Friday, January 30, 2015

You Get What You Pay For

'Careful only three more feet.' I thought. Which at the time seemed like a sure thing, which is why on a balmy summer afternoon I stepped back into oblivion with neither a care or a forethought to my actions. The consequences were both startling swift and troublesome since I can neither fly or have God suspend the law the physics on such short notice.

That law in case you were wondering has to do with that old adage of what goes up must come down. Or in my case the sudden lack of firm cement under my foot, and then I was falling. My left hand flayed like a wounded duck while my right clutched uselessly to the hand truck I was pulling. The handle followed my descending body towards mother earth. I turned in mid air and started to reach back towards well, anything that would keep me from falling. Too late.

With my left hand, I let go and turned back around and then in slow motion began to fall the long four feet to the ground. The hand truck started to follow me. "Ah shit!" I yelled. Completely letting go of the hand truck my body picked up speed and well I landed hard on my left foot and then collapsed like a marionette whose strings had just been clipped. 

I felt the pain travel up my legs and through my back. Rolling around like a drunkard I moaned in pain. The hand truck rolled to a stop at the edge of the loading dock. My partner who at the time was throwing empty boxes away in the dumpster across the parking lot heard my screech for help and then my moans of agony. Like any good friend, he laughed... hard... a lot.

Bill came over and after he stopped laughing asked if I was ok. "Shit that hurt." I moaned.

"Oh, how I wish that was on tape." He mused.

"Fuck you." I said sheepishly.

"Anything broke?"

I took a minute and assessed the pain. My toes still wiggled and my legs moved "Don't think so."

He leaned down and extended his hand. Reaching out I took it and briefly thought about kicking him like Donkey Kong in the nuts. But if I did that he may let me lie here forever. Or maybe he puts the boots to me. I let the thought go and grabbed his hand. Bill pulled me up and asked what happened.

My hands massaged my lower back trying to make the sharp shooting pain coursing down my legs subside. I mumbled something about the dock which only made him laugh again. 

The next day I could hardly get out of bed much less walk. It took several weeks, but eventually I could stand up and walk without sharp shooting pains. That was in June. Now it's December and my left foot feels like gremlins are trying to cut my foot off with a rusty blade. Which is how I wound up at the urgent care clinic in Rapid.

It wasn't just my foot that brought me here. My sinuses were inflamed and had been for months. The doctor looks me over and sees I'm favoring my left foot. Like a good doctor, he asks and I tell him.
Take your boot off and lets have a look he says. I comply and after a brief look he pronounces it broke. But first lets get it x-rayed. And that's how I learn its indeed broke.

Which brings me to the VA.

Now I would like to take a minute and pause here for a moment and say for the record, my treatment at the Veterans Hospital has generally been exactly what I need it to be. That's not to say I expect miracles or for that matter the same care as the Mayo clinic, but on par for the little things it has provided me with the level of care you get when quite frankly you're not paying for it. 

However, when news broke last year about the long wait times vets were experiencing across the country my first thought was, "I've never had an appointment less than thirty days." But to be fair a lot of the time my time on the road prevents me from always getting the earliest appointment. Which is why I've always maintained a board certified doctor on the outside that will accommodate my schedule.

And while I'm at it allowed me to ask this troublesome question. Why oh why is it the VA doesn't have the ability to share records? I mean, if I go into Cosco or Walgreens and for that matter any other facility, including doctors and hospitals they can not only get those records in no time flat but will then provide me with a fair and generally fair service.

 But The VA on the other hand would like me to provide them four forms of ID, DD214, comprehensive list of why your at the VA in the first place, dates of service, medals, first born, color of your house, whether your wife shaves upstairs and downstairs, where you were stationed, the day you enlisted, day you exited the service, type of discharge...and well you get the point.

And do not at any time speak ill of the VA or remind them of their shitty attitude and hobo like philosophy are the reasons they are in the news in the first place. Because to do so will only invite both scorn and ridicule. Not to mention going permanently to the back of the line.

So to semi quote the opening line to Law and Order. 'This is my story.'

I went to the urgent care clinic on Sunday December 21st. On the 22nd I called the VA to see if I could see a podiatrist. 

"Sorry, but first you need to see your primary doctor and he's really busy."  Said the discombobulated female voice.

"But my foot is broken. So is there any way I can get in sooner?"

"I have an appointment in three weeks." She said.

"You did hear me say my foot is broken right?"

"Sir, if you're going to be rude then I can't help you." Came the flat and dry reply.

"I'm not being rude, but my foot is broken so I don't think I'm out of line here. I need to get in today if possible."

"I'm not being rude, but my foot is broken so I don't think I'm out of line here. I need to get in today if possible."

"Hold please."

When she entered back into the conversation I was treated to the news my doctor would see me in two and half weeks and that was as good as it was going to get. Perhaps if I thought it was really important I could call 911 or see a doctor in the ER.

I didn't call 911 but I did make the trek down to the VA emergency room. Once there I went through the motions of answering the questions put to me in the kindest voice I could muster. 

On another side note the discombobulated voice informed me she would pass along my issues to the VA. Let me just say for the record if you're going to transcribe notes it would be helpful if A) you payed attention to what was said and B) the notes you take at least resemble what was said. She did neither.

But I digress. The ER looked me over nodded at all the appropriate places and then suggested I see a podiatrist. And could I take a seat in the waiting room until they figured out if I can be seen today?

"Of course. Why not." I said.

While I waited, they sent me to get x-rays. And since I wasn't paying the tab why not.

Three x-rays later the doctor granted me access into his lair. His nurse had tied one on the night before. I know this because of the tale tale signs of last night's intoxication. I'm not judging, but a semi sober nurse doesn't send a great message.  

Once again, I find myself retelling my tale. And once again, I am treated to head nods, pinched eyebrows and a dour expression. After he looks me he performs the same circus act, we've all seen doctors do. 

Using his feet as a means to launch himself across the three feet of open floor space he plants his left foot and then does the bipedal version of what you see stunt men do in the movies. His stool spinning him around as he careens into the wall mounted bench behind him and then launches himself up until he is standing in front of the x-ray screens above the bench.

Drawing his pen from his shirt pocket, he points and touches. I am then treated to a series of grunts and uh huh's. Satisfied, he turns and gives me the news I'm waiting for.

"Well, this was studied by two different radiologists and according to them, all they see are these calcium deposits on your posterior tendons."

"The doctor at urgent care pointed it out to me yesterday. Said it was probably the reason my ankle gets inflamed. But what about the stress fractures?"

Pinched eyebrows, he turns back and looks at the film of my bones. Apparently not satisfied, he checks his notes. "They said it's not broken."

"But it was broken yesterday, so what I have the same healing power as wolverine?"

"Like the badger?"

"No like the hero in the comics."

He shakes his head. "Not much into cartoons."

"They made a movie. Three in fact, starring Hugh Jackman."

Nodding, he replies. "Probably not."

"Help me out here. Yesterday a different set of x-rays was taken and the result was a busted foot with calcium deposits in the tendon. Now its healed, but I have the same lump from calcium deposits. How does that work."

He shrugs. "Different labs. But here is something that concerns me." Turning his back on me he goes back to the x-rays and starts to point at what can only be described as white hallows around the bones where tendons attach to my foot. "You see these?"

I nod

"When you see these types of fluffy marshmallows it usually is an indication of the tendons becoming detached from the bone. And in your case they appear everywhere a tendon touches the bone."

"So all my tendons are detached...from the bone?" I ask incredulously. "Wouldn't that hurt, like a lot?"

Slowly his head nods and then he shakes it carefully back and forth. "Maybe."


"I mean, yeah it probably would but not necessarily."

Now I'm both alarmed and confused. "Wouldn't I know if that was the case? I mean could I even walk?"

"When I was in private practice, I would take something like this on but really you want someone who knows what they're doing. So I'm going to fee base you to an outside clinic."

Which is how I got to the orthopedic clinic three weeks later.

I'm sitting in the exam room waiting to be seen. The check in nurse has taken the particulars of my ailments and informs me the doctor will be right in. It's a few minutes past two on a Friday afternoon. My wife is waiting to find out if I can pick up the kids from school or not. I'm pretty sure I can but be ready to scoop them up just in case.

Ten minutes go by and the nurse pops back in. "You can go ahead and take your shoes off. He'll be right with you."

I nod and say thanks. As the door closes I kick off my boots and then strip off my socks.

Another ten minutes rolls by. I hear a knock and the same nurse sticks her head in. "Just checking on you. Is there anything you need?"

"I'm good." I reply. "Thanks."

"He'll be right with you."

By now I've got the routine down. At 2:30 I hear the now familiar light knock on the door, followed by the same nurse stepping lightly into the room, asking me if  I need anything followed by the refrain of his imminent appearance. 

I return her polite question the same way I have been and then she steps out and closes the door. My wife is now demon texting me. I answer her the same way. 'Not yet, still waiting'

She's upset, but other than leaving, there's not a lot I can do about it.

Forty minutes go by before my ears are treated to a heavy knock. He steps inside and immediately sits down on what I presume is the Nascar version of the three wheeled doctor's stool. 

"So what brings you in here today?"

I looked at the time and note the almost three quarters of an hour I've been waiting and ponder if I should mention it. But since he may be cutting me open I let it pass. Instead, I launch into the now familiar story followed by my history. He takes some notes, but doesn't speak.

Setting his notes down, he takes a minute to look over my foot. His expression is neutral and the lack of dour expression I take as a good sign. But his lack of comment leaves me a little uneasy. "So what do you think?"

"Did we do an MRI or x-rays?" 

"At the VA. They were supposed to send it over."

"Well, I guess now would be a good time to look them over. Be right back." He says flatly. 

Left alone again in what I now think of as my own prisoner of war camp I ponder what he must have been doing for the last forty minutes or for that matter the last week. My blood is a little boiled and I work to keep my irritation in check. Ten minutes later he comes back in and takes his seat on the Nascar stool.

I don't wait for his explanation. "So two different doctors looked at my x-rays and gave me two different diagnoses. Is my foot broke or not?"

Nodding sagely, he scoots over to a desktop and pulls up my x-rays. He moves the mouse all around the x-ray. I trust the fast movements of the mouse and the in and out of focus is telling him something because to me it look likes he playing Tetris.

"Ah, you know I can understand why you're getting conflicting reports. You see these white orbs?" he asks.

He points to parts of my foot that I can't readily identify but I see what he's looking at. "Yea."

"Well, you see some people would classify these as breaks. And maybe they are but maybe not."

"So it's not broken?" I ask again.

"But maybe people who don't look at feet all day classify them as breaks."

"So it's broken?"

He shrugs. "Hard to say."

"So the only way you would know is if you cut me open and looked at it?"

"I'm not going to go and look. It's not germane to what we are talking about."

"So what are we talking about?"

"Well your foot has a lot going on. I'll tell you that." He’s moved back over and taken my foot in his hands. He turns it this way and that way. Rubbing the back of my ankle, then over the top of my foot. His brows are pinched. He clucks his tongue off the roof of his mouth and then nods to himself.

"What about those calcium deposits?"

"Yea you've got a rather large nodule here on the tendon. Does it hurt?"

"It hurts yea. But what causes it?"

He's dropped my foot and returned to the desktop computer. His back is to me he shrugs. And then turns back around to face me. "Nobody really knows. I mean there are theories, but nobody really knows. You know when I went to medical school, I thought we knew a lot, but as it turns out we know very little. Oh yeah, I mean we know more now than what we did, but there's still lots we don't know."

I feel my jaw go slack and my irritation return. "So what are we saying here?"

He shrugs "Well, we could do surgery." He says off handily. Scooting back over to me and picks up my foot and twists it back and forth. I wince in pain. He notices and then drops it.

"It's not a big deal really just cut out the tendon that connects your big toe and replace it."

"How much time are we talking?"

"Two maybe three hours."

"No, I mean, how long will I be down?"

He shrugs again. "No real way to tell. Six weeks, maybe eight."

"Alright, I can live with that."

"Well that's just for the surgery. I mean you won't be able to walk on it for two months and after that I'll put you in a boot but your going to need physical therapy."

"How long for that?"

"Depends, but probably two months."

"How often we are talking about?" 

"Two maybe three times a week."

"Well, that's not going to work I mean I travel for a living. Every week. I can't take four months off. I won't have a job."

He moves back over to the desktop and types in some notes. "Well, let me know." And with that he stands up and walks out.

I put my boots back on and walk out knowing full and well that if I was paying instead of Uncle Sam for this his attitude would be different and maybe the service would be better.

And that dear reader is a lesson in getting what you pay for.