and wires and bolts that reminds me vaguely of the Eiffel Tower and was developed by one Dr. Ilizarov in Siberia to straighten the limbs of Russian children. Lidbetter’s initial cost estimate is $3,000.
Every day that I’m in Nashville while Raymond is in Knoxville, I receive a call from a senior student at a pre-appointed time convenient to me. Each animal at the clinic is assigned a student as a personal slave on two-week rotations. Raymond goes through two Lisas, a Kim, a Jackie, and a Cheryl during his lengthy staythe student body at the UT vet school is more than 75 percent female. The first thing that each tells me after she rotates onto the case is that she ”just loves Raymond.“ I find it all but impossible to imagine such an expression crossing the lips of a human caregiver other than Mother Teresa. Perhaps that’s because the HMO-mandated brevity of hospital stays is hardly conducive to the generation of humane feelings.
The daily verbal reports from UT describe the procedures Ray has undergone that day, the medication he’s taken, and the quantities of food and water that have passed into and out of his system. Once he’s matriculated from the ICU, I hear of the walking and standing exercises he undergoes every four hours around the clock. I laugh at the news that the dog who has always avoided water deeper than his ankles is ”doing beautifully for the physical therapist on the underwater treadmill.“ I hear nothing of referrals and preferred providers. Evidently, if a dog needs something, he gets it.
During the vet’s months-long battle to keep Raymond’s leg safe from the complications of infection, Lidbetter also struggles to hold down my costs. He once waives his professional fee and presents me with a bill totaling a mere $40the radiologist’s material charge for an X-ray. I check tears of gratitude as I recall that in HMO-land, all fees are rigidly prescribed and enforced, that costs are contained by limiting treatment. In early January my dog walks out of the clinic on a wizened but working leg.
These days Raymond and I have resumed our morning exercise on the paths of Shelby Bottoms. As we jog, I sometimes recall that we each generated our own 2-inch stack of X-rays and received equally excellent care. And I send a mental message of sympathy to the doctors doing battle against the forces of insurance for me. I also give thanks that Lidbetter & Co. remain in chargeat least for nowof the medicine they dispense.
But as I sweat and Raymond forages, I can’t help but rue the major irony of modern medicine: that the most likely place to find the humane version is among the animals.
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