Wednesday, June 13, 2012

Okie-Dokie, Then!

I don't know how to describe yesterday, except to say that, during the night, evidence suggests that I ate a bag of microwave popcorn, one and a half apples, and a "carbsense" peach yogurt.  The evidence comes in the form of popcorn kernels all over the floor, one well-gnawed apple core, one apple sliced neatly in half -- brown but with that still (barely) good nutty apple smell -- smartly speared with a small utility knife, and an upside down carbsense peach yogurt balanced on the pillow I was hugging with wanton abandon.  A spoon smeared with yogurt sat neatly upon my carefully folded glasses.

In further riotous detail -- I woke hypoglycemic.

Back to yesterday, which shall absorb the blame and the shame for all of these disgusting nighttime activities.

I know that I apologized to my President, Mr. Obama, several times, even, on Twitter, for singlehandedly destroying the PCIP budget.

[ASIDE:  Please, MSNBC, among the many programmatic and philosophical changes you need to make, do not force Luke Russert upon us.]

As I was saying, I may have annihilated the Affordable Care Act all by my lonesome, just by the shenanigans of January and February, in our upteenth attempt to rid my body of an osteomyelitis that just won't quit.  Transfer to a Long Term Acute Care Facility was involved, as were superfluous surgeries, and massive failure to understand the machinations of CRPS / RSD.  One of the results of all the money thrown at my problems was the declaration that I had maxed out my PCIP coverage to the tune of.... "catastrophic" levels.  My main comment on that is that the maximum I was told I'd have to spend on my health care (not including, of course, premium costs and deductibles) was roughly $7,000.  Excuse me while I imitate someone doubled over in laughter.

So one of the joyous benefits of having been hit so hard financially in the space of the first two months of the coverage year is that I am exempt from paying any more co-pays for doctor visits, etc.  I am at that glorious 100% coverage realm, up where the air is so thin, one can hardly breathe.

And yet, every doctor's office that I visit demands that $25 or, at one place, that $55, before I can be seen.  Never mind that I've been with each of them for years and never, ever carry a balance.  (JOKE:  I'd rather die first!)  Now, this is the true me:  For a couple of weeks, I was just so tired, I said, "Okie-dokie, then, here you go!" 

Then I had the fire lit under my aching, red, and breaking-down butt.  It turned out that my orthopedic surgeon's office had NOT applied to my PCIP deductible the $2000 I put on my credit card when they called on January 17, 2012, claiming I needed to pay them the in-network deductible or they'd be unable to proceed with the grand screw-up of a surgery scheduled for January 23.  Did you follow that?  I could make it clearer, but I'm so stuffed with food I can barely think.

As I was investigating a weird charge from the LTAC, submitted by a pulmonologist I'd never heard of, nor needed, who also appeared to have no license in this area West of the Lone Alp... I became mired in the pages and pages of online data documenting the obscene, pornographic exchanges of money, it hit me that I could not find that $2000 payment from January.  

I can be quite the dip when it comes to money, so I thought a courtesy call to the orthopod's office was in order before I set my aching, red, broken-down butt afire.  Anyway... no, they had only "needed" about $200 of all that, and had just tucked the rest in between the brown corduroy orthopedic sofa cushions in their snack lounge.  Miss Melissa, after sternly reminding me that she had only known of the error since March, eventually returned the $1700+ to my credit card.

I had to jump up and down over and over on the radio that kept playing in my head:  "And what about the interest charges you incurred, nimwit?  What about the money you might have grown from that $1700+ had you been able to invest it in the equity that went up over 23% in that same period of time?"  Smashed that damned radio to pieces, I did.

So yesterday, Fred and I sat in the waiting room at ShoulderMan's office, discussing some hilarious scientific literature. [Not kidding!  He was showing me the studies proving that light, among all observable things, changes its behavior if... observed.  Hilarious and mind-boggling stuff that makes me believe in God even more than that rare child cured of persnickety and metastatic brain cancer.  Fred can be a brilliant man, knowing when to pull out the big guns.]  

Now, I already may have pissed one of the receptionists off, I am not sure.  I was trying to be helpful, but how often does "trying to be helpful" really mean "pointing out crap that no one wants to deal with, and thankyouverymuch."  All of these orthopods have installed "kiosks" for check-in purposes.  It scans your IDs, your insurance cards, updates your address and phone, and asks whether you're likely to vote for President Obama or Dickwad Romney.  Oh, and please press HERE if you are not white.

I always complain about these kiosks.  Several reasons:  I am in a wheelchair, and the slant of the screen makes it nearly impossible to read due to glare from the sun -- that sun that may emit particles or waves, but probably isn't a coherent light source, anyway, who knows?  I ask them for a lower kiosk, as well.  Think about it.  I am in a wheelchair.  The kiosk is raised for someone of normal height, standing.  And why am I there?  Because of my freaking shoulders.  There's something so not fun about having one barely working arm that you have to keep raising above your head to enter data that hasn't changed since the week before.

Ah, but none of those bitchifications were involved in my complaint yesterday.  When I rolled up to the kiosk, it had been left by its previous victim in mid-operation.  I silently acknowledged my agreement with the evidence of their frustration, briefly bowing my head, and saying my personal and shortened version of the Serenity Prayer.  There was no way to abort the half-finished session, so I just flew through each screen by pushing some version of "Don't Know" and "Don't Care." The last screen I saw, still dedicated to this long gone patient, offered me EVERY SINGLE BIT OF THEIR PERSONAL INFORMATION.  From social security number to address, phone, personal doctor's name, insurance data -- all of it.  I could have copied it all down, photographed it, or I could have gone slightly bonkers and rolled over to the receptionist to report what I thought a major flaw with their blessed little kiosks.  She said, "Oh, no, that's terrible." 

I shortened the Shortened Serenity Prayer and went back to the kiosk to enter my own data.

Fred and I resumed giggling over the double slit experiment.  ("In 2002, Jónsson's double-slit experiment was voted 'the most beautiful experiment' by readers of Physics World.")  I was waiting for my main man, Leo, ShoulderMan's left hand man, to call me back to the exam rooms, when instead I heard the receptionist's dulcet tones, asking me to report to her area.  Zoom, zoom, zoom, and there I was -- hidden, of course, behind the counter that was so tall someone in a wheelchair would never be noticed without use of an emergency flare.  

She has two things to accomplish.  One, could I please confirm the information I just scanned and entered into the goddamned kiosk.  Two, I owe a $25 copay.  I am already missing Fred and his promise of some mention of Schrodinger's cat.  I carefully repeat the necessary demographics, but balk at paying.  My chapped ass has had enough, already.

"Well," she said, between huge sighs, "I guess I can call and reverify your insurance coverage." 

"Okie-dokie, then!" I crow.

"You can stay right there, so you don't have to go running back and forth."

"Okie-dokie!" (Appreciative of her saving my thumb and forefinger all that effort...)

Twenty minutes later, I am the source of major human traffic flow complictions.  My wheelchair is blocking old men with walkers, little girls struggling with crutches, and various blue-hairs who just shoot me a dirty look before lining up behind me, despite my frequent announcements that I am not in line.

Every now and then, the receptionist says something in a loud voice and I've no idea if she is speaking to me, so I answer, even if at the "okie-dokie" level.  Occasionally, she says, "I'm so sorry!" and it is then obviously incumbent upon me to say, "You've got nothing to be sorry about."  Oh, how weird things get when you cannot see the person with whom you might be having a conversation.

Finally, I hear this:  "Oh, you're gonna hate to hear this, Ms. Profderien!  You are absolutely right. You don't owe us a thing.  You can take a seat now."

You'd have been proud of me.  "[cough::cough]  I don't suppose you could refund the $25 I had to pay last week...?"  And then I rolled my aching, red, broken-down butt to Fred, who was asleep under a book, snoring just the smallest bit.  He woke, thought I had already seen the doctor, and make ready to leave, cheerful at the well-oiled machine that was apparently in force.  I hated to break it to him -- we had yet to really begin.

The chase?  You want me to cut to the chase?  Okay... Leo called me back, told the same joke he always tells, the Nurse Who Really Runs Everything came in and I signed all the consents, and we looked at my blood work.  She kept saying, "Your CRP is *really* high..." After running back and forth to consult with the surgeon, she decided I needed to be the last case of the day next Monday, because odds are that there is more crapalaficious infection to be dealt with, and "the infecteds" are always operated on last in the surgical day.  She sends in the PA who says, "You know the drill," and then seems to fall into a fugue state.  "Bob," I said, "You seem really tired.  Why don't we just move all this along?" Bob seems grateful and says I need to "run" across the street to the hospital to pre-register.

Before I leave, I pick up all the paperwork (including the blood work results) that have fallen on the floor, and stealthily crept under the exam table.  I leave them in a place that's obvious, so that either the next patient can steal my personal data, or the Nurse Who Really Runs Everything can retrieve them, so as to fatten up my anorexic chart (we're on overstuffed Volume 3).

We did not know that hospital pre-registration was going to have to be done yesterday but Fred and I decide to see it as a good thing, meaning that we don't have to come back later this week, and can stay home waiting for the roofing dude to come save the collapsing roof over one of the rear porches overlooking the fruit orchard we share with our Cistercian neighbors.  Believe it or not, the whole thing sort of collapsed 5 days before the 5-year warrranty expired on the last time they came and did not repair it very well.  If there are any charges to come out of this repair, you can bet that we're inviting Abbot Truffatore over for dinner, al fresco, with his seat right under the most prodigious leak.

I pay the $5 for parking so that we can go park at the hospital, which will cost -- you guessed it! -- an additional $5.  Fred threatens to muzzle me as I launch into my "Dear President Obama..." routine.  Why try to save me with an Affordable Care Act and then bankrupt me with health care parking fees?

Anyway, we know this hospital like some people might know the back of their hands.  But right away, something is different.  I am in a cubicle with a polite young man who is reentering all that personal data stuff, when he pauses, actually stops working, and says, "Do you mind if I ask you a question?" 

Oh, what goes through one's mind.  "Yes, I know I still owe you many thousands of dollars.  I'm sorry.  If Google would just have a blow out of an earnings report, you'll be paid that much quicker.  In the mean time, would you accept $20 a month, or maybe a kidney?" 

But what he asks is this:  "Was your experience here back in January and February a good one?"

I think I swallowed my tongue.  "No," I said, "it wasn't." 

"Well, I am sorry about that, and I hope that from this moment on, your stay here this time will be much better."

I am tempted to yell out "WTF?" but don't.

Okay, so I got a Press Ganey thingy to fill out on the hospital, back in March, and filled it out with bloody honesty, but how the heck would he know anything about that?  And he is, no offense, just a data entry clerk.  And wasn't it anonymous?

I'll spare you.  The tenor of his overtly solicitous behavior continued throughout the pre-op check-in process.  The nurse was extremely polite and well-informed.  She knew what CRPS was.  She had an accurate list of my meds.  She listened as I begged for them not to change the marvel of the pharmaceutical arrangement that is helping me so much with the CRPS dystonia.  She did not make me repeat tests that had been done within the last six months.

She passed me along to the nurse anesthetist whom I absolutely HATE.  I am sorry to say that.  Ashamed to say that.  But this woman, every darned time, interrupts me when I bring up the need for stress-dose steroids pre-, intra-, and post- op... and then to please revert me to my normal dose.  She lectures me on the hospital's pristine record with steroids, given that it is one of the region's foremost transplant centers and blah blah blah.  This time, I talked over her, telling her that I was very nearly dead thanks to their own hospitalist not givng me ANY steroid for five days, while I became more and more altered, with systems failing, getting weaker and weaker, and no one sharp enough to check my medic alert tag, or even look at the hospital records from an admission a mere two weeks before.  "Oh, my," she says.  "That should not have happened.  I'm so glad we discovered it in time." 

Scrape me off the ceiling.

I tell her that I discovered it.  It probably would have been my last cogent comment. Vision fading, weakness rising, I asked the nurse who was giving me meds which one of all those white pills was my steroid.  She told me I didn't take steroids.  I believe I began blubbering "Oh, my God, oh my God." To this good nurse's credit, she RAN to get help -- and a syringe full of Solu-Cortef.

Anyway... we got through yesterday, I hyperfocused on the weirdness, and then we got a pizza, for comfort.  It was after 7 pm before Ruby the Honda CRV rolled gently through the labyrinth, among the ramparts and over the moats, drawbridges and cleverly converted battering rams, into the safety of the well-loved place called home.

I have not forgotten young Hannah, to whom I promised to look for inspiration in all this -- but I cannot think much about how mutilated I will be when I come out of anesthesia on Monday.  Later today, I will check on her progress, and again marvel at her strength, and pray to be able to imitate her just a bit, if nothing else.  She is doing well, I know, midst a sucky situation.  She's been fitted for a prosthetic leg and will soon begin learning how to use it -- which I expect will take her a full five minutes.  Keep on keeping on, Miss Hannah.

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