Bump Remover

January 1st, 2009  |  Published in Healthy Indiana Plan

The stiches after my cyst has been removed.

The stiches after my cyst has been removed.

“What’s CR10?” my surgeon asked as he pointed to the t-shirt I had gotten from my volunteer shift at the conference.  “It’s a conference that I went to about prisons,” I replied.  I have this problem where I either explain things too verbosely, or to simply.  This was one of the times where I should have been more specific.  “I think that we should deal with prisoners by putting two people in a cell together and giving them one gun,” offered the surgeon.  Stunned, isn’t exactly the right word, because the surgeon’s response was both a shock and totally expected.  I hate these moments when someone says something that is completely offensive, largely ignorant, representative of so many things that are troubling, but when one also has this overwhelming sense that, in the grand scheme of things, what was said, and any possible response, really don’t matter.  There was a lengthy, awkward silence, an expression of terror on the face of the surgeon, and then he quickly sputtered, “I’m joking, I’m joking.”  I don’t think that he would actually advocate for this kind of plan to reduce prison overcrowding, or that he really thought much at all about such things.   Sadly, his best guess at a joke about prisons said a lot about his reading of what the average person would probably think about incarceration and incarcerated people.  I didn’t want to think about this at the moment and didn’t want to add another item to my queue of hopeless things for humanity, I just wanted him to do a good job of cutting the bump out of the back of my neck.

In general, bedside manner and small talk didn’t seem to be his strong suit. This was fine with me as I’d come to expect perfunctory treatment from healthcare professionals.  I’ve started to expect doctors to be like tech support.  I just want them to get the job done quickly and correctly and to answer my questions and to make me feel like they’re not messing up.  I want a feeling of competence and not neccessarily warm and fuziness.  He started explaining the procedure of removing the cyst, and again, his tone indicated that such explainations were something you learned was important to do in medical school, but not something that he felt was important.  It all sounded reasonable enough to me anyway.  As he had explained, he injected the area around the cyst with a local anesthetic.  I had been offered the choice of this option, or general anesthetic, but chose the shots because it was cheaper and meant that the procedure could be done in his office instead of the hospital.  It was pretty painful, but momentary.  I was surprised at how quickly the drugs took affect and how there wasn’t so much a sense of numbing, but of complete absence of feeling.  As he made his first incisions, it was really strange to anticipate pain and feel nothing, to feel outside of just one part of my body.  All I ever felt was the strange, gentle tugging at my neck.  It was to physical sensation what dream is to memory and at least the feeling was something to focus on.  At one point, I felt a sharp pain as the anesthetic wore of, but after a few more shots, it was back to feelings of gentle tugs.  He said that in many cases, one could just peel the cyst from the surrounding flesh, but in this case, he would have to scrape it.  What did it look like, the inside of the mass that had been slowly growing for the past year or so?  With his description of the extraction, all I could muster was the image of removing the flesh of an avocado from the skin.  This was medically inaccurate, I know, but I couldn’t find a better relation for scraping and peeling.

The whole procedure, or the surgical part, at least, took only 15 minutes.  By then, he had stitched me up and I was out the door, my surgeon scribbling a prescription for antibiotics and hurredly giving me care instructions as we walked down the hall.  Do you have any questions?  No?  Good.  I walked out of the office, murky with its faded carpet and wood paneling, and into the pale midafternoon sun.  I felt off, maybe more for lack of side effects that are so common now (for example, in this case here http://sideeffectsofxarelto.org/xarelto-lawsuits/, one can get worse taking pills to get better!), than for any lingering effects of the surgeons incisions.  It seemed strange for my body to keep going, seemingly undettered by the extraction.

Recently, a few months from having the cyst removed, then the stitches, and the end of the no-swimming period (the cyst’s absence left a hole, the surgeon explained, and with permeable skin you don’t want the hole to fill with water), I’ve gone twice with my friend to visit her grandfather in his nursing home.  Her grandfather, whose exploits as a young man have become family legends that transfix his great-grandchildren with wide eyes and jaws agape when they are retold, is now mostly heavily sedated.  This, I am told, doesn’t have a particular medical purpose, but is instead to make it easier for the staff to deal with the residents, to make them pliable and to soften any emotional outbursts or expressions of discontent.  He swallows akwardly and I wonder if, through his entire body, he feels the disconnection that I felt in the square inch or so of my neck.  I realize that my expectations for my healthcare provider, my pragmatically constricted settling on the doctor as competant technician, are the expectations of a relatively young, relatively healthy person.  For someone facing greater uncertainty with their health, whether because of age or serious illness, I can understand the desire for care that is actually caring and not just fast and relatively error free.  The healthcare needs of different people are very different and healthcare systems, in general, and attempts to address the needs of the uninsured such as the Healthy Indiana Plan in particular, struggle to address this.  At the very least, they can aknowledge these differences with some empathy, but far more is going to be needed.

Becoming a health care consumer, after a few years of being uninsured, I’ve become part of a larger dynamic.  I’m going to the doctor with all the health issues that I had previously ignored.  In states like Massachusetts with healthcare systems that attempt to insure large numbers of the previously uninsured, this has put a heavy load on primary care physicians.  In addition to my cyst, I wanted to try to get rid of a wart on my finger.  I got referred to a dermatologist, but there weren’t any who accepted the Healthy Indiana Plan in Bloomington, so I had to go to Indianapolis and wait for a few months for an appointment.  My appointment ended up being a few days before leaving Indiana for a few weeks for the holidays so time was short and I ended up driving to Indy, having my appointment, and then heading straight back.  The appointment was at the university hospital’s outpatient center and navigating the campus and then the labirynth of the hospital was pretty frustrating.  I liked the doctors though.  I’ll chalk it up to the hosptital being a teaching hospital of the university because they had that laid-back, almost jovial quality that I’ve come to find through the halls of many universities.  It was in stark contrast to the crazy bustle of the hospital and the university.  The doctors were also very happy to take time to answer my questions in some depth, and I wonder if this can also be attributed to the frequent questions that come with being a student or teacher.  It took maybe half an hour to get the wart frozen and to answer my questions and for me to answer theirs and more than three-times that to make the drive up and back.  I’m happy to have been able to see the doctor, but I can’t help but feel like things could have worked more smoothly.

Having not had health insurance for a few years, and having not really used healthcare before that, it’s hard for me to tell whether my experiences are representative of some of the struggles that everyone is having with healthcare or if they’re the result of having only the sparsest health coverage.  In either case, I feel like I need to be more constructive in defining what I would like to have:

  • I want to be able to see doctors in my own community
  • I want to be able to pick from a variety of doctors and I want to have resources available to make informed choices about my doctors.  When most of the people you know don’t have health coverage, it’s hard to get good information through word of mouth.
  • I want a stable set of doctors who accept my health coverage
  • I want to be able to see a doctor within a few weeks, not a few months
  • I want dental coverage in addition to other types of health coverage