Thursday, April 29, 2010

Chimp's Escape

Incredulous is probably not what you would feel; disoriented probably, bewildered perhaps, possibly humiliated, most likely scared.  But had it happened before, at least the worst part, with long and agonizing aftermath -- then you might be incredulous.

I wound up the emergency room partly because of what I learned, and partly because I wasn't completely sure it was the end (of me).  I was met by disinterested intake staff, and shown to a nurse who confused disregard with professional detachment.  She asked me what happened, and I explained that I had blacked out, waking up on a tiled bathroom floor.  I was concerned that I had a head injury, but could not be sure, because there were no signs.

Therein lay the seeds of incredulity, and not even being sure I actually had hit my head was a tease.  Was it impossible that I had cushioned the blow on the way down by landing on my arms, say? 

Eight years ago I suffered a concussion, with several months of Post Concussion Syndrome and concomitant effects of the giant anxiety attack that led to the injury.  I had a CAT scan, which I do not trust at all as being safe -- we are assured that the equivalent of a year's worth of background radiation carries minimal risk, but where is the proof?

I saw a neurologist a few times, a doddering old specialist with little patience for questions.  I had no primary care doctor for a referral, and had little time to make a choice.  What do I know of neurologists?  So I did the best I could, and payed him his hefty fee for an initial workup and some follow-ups, which amounted to a diagnosis of a condition for which time is the only cure, with some trinkets like B-12 and a neckpad for symptoms.

My biggest fear in all of this was seizures, a possible consequence of head injury.  According to what I had read, it appeared that for five years I had double the risk than the general population.  My neuro basically concerred, though this was based partially on an EEG (the test where eletrodes are glued to your head, and strobes are flashed at you).  The general consensus of the medical community appeared to be that this test had no value whatever for Post Traumatic Epilepsy, but when I asked the neuro why he ordered it, he asserted the EEG's utility.  When pressed for details, he replied, "it's useful."  Oh, OK.

Somehow I managed not to snuff myself, and endeavored to make the five years really count.  I failed miserably, but was still pretty stoked on the five year anniversary.  So, you begin to see why this latest apparent head injury is cause for incredulity.  This is partly what's going through my head as the surly intake nurse takes my BP, and leaves both the arm wrap and finger harness on long after she had taken the reading.  Another was why are you leaving these constricting things on me for so long?  Bitch!!

She balked when I asked her to remove the apparatus, and kept writing and asking more questions.  She asked how I had blacked out, and I told her it was embarassing, does she really need to know?  Can't I save it for the doctor?

Apparently not, so I told her I was dehydrated from several hours of intestinal difficulties, and the dizzy component of a panic attack overwhelmed my dehydrated constitution.  She failed to recognize how humbling it is to wake up on the floor with one's pants around one's waist, knowing the general trajectory you took, but none of the specifics.  She, of course, had no way of knowing my gnawing concerns over another five years -- not that she would have cared.

She did nothing with the information, unless you count escorting me to a stretcher in a hallway.  She walked away before I could ask what I was waiting for, and for how long.  After many awful minutes (I'm dehydrated and still feeling reverberations of panic), I inquired as to what was happening, and why I am in a hallway.  I'm then shown to a private room, next to several other empty rooms.  Why was I put in the hallway?!!


The doctor, a somewhat puzzling Chinese man, came in and asked me what happened, whereupon I relayed the tale of cramping, crapping, freaking, fainting, and waking.  He was more concerned about the blackout than the fall, even though I told him I knew exactly what caused me to pass out, and that I was more concerned with the fall.  He ordered three tests, two of which were to pinpoint the cause of the blackout, despite my telling him that I have no insurance so why the fuck should I pay for tests to figure out what isn't a mystery.  You aren't listening, inscrutible asshole.

Apparently he did not believe I had experienced the dual psychic/physical eruption that led to the blackout, several times over many years, and that a psychiatric professional confirmed my suspicion that it is essentially an emotional event.  I should mention that the feeling of disintegration that accompanies the psychic/physical event is so painful as to put it up with head injuries on the "I never want to experience this again" list.  That the two occurred on the same morning was, for me, an incredulity cocktail of nearly suicidal potency.

My thorough five minute exam ended, and I waited for another year's worth of radiation. 

Later, back in my room, some sort of assistant came to see me.  I told her about my "exam", which included none of the procedures performed by my neurologist years earlier.  She humored me, tossing me a few token tests, none of which included examining my actual head.  She urged me to get the tests to pinpoint the cause of the blackout.  Oh, they didn't tell you, I KNOW WHAT CAUSED THE BLACKOUT.  I humored her on the blood test, mostly because I didn't know I would be charged additionally ($65) for it.  The test came back perfectly normal.

I was paid a visit by some kind of forms lady, with many to sign.  Never mind reading them, that's not important -- never mind that I probably couldn't make sense of them even if I wasn't delirious.  And never mind running off to the restroom before you soil yourself.  SIGN THE PAPERS!!

Why is this bitch allowed to work in a fucking hospital?

My CAT came back clean, and I was sent home, whereupon I began planning my death.  I saw another hopeless neurologist (I really know how to pick 'em), who at least did some proper testing, and waited for the bills to arrive.

The total was over $4,000, but  $2,500 was credited back to me as a self-payer.  The bulk of it was hospital fees, partly because I was listed as "Acuity 4" -- 5 is the worst, where you arrive a bloody mess, but I don't know how a guy with loose bowels and panic disorder is a 4, especially when the determination was based on a five-minute exam and a clean CAT.  I pointed this out to the hospital, whence it was explained that a potential head injury is "Acuity 4" -- apparently my head injury was taken seriously for billing purposes, just not as an actual physical problem.  I was reclassified as "Acuity 3."

And Dr. Inscrutible Chinese Man, he charged me almost $500 for his intensive workup.  Oh, sorry, he had to read the CAT too, and confer with the radiologist.  So he made only $50 a minute, not $100.

All of these costs may be insignificant, if my state assistance comes through, and in any event a call to the head of the ER halved my physician fee.  So maybe I'll get out of this paying something like the value of what was actually offerred.


The State took care of the hospital fee (gee, it's kind of like socialized medicine, except only for the incomeless.  Does that make any sense?).  The radiologist has agreed to go along with the State, so I'm left with the $250 physician fee.  I am grateful for the help, but must admit that even if owed nothing, I still would feel uneasy. 

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