Adventures in Health Care
My great-aunt Princess Neola died of pernicious anemia in the early part of the 20th century. She was seventeen. We still have the letters she wrote to her family from her hospital bed. Before she was born in the small Southern town of Lena, which was named for her Aunt Lena, Neola's mother had become friends with a Choctaw princess, who often passed through town to sell blankets and baskets. In fact, they had become so close that when my great-aunt was born, she was named for this Choctaw princess, Neola.
There is still no cure for pernicious anemia, which is a type of anemia caused by the body's inability to absorb vitamin B-12. However, with the treatments available today, people can live a normal life span. We are lucky to be living in the 21st Century with the medical advances, treatments and cures that were unavailable 100 years ago. We are also damn lucky if we have access to health care at all.
After I lost my job and health benefits, I carried health insurance as an individual for another year at a cost of $500 a month. That's $6,000 per year. During that year, I saw two doctors, two times each, for regular checkups in order to have my prescriptions refilled. I am basically healthy except for three medications: thyroid medication for hypothyroidism, cholesterol medication for genetically high cholesterol, and estrogen, without which, I would soon find out, I would fall apart. Break down the yearly cost and that is $1,500 per visit. I realize that nothing terrible happened to me, like accidents or diseases, which this same insurance would have covered. However, since nothing did happen, it still felt like $1,500 per visit, and for an unemployed person, this was painful.
Then last December I received a letter from my insurance company informing me that my premium would be raised to nearly $650 per month, beginning in January. That was it. I could no longer afford health insurance. I had still not found work or gotten my business off the ground, and I was living on unemployment and what little money I had left. I had barely enough money for rent and food, much less insurance. And if all I anticipated needing during the year were four doctor visits, I was looking at $2,000 per visit.
Over a period of ten years I had been the patient of two excellent Beverly Hills doctors -- an internist and a gynecologist. Both of the doctors were women and I was especially happy to be under their care. They insisted on regular, semi-annual check-ups and monitored my health carefully, making me a believer of their knowledge and expertise. I also believed that we had achieved fairly close personal relationships, at least as close as doctor-patient relationships can be. Giving them up would not be easy but with no insurance, there was no way to pay their fees. On the other hand, I still needed my prescriptions and I would just have to find the money to pay for them.
My internist filled the prescriptions for the thyroid and cholesterol medications for two additional months. After that, she insisted that I would have to come in for an office visit. I was relieved. At least she was giving me a little time to sort myself out.
Then I called the gynecologist. Without an appointment, this doctor, this Goddess of Estrogen, refused to prescribe the much-needed Estratest. (It's too complicated to explain, but estrogen unopposed by progesterone can cause uterine cancer.) I was shocked that she didn't call me personally. In a cold and detached manner (clinical?), her nurse delivered the news. And then she added that if I couldn't afford an appointment, I would just have to go to a free health clinic. After ten years, umpteen biopsies, mammograms, pap smears and the sharing of intimate secrets, the Goddess had cast me out and shipped me off on a slow boat across the River Styx.
For those who are too young or of the wrong gender, I need to explain what happens to a woman who has been taking estrogen for 15 years and who is forced to stop abruptly. As the estrogen depletion begins, the symptoms are at first merely annoying -- the hot flashes, night sweats, insomnia, irritability. Then as the symptoms escalate in severity, there is no sleep. No ability to focus. Incessant weeping. That is the worst part, the weeping, which is quickly followed by utter despondency.
As my body became more depleted of this vital hormone, these symptoms expanded and thickened until I was nothing but a sweating, crying, sleep-deprived ball of humanity. Two months without estrogen and I was near a complete collapse.
Realizing that I could not go on in this state, I spent hours on hold at several free clinics in the Los Angeles area. One would not take people from my zip code. One left me on hold for forty-five minutes. One could not give me an appointment for another month and I clearly couldn't wait that long. Finally, I spoke with a very helpful woman, who told me about a walk-in clinic downtown, open until mid-night.
Early the next morning, I drove straight there. After waiting for about thirty minutes to secure a parking place (the lot was jammed), I entered the free clinic and the Parallel Universe of Los Angeles.
Take a number. I was number 33, which I didn't think sounded too bad. The waiting room was crowded and chaotic but when the magic door to the doctor swung wide, everyone looked up, hoping expectantly that it was opening for him or her. The patient demographics were roughly 95% Hispanic, 4% African-American and 1% Other. I was the Other. The room buzzed, mostly in Spanish, and I was having a hard time understanding much of what was being said. The PA a system crackled and screeched and it was almost impossible to hear the names called. People grabbed empty seats quickly and furtively, as though playing a game of musical chairs. I asked a young Hispanic couple about what to expect the rest of the day. Their answer was chilling. This was day two of waiting for them. I gave them my name and asked if they would help me listen for it if announced. Mostly I kept my nose buried in a book.
A while later an attractive African-American woman sat down next to me. Being talkative, energetic and friendly, she informed me that she was "mental." To prove her point she began pulling out bottles of medications from her purse, like it was show-and-tell at the free clinic, explaining which ones helped her sleep and which ones woke her up again. Then she began working on homework for her therapist, one of two, she bragged. "Who? What? Where? When? How do you feel?" She asked me to spell the word "unsociable" and flung her arms out to push away the man sitting on the other side of her. I wondered what had happened to this obviously bright and beautiful woman that had left her so badly broken.
At around two in the afternoon I asked the Hispanic couple if there was any food nearby and indeed, there was a snack bar in the clinic. Leaving my closely guarded chair was risky and I asked the husband to watch it for me as I headed to the snack bar. I returned to the waiting room to find my chair occupied. In fact, all of the chairs were occupied. The floor in the hallway was available. As I ate my chicken salad sandwich and chips, trying to be invisible, the tears started to mount. I told myself, it's just chemical, chemical. Then I looked up to see the "unsociable" woman surrounded by four security guards.
Finally at around 4:00 PM, they called my name. I entered a tiny room, where a nurse took my blood pressure and temperature. Then the nurse informed me that I would have to come back the next day. If I waited, I wouldn't see a doctor until around 11:30 PM because there were still 30 people ahead of me. If I came back the next day, I would be given first priority.
The next morning it took me around an hour to find a parking space but when I checked in at the window, they were true to their word. I was a priority. By 11:00 AM they called me in to see the doctor. He asked why I was there and I began to explain my medications and my situation. I couldn't help it, but in hearing my own situation, I began to cry. He handed me a tissue and tried to calm me down as he explained that he could not give me a prescription for estrogen. The drug I needed wasn't in their system. I would have to go to the Los Angeles County Hospital emergency room and have a doctor there prescribe it.
Hot tears flowed and I said, "look at me, what a mess I am and the only reason I'm here is for the estrogen and without it, I'm falling apart, can't stop crying, and I'm becoming irrational." Then in joking exaggeration, I said, "I'm suicidal!" The doctor responded quickly, "I'll send you to 'mental.'" I flashed on the "unsociable" woman and tried to explain that I was kidding, just exaggerating my situation and that if I just got the estrogen, I was sure that I would be okay. I don't think he believed me. As I tried to reassure him, I envisioned myself locked up in a county mental health ward under suicide watch, where no one would know where I was and from which I would have no hope of escape. I was visualizing the scene from the movie The Snake Pit, shot from overhead, with all of the women below, slithering about like captive snakes.
After trying to insist on some mood-elevating drugs, which I refused, the doctor sent me for blood work. In the lab waiting area the men next to me looked on sympathetically as the tears ran down my face. Across from me people were in beds, attached to various drips, and I tried to calm myself, knowing that there was nothing wrong with me except a little estrogen depletion. It's just chemical, I repeated to myself.
Finally the doctor called me back in. He had taken it upon himself to locate the drug Estratest at Wal-Mart and had written a prescription that could be filled "outside the system." He did a search on his computer and found the nearest Wal-Mart, which was located in Baldwin Hills. Not only did that pharmacy have the drug, they had it in generic form. Instead of $90.00, it would cost only $9.00. I could have hugged the doctor. He had taken the extra time and trouble of researching how he could get the drug for me and he had pinpointed where, directions included. He was a true healer and a gentleman.
While I waited for the other prescriptions to be filled in the free clinic's on-site pharmacy, a wait that dragged on for another two hours, I called my regular pharmacy to get their cost for generic Estratest. The pharmacist there said no such drug existed. I argued that it did exist at Wal-Mart. This will be my next battle.
As I drove toward Baldwin Hills and another two-hour wait before finally getting my prescription, which I would take immediately, I thought about all of the people crammed into that free clinic's waiting room, listening for their names to be called over the screeching PA. They didn't know the Beverly Hills doctors with lovely waiting rooms and immediate, albeit expensive, care. They knew only long lines, and "come back tomorrow," and "go to the emergency room," and two-hour waits for lab work and medications, and lunches sitting on a hallway floor. I was now no longer the "Other." I was one of them, a fellow traveler in the LA Parallel Universe, and I felt damn lucky.
Previously Published in Open Salon
© Elizabeth Dollarhide
My great-aunt Princess Neola died of pernicious anemia in the early part of the 20th century. She was seventeen. We still have the letters she wrote to her family from her hospital bed. Before she was born in the small Southern town of Lena, which was named for her Aunt Lena, Neola's mother had become friends with a Choctaw princess, who often passed through town to sell blankets and baskets. In fact, they had become so close that when my great-aunt was born, she was named for this Choctaw princess, Neola.
There is still no cure for pernicious anemia, which is a type of anemia caused by the body's inability to absorb vitamin B-12. However, with the treatments available today, people can live a normal life span. We are lucky to be living in the 21st Century with the medical advances, treatments and cures that were unavailable 100 years ago. We are also damn lucky if we have access to health care at all.
After I lost my job and health benefits, I carried health insurance as an individual for another year at a cost of $500 a month. That's $6,000 per year. During that year, I saw two doctors, two times each, for regular checkups in order to have my prescriptions refilled. I am basically healthy except for three medications: thyroid medication for hypothyroidism, cholesterol medication for genetically high cholesterol, and estrogen, without which, I would soon find out, I would fall apart. Break down the yearly cost and that is $1,500 per visit. I realize that nothing terrible happened to me, like accidents or diseases, which this same insurance would have covered. However, since nothing did happen, it still felt like $1,500 per visit, and for an unemployed person, this was painful.
Then last December I received a letter from my insurance company informing me that my premium would be raised to nearly $650 per month, beginning in January. That was it. I could no longer afford health insurance. I had still not found work or gotten my business off the ground, and I was living on unemployment and what little money I had left. I had barely enough money for rent and food, much less insurance. And if all I anticipated needing during the year were four doctor visits, I was looking at $2,000 per visit.
Over a period of ten years I had been the patient of two excellent Beverly Hills doctors -- an internist and a gynecologist. Both of the doctors were women and I was especially happy to be under their care. They insisted on regular, semi-annual check-ups and monitored my health carefully, making me a believer of their knowledge and expertise. I also believed that we had achieved fairly close personal relationships, at least as close as doctor-patient relationships can be. Giving them up would not be easy but with no insurance, there was no way to pay their fees. On the other hand, I still needed my prescriptions and I would just have to find the money to pay for them.
My internist filled the prescriptions for the thyroid and cholesterol medications for two additional months. After that, she insisted that I would have to come in for an office visit. I was relieved. At least she was giving me a little time to sort myself out.
Then I called the gynecologist. Without an appointment, this doctor, this Goddess of Estrogen, refused to prescribe the much-needed Estratest. (It's too complicated to explain, but estrogen unopposed by progesterone can cause uterine cancer.) I was shocked that she didn't call me personally. In a cold and detached manner (clinical?), her nurse delivered the news. And then she added that if I couldn't afford an appointment, I would just have to go to a free health clinic. After ten years, umpteen biopsies, mammograms, pap smears and the sharing of intimate secrets, the Goddess had cast me out and shipped me off on a slow boat across the River Styx.
For those who are too young or of the wrong gender, I need to explain what happens to a woman who has been taking estrogen for 15 years and who is forced to stop abruptly. As the estrogen depletion begins, the symptoms are at first merely annoying -- the hot flashes, night sweats, insomnia, irritability. Then as the symptoms escalate in severity, there is no sleep. No ability to focus. Incessant weeping. That is the worst part, the weeping, which is quickly followed by utter despondency.
As my body became more depleted of this vital hormone, these symptoms expanded and thickened until I was nothing but a sweating, crying, sleep-deprived ball of humanity. Two months without estrogen and I was near a complete collapse.
Realizing that I could not go on in this state, I spent hours on hold at several free clinics in the Los Angeles area. One would not take people from my zip code. One left me on hold for forty-five minutes. One could not give me an appointment for another month and I clearly couldn't wait that long. Finally, I spoke with a very helpful woman, who told me about a walk-in clinic downtown, open until mid-night.
Early the next morning, I drove straight there. After waiting for about thirty minutes to secure a parking place (the lot was jammed), I entered the free clinic and the Parallel Universe of Los Angeles.
Take a number. I was number 33, which I didn't think sounded too bad. The waiting room was crowded and chaotic but when the magic door to the doctor swung wide, everyone looked up, hoping expectantly that it was opening for him or her. The patient demographics were roughly 95% Hispanic, 4% African-American and 1% Other. I was the Other. The room buzzed, mostly in Spanish, and I was having a hard time understanding much of what was being said. The PA a system crackled and screeched and it was almost impossible to hear the names called. People grabbed empty seats quickly and furtively, as though playing a game of musical chairs. I asked a young Hispanic couple about what to expect the rest of the day. Their answer was chilling. This was day two of waiting for them. I gave them my name and asked if they would help me listen for it if announced. Mostly I kept my nose buried in a book.
A while later an attractive African-American woman sat down next to me. Being talkative, energetic and friendly, she informed me that she was "mental." To prove her point she began pulling out bottles of medications from her purse, like it was show-and-tell at the free clinic, explaining which ones helped her sleep and which ones woke her up again. Then she began working on homework for her therapist, one of two, she bragged. "Who? What? Where? When? How do you feel?" She asked me to spell the word "unsociable" and flung her arms out to push away the man sitting on the other side of her. I wondered what had happened to this obviously bright and beautiful woman that had left her so badly broken.
At around two in the afternoon I asked the Hispanic couple if there was any food nearby and indeed, there was a snack bar in the clinic. Leaving my closely guarded chair was risky and I asked the husband to watch it for me as I headed to the snack bar. I returned to the waiting room to find my chair occupied. In fact, all of the chairs were occupied. The floor in the hallway was available. As I ate my chicken salad sandwich and chips, trying to be invisible, the tears started to mount. I told myself, it's just chemical, chemical. Then I looked up to see the "unsociable" woman surrounded by four security guards.
Finally at around 4:00 PM, they called my name. I entered a tiny room, where a nurse took my blood pressure and temperature. Then the nurse informed me that I would have to come back the next day. If I waited, I wouldn't see a doctor until around 11:30 PM because there were still 30 people ahead of me. If I came back the next day, I would be given first priority.
The next morning it took me around an hour to find a parking space but when I checked in at the window, they were true to their word. I was a priority. By 11:00 AM they called me in to see the doctor. He asked why I was there and I began to explain my medications and my situation. I couldn't help it, but in hearing my own situation, I began to cry. He handed me a tissue and tried to calm me down as he explained that he could not give me a prescription for estrogen. The drug I needed wasn't in their system. I would have to go to the Los Angeles County Hospital emergency room and have a doctor there prescribe it.
Hot tears flowed and I said, "look at me, what a mess I am and the only reason I'm here is for the estrogen and without it, I'm falling apart, can't stop crying, and I'm becoming irrational." Then in joking exaggeration, I said, "I'm suicidal!" The doctor responded quickly, "I'll send you to 'mental.'" I flashed on the "unsociable" woman and tried to explain that I was kidding, just exaggerating my situation and that if I just got the estrogen, I was sure that I would be okay. I don't think he believed me. As I tried to reassure him, I envisioned myself locked up in a county mental health ward under suicide watch, where no one would know where I was and from which I would have no hope of escape. I was visualizing the scene from the movie The Snake Pit, shot from overhead, with all of the women below, slithering about like captive snakes.
After trying to insist on some mood-elevating drugs, which I refused, the doctor sent me for blood work. In the lab waiting area the men next to me looked on sympathetically as the tears ran down my face. Across from me people were in beds, attached to various drips, and I tried to calm myself, knowing that there was nothing wrong with me except a little estrogen depletion. It's just chemical, I repeated to myself.
Finally the doctor called me back in. He had taken it upon himself to locate the drug Estratest at Wal-Mart and had written a prescription that could be filled "outside the system." He did a search on his computer and found the nearest Wal-Mart, which was located in Baldwin Hills. Not only did that pharmacy have the drug, they had it in generic form. Instead of $90.00, it would cost only $9.00. I could have hugged the doctor. He had taken the extra time and trouble of researching how he could get the drug for me and he had pinpointed where, directions included. He was a true healer and a gentleman.
While I waited for the other prescriptions to be filled in the free clinic's on-site pharmacy, a wait that dragged on for another two hours, I called my regular pharmacy to get their cost for generic Estratest. The pharmacist there said no such drug existed. I argued that it did exist at Wal-Mart. This will be my next battle.
As I drove toward Baldwin Hills and another two-hour wait before finally getting my prescription, which I would take immediately, I thought about all of the people crammed into that free clinic's waiting room, listening for their names to be called over the screeching PA. They didn't know the Beverly Hills doctors with lovely waiting rooms and immediate, albeit expensive, care. They knew only long lines, and "come back tomorrow," and "go to the emergency room," and two-hour waits for lab work and medications, and lunches sitting on a hallway floor. I was now no longer the "Other." I was one of them, a fellow traveler in the LA Parallel Universe, and I felt damn lucky.
Previously Published in Open Salon
© Elizabeth Dollarhide