My strange descent into doctor land

(No. 126) What happens if you aren't connected enough to game the American medical system? I'll answer that: you're screwed.

The DNA of our medical system is wack. Illustration by Stephen

This week I had a strange descent into doctor land that was emblematic of the disparity, high costs and incredible treatments available to some aging people in the US — and not to others. My treatment began last August, when I experienced flashes of light and floaters in my right eye. Based on what I’d learned several years ago when the same thing happened in my left eye, I went to an emergency room that specialized in eye care.

I couldn’t find the ER entrance, only a winding hallway to a clinic. Turned out that the hospital had shut down the only eye ER in the New York metropolitan area, due to insurance concerns — they were not certified to treat heart attack patients (remember, this was an eyeball ER), and thus couldn’t get coverage. I found myself waiting in line in the crowded clinic, surrounded by mostly older people. I hoped they’d see me before my retina went south. Eventually, I saw a doctor who examined my eyes and reassured me that the issue would pass.

Assuming this clinic was filled with all the great ophthalmologists associated with the hospital, I continued to use it for followup visits to check on my retina. I was puzzled by the fact that at each visit I was assigned a new doctor, and that all the doctors were very young — so young that I wanted to ask them how long they’d been practicing. I didn’t. None of it made sense to me. After imaging my eyes, one of these doctors announced that my optic nerve was thin and “weird.” Yes, weird was the word the doctor used. They prescribed eye drops for glaucoma and told me to return in three months.

The eyedrops made my eyelashes very thick and long and dark, as though I’d covered them with mascara — not a bad side effect. People began to comment. I felt proud of my Elvis Presley eyes.

After three months I returned to the clinic, to yet another new doctor, who told me that, after all, he wasn’t sure I had glaucoma. I had none of the vision or eye pressure symptoms that usually accompanied the disease. All I had was my “weird” optical nerve. He said he’d keep me on the medicine, just in case. This diagnosis seemed very odd.

Strangely enough, I had recently witnessed a brain surgery for a writing project, standing just over the surgeon’s shoulder as he entered the brain and sucked out a tumor. During that, I’d actually seen what the optic nerve looked like — delicate and tiny, deep inside the brain. I began to wonder what the hell was going on with my own such nerve. How could this clinic have just sent me home with the possibility I had glaucoma, and no further diagnosis other than that my optic nerve was weird. It seemed careless and irresponsible. So I asked the brain surgeon what I should do. This is where I began to learn a lot about modern healthcare and modern America.

The brain surgeon is a famous, very well respected guy, and knows the best doctors in New York. He referred me to a leading neuro-ophthalmologist, who told me the clinic I’d visited was probably not the best place for me to go. What? That’s kind of unsettling, I thought. Hmm. Is that why the waiting room seemed so egalitarian and far from elitist? It turns out that the wealthy and connected in New York go to different doctors than the hoi polloi.¹ This should have been obvious to me long ago, but it wasn’t.²

The neuro-ophthalmologist told me to get examined by a leading retina guy first, and then come see him. Using the neuro-opthalmologist’s name, I easily secured an appointment with the leading retina guy, who was in the same building as the clinic, but also very far away — they didn’t even share the same medical records system, though all of them were under the banner of the same research and teaching hospital. Apparently, the big shots work on their own. He was fantastic, and did a very thorough workup. I must have done five different eyeball tests over the course of two hours before the doctor declared that my retinas were in good shape. He agreed that my optic nerve was unusual. (He did not say “weird.”)

Two days later, the neuro-ophthalmologist did a separate battery of tests. I passed them all, over the course of three hours. He checked my nervous system. He watched me walk. He declared me fit. And then he said that I didn’t have glaucoma and no longer needed to take the eyedrops.

Damn, I thought. There go my beautiful eyelashes. They had done so much to satisfy my vanity as I crossed the bridge into age 65 last week.

I had been thinking about braiding them, but, alas, now I have to bid my eyelashes adieu. Selfie at 65 by Self.

But what a relief to be told I didn’t have a brain tumor. I wasn’t going blind. I was fine, except that my optic nerve was different. It could have been like that forever. No way to know. We would keep our eyes on that, with annual checkups. Otherwise, all good.

Unlike with the clinic, I when I left these leading experts I felt satisfied that I’d received incredible care. And all of it was covered by my AARP Medicare supplement, which had kicked in on the first of the month. I also left the doctor’s office aware that the crowds of people who I had once shared the waiting room with at the clinic were no longer part of my medical orbit. And that was strange. I’d used my connections to get ahead. I’d gotten better care because I knew someone who knew someone. And I had good insurance because I could afford to pay for the supplement (I’ve been surprised by how expensive “free” Medicare is — anyone who is turning 65 soon, and needs some advice, just reach out. Still, it’s great insurance if you can afford it.)

I hope my next decades are not filled with doctor visits. These long appointments filled with tests wore me out so much that I didn’t feel like working after them. Rather, I felt like indulging in creme crème brûlée, which I did after my final appointment. I hope that our country gets its act together regarding health care. The system we have is ridiculous.

1. As an aside, L. Ron Hubbard, who founded Scientology, believed there was a race of aliens called Hoi Polloi. Now it’s mostly used as a condescending term for the masses. Or maybe the masses are aliens? Who really knows the truth?

2. These revelations about things I should have “seen” years ago become more frequent as I age. I truly was conditioned by growing up in the 60s and 70s, and my worldview sometimes has to be shaken up a bit to see what the reality of America really is.

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From the department of fiction

I wrote and illustrated a novel about some young people in the future who go for an epic wander to find the truth about what’s beyond the wall. It’s called The Lost City of Desire, and you can read the chapters at Everlands. Subscribe for weekly chapter updates and other posts about the writing life.