10 April 2007

Chez les médecins

For the past month and a half or so, I have been idly tracking down a worrisome but vague physical symptom. By tracking down, I mean moving my way through the infrastructure of managed care that is typical of American health care at the dawn of the twenty-first century. As of this moment that involves two consults with my GP, or “primary” physician in the nomenclature of the health care system, or rather what passes for a health care system in the world’s "leading" industrial democracy, a couple of imaging scans (CT and MRI with contrast), a consult with a friendly emigrant neurologist from Romania with a funny leather bag, an amber necklace, and fabulous, richly textured woolen embroidered skirt. My GP ascribed a side effect of a chronic condition; the neurologist, stress. We are waiting on the results of the MRI, which I have a feeling will show nothing more than the CT scan has already demonstrated, which was, in fact, nothing.

I am no stranger to the health care system. I have a serious, but not debilitating, chronic condition that means I have done my time in doctors’ offices and phlebotomist chairs. I am on the Patient Consultancy Council for my health insurance company. I am an intellectual who reads widely on chronic and acute disease and health care issues, and am versed in the descriptive language of doctors and nurses. I am a professor who teaches on the social and cultural impacts of HIV disease, which provides a broad-based understanding of medical and scientific politics, as well as the need for assertive attitudes when confronting the medical establishment, especially the rigamaroles of managed care. I understand how to describe my symptoms for maximum impact, and generally know exactly what to expect when I enter a doctor’s office. I make it a point to remember and greet my nursing staff by name, as they are the front line caregivers so important to efficient care. I am a savvy customer.

And as such, I have had some time to regard, from inside, the health care apparatus that most people only experience through accident or tragedy. I wasn’t always this way, though. I grew up, like most working class Americans, with poor or inadequate health care coverage. I can count on one hand the number of times I saw a doctor before I went away to college. I was in graduate school when I had my first visit to the dentist. As a young boy, I was blessed with good health, good teeth, and good luck: no broken bones, no tragic conditions— an unremarkable youth. The point I would ascribe to change, to transformation, happened the summer before I went away to Prestigious Eastern U. I was working in a paper factory for pin money, really, alongside a line of undocumented women. One morning, I knocked my ankle against a steel cart, and within a week my left foot was swollen and red. Since a visit to the doctor’s was in some senses out of the question, my mother and I ignored it, even as the pain and discomfort increased. My cousin, a Marine, came to visit us the following weekend, took one look at my foot, and demanded we go, in the middle of a July 4th barbecue, to the Emergency Room.

It was a disconcerting visit. I thought, truly, with a rudimentary 19th century foreboding, that they would have to cut my foot off. I was terrified. Instead, they gave me an antibiotic shot and a prescription, a skim treatment for the type of cellulitis it turned out I had acquired, although I survived. However, that moment later understood emotionally (the memory of terror) as well as intellectually (the condition of cellulitis), combined with the stress and trauma of leaving for college, in tandem with an excellent student health care clinic at PU (albeit with a fairly bad reputation among undergraduates), turned me towards a mild hypochondria that increased exponentially in my twenties. Hypochondria, of course, has a bad social reputation: health worriers, health nuts, panic-stricken hysterics going to the doctor for every pimple and bruise, focused on terminal illnesses in place of the flu, the common cold, the knocked knee. A more sophisticated reading is that hypochondriacs steal health care resources and increase health care costs for the vaunted “everybody else,” whoever that is. However, hypochondria and intellectualism is a beast of a different nature: perhaps a similar form, but much more powerful, ultimately, and therefore, more dangerous (alternatively, a blitheness towards one’s health and intellectualism can be occasionally as nefarious, in a strange ossicilation of unresolved consciousness: Ignore the lump, obsess on the tingling, ignore the sudden change, obsess on the slight difference).

My hypochondria has waxed and waned over the years, reaching a peak in my twenties, in the midst of writing the thesis and TAing. I was a regular at the more modest student clinic on my public graduate campus, having one of the largest files there. Shortly before I graduated, I was in the clinic, shooting the shit with a couple of providers and physician-assistants, when we realised it had been nine years to the day since my first visit: an auspicious if curious memorial to my investment in the emotive powers of the modern American health industry. Yes, the emotive support of health care. For if I think of my interaction and relationships with the dozens of doctors, physician assistants, and nurses over the course of the last twenty years, for the most part what I was responding to wasn’t necessarily a set of physical, empirical symptoms, but some deeper desire for reassurance, for care, for attention, not (necessarily) in a crazy narcissistic way but rather in the effort to build an infrastructure around a life, my life, that seemed unanchored and dangerously adrift from the biological family and stable profession in the extended free-floating realm of graduate study.

In other words, in response to being prematurely but completely emancipated from my family subsequent to Prestigious Eastern U., I turned to the medical establishment, not only the tactile one-on-one relationship with health care providers, but the whole shebang: the machine of the health care industry itself. Part of this was obviously feeling comfortable with the peculiar nomenclature and manner of thinking of medical professionals, along with various morbid fascinations with disease and medical history, the reassurance of techne, of imaging, of blood tests. But within the embrace of the institution (which, oddly enough, is mimicked by the vocational dimensions of the academy, perhaps incompletely? Do academics need a Hippocratic oath?), solidified by my chronic condition, which almost as a principle required a heavy investment in a “care team” encompassing everything from endocrinologists to dieticians, one felt an odd, unsettled joy: a mimesis of care. Is it real? Is it permanent? Does it matter?

Today, I had my MRI imaging. The clinic, a new facility near campus, is beautiful: it has a café, friendly white-haired white lady greeters to direct you in the laconic Cold State accent (itself reassuring in a strange, haimische, all-American sort of way), and an actual indoor waterfall. The imaging suite was clean and gorgeous, with a lighted mosaic on the ceiling and NPR on the headphones, above the clanking and gurgling and banging of the machine itself, which feels like descending into the brain of HAL (for the uninitiated, MRIs are notoriously loud). Being a professional, there was no need to retake my images. I remained completely still, focusing on breathing and the radio while the machine reoriented my magnetic field, occasionally interrupted by the reassuring voice of the technician, located behind the glass in the control booth. (A flash of memory: accompanying my grandmother to radiation treatments for her brain cancer when I was 11; it all ended badly, of course, but the memory is not as clean, as fresh, as modern as my own experience in the technological wards of American medicine. Why? Is it because of the disastrous ending? An older, inner city hospital in the seventies? Or was I not perceptive enough, bored and vaguely anxious? Or perhaps overly perceptive? Ultimately, the wisdom of such missions of accompaniment seems shaky).

Afterwards, I was assisted by a friendly gay tech, blond and white with a soul patch, trendy eyeglasses, and smelling vaguely of some commercial "masculine" scent, who escorted me back to the dressing room chatting about crazy MRI mishaps: an errant lighter become impaling object by the magnetic field, a patient who wanted to bring her cell phone into the machine with her. Again, the oddly reassuring but ultimately off-putting soin in the hands of technology and technocrats (strange intimates), to the tune of $2000 a pop. I am lucky now to have a generous insurance plan, with which I can schedule $2000 MRIs and $800 CT scans at the drop of a pin, to be surrounded by fluttering, competent technicians in white coats and shiny, new machines, to confirm diagnoses of nothingness while in other places in this country, perhaps even in Cold City itself, children are dying of simple Staphylococcus aureus infections.

Tonight, Mr. Gordo, unremarkably, accused me of escalating hypochondria. It was impossible to convince him that my current state of health anxiety is, for what it's worth, much better than before. Having a full time job means a lot less time sitting around wondering if your symptoms are nothing or indicative of any number of potentially dangerous conditions. To wit, after my imaging I returned to the office and worked efficiently until 8:00 pm. If anything, my experiences so far, luckily, have demonstrated the limits of the technological wonders of modern medicine: some things and feelings and conditions are unexplainable, and therefore beyond the reach of medicines and treatments and doctors. Just one of those little mysteries. But my hypochondria is both an existential terror, on some essential level, as well as a mechanism for something else, something more integral and emotive. It is a friend, a companion, a permanent aspect of who I am, for better or worse.

And while most people still wrinkle their noses at hypochondria, we live in an increasingly hysterical hypochondriachal state. The Internet and new information technologies have increased the range and scope of medical arcana, now landing in our front rooms and dens. Gone are the days when you actually had to track information down surreptitiously in a bookstore or heaven forbid go to the library. The Internet and medical television dramas have erased the mystery, the exquisite labour of hypochondria, reducing it to banality, to a generalised social malaise of worry in a world where most people still die of simple one-celled bacterial infections and dirty water. I may have hypochondriac tendencies, but at least this isn’t my first time at the rodeo. In comparison to these new amateurs to health anxiety, I may actually even be more “normal,” more balanced, more serene in my embrace of the machine, recognising its power as well as its limitations. The beautiful humming, twirling apparatus of medicine.


Paris said...

Ahh doctors. While my relationship with healthcare providers is probably exponentially more love-hate than yours, I wonder if some level of hypochondria is an inevitable side-effect of chronic conditions. I have had official early-warning symptoms drilled into me, which are complimented by a batter of unofficial ones that I have collected but only the most imminently sensible doctors will acknowledge might be related. So when one sweeps into the exam room, one arrives pre-armed with knowledge about one's condition. In my experience, many doctors dislike that, which fuels the tinges of paranoia necessary for maintaining a chronic instead of acute condition.

GayProf said...

People who live alone are more prone to hypochondria than others . . . Which reminds me, I don't feel well.

In college, I worked for a hospital as a secretary. Nothing could have lowered my estimation of health care more (which wasn't particularly high when I started).

My parents, despite actually having health insurance, almost never took their children to the doctor. I wonder if there is some New-Mexico presumption that is anti-health care (or healthy children).