Friday, October 19, 2012

Guinea-Pig at Nameless Clinic

Guinea-Pig at Nameless Clinic
Part II of "Complaint against Dr Alpha and Dr. Beta"

I was a guinea-pig (yes, a pun on my own obesity) for protégés of Dr Alpha on their way to greener pastures, until he at last put me on his own patient list (for which I am deeply thankful). I think it was he, by means of his blood-testing procedures, who determined my diabetes diagnosis. I am grateful for this, because in particular, for instance, he found a developing weakness in my kidneys by blood-testing me (a weakness which a downtown specialist at Catholic Hospital said was not my fault due to dietary transgression and obesity, but most probably a genetic weakness), for which another pill was added to my regimen. Over the years, he also sent me downtown to some specialists at Catholic Hospital's main campus – for the diabetes dermatosis specialist, for the eye-diabetes specialist team, and most-recently for the diabetes specialist who told me about my kidney, told me I was High Risk for a heart attack. (Dr Nameles had made me fearful that I woud need renal dialysis, but the diabetes specialist never mentioned anything like that . Instead: high risk for heart attack or stroke.) So, really, it was another wild-goose chase. Yet, I tried to turn that useless visit to my advantage in regard to some that was troubling me about the degeneration of my body. It was with the downtown renal specialist that I timidly raised the question of an alternative end-of-life plan -- with the prospect of amputation for gangrene in the legs, renal dialysis, and heart attack / stroke in mind). Perhaps I was too oblique; he started rattling off the Living Will stuff. He gave me platitudes that had nothing to do with my thawts or values. The other specialists just mentioned, I might add, were attached to clinics that were open only in the mornings, as I recall. I learned in contrast that I coud not rely on myself and my sleep (non-)patterns, learned that I had to restrict myself to mid- or late-afternoon appointments. Just knowing I had an appointment at 9 AM, even having taken a sleeping pill, I woud often remain awake worrying until the wee hours, almost guaranteeing I woud be exhausted and miss the appointment. I have an aversion to downtown medicine, even at my beloved Catholic Hospital. I don't like the travel needed to get to the downtown campus, nor the changes of TTC streetcars. It's simply unbearable in the heat and cold; it takes a lot of nerve-wracking time. I woud arrive at appointments in a state, and often was disappointed by the results. Fortunately, in recent times, a Diabetes Education Initiative has emerged in connunction with Nameless, combining the Nameless and the Other Clinic in the same building. Alpha never mentioned the Diabetes Education Initiative to me, but in a work around his late return from vacation, I got an appointment with his protégé in January 2012, a resident, Dr Beta. He mentioned the new programme. That's one reason why I can't possibly accept Alpha's action (apparently with Beta's subsequent connivance) in expelling me from the Nameless Clinic, cutting me off from the Diabetes Education program on the easier route that requires no streetcar changes, no coping with freezing or boiling waits for streetcars. No entering one of the claustrophobic, labyrinthine downtown edifices of the Hospital main campus.

I have a whole set of disablities in regard to travel, timing, and dealing with specialists to whom I am only a cipher in the endless stream of ciphers to whom they attend. I'm unsuited to this process, for which by the way I am not paid, while they all are. I'm glad they exist and that they do what they do for others, but I need a better fit in the doctor/patient relationship like that being tawt in a collaboration between the Divinity grad school and the Medical grad school at Duke University, Durham, North Carolina ("Medical and Divinity schools partner to cultivate compassionate, patient-focused physicians); in comparison the University of Toronto Medical School is still in the Dark Ages of Humanism and Atheism. ,  travel to the clinic/hospital, timing, and meeting new specialists. Thus, overall I need a patient/doctor dialogue at Nameless in regard to both the scientific side and the inter-human side of all these arrangements.

Christmas-NewYear 2011

Please remember that I only need to see Dr Alpha 4 times a year – once every three months to renew my prescriptions. And that I refuse to be manipulated to see him more often, for no reason that is originated by me. That's why I can't afford or tolerate without rebuke an abuse of my chance for a timely renewal of my prescriptions. Dr Alpha doesn't want to work with me toward a mutually agreeable scheduling. His unusual comings and goings with days and periods of inaccessibility are not even posted in the clinic, nor phoned or emailed to me. Yet the clinic is exceedingly hi-tech.

Every year, in the grey and cold of winter as we approach the Feast of the Nativity, I go into isolation, virtually hiding, as all of my close family are long since dead. It gets harder and harder to get out at all as the days get shorter and the nights lengthen (I hate going out after dark any time of year, but have done so for 6pm appointments in Autumn with the diabetes-opthamologist Dr Eyeball – at least in that case of travelling in the dark, I don't have to visit downtown specialists in morning hours when I'm exhausted from lack of sleep). But as my pills were running out, and the clinic shuts down, and Alpha goes on longish vacations, I had to somehow get to the clinic last Christmas (the clinic closes for some days). It was the day before Christmas, and when I got to the clinic, I was told that Arbess had already left on his vacation and that no one else woud see me to extend for a least one month my prescriptions based on the pill-list in Alpha's file on me. I don't know if I sounded off on that occasion or not. But I don't think so; I do remember that the waiting room and line-ups were bedlam. It looked frantic. I only know I woud thus have to spend the period until Jan 6 or so without medication. A resounding curse on that, I think, but don't shoutout. Alpha, as it turned out, stayed away until even after the January 6, when he shoud have been on hand on the December 24, and if memory serves I saw Owen his protégé-resident instead (I'm not sure) soon after Jan 6. So, with a one month's set of prescriptions, I went thru a Christmas Hell – no sleeping pill, no psychotropic, no diabetes-amelioratives. In February, then, when I got to see Alpha, I had been suffering because of his not-benign neglect; he harmed me by his unaccessibility. He coud easily have had an email sent to me or had his secretary phone me to warn me of that coming inaccessiblity – warned me before I woud be left stranded, sleepless, without my steadying psychotropic and sleeping pills. My Christmas into the New Year and after was a hell on earth that I hoped I woud never revisit. Little did I know. My suffering on this occasion was doctor/clinic-induced.

When I finally got to see Alpha, I promised myself I woud not get angry. But when I told him how hurt I was by his neglect and abandonment, he was at first simply sort of baffled. He had no clue that he had left me to my disabilities, nor any sensitivity to the fact that his manipulation of his vacation-time scheduling had let me fall between the cracks in Nameless medicine. When I mentioned that, compared to me, he was rich and had all the power in the relation, so he coud suit himself with his vacation scheduling, and it had cost me money, he smirked, smugged. As tho he had at last found the hermeneutic key to what I was complaining about:  money. His blindspot seems so huge, that when he heard one aspect mentioned that he coud comprehend, he seized on that as the explanation. I'm good at reading body lanaguage, facial expressions, and intonations. When he took the stance of irresponsibility, I got furious. I woud not be dismissed or have my unmet needs or consequent hurts diminished by his noblesse oblige: I cursed him out. I went over a limit, and when I regained my composure in later days, I was remorseful and wrote hand-wrote him a letter of sincere apology. He was unable either to comprehend me or apologize to me for his self-serving neglect of my health needs and his abandonment of me to a really cruel Christmas and after. The next time I saw him, he assigned me again as a guinea pig for an intern to practice her skills. By the time I got to consult "my" doctor, I was assigned to the intern, a hesitant female.  He had finally read my letter of apology for the curse-out, it being stapled to my medical file and reaching him only upon the day of this visit to Nameless; and he was magnanimous. “We all have our bad days,” was the best he coud do, when I next saw him. Unsatisfactory. But that left him secure on his pedestal of smuggery. He's only a scientist, someone shoud let him know. He doesn't have the other half of the doctoral skills he needs to cope with the new medical era, and the dynamics of the oncoming generation of seniors, many of whom require a medical ethos with room for death with dignity. As far as he was concerned, there was only one party at fault in this instance, and it was me.

But I say my anger was just. Just look at my medical record. On the other hand, I crossed a line of politeness. He caused my anger. I caused his anger by my cursing him out. He spun across the six feet between us in his wheeled chair putting his face within a inches of mine, leaning intently forward, and vigourously wagging his finger at me, while he in turn spouted his anger, flush in the face. Huh?  He can do that. He can get angry. He can use aggressive language on me. But I can't, he assumes. He was the chief responsible person in that entire imbroglio. But he never accepted responsibility to my medical case, my need for accessiblity, and my need for my medications. This makes his letter of expulsion quite disengenuous when he faults me for “angry outbursts” and “aggressive language” which latter itself is misleading. I never threatened him or Dr Beta, altho I may have been threatening to them because they live in an encapsulated and solipsistic world of self-protecting politesse, where the patient is the scientific Geganstand to be objectified but can't hold them responsible. Medicine, after all, is a scientific affair to the exclusion of an inter-human patient/doctor relation. Professional morals (best practices) don't matter when it comes to keeping a schedule notifying patients of upcoming absences, or emailing them, or posting the info in the waiting room regarding the impending absences of doctors (instead of erecting a big sign in the waiting room to solicit donations for condom distribution, in the Nameless Shameless Clinic of Catholic Hospital (of all places) -- which tedious moral lapse in his commitment to the Hospital, he tolerated for months on end, while never contacting patients who are placed at risk by such anti-normative absences of doctors from their posts, making sure a pill-dependent patient can get access to prescriptions in a timely way and for a travel-lessening period (3 months).

Dr Alpha can't accept co-responsibility for the history of our patient/doctor relationship, which depends on an open and honest dialogue human to human. It's, therefore, all my fault.

 — end of Part II — continued in Part III "Between 2 pill-prescripton periods (3months)" of "Complaint against Dr Alpha and Dr Beta"

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