Archive for December, 2009

Adventures in Health Care-Part 3

The door opened and a young man in a white smock entered the room.  He had a folder of papers in his right hand.  Papers that contained the results of Steven’s biopsies.

We started this odyssey in September when son Steven went for a general physical from his newly assigned primary care doc.  “I’ve got this thing on my back.  It gets irritated by my guitar strap.  And sometimes it bleeds.”  Off to the dermatologist.  “Hmmm, we should remove that mole and have it biopsied.”  It came back “melanoma.”  An advanced one, stage 4.  The internet screamed the dire possibilities.

Steven gets his health care through the Healthy San Francisco  program.  A program for the uninsured.  Only for those who live in San Francisco.  All services to be provided in San Francisco through an array of clinics.  Get sick in Oakland and you’re out of  luck. The bulk of hospital services are provided by San Francisco General Hospital, a county facility.  Visions of Martin Luther King Hospital flashed through my head.  An ER without compassion.  Patients left for dead.  Or worse.

Sweetie and I accompanied Steven to the hospital in mid-October to meet the surgeon who would, we hoped, remove all trace of the invader melanoma.  We found the last space at the top of a six-story parking structure, stowed the car and crossed 23rd street to the main hospital building.  Maybe forty people in line at the first floor pharmacy window.  Waiting for their free meds.  Not a good sign.  We wandered about the third floor searching for the registration desk.  Found it and took our seats in the waiting room.  The walls were lined with notices in multiple languages.  The only one I could read offered the services of a wide array of interpreters.  A good sign.

“Steven Rothenberg” the voice shouted from somewhere down the hall.  Afraid of immediate loss of our appointment if we didn’t respond instantly, we all leaped to our feet and were greeted by a small, friendly faced female.  “Come with me.”  We obeyed.  And we waited in one of those small, windowless examining rooms that after ten minutes makes you believe that you have been forgotten…forever.  But we weren’t.

Dr. Horn became our new, best friend.  A surgeon with a terrific bedside manner.  An oxymoron, but true.  He patiently explained what needed to be done.  Not displaying the pressure of a large patient load, he slowly answered my questions about his background and experience.  A salaried physician on the teaching staff at UCSF.  “I seem to get all the melanoma patients.”  A very good sign.  “You’re lucky”, a nurse told us after Dr. Horn left the room.  “He’s a wonderful surgeon.”  A very good sign.

The surgery wouldn’t be performed for several weeks.  Discomforting because of the popular understanding of the rapid spreading nature of the evil melanoma.  Discomforting because of the time we would have to wait, the uncertainty and the fears.

We returned in early November for the surgery.  Arrived at SF General at 7am.  No parking problems.  Steven checked in and had his body autographed with Sharpie pens delineating the surgery sites.  More suspicious moles were to be removed in addition to the original offender.  Then off on the shuttle bus to UCSF hospital for a nuclear tracer that would identify the lymph nodes that were also to be removed and inspected.  We caught the shuttle back to SF General.  Steven was ushered into the ambulatory surgery suite at noon for the procedures, including general anesthesia, that were scheduled for 1:30.

Five hours had passed since our early morning arrival.  We took our seats in the windowless waiting area.  A TV set hoisted out of reach of adjustment played an array of stuff that I would normally have not watched other than under the threat of bodily harm.  By 4pm I had read all of the magazines we had shlepped with us and half of a 400 page, small print book.  A friendly nurse appeared.  “Would you like to come into the ambulatory suite to see your son?”  Well can you beat that, I thought.  Not bad.  Only 4pm and they’re done.

Only one person at a time is allowed in the surgery suite.  I elected myself as the first visitor while Sweetie waited her turn.  As we walked to the door I asked “How is he doing?”  Nurse Ratched responded oddly.  “He’s not a happy man.”  I entered and found Steven, blue hair bonnet in place, lying on a gurney in the hallway.  “Well you look pretty good after a bout of general anesthesia and multiple stab wounds.”  He was, indeed, not happy.  “I’ve been laying on this gurney for four hours.  I haven’t seen a knife yet.”   I left and relinquished the pole position to his mother.

Five hours later he was recovering from the stab wounds inflicted by Dr. Horn and the twenty-four metal staples that now held his wounds in place.  The good doctor had removed a large chunk of flesh surrounding the melanoma, an assortment of lymph nodes and two more suspicious moles.  Fresh as a daisy at 9pm, Dr. Horn displayed a positive attitude and announced that things had gone well.  “We should get the biopsy results in about five days.”  Following an hour in recovery, we bundled Steven into the car and got home around midnight.  It was a long day.  Longer days and weeks were around the corner.

Three days later, after the usual two-hour wait, we watched Dr. Horn remove the dressing that covered the staples.  “No results yet.”  Five days passed.  Then two weeks.  Then four weeks.  An assortment of horror stories passed through our heads.  We spoke almost daily with Steven.  His disposition was a lot better than ours.  Last Wednesday we loaded ourselves into the car, drove to San Francisco and anxiously awaited the scheduled Thursday visit with Dr. Horn.

Usual routine.  Drive to SF General, find one of the last parking spaces, enter the main hospital building, and wave to our new druggie friends in line at the meds window.  Plunk ourselves down in the waiting room three minutes before our 10:45 appointment.  At 1pm we were still on the wait list.  Kindly nurse Ratched appeared.  “Follow me.”  You bet.

Ila took the little wheeled backless stool normally reserved for a doctor.  After 15 minutes of sitting stoically, she began to wheel about the room.  After 20 minutes she wheeled to the open door of the exam room, stuck her cute head into the hall, and spotted Dr. Horn as he moved from room to room.  “Yoo hoo, we’re here Dr. Horn.”  This movie replayed itself every five minutes.  Until the young man in the white smock with a sheaf of papers entered the room.  The papers announcing the biopsy results.

What seemed like an hour passed while Doctor-To-Be Alekko, a fine-looking boy, told us that he was a third year medical student at UCSF.  Finishing his resume and displaying a yet to be developed bedside manner, he mechanically intoned,  “Steven is fine.  The old melanoma is gone and the margins are clear.”  He went on.  “No evidence of any cancer in the lymph nodes.”  And, blessedly, “The other moles were non-cancerous.”  We showered our relief and gratitude on him.  Somewhat embarrassed, Doctor-To-Be Alekko said “Dr. Horn will be here soon.”  Alekko left and Ila resumed her imitation of a roller derby queen.

Dr. Horn arrived and repeated the biopsy results, but in a way that made you feel that he really believed them, that they weren’t just words on a piece of paper.  “By the way”, he said.   “The reason they took so long was that one of the moles was a bit of an enigma.  We had to send it to the University for another opinion.”  I thought “they must have turned it into a case study for the entire medical school, written a book, and made it into a movie.”

We thanked Dr. Horn for his work and, I hope, made his day.  A funny feeling was shared by the three of us as we left the hospital, crossed to the parking lot, found the car and drove home.  No elation.  Just sort of like air exiting a balloon.  It reminded me of when I watched the election results and the moment that Obama was declared the winner.  After what seemed like years of hoping, we had been rewarded.  Thankful for a wonderful result but no excitement.  Happy that things had turned out as we hoped they would, but no dancing in the streets.  A feeling of comfort after a long journey.

War is hell!

A week ago Sweetie and I shlepped downtown for the 4:30 movie at the Ojai Playhouse.  I love going to the Playhouse.  Since its extensive renovation, my only complaint is that some guy usually opens the men’s room door into my back as I stand in front of the urinal.  Progress sometimes occurs in small steps.

The movie, Afghan Star, chronicled the adventures of five everyday Afghans as they competed for the title “best new singer in Afghanistan.”  Three young men and two young, vibrant women made it to the finals, having been winnowed from hundreds of sometimes comical, sometimes pathetic contestants.  A home-grown TV station sponsored the contest. Votes were cast at each stage of the competition by anyone with a cellphone and a desire to be counted.

The entire country seemed to be caught up in the excitement.  Befitting the political mess in Afghanistan, there was ample opportunity to cajole, threaten and cheat in order to make your favorite singer a winner.  People were glued to TV sets, placards were everywhere, handouts extolling your favorite singer’s virtues littered the landscape.  It was exciting, meaningful, happy.

The camera also captured the sorry state of the country, focusing on bullet holes in what once were attractive buildings, dirty street urchins making a living by recharging car batteries used to power TV sets equipped with home-made antennas and, sadly, the continuing less-than-second-class status of women.  Death seemed to be lurking around every corner.

Yet there was a certain hope that permeated the film.  A hope that things could be different, better.  Flashing back to 1980, a video of an Afghan dance hall highlighted men and women in daring western dress, swinging to rock music, smoking, drinking and looking as happy as our kids did.  Much has changed since then.

I watched and found myself thinking about the war and our part in it.  I thought back to my tirades about the war in Iraq.  How we should have never been there.  How we needed to get out now.  How our then-president had cheated us, let us down, been out of touch with reality.  How I was elated when Obama took over.  How I hoped that we’d all come home.  How it wasn’t our war.  How I hadn’t given much thought to his belief that it was Afghanistan where we were really needed.

Now it’s Obama’s turn in the box and I’m torn.  Why do we need to be there?  The place is a hell hole.  The government is run by crooks.  The country is divided among egotistical warlords.  Religion is taking its toll on human freedoms.  The Taliban are everywhere.  Money needed here at home is being pissed away without meaningful improvement in Afghan lives.  And, worst of all, our kids are being killed along with the poor, unfortunate Afghans.

But then there’s the hope, the possibility of an Afghan Star.



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