Outside Counsel

So last week -- last Thursday morning, at about 3:30-- I woke up with serious abdominal pain. After I ruled out ectopic pregnancy I really wasn't sure what might be the cause, so I vomited for a while, and went to sleep in the back bedroom so my thrashing and moaning wouldn't disturb A. Of course, sleep was not in the picture, and in the morning I told A. that I'd be staying at home in agony. Naturally she wanted to be all helpful and stuff, but she also had a deposition to get to. I told her that if things took a turn I would either call her or die. I didn't die, although there were moments when I considered wishing for death's sweet release. Long story short, ER that night, and it was a kidney stone, which they told me I had passed. Friday I felt improved until about midnight, when I was revisited by the tortures of the darned. I'm not going to say that it was the worst pain I've ever experienced, but it was certainly an experience that I would wish upon a very select few people.*
(*Names available on request.)

I'm all better now, thanks, but the experience gave me a glimpse into modern American medical practice that I hadn't had before. The ER at Sister's Hospital, where A decided to take me ("What if I need an abortion?" I moaned) was the usual ER thing. Sisters is on the border of white/black Buffalo, so there was a pleasing demographic mix, and it's not the first choice for trauma, so there was nobody there holding cups of ice with severed pieces in them, which was also nice. They told me to follow up with a urologist, and that's where it started: the next day I got a call from the urology practice they'd recommended. They called me. I wasn't up for taking the call on Friday, but on Monday I checked in, and they gave me an appointment for that afternoon. That sort of alacrity in scheduling struck me as unusual, but if they had an opening I wasn't going to question it, so I made my way out to one of those big medical office buildings that one sees in first ring suburbs-- a fancy new building, with an attractive little coffee shop in the lobby. There were two or three practice groups in the building-- the urology group, an oncology group, and maybe one other, and it didn't occur to me til latter, but I'd be willing to bet that the docs who own the practices likewise own the building in some sort of real estate investment partnership independent from their practices. That nice little coffee shop is a cheery cherry on top of their return-- they rent the practice space to themselves, and get a little bonus every month in the form of the rent from the guy who sells sandwiches to the staff.

The parking lot was jammed. Seriously, I drove around three times to get a spot. When I got out of the elevator I saw why. The entire second floor was divided into two large spaces, on either side of the two elevators. On one side was a large waiting room, filled with sad men whose penises won't even piss any more. On the other side was a big circular reception desk, about the size of a circus ring, with white-coated women taking patient information. There were, I'd say, about a dozen of them. In front of each was an electronic signature pad. In between the waiting room and the desk there was a line with about twenty or so more of the sadly afflicted. It was a daunting picture-- I've walked away from movie lines that long, but it moved along briskly. As we shuffled toward the head of the line more white-coated women bearing clipboards would walk out past us in to the waiting room, call out patient names, and escort them back to the examining area. (Isn't it odd that the way you know who the doctor is today is that it's the person who is not wearing a white coat? )

At the desk you give your insurance information. They had my chart-- they had a copy of my ER discharge. I signed HIPPA stuff, and insurance stuff, and the rest electronically-- the reception person told me what it was, and I suppose if I'd cared to read any of it they'd have given me a copy to sit down with, but if that ever happens I'd fall over from shock. I was given a cup, and directed over to the right, where there were a half dozen lavatories. Inside the lavatories, of course, were more sad old men, struggling to produce urine-- the very reason they were there in the first place. When a room opened up I pissed into the cup, put the cup into the little automat door, returned to the desk and was given a clipboard and some paperwork to play with for a while. I was on the second page when a woman in a white coat who looked a little like Kristin Chenoweth called my name and took me to an examining room. Five minutes latter I was chatting with the doc, who thought the hospitality aspect of my practice sounded cool. He wanted to talk about some of his tourism adventures, so we worked that in with our discussion about kidney stones. My urine had already been analyzed. (There was still some blood, but nothing to get worried about.) We probably spent about 15 minutes together, and probably we spent that much time because we were enjoying our chat. I'm sure it was a happy respite from examining the parade of sad old man penises that comprise most of his day. Outside each of the examining rooms were computer stations, so that each doctor could complete his or her report on the spot. Since we were having such a fine old time talking about Scandinavian travel my guy filled out his while I was standing there. In that time I saw two other doctors writing theirs too, while their patients waited. I was sent to the desk again-- a different quadrant this time-- given a follow-up date, and sent on my merry way.

The whole experience was polite-- even cheerful. The place was clean and brightly lit. Except for the sad old men (and their stoic wives) everyone was attractive and nice. It took less than an hour, but it didn't feel impersonal-- just mind-bendingly efficent. And that's what medical practice is today, I guess. The doc I saw-- very nice guy-- was an employee. Everyone I saw was an employee. It was not at all the way I'd thought an industrialized medical practice would be-- no concrete block walls or metal desks, nothing squalid or depressing, just a big machine for making money. It was completely different from the ER (Florescent lights, linoleum, concrete block walls), or my doctor's cheery little sole practice, or any other medical interaction I've ever had. It sort of reminded me of a casino-- there is a service being delivered, but the chief function of the place is to efficiently make money. Or maybe a better analogy would be some place like the Cheesecake Factory. I've never been, because I see no reason to go to a chain restaurant, but I understand the food is good, and the service is chipper. They have the restaurant experience defined down to the number of steps it takes to take your order, prepare the order and bring you your order-- really, down to the steps it takes to set up the mis en place. From what I have read the experience of a meal at the Cheesecake Factory is very nearly exactly like what one might have at an actual fine dining restaurant, except that as you are having your experience thousands and thousands of people all over the country are having the exact same experience. That's a bit unnerving.