Swans Commentary » swans.com September 26, 2005  



Managed Care Is Neither


by Michael Yonchenko





(Swans - September 26, 2005)  You can have a great laugh in hospitals. Good medicine aside, I have learned MANAGED CARE, as it is called by the healthcare industry, is neither. And when did healthcare become an industry? To survive the rat-in-a-maze system requires that you be long on patience and short-fused when the cheese is moved to the other end of the labyrinth. As a medical filmmaker I have spent many hours as a casual observer of American healthcare at its best, and worst. I have seen surgical procedures that Robert Heinlein couldn't ever imagine. I have watched heart surgeons perform under breathtaking pressure, concentrating with the ease and confidence of a man playing a good hand of Gin Rummy. I have also watched as health managers run their facilities like a shopping cart with one flat wheel. It can be frustrating to watch, and worse to be part of. At my best, in the worst situations, I try to laugh like hell at what has just happened to me in these daytime nightmares. It feels like I am standing there and thinking, "I had testicles and a wallet a minute ago. That nurse who looks like a Pit Bull with a hangover has just taken all three from me and was gone before I could bleed or ask for change."

It gets better. I was on the table for eight hours having a discectomy. The surgeon came out to catch his breath and talk to my lovely wife Lea. She asked how it was going, expecting a well-considered answer from the man who was rooting around in my neck like a pig nosing for truffles.

"Well, I'm doing ok. A little tired but I can handle it."

Poor man. He won't even get in nine holes today or grab a nurse. Again. These guys scrub for surgery so that they don't leave incriminating fingerprints on the drag-ass tired nurses.

"Doc? Michael? Is he doing okay? Is he tired? Can he handle it? Isn't HE the one with the disease?" Lea knows the drill with doctors. Her belief in the healthcare system can be distilled to a simple philosophy: If you are in big trouble, find a nurse.

This is what I am thinking about as I wait my turn in the local Urgent Care Center. Lea and I have other names for it. Doc-In-The-Box is a favorite but they never ask me if I want fries with my sutures. Michael's Weekend Getaway is used often. My weekend projects are often completed at the Doc-In-The-Box. I get a discount if I go there with a coupon from Black & Decker. Power tools are my weapons of self-destruction. "Laceration, secondary to testosterone poisoning" is how it is entered in my thick income-generating medical file. The ER charge nurse has told Lea to please call ahead and make an appointment whenever I start building something. When I was growing up in Queens the emergency room at Long Island Jewish Hospital was renamed for my father because he paid for it. I was a great contributor to the art of emergency medicine.

I got a raging case of poison oak a few weeks ago. Our Californian property in Sonoma County, North of San Francisco, is overrun with ground squirrels. These rodents look like the cute gray tree squirrels except that they destroy gardens and fruit trees and they are not at all cute. I try to make them understand that it is not nice to fuck with Michael and Lea's fruit trees. My neighbor wonders why I am on my hands and knees talking to an empty hole in the ground. The little shits. They don't listen. I tried to be nice about it. But no. They had to make the unthinkable, thinkable.

I started by setting "humane" traps with no noticeable effect. I ratcheted up my efforts with inhumane traps. They watched, snacking on plums as I wandered our property. I can't use poison because of the risk to our dogs and other harmless and blameless critters.

So I bought a gun. Yep. Yonchenko with a gun. A man with bipolar disorder and serious attention deficit disorder buys a high-powered pellet gun with a scope. I think this falls under the purview of Homeland Security. But it is a high-powered pellet gun...a glorified BB gun. No need to join the NRA.

I've gotten a lot of gas from well-meaning folks who think food grows in cellophane-wrapped packages and who put little hats on their dogs. I hear a lot about how vile a human I am for shooting cute furry critters. I try to tell them that these creatures are rodents. They live with rats, which I have also shot. These animals are seriously interrupting the food chain of our household. What would Willa Cather do? How about Fess Parker? Even Mr. Greenjeans! These people knew what they were doing. If people saw what the squirrels have done to our melons they would understand. Or they should. Listen to me! These are rats with furry tails. They need to be shot. This is what every exterminator and County Ag officer has told me.

So I've been shooting them. And I'm good at it. But Lea is frightened when she sees me stalking around our property, with a rifle at the ready, looking like some guy from a SWAT team. She calls the ER to make the appointment. I've bagged at least 20 to 30 of these little fuckers. Ten more and I can hire myself out as a gamekeeper.

But there has been no significant decrease in their numbers. Little bastards...they're good! Mind you, now I'm getting a little TOO obsessive about this. I started driving my car around the property and connecting a garden hose to the exhaust pipe and pushing the hose down into the squirrel tunnels. It seemed to work well enough that I put a major offensive into motion. I bought over 100 smoke bombs and walked along the creek bed beside our house, clearing brush, and setting off the bombs in any squirrel hole that I found. 100 bombs were not enough. But I spent a day doing this. I was working up a good sweat. Gentleman Farmer Yonchenko. Woman! Bring me a cool refreshing adult beverage! However, I wasn't paying attention to blackberries and poison oak. I was too tough to be concerned with thorned plants. Real hunters focus on their prey. This time the prey was focusing on me.

Cut to the next morning. I look like an overripe tomato. I have poison oak. So much for Mr. Tough Guy.

So I use every imaginable "cure" and treatment I can read about. Except one... Prednisone. This is a very nasty drug, a steroid, with major punch. Docs prescribe it when they have nothing else to try for ANYTHING. Toothache? Give him Prednisone and send him home. Swollen ovaries? Eczema? Split Ends? No problem.

It is used for any dermatologic problem that is getting out of hand. Except the side effects are loss of appetite or increased appetite, itching (go figure), loss of libido or increased libido, and here's the big one: SEVERE MOOD SWINGS!

Oh boy. Just what this bipolar boy needs on a hot summer day: an unchecked, unprovoked outburst of rage. Makes you glad to get up in the morning and run away.

The rashes got so bad that I finally went to the Doc-In-The-Box (no appointment necessary, even for me) for old fashion palliative care and to have a pretty nurse give me all the "there, theres" I can use. When I checked in I quickly discovered that the sudden pain in my ass was not the poison oak but instead the frightening realization that I won the Booby Prize. I was told that everybody was treated on a first-come-first-served basis. This is a warning. I realized these people know nothing about triage, or they have seen me coming and are trying to head-off any "scene" I might create after prolonged waiting. EITHER WAY, I LOSE. I feel like I'm in the medical bullpen with a few other washed-up, dead-armed veterans.

I sit with "Exhausted African-American Mom" and her 10-year-old daughter who has a cough that sounds wetter than Satcho with Tuberculosis. This is not a song you will be able to download for your iPod. I expect a loogie the size of a softball to fly out of her mouth across the room and crack the glass at the receptionist's desk.

Beside her is a "Once-Beautiful Woman." She is graceful and understated in her elegant posture, with open sores all over her legs. Once-Beautiful Woman deserves empathy, sympathy, or a double scotch. She is clearly suffering quietly, with dignity that is becoming harder to muster with each hour she waits to see the doc.

Across from her and next to me is "Obese Woman." She has no discernable ailments. But her muumuu is stuck in the crack of her ass and every time she stands up I get to see her thighs. They look like pasta laced with blue Magic Marker.

In the corner is "Old Latino." He's asleep. He's clearly been here before and knows the game. He can out-wait any of them and get the help he needs. Green Card? No problem...now fix me!

Near me is "Old Bottle-Blond." She sits down next to me on the floor like a 5-year old. She turns on the waiting room TV and tells me that she loves to watch C-SPAN. Foolishly, I ask her if she likes politics. She says, "No. I protest everything." She reeks of cigarettes.

We are a fine group indeed. I look like I'm covered with a paint color system chip in the red category. Pick a shade number, any number. You probably find that color on my ass somewhere. My scratching makes me look like I should be picked up by an Animal Control Officer.

I try to deal with the waiting. I'm not good at this and I have many coping techniques, like counting the holes in the ceiling tiles above me. I also like to look for patterns in the holes. This day I found a bust of Lyndon Johnson wearing Jimmy Durante's hat. When I tire of this I read Positively Fifth Street by James McManus...great reporting of the Poker World Series and the murder of casino operator Teddy Binion. A healthy read for a sick room. Now Old Bottle-Blond gets up from the floor and goes outside to smoke. The 10-year old girl sits down in front of the TV and changes the channel to some cartoons. Old Bottle-Blond returns and sees that she has been aced out of the TV. She explains to the girl, in a loud voice "it's okay." We all listened to her explain it's only fair that the girl got to change the channel because she left the room. OBB goes through this explanation three times, obviously trying to guilt the kid out of the TV. Exhausted African-American Mom is watching quietly. This kid is no chump. She holds her own (and the TV) and OBB gives up. EAAM goes back to her People Magazine.

The room returns to its routine boredom, when a mean-looking dyke busts in through the door and announces that "her friend has slashed her finger open while washing the dishes." "Friend" now enters the room...Tah Dah!!! "I am FRIEND! BOW BEFORE ME! My entrance is always announced by a woman whose every body part is pierced and is wearing a T-shirt that says 'Hey Mister! I have bigger balls than you!'" She probably does, too. Mine shrivel in self-defense. I believe that you can never be too sure about certain situations. The back of her T-shirt says something about the Gay, Lesbian and Transgender Center Bowling Team. This explains the balls. The ladies check in with the nurse and are immediately ushered in. So much for first-come-first-served. Triage lives, or dies as the case may be. Shit! I'm definitely stuck here for the day.

Now "Cowboy/Farmer" enters. He is neatly shaved, wearing a pressed shirt, clean jeans and sheepskin booties (a nice sartorial touch). He is in A LOT of pain, using a cane supporting his bum right leg. He is very polite to the nurse; soft-spoken and considerate of everyone in the room. A true gentleman in the Old West sense. He sits down wincing.

"Dyke" jangles back into the waiting room and gets two cups of water from the cooler and goes back to "Friend."

The tempo begins to pick up. An average looking, young, white-collar-type guy comes in wearing a "Hog Island Oysters" T-shirt. Cool. "Oyster Boy" has good taste. Oyster Boy explains to the admitting nurse that his back is "torn-up" from a... I couldn't hear what happened. He sits down next to me.

OBB goes outside to have another cigarette. Dyke jangles by again for some more water. "Friend" is gonna need Depends if she keeps this up.

It is now time to pay very close attention. The show is moving along and I don't want to lose the thread, the arc of the story... In walks Mouth Breather. Oyster Boy and I play it cool and just listen to the following exchange, verbatim, or as verbatim as I can remember it.

Nurse: Can I help you?
Mouth-breather: I stabbed myself.
N: Where?
MB: At work. (Oyster Boy and I smirk).
N: No. Where on your body?
MB: On my ass. (Giggling begins in the room)
N (who has heard it all and never breaks character): Date of Birth?
MB: I don't have any kids. (Laughing begins).
N: No. What is your birthday?
MB: Oh... (He gives her a date that might be his birthday).
N: Where were you born?
MB: In a hospital. (Nurse now laughs. Oyster Boy and I sit up to play close attention).
MB: Can all you people hear everything I am saying? (This is becoming a fucking sitcom!)
N: OK. Which hospital?
MB: Santa Rosa Memorial.

OBB comes back in. She kicks the Cowboy/Farmer's right leg as she walks past him. He screams and she says, "Sorry mister. You should really be taking something for pain!" (No shit! Except he is too much of a gentleman to say this out loud).

N: When did you stab yourself?
MB: Last week.

Dyke comes out to the trough again. I think she should just carry the entire cooler back into the treatment room. I KNOW she has the balls to do it. It says so on her T-shirt. Oyster Boy looks at her and looks at me. He wants to say something. I look at him and say, "Don't." I'm thinking, "whatever you have in mind, don't say it!"

N: How did it happen?
MB: We was hanging around and I lean up to jump on the fence to sit on it and it had a nail in it and I got it in my ass. (Who the fuck writes this guy's material? Is this the Dukes of Hazard? Deliverance? Is there a NASCAR event nearby?)
N: Why did you wait so long to come in?
MB: I thought I was ok 'cuz I could still ride my Harley. Now it hurts too much to ride.

The 10 year-old girl gets up to go to the bathroom. OBB sits down on the floor and changes the channel back to C-SPAN. The nurse calls my name and I get up. Oyster Boy says goodbye and Dyke comes for more water. I leave a path for her.

I waited another 45 minutes in the exam room to see a doctor. I go on a pissed-off world tour. Do not fuck with me now because I have been to the Valley of Raging Fires and I bought a condo. I step into the middle of the treatment area and announce "I have been waiting on the bed for 45 minutes and I am ready to see any medical professional, regardless of their qualifications, who might be working today." A nurse asks me in a very annoyed tone if she can help me. She has thrown gasoline down into the Valley. I point to the angry looking rash on my arm and ask her "Wanna scratch this for me or do you wanna get a doctor to come look at me?" She says, "He'll be right with you." Sometimes kicking a dog will wake him up. I hate when people kick dogs. I feel like I have been kicked hard and I'm pulling at the choker. I wait another 15 minutes when in walks a pony tailed Doogie Houser. Oh boy. Fresh meat.

Doogie Houser: I'm giving you Prednisone.
MY: No you're not. Did you read my chart?
DH: Have you tried Benadryl?
MY: Did you read my chart? If you had you'd see that I have tried Benadryl cream, spray, and tablets three times a day as directed. I have tried ice. I have tried cool showers. I hate oatmeal so don't recommend an oatmeal bath. I will not be a compliant patient. Non-compliant patients are bad patients. Not good for your win/loss record.
DH: Mr. Yonchenko, I am sorry you had to wait so long but we are not going to be able to help you if you talk to me like this.
MY: Who's "we"?
DH: I am giving you Prednisone. (More Gasoline! More Gasoline!)
MY: No you're not. I won't take Prednisone. If you looked at my chart you would see that I am bipolar. Prednisone is a serious mood-altering drug. Look at my mood now! You'd also see that I have high blood pressure and any systemic steroidal can make me stroke out. So what else you got? I'm talking topical... nothing in the Betamethasone class... nothing over .05% topical steroidals.
DH: Are you a physician?
MY: Want the truth?

DH says nothing. He tells me he will give me a prescription for PREDNISONE!!! I go out to the waiting room. Oyster Boy and Cowboy/Farmer are gone. OBB is watching C-SPAN. Latino is sleeping through all of it. I wonder what happened to the mouth breather. Doogie better not piss him off.

I decided to call my shrink about the Prednisone. He told me to take half the Prednisone that Doogie prescribed. Either that or Lea should grab the dogs and check into a motel for a week. Then, oddly enough, he told me he was leaving town for three weeks. I'll let the Prednisone do its stuff and I told him that he was a real chicken shit. He laughed and told me "that may be, but I'm still leaving town for a vacation." I do love this guy. I'd be dead without him. He doesn't know that I have his cell phone number. I like him so much that I won't call him.

A week of Prednisone, Benadryl, as well as the other stockpile of meds that I take has completely fucked-up my sleep cycle. Do ground squirrels come out at night? Where's my gun?!?

So this is Managed Care. I have managed to spend several days uselessly hunting ground squirrels. I have managed to get poison oak. I have managed to spend another Saturday at the Doc-In-The-Box. I have managed to try Lea's patience once again. Who manages to care?

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About the Author

Michael Yonchenko is an independent media producer and gentleman farmer in Kenwood, California.



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Swans -- ISSN: 1554-4915
URL for this work: http://www.swans.com/library/art11/myonch01.html
Published September 26, 2005