Chapter 54: Bidet and the Healthcare Beast

 Chapter 54: Bidet and the Healthcare Beast:

              The evening after I return Spencer and William arrived at my apartment; they were on their way to San Francisco and stopped for rest. The following morning, we stroll through Sugarhouse Park. The Wasatch mountains to the east are gorgeously snow-capped atop a sea of yellow and red deciduous trees, with long shadows cast by the low morning sun. The saturated and saturated colors of the landscape was a palette prepared for painting. Looking at the snowy mountains, I was determined to ski excessively as long as I remained functionally able. Ben, Spencer’s brother, had, in fact, already arranged ways to pull me up several mountains, in case the resorts had poor snow and I lacked the stamina for hiking, just so that we could ski together. Again, I’m reminded how great my friends are.

              When we return to my apartment, Spencer loudly announces, “I’m going to go bidet myself!” He runs into the restroom. What follows is a complex symphony of screaming, and giggling. When he exits, he’s followed by a powerful miasma of colonic content. We force him to turn on the fan and light a candle. Apparently, the deodorizer in the bidet was not enough. He then announces that the bidet was very nice, but that he pressed all the buttons and that the “strong mode” was shocking. He also mentioned that the heated seat was wonderful. Next, William decided next that he wanted to try the bidet. Again, more stifled screams and giggling. Apparently, he was so surprised by the “strong” mode that he stood up and got sprayed. Obviously, we decided that everyone should have a bidet. Spencer and William leave early the following morning, and so we say goodbyes before bed.

              The next morning, I have a neuro-ophthalmology appointment to investigate my visual deficit. After 4 redundant and inefficient hours, they finally map my visual fields. The map confirms my basic suspicions: the whole left side is affected, with mild sparing of inner upper left quadrant. I was signed up for driving occupational therapy to objectively monitor if I could effectively use compensating strategies to drive safely. The driving OT went strikingly well, and I was told I should be able to drive without restrictions. I felt a confident renewal of my independence.

Physicians often need to have conversations with patients about driving, for obvious public health and safety reasons. I regret not taking these conversations more seriously when I was practicing. Driving is a deeply dignifying task that exudes independence in a way that other activities cannot. Driving is additionally baked into the shared American Mythos and identity. We stop a patient from driving, and we take away their sense of nationality and personal dignity; it’s a big deal and the paternalistic overtones infantilize the patient. I’m certainly not advocating letting unsafe persons drive, but I am saying that the conversation is more layered and meaningful than the surface-level, functional conversations that often occur.

              A most aggravating part of being diagnosed with terminal cancer was the shift in priorities. My schedule became dictated and structured by appointments or therapies; some would occasionally change suddenly without warning. While most visits shared the same electronic medical record, all invariably required the same medical and personal information paperwork to be redundantly completed by hand ad nauseum. I open my chart on my phone and immediately see the same information I was presently writing. There had to be a litigious reason. Apparently, certain elements needed to be documented for each new or returning patient visit for billing purposes. Like most Kafkaesque inconveniences, these were products of bureaucracy and billing. As a patient, I’ve come to understand how many people can feel abandoned by their doctor or lost in the health-care system: money is opaquely of primary import to the system and to the patient. Costs seem to increase, while patients’ time is increasingly occupied by redundant paperwork.

 The doctor and clinic staff are the most patient facing and receive the bulk of complaints and active frustration. But they have no control over this Kafkaesque nightmare. Insurance and administrators are poised to profit from persons’ sickness and misery, and unwittingly create systems that prioritize cash over care. The system needs to change, but nucleation of that solution will not come from these patient-facing employees. And so, I chose not to be visibly upset at staff when presented with excessive documentation or must spend hours with no relation to my care in sterile clinic rooms.

Our healthcare system is for-profit. As a patient, it becomes quickly obvious that the chance for profit is more important than my care. Standard care: “Do you want to try this? Insurance might not pay, but you might be able to get a financial discount through the company. You need to fill out this financial paperwork.” Then an unexpected bill comes, and I must do it all over again. Some physicians will tout the clinical trial system as a way for patients to get access to novel medications without large expense. But eligibility in a trial depends on a prediction of positive results, and so the sickest and most destitute patients are preemptively cut or are unable to afford travel to join many trials. The clinical trial system is really designed to produce new and profitable medications that can be sold for millions to billions of dollars.

And hospitals in general abuse a free labor pool. Hospitals are paid approximately $150k per resident per year. In general, residents receive $50-70k; the rest is used for “graduate medical education.”However, it’s patently obvious that $80k is not spent per year per resident to present last year’s PowerPoints, or to assign topics to residents to teach other residents. Residents work at least 60 hours per week, and often 80 or more. They perform a job for which the hospital would have to pay a midlevel or fully licensed physician hundreds of thousands of dollars per year. So, residents are essentially free and come with bonus money for the hospital. Thankfully, the University of Utah generally treats residents well, especially given the recent pandemic conditions. However, friends at other medical programs have been forced to work as nurses or phlebotomists on COVID units and to put in hundreds of hours of extra time working on COVID units. All unpaid. So where is all that money going? Hospital administrators, insurance companies, and pharmaceutical industries. What better time to make money than during a pandemic? Some argue that without a capitalist, profiteering healthcare system, research innovations and advances become uninspired and cease. Yes, I would love for a miracle cure for myself to be developed, but not at the expense of thousands of hours of life from untreated illness due to poverty and care-access issues. The benefits of our “quick care” and “unique treatments” come at the expense of lower socioeconomic persons losing access to healthcare altogether. We must acknowledge that we’re trading “less-valued” persons for the health and comfort of “well-valued” people. It’s a form of gentrification and it’s visibly appalling.