April 25, 2006

The Black Hole of Bethesda: Life in the Twilight Zone

Occasionally I get a letter from a reader of myTwilight of American Culture, complaining that history and sociology are all well and good, but that I should give the public more of the actual details of the decline of the United States. They are right, of course, the more so since we swim in the raw data of the latter on a daily basis. A recent encounter with the American medical establishment provided me with clear evidence that “twilight” is hardly an abstract concept.

My regular doctor, a very intelligent, white-haired gentleman of the old school, also happens to be a gastroenterologist, and so is always on my case about having a colonoscopy. (“I’m lucky you’re not a neurosurgeon,” I once kidded him. “Would be too late in your case anyway,” he shot back.) He had given me one six years ago, when I briefly had a real job and therefore had real health insurance; but one reason I kept putting it off was that as a free-lancer, I was now paying a high monthly premium for insurance that was, in the crunch, worthless. Somehow, my insurance company always had a reason why this particular claim (whatever it was) was not covered, and I could either let it go–my usual choice, since arguing with them was pointless–or appeal it, in which case I would get a check for $50 or so six months later. So I kept telling him I couldn’t afford it, until he finally offered to cut me a deal. “I usually get a grand for the job,” he said; “I’ll do it for you for $600. In addition, you should call the surgery facility in Bethesda and tell them that for a significant reduction in price, you’ll pay them up front. Finally, you can try to negotiate with the anesthesiologist, who also charges a grand.”

So I took his instructions. I called Judy at the surgery facility; she told me that if I brought the cash in an envelope, she’d drop the cost from $1000 to $470. As for anesthesia, I decided to go without, and save myself at least $600, probably more. “I don’t recommend it,” my doctor said; “the procedure takes about fifteen minutes, and without anesthesia it’s going to hurt.” “Hey,” I told him, “a total of $1070 out of pocket is already more than I can afford; I’m a writer, you know what we make.” “Your call,” he shrugged.

Two months later, the day before the procedure, I called Judy once again. She had no memory of our conversation, so I had to tell her that we had agreed upon $470, and that there would be no anesthesia. “I’m sorry I can’t remember; I just dropped my daughter off at the testing place, where she’s taking her SATs. I’m concerned about her doing well, so I guess I’m not thinking very clearly.” “No worries,” I told her; “they now add something like 200 points for free. All American high school kids are now above average, so I’m sure she’ll do well.” She laughed. “Yeah...I know, you’re right.”
“Listen,” I said, “why don’t you take down all my data now, so that when I come in tomorrow, I won’t have to do reams of paperwork.” She agreed, noted the various meds I was on and so forth. “See you tomorrow,” she said brightly.

I arrived the next day, and handed Judy $470 in a plain brown envelope. It felt like hush money, or some sort of payola. Then they took me back to the pre-op room; it turned out that there was no record whatsoever of yesterday’s phone conversation with Judy, so I had to repeat everything I had told her the day before, including the bit about no anesthesia. Then my doctor came in. “How’s it going?” he asked. “Fine. Listen,” I said, “you’re doing me a favor by cutting me a deal, so I’m going to write you a check right now, before we get started.” He grunted; I handed him a check for $600. He pointed to the OR. “See you in there when you’re ready.”

So next I’m lying on the hospital cot, hooked up to a monitor, and he’s telling me about his vacation in Germany and Switzerland as he’s poking my anus. “OK, here we go.” Before too long I was screaming. It seems that there’s no problem when the plastic tube traverses straight colon, but when it goes around a bend–watch out. While I was screaming, I reflected on the fact that this would be a useful technique for extracting information at Guantánamo and Abu Ghraib, except that I had no information to disclose. It was unbearable, and of the fifteen minutes I spent on the cot, I probably screamed for three. In the middle of this, my doctor’s cell phone went off, and he took the call. I tried to say, “If it’s for me, tell them I’ll get back to them later,” but I was too busy screaming. “Can’t talk right now,” my doctor said, and rang off. (Then why have the damn thing on? I thought.)

Finally, it was over. I got off the cot and slowly made my way back to the pre-op room to dress. My doctor stuck his head in. “Doing OK?” “Yeah...I guess so. Say, it says on this sheet the nurse gave me that I need to make a follow-up appointment for two weeks from now.” He waved his hand dismissively. “Don’t bother with that, since we’re economizing here”; meaning: we only schedule those things to make more money, but since you are relatively broke, I’m not going to screw you. “See you in five years,” I said.

Out in the waiting room, the receptionist handed me an envelope. “Here are your personal effects,” she said. I looked at it closely: “Seymour Hockenhauser” was clearly printed at the top. “I’m not Seymour Hockenhauser,” I told her, handing it back. “Oh,” she said, “didn’t you give me anything?” “I guess not,” I replied. “Have a nice day,” she said.

I dragged my sorry ass out to the parking lot. One advantage of not having anesthesia is that you get to drive yourself home.


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