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.