Tuesday, March 12, 2013

TING AND I, Trips to the Doctors

We see a pulmonologist four times a year, a throat surgeon four times a year, a general practitioner as needed, typically several times a year. If something is amiss, there will be tests and scans, hither and yon. We bring our most recent records. We record the results of the visit in a book dedicated to doctor visits.

Each trip requires the life-support equipment. Each trip is an adventure, because if the specialized van breaks down somewhere, we’ll have major trouble. The van’s lift requires electric power, without which Tina is trapped in the van. If the van’s doors jam, the same problem results. Even if we get her out, what next? Call 911 and transfer her to a stretcher and take her home. Don’t forget to bring the cell phone.

The consequences get more serious if we are brought to a halt during a summer trip. Heat is very hard on MS patients, as it aggravates the deficiencies in the insulating properties of the myelin covering the nerves. In the winter, cold is the threat. We try to schedule most of our trips for the spring and fall, the more temperate seasons.



The doctor trip from hell would be one where our special van breaks down on a lonely road in the winter or the summer, with an electrical failure. No heat, no air-conditioning, no power lift for entrance or exit from the van, with Tina stuck inside. As I write this section on April 25, 2011 we had just had a somewhat less than hellish trip.


The multi-specialty doctors’ practice in Middletown is about twenty miles away, typically a forty-minute ride, plus loading and unloading time. We allocate an hour each way. For this trip, we had originally scheduled back-to-back appointments with two doctors in the group, a pulmonologist and a new gastroenterologist, to save us from having to make two trips. A few days previously, we were told we had to postpone one of the appointments, because Medicare does not pay for two doctor visits to the same practice on the same day. We put off the pulmonologist for a few days.


The van’s motor started up well, despite not having been used for a few days. The horn was strangely anemic. The power lift rose more slowly than usual in getting Tina into the van and descended more slowly in delivering her to the doctors’ parking lot. An electrical problem? Stay tuned.


We waited almost an hour for the gastroenterologist. When we saw him—presentable, articulate, speaking rather good English, though a bit too softly for my poor hearing—it became clear that Tina’s feeding tube was not going to be changed then and there, as we thought it would be. No, no. You can't have fed her within five hours of the procedure (which itself is often done by nurses and takes about five minutes). No one had warned us of this. Furthermore, they had no gastric tubes on hand. You have to bring your spare, then they use it and give you a prescription for one or two more. No one had told us this, either.


When I explained the inconvenience of making two trips, the doctor informed me about the Medicare reimbursement rules, emphasizing that he would not lie for us and claim we had come a different day. Charming. I might have said I would not lie for him and tell someone else that I thought his practice was well run, but I did not. I’m more charming than he is, surpassing a low standard. We used this man because his predecessor gastro kept us waiting a couple of hours without a warning of any kind. What is it with the gastro guys?


After making a new appointment for a week later, we packed up our gear to take our van home. I turned on the ignition—and nothing happened. No gauges moved, no radio came on, certainly no starter motor was motivated. Dead. We tried jump-starting, with the help of the kindness of strangers. No luck. I called AAA. The van’s electrical system was too complex for local garages, because of the power-lift modifications for the wheelchair. We called an ambulance and got Tina into it, transferring her from wheelchair to stretcher and folding up the wheelchair to squeeze it into the vehicle. We had wanted an ambulette (wheelchair, not stretcher) service, which would take us all and leave Tina in her chair, but the listing in the Yellow Pages was not sufficiently clear.


Much waiting ensued. Tina, our nurse, and I all were patient. We were in the temperature-controlled waiting area of the office building containing the medical practice, safe and sound. We had two oxygen bottles with us. Nothing really bad happened. Of course, nearly a thousand dollars in ambulance and towing fees were put on the credit card. It’s only money. Better yet, it’s only plastic.


In a few days, we were scheduled to return to the same practice, this time for a pulmonary check-up. We could hardly wait.


Postscript: We junked that van and bought another, newer, used van, one whose exit access was not dependent on electrical power, so that we could get Tina out of it even without battery power.

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