We made it to the second appointment of the day on time. We signed in, and expected to have to wait awhile to be called for the ‘meet the primary care physician’ appointment.
As it happens we were called in right away.
Jerry was weighed and measured (yes, she had to remove and replace here shoes, but I helped her to save time) and we were ushered into a typical examination room.
A nurse came in, introduced herself, and proceeded with the business of blood pressure, temperature, health history, and questions about how and why she happened as a new patient for ‘Dr. Young’ Jerry clearly had robust insurance or we would not have been in the examination room at the Cleveland Clinic or any other place like it, so the question about why Jerry had no particular primary care physician to date seemed reasonable.
Jerry dutifully and patiently answered each question and explained that since she had not been sick, but had been diligent about her routine ‘female exams’ she saw no need to hover around a doctor’s office.
Her personal history revealed that she had been the Director of the municipal probation department and was retired. Prior to that, Jerry had been a Spanish language teacher in the public high school system. (I had always thought it fascinating that she preferred working with convicted criminals rather than high school students.)
While this interviewing was transpiring, I could not help but notice how my highly educated, elegantly spoken relative looked much like a typical homeless person.
Jerry’s sweatshirts were layered three deep and each had frayed edges at the neckline. Her sweat pants had seen better days and looked like they were over do for a wash. The railroad engineer style jean cap she always seemed to wear displayed the same frayed edges as her many shirts. Her footwear was practically new, though, … which only reinforced the homeless look.
I became concerned, not only about her ability to care for herself, but about how she might be treated and cared for by these elitist western medics.
The nurse finished her charting and told us the doctor would be in in just a few minutes.
True to the nurses’ promise, Dr. Young appeared shortly thereafter. She entered the small room, and while closing the door behind her peered at me intently and said, “I know you from somewhere”. I was certain that I had never seen her before.
I mentioned that I was an attorney, and threw out a few suggestions about where we might have crossed paths, mostly so that she would get the right idea, that I was not bringing her a uncared for derelict or ” ‘ner do well” , whom I was finally through neglecting; but, that we were respectable people, whom she would do well to treat accordingly.
While she interviewed Jerry I took in Dr. Young’s over-all look and tone. She was short, quite over weight, hair tightly braided but not carefully styled, casually dressed with no make up or jewelry, young, and a little to informal with my sister, who was probably 40 years older than she.
I began to get irritated again. This day was proving to be quite vexing for me.
Dr. Young finished her preliminary interview and instructed Jerry to entirely disrobe and take a seat on the table. She offered to have a nurse help her get undressed, but I quickly spoke up and said that I would help her. She left the room saying she’d be back in a few to finish her exam.
We began undressing. Jerry, despite her appearance, I realized evidenced an interesting combination of modesty and vanity… another family trait. She babbled on about how she hoped to not have to remove the cap she always wore. It seems she had become self-conscious about her alopecia that was an undisclosed side effect of her glaucoma medicine. She had brought a blue scarf with her, to switch out for the hat, to wear during her exam.
As I removed her shoes (her laces were tied in a knot and then into a bow to prevent unraveling) from her bloated feet, I could feel the dampness in the socks from her feet which had perspired. I then saw that the skin around her lower legs and knees, where the edema was so pronounced, was flaky and caused her legs to look as though they had a bad case of dandruff. As I peeled off the damp socks I noticed that her toes were gnarled and her toe nails looked like there might be a slight fungal infection taking hold.
I felt deeply sad for her state of being, but I kept a poker face so she would not feel more embarrassed than she already was by what time and illness had done to her.
Dr. Young returned as if on cue and the examination began. There ensued the usual palpating thumps around the lymph glands and the listening to of the heart and lungs. She poked the skin around her ankles and shins. She looked into her nose and throat.
While all this examining was going on Dr. Young was asking questions about Jerry’s health history…the same questions that the nurse had previously asked.
Jerry responses revealed, again, that she had enjoyed vibrant health with only a few very minor glitches in her 70 years on earth. She had no children nor had experienced any pregnancies. She’d never broken a bone. She had not suffered from nor been treated for any chronic disease, except for the recent treatments for her age related glaucoma. She had never been over weight. No social diseases, no drinking, no smoking. She’d had the same eye glass prescription for decades.
I cannot go into further detail without revealing private information at this point. But, suffice it to say, the old girl had lived a clean, sober, independent, healthy and respectable life.
She ended most of her answers with the formal “ma’am” traditionally reserved for people for whom you are showing respect.
Dr. Young finally got around to Jerry’s distended abdomen, felt around it a time or two, and asked when she first noticed the growth. Slender Jerry said, ” earlier in the year, but [she] thought [she] was just picking up a little weight and did not think more of it since [her] abdomen area is where [she carries] the few extra pounds [she] might have.
Then Dr. Young asked when she first felt the growth by touch. Jerry replied, ” several months ago, about June”. It was currently early October.
Dr. Young was incredulous and asked again. She got the same answer.
Then Dr. Young said, “How could you have not felt all this before June? It took a lot more time than four months for these tumors to get this big. Are you in denial or something? Why don’t you take better care of yourself?
To add insult to injury she even said it in the tone of voice usually only utilized by impudent, teen-aged girls.
I could feel my mouth drop open and my breathing stop. I saw Jerry’s eye lids begin to flutter. She looked as if she might cry… and then she looked as if she might tell her off. Ultimately, she did neither- and neither did I… but you really could have heard that proverbial pin drop in the room.
Jerry eventually replied, in a tensely even tone of voice, that she was not crazy or neglectful of herself and that, indeed she had only recently become aware, and simultaneously concerned, about the growths and immediately thereafter sought medical attention.
Dr. Young instructed Jerry to get dressed, again offering to have a nurse come in to assist with that matter. I wondered if she did not get it the first time, that I and only I would be helping my sister with such intimacies. I wondered if she really was as dense as she seemed. I simply replied, “No, I will be glad to do it, but thanks anyway.”
Dr. Young explained that Jerry’s tumors rapid growth was cause for concern and that time would be of the essence. She explained further that the tumors were beyond the scope of her practice expertise and that we needed to see a specialist. She carefully and specifically pulled out one business card and handed it to Jerry. She had at least 20 of them in the banded pile she pulled from her pocket. I felt a little left out since she made absolutely no effort to offer me one.
I asked Jerry to give me the card, so as to put it into her folder that I had started for her for just such items. I glanced at the card and noticed that Our MD was also an MBA. The political activist in me found it deeply disturbing that our Doctor was also an official business person.
I wondered if the combination made for her insensitive and rude bed side manner.
We managed to have a civil conversation about getting a referral to an oncologist, and Dr. Young even said she would pull some strings to get us in immediately rather than in several weeks. That did not seem like such an special accommodation to me.
Dr Young then left the room in order to make the arrangements. She returned a few minutes later and told us that she had made an appointment at 7am the next week. Jerry and I both chimed in that a later time would be more convenient since I had to come across town, pick her up, she was slow gong in the morning, especially now, etc., … all the same information that had come out in previous conversation with both her and the nurse.
She threw her pudgy hands up into the air, deeply frowned and exclaimed, “Oh, come on, ya’ll. I don’t have time for this!”
Again, pin drop conditions arose.
We both thanked her for her efforts.
In an effort to neutralize the tension in the room, and since President’s Day was the next day, I thought I would inquire if the doctor had any special plans for the holiday?
I used my very best fake friendly voice. I even smiled.
She quipped, again with the frown, “Hey, I don’t work for the government and we do not get every piddling holiday off here, I’ll be working.”
Then she left the room with no further word.
Later, while we were in the seeming endless corridors leading us back to the parking garage, Jerry exclaimed that she felt that Dr. Young was too familiar with her an how much she resented it when ‘our people’ treat us that way. I agreed and added that I was sorry that I did not speak up about it. I explained that I was trying hard not to come across like the domineering caretaker type, in either of their eyes.
We both agreed that the experience had been disappointing on several levels. I felt confused about when and how to defend her. She was confused about why she was having to have this experience, in general.
In the end, we agreed that it at least felt good to finally be scheduled with an oncologist so that we could get some determinative answers about what this alien thing was that was protruding from her gut and sucking the life out of her.