Mom & Me Three Archive

...to the appallingly bad doctor's appointment two weeks ago...thus, I'm feeling much better. Pissing out my feelings here helped. The final touch was discussing it with MCS. Once I've responded I'll, of course, report on my response here.
    So I don't forget, since I don't plan on updating the Daily Tests & Meds site until sometime this weekend, two remembrances:

1. Bowel Movement: 1045; diarrhea, probably from all the jalapeno stuffed olives she ate yesterday (she loves the damned things); no other signs of digestive distress; extremely easy elimination, unusually excellent volume and rigorous clean-up, so rigorous that I accidentally abraised the sensitive skin around her urethra and caused to to bleed a little.
2. Gave her a third 2.5 mg lisinopril tablet tonight. Although not terribly high, her systolic was in the 130's when she went to bed. Diastolic was fine in the low 60's. She was well hydrated when she went to bed, something that has been hard to achieve over the last few days.

    Later.

...over the last couple of days, just saying, "To hell with the non-alternative medical establishment...they cause more health problems than they solve," which in my mother's case has happened at least 50% of the time, and taking it upon myself to put her completely out of medical reach and do what I can to take care of her myself without prescription drugs, without testing procedures, without anything but what I can get my hands on and what I can figure out to do. I'm sure I won't do this but it is a fantasy that I have a feeling is a common one among many people in these United States under our current health care system. The truth is, I doubt that, if I did this, it would make any difference in either the quality or extent of the rest of her life. But, whatever courage it would take to do this, I haven't yet gathered.

...for having allowed posting to languish here. It's been a weird two weeks since my mother's doctor's appointment. My mind has been preoccupied on a sublingual level with the incredible detail of the appointment. I've needed to mull it over, in part in order to respond fairly to it and in part to work through my intellectual and emotional reactions. So I've diverted my attention to other issues, including paying attention to my mother, of course, updating another of my web sites that has languished since November 30 of last year, odd job stuff around the house and yard, you know, the usual, only much more intensely. I think better sublingually when I my conscious mind is enmeshed in other projects.
    First of all, though, let me get this down before I forget: Bowel Movements not recorded (stats, which have been taken pretty regularly, will be recorded later):
July 6, 2005; 1230; excellent volume and consistency, not a difficult elimination but a long session, very easy clean-up.
July 4, 2005; 1145; fair volume, excellent consistency, easy elimination, very easy clean-up.
    There, now I won't forget those. I'll transfer the data later.
    I just read my first short report about our appointment, written, I see, on the evening of the day it happened. It's a good thing I read it. It reminded me that I was upbeat about it even though the appointment was a miserable failure. Since then, because I hadn't wanted to report on it again until I'd managed to work through all the folly connected with it and was ready to write the doctor in question, my upbeat attitude has been shot to hell. That's been the problem. I swear, this appointment has been on my mind every minute of every day since it occurred and I still can't seem to pull myself out of its mud and into the clear pool that I'm sure must rest on top of the mud base. The circumstances of the appointment have been pushing trigger after trigger related to all our previous misadventures in medicine. This time I feel as though I owe it to my effort in caring for my mother as her medical advocate to try to make some sense of the last five years of her medical history, since it's been over those last five years that I have very reluctantly but obviously necessarily been pulled into the position of managing her medical care so that medicine mismanages her as little as possible.
    So, tonight, while lying in bed, all this stuff, this stuff, this stuff, has been roiling in my mind. Words, now, are beginning to come through the mud. Loads of them. Which creates another problem. In order to be effective, I feel, I need to slosh through all those words in all that mud and come up with a succinct presentation for this doctor. It finally occurred to me a couple hours after I'd retired that maybe if I just start throwing the words down here, words containing the detail of the appointment, the connections I'm making with other appointments and medical misadventures, my shock at the detail of this particular appointment, my off-the-cuff reactions, etc., it might help me make some sense of all this before I reapproach the doctor and the clinic. That's what I'll be doing over the next couple of days.
    The doctor and the clinic have both been alerted, once again, previous to the fated appointment and during the appointment, of my web sites regarding my mother that include information of interest to her medical care providers, including this one. I have no idea whether they've yet taken note of these sites. If they have there's a good chance they'll read the dross before I make a firm decision on how to respond, including what to request from the clinic now. Some of the dross may be hard for them to face, especially since it is imperative to me to include all my internal reactions so I can get beyond the reverberations. But, you know, I think they ought to face the stuff I'll be recording here. I hope they access this but if they don't it won't make any difference. My final approach will be well thought out, stern, no doubt, and will carry every expectation I have for their cooperation.
    Anyway, there isn't much I'm going to record tonight. Just the stuff that has been uppermost in my mind since that day:

• My very first aloud reaction to the appointment after it took place happened when I called MCF to alert her that we were on our way to her house: As soon as she picked up the phone I growled and paraphrased Shakespeare, "Let's kill all the doctors!" Funny thing, she didn't laugh. She had to deal with doctors on her elderly father's behalf, who has since died. She knows.
• The one complaint I couldn't stop repeating to everyone to whom I talked over the four or so days after the appointment: "He wasn't prepared! I gave him plenty of material, plenty of time, the office is on summer-dim (that's what happens in Mesa to medical offices who specialize in gerontology in the summer, since many of their clients are in other states escaping the extreme temperatures), it was especially quiet the day we were there and yet he was completely unprepared and totally nonchalant about his lack of preparation!"
• The nurse tried hard to cover for him but she was also unprepared, which was even more of a surprise since we've had her before and I've always respected her abilities and her work on our behalf. She, however, (as was true of the doctor), didn't even realize that a very recent urinalysis had been done. After I'd completely floored the doctor with my shocked reactions to his lack of preparedness and he'd escaped the office, she reentered and asked for a urine sample. "Really? Even though you've got the results from last Friday's monthly urinanalysis?" She halted, dazed, focused on the ceiling, and said, "Oh. Well, I want my own."
• As always seems to happen when my mother visits either a doctor's office or a hospital, within a week my mother had yet another urinary tract infection. This is getting weird, I'll tell you.
• I spent a good deal of the appointment saying to the doctor, "It's in there, you need to read my mother's history," and pointing to her file which he'd brought into the examining room. At one point he motioned toward the file (which is fairly thick but not nearly so thick as many I've seen in that office) and gave me a helpless look as if to say, "But look how much is in it." Although I didn't respond to this, I will never forget it. Doctors insist on all this paperwork in order to have "a history". Aapparently, though, when they need to do a little healing work they don't bother to read the history they've created because it's too cumbersome so they prescribe for more "history".
• I'm especially disappointed that neither were aware of anything in connection with our last appointment in January with The Wondrous FNP. Her notes (which I watched her take) would have explained a lot. The rest, including my intense involvement in my mother's medical care, would have been explained by my updates. It was obvious, though, that neither had read any of that material. The doctor didn't even know why I had brought my mother in, nor was he familiar with any of the objectives for the appointment I'd faxed more than a week previous to the appointment.
• I don't think he was even aware that we commute from Prescott for these appointments.
• At one point toward the end of the appointment, when the doctor was covering himself by bombarding me with "we've got to do this and this and this," I stopped him and said, "We are not going to start over again. There is no reason to. She's got a history. You need to read it."
• I remember telling him that I was amenable to a "do-over" appointment so he could prepare himself, but by that time he was so confounded that he didn't respond to this.

    You may, at this point, if you aren't a regular reader of this journal, why I'm even bothering to try to work my way through to a point where I can coherently continue with this clinic. My extensive experience tells me that because my mother has received an overall high to excellent quality of care through this clinic since 2000, and, too, at this point in U.S. medicine my experience tells me that virtually all medical providers have exactly the same problems this office has, since her history resides here (unread as it is) and despite its recent turnover in employees, it would be silly for me to start looking for another doctor's office before I try to come to a workable understanding with this office.
    Some of the aspects I want to address with this new doctor:

1. My mother is beyond the point where I will allow medicine to blythely use her to gather medical data about aging when that data will do her no good and will cause her unnecessary discomfort.
2. My and my mother's medical goals for her are to not to try to turn back the clock but to see to it that she is allowed to continue to age in relative peace within her unique standard of health and without aggressive treatment unless absolutely necessary, if that aggressive treatment has a high chance of actually improving some of her health situations.
3. I will never again, since the colonoscopy misadventure, allow myself or my mother to be bullied with the the phrase, "But, she'll die!"
4. I am sure that much, if not all, of the analysis, advice and prescriptive treatment to which The Wondrous FNP treated us in January was completely appropriate for my mother and me as her caregiver. I expect adjustments to have to be made but I also feel that the course set at that appointment is the proper medical course which should be continued for the rest of her life.
5. I'm definitely going to pursue a do-over appointment, although I'm going to make it clear that I am not completely happy about having to do this and that the doctor and the clinic need to take responsibility for this happening. My feeling is that my mother (through her insurance carrier, of course) should not be charged for the do-over. I also feel that as long as nothing urgent is happening to her and her life progresses on an even keel the do-over doesn't need to take place for awhile.
6. I'm considering requesting a phone do-over, initiated by the office, with a fully prepared doctor so we can come to a consensus about what is urgent, what is not, what is reasonable and what can be delayed until cooler weather sets in. I intend to make it clear that routine appointments are not an easy matter for us and our willingness to take the difficulties of travel upon ourselves should be respected in exactly the way that The Wondrous FNP respected them in January (a concession, I might add, that I'd never thought to request until The Wondrous FNP voluntarily offered it to us).

    Well, I know all this is a mess. It's a beginning. It will continue over the next few days. Some of it will be pure letting off of steam. Some of it may even be expressed rudely. I'm excited, now, though, having started the search through the mish-mash. This is what I needed to do tonight, this beginning. I'm now ready to sleep, despite that I've probably completely screwed up my plans for later today by staying up so late.
    Tonight was the time to start.