I suppose this story really begins when several months ago I noticed bubbles in my urine.  Not all the time, but occasionally.  What alerted me was a story in the New York Times weekday edition.  I never considered bubbles before reading this piece.  I don’t buy the Times; I don’t buy any newspaper these days, but I do read it and others at restaurants or coffee shops I frequent.

          The article said bubbles occur when there is protein in your urine — too much not being desirable, apparently — often caused by  dehydration, or a heavy meat diet, or a recent injury, as in a blow to the kidney.  And lastly, something amiss in the kidney, such as a tumor, cancer.

          I am seventy now and I have been pretty healthy all of my life.  I have had a hernia operation twice, and for the same hernia, and my appendix was removed about four years ago.  That’s pretty much it.

          I have begun to believe that something has to be lurking out there, ready to pull me down, perhaps permanently.  This bubbly urine thing, I thought, just might be the ticket.

          I have excellent health insurance, by the way, Medicare and a very pricey supplementary insurance.  I’ve been told I should drop the secondary insurance in favor of a cheaper version.  What keeps me from doing so is that the other cheaper version might not cover as well or it might keep me within the boundaries of Kentucky for treatment, whereas the one I have now permits me to go wherever I want.  And once I drop this one, I cannot get it back.  I’m not sure in a pinch I want to be restricted to treatment solely in Kentucky; in Louisville, in my case.   I have heard the quality of medical care here described as ‘great.’    I feel that quality is hyped and overrated.  I would say it is okay, but hardly ‘great.’

           I have had, as already noted, surgery for the same hernia twice, and regrettably, I tell you, I still have a hernia.  My ex-wife, Mary, who is now a nurse-practitioner, chose the surgeon I used.  Still, I have this hernia.  And this particular surgeon, upon examining the latest returned hernia, recommends it not be operated upon again, after which he predicted that another surgery would be a ‘hard surgery.’  Not exactly what I wanted to hear, you understand.  So I do nothing.  I live with my hernia.  If I get it repaired again, I will go to a place that specializes in hernia repair and nothing else — if such a place exists.  Undoubtedly, such a facility would be outside of Kentucky, and so, consequently, I keep the better, the more complete and more expensive insurance.

          If I knew what I know today about hernias, I would not have had the initial surgery.  The surgeon neglected to tell me at the time, as do all surgeons, I suspect, that as many as a third of hernia operations don’t exactly work out.  Furthermore, my initial hernia was small.  Now it is not quite as small, due to the two operations.

          Nevertheless, I trust my ex-wife’s medical opinion.  She is pretty sharp.  Still, she is capable of fucking up sometimes when it comes to advice.  I just wish it hadn’t been with me.  I am well aware that her medical colleagues think highly of her and the skills she brings to the profession.  I am not so sure about some of the medical picks she has made concerning my health issues.  She was trained as a nurse in New York City and has good experience in big name hospitals like the Sloan-Kettering Cancer Center in Manhattan, and Boston’s Massachusetts General  (It was in Boston that I met Mary, where her specialty then was intensive care).

          So when she said a couple of years ago that I should have a personal physician — which I didn’t — I took her recommendation and began to see someone she recommended, a woman by the name of Dr. Torino.  She was all right, this Dr. Torino.  Her English was a little hard to understand, but maybe some of it was that I am a little hard of hearing.  She was from the Balkans, and a pleasant enough lady. 

          What I didn’t care for was her office staff.  They were also from her part of the world, and they were often abrupt and downright unfriendly, even dour.   Now since my expensive insurance pays well,  I expect more as a consumer.  I have developed a certain consumer attitude, I guess you would call it.  I mean, it seems to me the providers out there ought to provide damn good service in return for my premium insurance.  And provide good medical advice, too.  Seems obvious to me.

          In these less-than-robust economic times, I believe physicians are beginning to get exactly that message.  If they are not, it’s not because I have failed to make the effort to teach them otherwise.

          I parted company with the Balkans woman, not because she gave bad medical advice — it was largely because I didn’t like the atmosphere in the outer office, and having to deal with it.  When one day I tried to make a new appointment after having just seen Dr. Torino, the Serbian lady at the appointments desk informed me that appointments can only be made up to one month in advance, and the doctor and I had agreed I would return in two months.  I was told I would have to call back after one month. 

          You know what?  I never called back.  I never went back.  I admit in my advanced age I can be a mite cranky.  I went to a foot doctor not so long ago with a minor problem.  The outer office staff insisted I had to sign a paper stating I would pay if I failed to come in for an appointment.  I explained that I don’t miss appointments.  And I added that I didn’t see where such a document was worth the words printed on it.  I just didn’t see how it was enforceable.  Mainly though, I tried to explain to the ladies that I do not ever miss appointments without calling, and often not then, either. 

          The staff person made quite a fuss, and the doctor emerged from the back and said it would be all right if I did not sign the paper.  Later, he told me he recognized my Massachusetts accent, and it turned out he grew up about twenty miles from my hometown.  Of course he was quite a bit younger than me.  The bill was $100 for his services, and my insurances paid either $96 or $98.  I’m sure the fellow was pleased with such a payout.  I never have co-pays.  I did not have to go back, but I suspect I would be very welcome to return, considering how well my insurance compensates.

          Which brings me to my latest doctor experience.  How it happened, was that Mary gently suggested I find a new doctor again, since I had ditched Dr. Torino.  She had another recommendation, and I took it.  It had been a year since I had seen Dr. Torino, and since I had been prescribed light doses of blood pressure medicine, Mary, my ex, continued to renew the scripts.  I guess she felt she needed to be freed from this duty.  She did not wish to prescribe for me indefinitely, and I can’t blame her.  I was, after all, not really her patient. 

          Nurse-practitioners function very much like doctors, in Kentucky, anyway.  They prescribe medicines, of course.  There may be some limits on prescribing narcotics, but not much else.  I was ready for a new doctor anyway, and the doctor she picked this time, Dr. Spurling, was a man Mary once worked with closely.  Indeed, when he was away on vacation or out of town for some reason, Mary covered his practice for him.  There existed, obviously a mutual high regard and respect.  So I called and made an appointment. 

          The first question the woman asked me was, What was my Social Security number?  What an odd question to ask, I thought.  I mean, on the phone and the first words out of her mouth.  I fought back my inclination to inquire as to the need for such basic information so soon.  I understood full well that such queries would be made later.  Nevertheless, I sucked it in and gave her my number.  Of course, what followed was a series of questions about my insurance coverage.  I knew full well that without the necessary coverage, I would be turned away.  That goes without saying.  I had not yet mentioned my connection with my ex, Mary, and her association with the doctor.  He was in practice by himself, by the way.  I knew Mary had to be well-known there and likely well-regarded among the staff.  I was to discover this for sure when I went in for my first appointment, my first and last, as it turned out.

          My thinking concerning getting a new doctor was that if I keeled over one day, but was not dead, and got hauled off to a hospital, it might be useful to have a doctor, a personal physician, to supervise my care thereafter.

          I deliberately made my appointment for about three weeks in the future.  There was no emergency involved, and I just like to get used to the idea that I have to visit with still another doctor, and a complete stranger, and for the first time, at that.  The staff person, a woman, indicated I could easily get in sooner if I wished.  I said I didn’t see the need for doing so.

          Before I knew it, the appointment was at hand.  Time for me to meet my new doctor.  Dr. Spurling.  Did I say it was a he?  I guess I did.  His office was not as conveniently located for me as that of Dr. Torino, but I managed.  I got there early, as I usually do, and filled out all the forms, provided insurance cards, and my driver’s license (a new requirement, I gather).  I carried with me two annual lab reports, blood profiles.  My ex had written the scripts for these tests and I went to nearby Baptist Hospital to have my blood drawn, two years in succession.  I have kind of come to believe, correctly or not, that a lot can be determined about your overall health by a careful blood screening.  I checked out pretty well, only a slight elevation in fasting blood sugar.  Something to watch, I am sure.

          The woman made copies of my blood levels, which reminds me of still another doctor I used to frequent but dropped several years earlier.  He would order blood work and then complain to me when I next saw him that I was his only patient — and he had a large practice — who insisted on going to an outside lab, refusing his in-office lab service.

          I figured that was entirely my business, and when he commented on the subject a second, and even a third time, I dropped the fucker.  I didn’t much care for his aloof, unfriendly office staff either.  I’m too picky, I guess.  I don’t much like doctors.  Truth is, I don’t trust them.  It is quite a lot unto itself for me to trust my ex wife’s judgment, considering our stormy domestic history going back many years.  But I do trust Mary’s medical decisions, overall.  Other decisions of hers, though, seem out to lunch to me.

          My appointment with Dr. Spurling was for 10:30 a.m. and by 11:00 I was still in the waiting room, having arrived before ten.  Okay, I thought, but soon a nurse’s aide appeared at the doorway calling my name.  The waiting area was quite empty by now.

          “Right here,” I said and followed her to the inner offices.  I noticed at once that she was adorned liberally with tattoos, several fairly large ones on each arm.  To me, that was not a good sign.  But of course she would not be the doctor.  I don’t like tattoos on anyone, but especially on women.  I live in rather a trendy neighborhood in Louisville where tattoos reign.  I see lovely young women scarred for life.  They know not what they do.

          When I pass the multiple tattoo parlors on Bardstown Road I think there ought to be a law against such mutilation.  If I go into a restaurant and the server has tattoos, I just don’t go back.  I view such persons as possibly diseased, maybe carriers of hepatitis.  But mostly, I consider them dumb.  I know tattoos are supposed to be much safer and cleaner today than they once were.  But I wonder if they really are.  When you see the tattoo artist emerge from his little den, his hovel, he looks pretty scruffy to me.  Always they are men.  Doesn’t help either, that they are inevitably covered with tattoos themselves. 

          I knew I should not have said anything about the woman’s tattoos, but I did.

          “You like tattoos?”  She was Hispanic-looking, and in need of dental work.  Maybe in her early thirties, slim and reasonably attractive.  I expected her to say, “Unfortunately, I had them put on when I was much younger and less wise,” or words to that effect.  She didn’t, though.

          “Oh yes, I have eight tattoos altogether.”  She said this rather proudly, I thought.  Would she drop her pants so I could see tattoos on her ass?  I could see several of the tattoos on her arms.  I didn’t ask where the others were.  I was thinking by now, This is not a positive beginning

          She weighed me and then took my blood pressure and, as always happens in the doctor’s office, it had jumped up.  It was higher than it should be, and I explained how this often happens for me when I am being examined, and she said she understood.  When she was finished, I headed for the bathroom, and she cut me off halfway there to hand me a cup and say that the doctor was almost certainly going to want a urine sample.

          “Let’s wait until he asks,” I said.  This comment did not please her, I could tell.  But my thinking was this.  About a week ago I had gone to the lab at Baptist Hospital and had given them a urine sample.  My ex had written the order.  I figured we needed to get to the bottom of the urine bubbles I had been seeing.  I didn’t yet have any results, however.  Now I was being asked to provide another sample, and it occurred to me that maybe that great insurance coverage I had might not include paying for two urine samples within a week.  I couldn’t blame them if they balked.  It was excessive.  Besides, as a matter of principle, I always do my lab work outside of doctors’ offices.  It occurs to me that running up unnecessary tests costs a bunch, and it seems somehow wrong.

          I went to the cubicle and awaited the arrival of Dr. Spurling.  He soon showed up, and brought along a woman who told me she was a student preparing to become a nurse-practitioner, what my ex is.  If the woman was preparing to be a nurse-practitioner, she had to be an RN already.  She introduced herself; the doctor did not.  He said nothing, but sat very close to me and began to write in my folder.

          I then proceeded to tell them a story about another doctor, a Dr. Kaplan.  He was a colon specialist and I was scheduled to undergo a colonoscopy a few days following my office visit with him, which I did.  I sat in his office as he asked questions about my bowel functions.  Sitting there next to him was a very attractive young woman in her early twenties, I guessed.  I doubted if she was old enough to be in medical school.  Maybe high school, I thought.

          The doctor did not introduce her.  He didn’t need to introduce himself because I had had a colonoscopy with him before.  He didn’t ask either if it was okay that she was there.  I said nothing because I knew in a couple of days this fellow across the desk from me was going to hoist a tube up my ass, and I figured I didn’t want to offend or otherwise unsettle a man designated to perform this function.

          As I say, I told this story to the young woman there with Dr. Spurling, whereupon she offered to leave if I wished.  I did not reply to her offer.  Dr. Spurling, meanwhile, had nothing to say.  He did not offer to send her away, nor did he even take a moment to explain her role.  If she had not introduced herself, I would have been left to figure out things for myself.  My thinking was, and is, that common courtesy requires, even mandates, the doctor to inquire if it is all right that another person be in the examining room with us.  That did not occur, however.

          Do they do this with all patients, I wondered, or only with older persons such as myself who are believed less likely to complain?  Such a wrong assumption, in my instance, anyway.  I had visualized the new doctor coming in and chatting for a couple of minutes with the purpose of getting a sense of his new patient and allowing time for me to size up the new doctor.  This didn’t happen, either.  By the way, doctors charge more for initial visits, for the time it takes to get acquainted.

          This man meanwhile sat in a chair making lines in a chart, which looked like a sentence being diagramed.  Does anybody remember diagraming from grade school?  Clearly, it does not happen in schools nowadays.  It once did.  The doctor told me he was putting together a family profile.  Who was still alive, who was not, what they died of, that kind of thing.  He was asking me questions, of course, as he went along, but so far, he had not looked up or looked me straight in the eye, or even given me his name, which was Larry Spurling.  And all the while, he was sitting uncomfortably close to me.

          Oh God, I have another bias, too.  This man was little, not just short, but little, maybe five feet tall.  Shit!  I thought of my father, who was short, but probably taller than this fellow.  He was all right sometimes, but he could be a mean cuss at other times, especially when he was drunk, and he was drunk more often than he should have been. 

          And then there was Stanley Delecta, a Polish fellow and an astronomy professor back at UMass.  He twice failed me in astronomy.  He was short and balding and nasty to a fault.  So I had my reasons for my biases, I thought.  And if all of this were not enough, Dr. Spurling was a Low Talker.  He was practically sitting on my lap and I could not hear him.  I informed the twosome there that I was a little hard of hearing, but they did not seem to make any effort to speak louder to adjust for my condition.

          It went on in this fashion for quite some time, with me frequently asking the doctor to repeat what he said.  He asked about my cholesterol levels, and I gave them to him as I remembered them.  They were quite low, I said, and I told him I had brought this information with me in the form of two reports, and he looked in the slim file, but they were not there.  The paperwork I had provided had not gotten into the file yet.  The insurance information and various disclaimers I was required to sign were there, sure enough.

          I then explained who I was, and that my ex-wife Mary had recommended him.  I knew she was a medical professional he valued highly, if only because she covered his patient load when he had to be away, such as on vacation.  Seeking to introduce a bit of levity to what was so far a rather tense situation, I told the two of them I was Mary’s third husband, which was not true.  I was her first.  I saw no response, none at all, not that I should have.  Then I admitted I had been kidding. 

          “I was her first,” I said.  I suggested he tell her I said this, that I was her third, and watch her reaction.  He barely looked up from whatever he was writing.  He took my blood pressure, which remained somewhat elevated, and commented upon this fact, suggesting, I thought, that he didn’t see why I had any reason to be agitated in this particular setting.  He hinted that it was for more organic reasons.  I explained that I have a blood pressure apparatus at home and that I check my levels often.  He wanted to know what they were, and then he abruptly left the room as the nurse’s aide came in and I heard him mutter to her that he needed a urine sample. 

          I think he said this.  But he was such a low talker, I was not entirely sure what he said.  The tattooed lady, upon the departure of the others, announced rather triumphantly, it seemed to me, that the doctor had indeed ordered a urine sample, as she had predicted he would.  I asked why, and she said he was checking for an infection.  I didn’t have any infections, I was sure.  I explained to her again that I had given a urine sample at Baptist Hospital recently, and I just didn’t see the need for another so soon.  I would have the results of that sample sent on, I offered.  I suggested she communicate this news to the doctor.  My resistance to the urine sample must have made them think I was hiding something, drug use or something of that order, which is perfectly ridiculous.  But I bet that’s what they thought.

          The tattooed lady left, again not very pleased with me, but she dared not say anything, of course.  I got to thinking, I bet a urine sample is standard fare when you come to this office.  At $50 or $100, perhaps more than that.  Who knows?

          I waited, and waited some more.  I had arrived before ten a.m. and now it was past 12:30.  I finally got up, opened the door and stood in the hallway.  Across the hall was a very pretty, well-dressed young woman.  I had a sense of who she was immediately, without asking, but then I did ask,

          “Are you a drug rep?”  She said she was and I explained how I knew this was, that a few years before I had worked in mental health as a social worker and I saw plenty of drug reps. Few men, but many beautiful, well-groomed and well-dressed young women.  I didn’t say this part to her; however, I did tell her I believed the drug companies were in league with the mental health agencies, including the one that employed me, and were giving the taxpayer, and the actual consumers of the substances, the patients, a thoroughgoing hosing.  I didn’t suggest the same thing was going on in other realms of medicine, even though I think that is true, too.  The pretty woman hardly had a response, not that I expected one.  It would be unfair to expect her to comment on what I said, but she did say how she did not work in the psychiatric drug area of the business.

          Then I returned to my little cubicle and waited, I guess, for about another thirty minutes, and then decided to leave.  I tried to find someone in the outer office to tell them I was leaving, but the window was closed, darkened for lunch, I guess.  The waiting room was completely empty, deserted.  And that was that with Dr. Spurling.  I never went back.

          I did call the office that afternoon to say politely that I was finished with them, I was a one-timer, although I didn’t use those words.

          In spite of my admittedly numerous complaints and prejudices, I did not require a whole lot.  I could have gotten beyond the tattooed lady and the short stature of Dr. Spurling.  Those I could have dealt with easily.  The doctor was not young — I estimate he was fifty-five or so.  He had thick gray hair and was well fed, or as they say in medical parlance, ‘a well-nourished white male.’  But the fact is, he simply brought little to the encounter.  He is busy, I know, but he was being generously compensated for his time and efforts.

          I am less forgiving of doctors bringing observers into the exam room, and without permission.  How long does it take to ask if it is all right?  Minutes, maybe.  No, I am less giving on that score.  But that too could have been quietly dealt with, I believe.

          But this factory atmosphere that prevails everywhere I go, complete with the insistence that lab work must be done in doctors’ offices, even when the analysis might be duplication of an earlier test — that practice can be moderated considerably, and at a savings to patient and society.  The doctor needs to make a living, yes, I understand that, but he could be a bit more modest as to how this is accomplished.  My take, anyway.

       Finally, when I began this piece, I spoke of bubbles in my urine.  Well, the urine sample I provided at the Baptist Hospital labs came back as it should be, normal.  Nothing remarkable observed, so I was told.

          Lessons learned:  Don’t watch your urine.  Just piss and walk away!  And don’t read the New York Times too carefully.

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