July 13, 2008

Medical Spite


I normally try to keep on top of my prescriptions. It often takes a few days to get them filled, so I never wait until the last minute, calling in a refill while I still have a week or two left before the pills run out. That’s why I was shocked to poke my finger into the bottle containing my heart medication to find that I only had four pills left.

            Things had been crazy around here with electricians and plasterers, so I guess I hadn’t been paying attention.

            So I picked up the phone and called the pharmacy, thinking it wasn’t a major problem. They usually have the pills on hand, and I’d be able to pick them up the next day. The only thing that worried me was the recorded message informing me that I was out of refills, and so they’d need to contact the doctor to get his okay. Still convinced that everything would get sorted out, I hung up the phone and went about my business.

            Three hours later, the phone rang. It was the pharmacist, informing me that the doctor refused to refill the prescription because I hadn’t been in to see him in over a year.

            “That’s true,” I told the pharmacist. Then I explained that I hadn’t been in to see him for the simple fact that I had no job and no insurance, and so couldn’t afford it.

            “What are we going to do about this, then?” she asked.

            “I . . . don’t know,” I admitted. “It’s quite a pickle—they put me on this medicine, tell me I’ll die if I stop taking it, and now won’t give it to me because I can’t afford an appointment. Way I see it, it’s a particularly vicious form of blackmail.”

            The pharmacist suggested that I call the doctor, explain the situation, and see what we could work out. That seemed reasonable enough, so I looked up the doctor’s phone number.

            It took some doing, but I was eventually patched through to his assistant. I’d dealt with this woman before. While she’d always been fairly decent to me, I also knew that she was grossly overworked and under a great deal of stress. From her tone, it sounded like I’d caught her on a particularly bad day.

            “We can’t authorize a prescription refill because you haven’t been here in over a year,” she said.

            When dealing with people who are clearly having a bad day, I’ve learned that it’s always better to be as friendly as possible. You feed into the bad day, it’ll boomerang on you.

            “Yes, I realize that,” I said, trying to sound pleasant and calm, “but here’s the deal . . . ” Then I gave her the same “no job, no insurance, no money” sob story I’d given the pharmacist. This time it didn’t quite work.

            “So you can afford the drugs, but you can’t afford the doctor’s visit?”

            Well, that’s a little harsh, I thought. What had simply been “overworked” before had quickly slid into the accusatory and snide.

            “Ummm . . . yeah. Yeah, that’s pretty much the gist of it.” I said. “The pills cost twenty-five dollars a pop, and the doctor’s visit costs what, two hundred fifty dollars? That’s, um, kind of a big difference.”

            “Have you even tried to get insurance?”

            This was not what I expected. I’m generally not one to think in terms of class structures, but if you want evidence of a living, breathing American class system, try getting medical care.

            “Yes I have, uh, ma’am,” I said, trying desperately to remain reasonable and friendly. “But do you have any idea how much personal insurance costs these days?”

            “Yes, I do.”

            “Okay then. Then you know that if I could afford that, I’d also be able to afford a doctor visit.”

            There was an angry silence on her end.

            “Here’s the tricky part,” I said, “the doctor put me on these pills, and told me that if I ever stopped taking them that something horrible would happen. Now you won’t let me have them, so what am I supposed to do?” I consciously avoided using the term “blackmail.” Yet it was obvious that my honey-voiced rationality wasn’t exactly doing the trick.

            After some more silence, she finally relented and told me she’d talk to her supervisor to see what could be done. Then she’d call me back.

            Now, this is neither here nor there, but for all the times I’ve been in that office, I’ve never seen any evidence that this woman had a supervisor. But what do I know? I told her that sounded fine, and hung up.

            When the phone rang two hours later, I picked it up with foolish high spirits, assuming everything was taken care of.

            “My supervisor says we won’t authorize a refill until you come in for a check-up,” she spat.

            “Oh,” I said, realizing that I was trapped here, that I had no real choice. “Well then, I guess you might as well schedule an appointment, and in the meantime, I’ll start trying to scrape the money together.”

            I listened as she began to flip furiously through her appointment book, finally choosing an opening three weeks away.

            “Three weeks?” I asked.

            “That’s what I said.” Then she hung up.

            It was okay, I figured (again quite foolishly). So long as I had an appointment, they’d certainly authorize that refill. So I called the pharmacist back and told her that I would be seeing the doctor in three weeks.

            “Okay then,” she said, “I’ll call over there and see about the refill. At the very least, I’m sure they’ll authorize one refill to carry you over until then.”

            Before hanging up, she told me that she’d only call back if there was a problem—that if I didn’t hear anything, I should assume the prescription would be waiting for me the next day.

            The rest of the day passed in relative silence, and I went to sleep that night knowing all was well.

            The next day while out running a few errands, I stopped into the pharmacy, relieved that the ugliness of the previous day was about to be behind me. But when I reached the pick-up counter, the pharmacist saw me and said, “Oh! I’m so sorry I didn’t call back—they won’t authorize anything . . . not even a week’s worth.”

            That’s when I started to laugh. At this point the refusal on the part of the doctor (or his assistant) had nothing to do with policy—it was clearly an act of spite. It wasn’t morphine or OxyContin I was after—it was goddamn heart medicine. This was not just neglectful and uncaring—I’d expect that—this was malicious.

            If you want to toy with the “doctor as evil pusher” analogy, go right ahead, or maybe comment on the contempt doctors feel for those among us who can’t afford insurance. Or maybe you’ll just take it as more simple, sad evidence of how deeply corrupt the medical industry has become (you should’ve seen the endless battery of tests he ran on me when I did have insurance).

            Do what you will. In the meantime, I’ll probably cancel that appointment. And should I have a stroke while eating my breakfast, or my heart explode while I’m looking for light bulbs at the Save on Fifth, you can place the blame squarely on that fucker’s head.


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