It began with your front office staff deciding I was a public healthcare patient and making me jump through hoops to be seen.
No, wait, that is inaccurate. It began before that, with my being new to Massachusetts trying to find a physician within 70 miles of my home accepting new patients. What I didn’t know was in a state where less than 3% of its residents are uninsured, half of the primary care practices are closed to new patients. This forces the sick person to wait months to get in to see a doctor or to settle for care from poorly managed practices. That is how I came to be your patient – desperation.
Your secretary refused to book my appointment over the phone until I received the packet of new patient forms that, based on your office policy, must be filled out prior to the first office visit. I was told to call back in a week after I got the forms in the mail. I told her I couldn’t wait a week. She repeated it was the policy. To expedite matters, I left work two hours early, made the 30-minute drive to your office, and picked up the paperwork in person.
I walked up two flights of stairs to your medical suite, gripping the railing with each step because my pain made climbing, squatting, running, and walking near impossible at times. I was out of breath with sweat beads along my hairline and nose when I finally reached the check-in window.
I gave your secretary my ID and insurance card. She held them, quizzed me on the spelling of my first and last name, birthdate. Is this your low-tech office policy for detecting fraud? What made me appear suspicious? Why was I deemed high risk for dishonesty? Was it the sight of me standing at her desk, bent slightly at the waist, the pain from an undiagnosed tumor gently stabbing me in the groin?
I was given Medicaid forms. I gave them back, told her a second time I had private insurance, and then pointed to my insurance card still inside the photocopy machine behind her desk. She sneered, rearranged a stack of scattered papers, and shoved the correct forms in my direction.
I returned two days later. It was to be our first meeting. You appeared normal: a portly, middle-aged white man with rosy cheeks and a warm smile. I greeted you with a handshake and my medical history including recent blood test results from the gynecologist confirming I should be prescribed medication for an underactive thyroid.
“Your numbers aren’t all that high,” you chuckled.
My TSH was twice the highest point within normal range.
The lab results also revealed I was anemic. The gynecologist recommended daily slow-release iron. You weren’t convinced. Maybe I had an iron deficiency as a result of a birth defect, you offered.
“From birth, I asked?”
“So you’re saying I could have an iron disease that has gone undiagnosed since birth?”
“Actually, one of your parents, your siblings, and you.”
“How is that possible?” I asked.
“Is your family the type to go to the doctor?”
Don’t you review the forms you require of each new patient? I’d fully mapped out my family medical history for you as stated in the paperwork: Father, deceased, early onset dementia; Mother, 60-something marathon runner in great health; Brothers, healthy, athletic, professional 30-something men with no chronic health conditions; Me, divorced single professional writer and mother of a college-age child.
What about my family profile suggested we didn’t make routine healthcare visits?
We moved on to the reason for my visit.
“Can you describe your pain? Is it sharp or dull?”
“Both. And pressure.”
“All day, especially when I use the bathroom.”
“Are you in pain now?”
“Five on a 10 scale.”
“Do you have hemorrhoids?”
“I don’t know. I’ve never had hemorrhoids.”
You told me to disrobe from the waist down. You returned to the room with a nurse and had me curl into the fetal position on the table. You were clumsy, loud. You stumbled over your words, rushed through it. How were you, a trained physician, more uncomfortable performing a rectal exam than I was receiving one?
You didn’t feel or see anything troubling, but said there was blood in my stool. I asked if I should see a specialist. You mentioned a colorectal surgeon, but it required a referral, and wasn’t that putting the cart before the horse? Your advice was to wait and see how the thyroid medication worked.
I returned to your office six weeks later for a thyroid follow up. You were shocked when I told you I was still in pain.
Again, I asked about a referral. You said it would take weeks and someone would contact me.
That was early April. I contacted your office in May. Your secretary assured me they would get me in as soon as possible. We danced this dance all through the summer until July.
The morning of July 4th, I was driving with my family to the beach for the holiday. The pain and pressure in my groin began to radiate down to my thighs. I had to pull off the highway into a Starbucks parking lot where I reclined my seat and lay in pain waiting for the anti-inflammatory to kick in. After calling the pharmacy to confirm the largest dose of over-the-counter Ibuprofen I could safely consume, I called your office, hysterical with pain, demanding contact information for the surgeon.
Four weeks later, I had my first consultation with the colorectal surgeon. A five-minute exam revealed a visible and palpable mass that should have been detected during the exam you performed 6 months earlier. Within 10 days of my consultation, I had a biopsy, and was diagnosed with anal cancer with nearby lymph node involvement.
You were the first person I thought of after group texting the news to my family. I sat in the lobby of the surgeon’s office, afraid to move, fearing I might pass out. I was wondering if I would live to see my daughter’s college graduation when your cherubic face filled my mind’s eye. I cried. Not because of the cancer, but because I wondered why you decided I was disposable. I have people who love me, I contribute to my community, I do good, I am someone’s daughter, sister, mother, friend. Why were you unable to see me?
You should know I was afraid when I first entered your office in February. When you reviewed my symptoms, conducted an exam, and said there was no cause for concern, I believed you. When you said to take a wait and see approach, I was relieved. I trusted you. I defaulted to your expertise and the letters behind your name.
You denied me months of access to treatment. You delayed me months of access to a cure. You pretended to welcome me into your practice, assessed me, and decided I was not worthy of care and consideration. You didn’t see a link between low iron, abnormal bleeding, and anal pain in a woman without history or the presence of hemorrhoids. You saw a woman without a husband to steer her, a single mother seeking medication for exaggerated or phantom pain, a black body you couldn’t be bothered to examine astutely.
Do I cross your mind? Did you think of me upon receiving my biopsy results from the surgeon? Did you read the word ‘cancer’ and feel the earth’s rotation come to an abrupt halt like I did? Did you fall back into your leather office chair, winded, and count on your fingers the months that passed between our initial meeting and the diagnosis? Did you go home and tell your wife you made a mistake, felt regret?
I think of you. Each day I ride through the halls of the hospital in a wheelchair on the way to radiation, when a nurse or other caregiver asks how long was I in pain before diagnosis, when I stopped going to one of my favorite cafes because it’s across the street from your office and I didn’t want to run into you because I was embarrassed. You made me feel inept and small a year ago. But after surviving chemotherapy surging through my veins and radiation burns scorched into layers of my flesh, I feel twice my normal size.
This morning I had a low-fiber muffin at that cafe near your office and hoped to cross paths with you so I, an angry black woman, could make a scene when I yelled for you to kiss my fat, tumor-free ass.