Fighter

It’s said that nurses can tell a fighter from a patient who’s given up. And they say fighters often survive, sometimes against long odds. But those who’ve given up often slip away even when they stand a fair chance of making it.

I like to think I’m such a fighter. I’ve been fighting AFib, and it’s been landing some pretty hard blows lately. I’ve been sucker punched, rabbit punched, and had sand tossed in my face. Hey, this mutherfucker fights dirty.

But not as dirty as the medical system. That cocksucker will shake your hand, then kick you in the nuts.

I have two opponents: my heart condition, and the medical system. They’ve both been circling me lately, one armed with a switchblade, and the other with a sock full of rocks.

I got the go-ahead from my worthless PCP to visit my worthless cardiologist again, to consult with him over the possibility of an ablation procedure. But after my previous experience with this highly credentialed stooge, where he ambushed me with a dismissive attitude and incompetent advice, I decided I needed to arm myself.

So I clicked on over to the American College of Cardiology’s website. There I found their Guideline for Management of Patients With Atrial Fibrillation. It was available, free of charge, so I downloaded a PDF version. And I studied the hell out of that complex, technically-worded Guideline, while familiarizing myself with the medical jargon. This way, armed with knowledge, I figured I could show that cardiologist that I knew what was what, and could insist upon proper, guideline-based treatment.

I felt nervous entering the doctor’s office. My cardiologist is a hard case. He’s very arrogant. I hoped I’d be able to stand up to him and fight effectively for my cause, rather than transform into a mewling kitten who gets picked up by the scruff of the neck and thrown out to the wolves.

I puffed myself up and boldly approached the front counter. And then, in an instant, the receptionist whipped out a gravity knife and popped my balloon. She informed me that my appointment had been canceled, due to the doctor having to assist a patient at the emergency room.

I protested. I’d waited weeks, and driven nearly an hour to this appointment. So she told me that the doctor should be back in a few hours if I wanted to wait some more. Nice rope-a-dope, lady. Yeah, wear the patient down. But I wouldn’t be worn down. I’d have to draw on my reserves for this, but I bit the bullet. I told her I’d wait.

Finally, a few hours later, there I sat in the chilly examining room, anticipating action at any second. My stomach churned. My body trembled. Was it from the cold, or the anticipation? That’s the problem when there are lulls in warfare. Anxiety can drive you nuts, because you know all hell can break loose at any moment.

Suddenly I jumped, as Dr. Sherman Tank burst into the room with his cannon blazing. “Sorry I’m late,” he loudly apologized, his tone betraying a hint of irritation. “I was attending to a patient in the ER. I had an ambulance rush me here, so I could see you.”

Huh? I wondered. The hospital is only a hundred yards away. Is this son-of-a-bitch trying to guilt me?

“You’re in normal sinus rhythm,” he sprayed at me like a machine gun, without giving me a chance to say anything. That’s one of his tactics. He talks loudly, quickly and impatiently, without giving me much chance to interject and tell him about my health concerns. “You don’t need to be cardioverted.”

I managed to regain my composure and grabbed my carbine, so that I could plink at this Sherman Tank. “I’m not here to be cardioverted,” I shot back. “I want to discuss ablation.”

His turret whipped around at me, and blasted, “You don’t need ablation! You don’t have AFib! I just told you, you’re in normal sinus rhythm!”

The concussion knocked me across the room. But I staggered to my feet and took unsteady aim again. “Uh . . . uh, yes, but I have recurring episodes of AFib. It’s paroxysmal, and brought on by physical activity. I want ablation so I won’t have fatigue anymore, and so that I can exercise more and be more physically active.”

He lobbed a hand grenade at me. “No, you can’t get fatigue from AFib unless you’re in AFib! If you’re not in AFib, you’re not tired!” Untrue, as many with AFib will attest to. AFib takes a lot out of you, and fatigue can linger well beyond an AFib episode. Besides, I know when I’m tired.

Then the Sherman Tank fragged me with something that was clearly contrary to the Guideline. His Guideline by the way. He’s an FACC, or Fellow of the American College of Cardiology. His FACC colleagues wrote the Guideline. So this was his Guideline. The fake, FACC fuck.

So I hurled a hand grenade back at him, with the protest, “That’s not what it says in your Guideline!”

He puffed up and kicked the grenade back at me, “YOU’RE telling ME what’s in my Guideline?!” Ah, the all-knowing-doctor-is-the-authority tactic. I’m supposed to defer to this fool, no matter what stupid thing he says, because he’s a DOCTOR and cannot be questioned, while I’m just a pissant, ignorant patient.

I had a copy of the Guideline in my arsenal, with relevant passages highlighted in yellow. But before I could whip it out and show him the damning truth, he changed the subject by announcing, “There is no evidence you even have AFib!”

Oh this was even better. Apparently, he had not reviewed my medical record before this skirmish broke out. He had barged into battle unprepared. But I was prepared. I reached into my armory (a file folder) and pulled out three ECG traces from emergency rooms, and let him have it.

There was no denying it. Even his cursory review of the traces clearly demonstrated that I’d been irregularly irregular (an AFib term). These bomb blasts staggered him. Finally he sputtered, “Okay, so you were in AFib then, but you don’t have AFib anymore. Anyway, there’s no cure for AFib.”

He was flailing. He must have realized how illogical he sounded just then. Besides, it’s not even true. There is a cure for AFib. Ablation cures it about 75% of the time.

I had this son-of-a-bitch on the ropes. But before I could move in for the kill, the nimble Dr. Tank beat a hasty retreat. He stormed out of the office while tossing a smoke screen behind him. He hollered to the receptionist, “Refer this patient to Dr. Fubar!”

Great, a new cardiologist. That’s what I needed. At least Dr. Tank was good for something. But later, my insurance plan would intervene and change the referral to a nurse practitioner, leaving me with a new battle on my hands.

I appreciated the referral, at the time, but Dr. Tank offered no explanation as to why I was getting this referral, and he quickly disappeared through a warren of office doors and passageways. I was shaking. The combination of combat and a bad heart left me feeling wounded and weak. It’s not good to excite a heart that has a propensity to go out of rhythm. I just wanted to get the hell out of there and rest my nerves.

I staggered to the elevator and pushed the button for the parking level. But suddenly Dr. Sherman Tank rushed in and joined me. Geez, this was awkward. I was tired of war and out of fight. But there I was standing next to the buttons. And Covid and social distancing, you know. So I politely asked him what level he wanted.

“Oh, where you’re going is good enough,” he blithely replied. Hmm. Is this guy stalking me, I wondered. The doors slid closed as he fixed his bayonet for some mano-a-mano action in close quarters.

He eyed me. “I know my Guideline,” he suddenly jabbed. “And it says what I told you it said.” His voice was authoritarian and patronizing, as if I was a kindergartner needing correction.

Why was he even talking to me about this? Was he as full of shit as I thought he was, and worried I was going to expose him?

I’d had enough of this bullshit. When a warrior tires he either lays down and dies or throws everything he’s got at the enemy. I chose the latter. With all the adrenaline I could muster, I parried his thrust and drove my blade home, declaring, “Sir, I’ve READ the Guideline. I KNOW you don’t know the Guideline.”

He stiffened up. For a fleeting moment I feared he was going to physically attack me in that elevator. But he kept his body still and mouth shut. For the first time, something I said triggered silence in this bastard. Perhaps he’s not accustomed to patients telling him they’ve read the Guideline.

The elevator doors slid open and Dr. Sherman Tank stalked away with a stiff gait and clinched fists. I quickly retreated in the opposite direction. He was younger and athletic, and I figured he could easily whup ass on me. I wanted away from him.

I don’t know who won this battle. I did not get what I wanted, which was a referral for an ablation procedure. Or at least a stress test, or a Holter monitoring. These are two standard, guideline-based tests I’ve never had before, but would have had six months ago if this quack knew and followed the Guideline.

But he apparently didn’t get what he wanted, either. Which I think was for me to back down, shut up, and meekly let him call all the shots with no dissent. I suspect he didn’t like being stood up to by a well-prepared and well-informed patient. And I’m hoping he spent the next week losing sleep, while worrying that I might file a formal complaint against him. I suspect I could devastate him with such a complaint, simply by citing the Guideline he didn’t follow.

But I won’t do that. Instead I’ve chosen the nuclear option. Open Season is coming up, and I’m changing insurance from my HMO to a plan that will allow me to go to any specialist I choose.

With an HMO, you’re stuck with a small selection of specialists, confined within the HMO’s sub-network medical group that you’ve chosen. And often these doctors aren’t, shall I say nicely, the cream of the crop.

But my new insurance plan will allow me to choose from a wide range of cardiologists. If I make a bad choice I’ll figure that out quickly, due to my familiarity with the Guideline they’re entrusted to follow. And then I’ll fire the bastard and choose a new one.

This new insurance plan will cost more, but hey, you get what you pay for.

I’ll have to wait until January before I can see a better doctor. A considerate, competent doctor whom I hope I won’t have to do combat with. And with any luck, my heart will hold out until then. In the meantime I’ll stay in the ring, bloodied but unbowed, and keep duking it out with AFib.

I ain’t gonna let it knock me out. I’m determined. I’m a fighter.

44 comments

  • I hate that people have to fight like this for good care. You have described the feels in every action just as many of us have experienced it. That took courage because just describing it means reliving it. I’m so glad you’re using a different insurance so that you can FIRE THAT CREATURE’S ASS! Jus’ sayin.

    Huggerz. Keep fighting for your best outcome.

    Liked by 1 person

    • Thanks. I think everyone has experienced a doctor like this from time to time. My insurance change won’t be effective until January 1. I’m looking forward to the empowerment that will bring me.

      But in the meantime, I was able to change subnetwork medical groups, and this might result in a referral to a better cardiologist.

      Liked by 1 person

  • A lot of people don’t realize it’s ok to question their doctor, that they should ask questions, and that that’s in their best interest! Doctors are looked upon as gods, and someone who knows everything. Not always true. And I’m a nurse encouraging everyone to always ask questions, and disagree if necessary. I’m here today because I did just that twenty years ago; had I not disagreed and pushed my then doctor I would be six feet under.

    Liked by 3 people

    • Good for you, and I’m glad you’re still here with us. Yes, if something doesn’t seem right, then question it. And do some research. And push.

      This doctor is an Interventional Cardiologist. Meaning, he may be great at treating coronary artery disease, and such, but he doesn’t specialize in arryhthmias. For that, I think I’m better off with an Electrophysiologist, so that’s the kind of cardiologist I’m looking for next.

      Liked by 2 people

  • Wow, you had me swearing at the Dr as I was reading! Good for you in standing up for yourself and not taking his crap! Keep the fighting spirit, we all need you around!
    Very glad that you are getting new insurance and I pray that you will finally get a Dr who isn’t a Quack!
    Hopefully you can get something done before January. I hope you went home and did something to cool off after that stressful visit with your Egotistical Quack!

    Liked by 2 people

  • Good luck, TG! Hopefully no more arrogant asshole doctors to encounter!

    Deb

    Liked by 2 people

  • HMO “Medicine” and institutional Medical Billing were among the first bureaucracies established by the Robot Overlords. Despite carrying my own, pricey and comprehensive insurance, there just isn’t anywhere left to go. My excellent Cardiologist quit and moved off to Texas a couple of years ago, followed in a path of exodus or retirement established by my previous two personal physicians, and just about anyone else who’s ever been granted professional access to my innards (even my dentists!). This year, my only “physical” was the annual, cursory Q&A, ultrasound and blood-suction I get for being a part of a couple of long-term studies. And at that, the university apparently lost my blood samples and Covid test results (I noticed that they weren’t labeled on the spot… a major phlebotomy faux pas).

    I think I’ve mentioned this before, but my dad was a physician (Internal Medicine). He really disliked industrial, “5-minute-appointment-and-two-prescriptions” medical practice. So he maintained a private practice with a team (almost impossible to do anymore), and salved his conscience with gratis and volunteer work. At any rate, he always said that making a proper diagnosis requires a great deal of listening and focusing-in with questions to get feedback. He advised a new doctor, regardless of the discipline, when they didn’t.

    I hope Dr. Fubar works out better than Dr. Tank… but I suspect you’ll get some cross-pollination. Bringing your records with you is good (they’re often difficult if not impossible to find in “cloud” systems). Not to sound so discouraging, but I think US “health care” is in the death throes of a parasitic, corporate profiteering infection.

    Liked by 2 people

    • I’d imagine that living where you live, there aren’t many doctors to choose from. That might be the perfect environment for quacks to hang out their shingles. Little or no competition.

      Not labeling your blood samples seems pretty damn negligent, to me. Maybe this is how some people get misdiagnosed with diseases, while others don’t receive a timely and life-saving diagnosis. Medical practice requires high attention to detail.

      I wish I had a doctor like your dad. But these days, doctors seem intent on entering everything you tell them into a computer. This seems like a distraction, to me, and can interfere with dialogue and careful listening. So does their time limit, which often seems like somewhere around 5 minutes.

      I agree about medical records. I’ve already acquired my records, and will be hand-delivering them to my next medico. And yes, the U.S. healthcare system does seem to be ailing, and I’m sure that following the money would lead to the diagnosis.

      Liked by 1 person

      • I lost my great local doctor many years ago when he retired and moved off to New Zealand. My next doctor (good) was down the hill in the state capital. Alas, he quit doctoring as soon as he had his medical school loans paid-off and opened a private (cash only) consulting practice as a liver specialist. I always liked his very Mormon attitude about avoiding the prescriptions as much as reasonably possible. I got a kick out of a discussion about cholesterol drugs… not at all “tinfoil hat”, either. Since then, I’ve only seen either an available doctor or their Nurse Practitioner… even for my last cardiology referral.

        And yes… not immediately labeling a blood sample is considered a very serious breach of procedure. That’s why I noticed it. I had my blood drawn outdoors due to the Covid situation, and it seemed like the people from the university weren’t all that well prepared. Probably figuring they’d just do it from memory when they went back to… wherever, since I was the only person there. Didn’t exactly inspire confidence in our next generation of medical “professionals”.

        Liked by 1 person

        • I agree with that Mormon doctor about avoiding prescriptions. And he, being a liver specialist, probably understands much of the danger.

          Maybe whichever student took your blood that day, ended up getting an F.

          Liked by 1 person

  • I’m surprised that you didn’t go into a-fib during your confrontation, since stress is often a trigger for it. I’m lucky in that I seem to have a competent cardiologist/electrophysiologist who seems to be current on the latest research on a-fib and is also willing to answer any and all questions I have about the condition and possible treatments…

    Good luck with your new doctor, and I have often thought of switching out of my hmo, but so far, it seems to have worked out well for the past 35 years…

    Liked by 2 people

    • I think the key word is “electrophysiologist.” That’s what you have. My cardiologist is an “Interventional Cardiologist.” He may be dandy at dealing with occluded coronary arteries and such. But I don’t think arrhythmias are his strong suit. Rather than admit that, he’s tried to bullshit me, and I think he got upset when he figured out that I could see through him.

      HMOs are much less expensive, and more convenient, and I’ve used them for years. But when they stop working for you, and you need higher quality care, then it’s time to switch to a PPO. That time, for me, seems to have come.

      Liked by 2 people

  • What an absolute nightmare. Good for you for not backing down. I believe you got him good.
    I’m sorry though that he treated you that way to begin with. I know how it feels and it’s awful. Here’s hoping you get a much better one in the near future.

    Liked by 2 people

    • I know you’ve had your share of crappy doctors, too, along with your battles to fight. I have my fingers crossed, but with any luck I won’t have to put my flack jacket on, with my next cardiologist.

      Liked by 1 person

  • I hope you can get regular again.

    Liked by 1 person

  • Dr. Tank is in bad need of a punch in the face…or a swift kick in the ass. What a pompous motherfucker… “Physician, heal thyself.” I’m so sorry you had to deal with that. The description was great, tho… LOL!

    I told a lady “cardy” that I had rhythm issue and I wanted to know what it was. With very good state insurance at the time, I demanded a heart monitor when she suggested that I was way too young to have some kind of arrhythmia. I had two PACs and one PVC show up and, she still tried to brush it off as “nothing.” “The only treatment is beta blockers.” I refused. I think I told you this but, I have found that magnesium helps a LOT…and I take the seaweed kind.

    I’ve met folks that went into “medicine practice” (the ultimate oxymoron) for the glory & the power of it. Healing patients never occurred to them. I haven’t seen a doctor in over four years, now. If I get in dire straits, either an ER Doc will perform a miracle or…it’s my time. I’m done.

    Liked by 1 person

    • Thanks. Medical issues tend to be boring, so I try to add a little color to my medical posts. But that doctor really was pompous. And arrogant.

      I think your cardy was wrong. Some people start having arrhythmias from a very young age. For reasons not entirely clear, some hearts tend to be prone to them.

      I hope you continue in good health, and won’t have to see an ER doc.

      Like

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