Last summer, I wrote a post - A Tale of Two Offices - in which I asked all of my blog friends on both sides of the medical fence for advice on what to do about a PCP that quite literally gave me hypertension. I received a load of great advice from so many of you …

… but when it came time to actually following the advice, I simply didn’t have the courage to follow through.

Well, in the span of time between that post, and this one - there have been some serious changes … and although I’ve been reserving this particular type of topic for my private journal rather than my public blog, I thought I would try to fill all of you in on some of the changes, their consequences, and decisions that I’ve finally been cornered into making.

First of all, my nephrologist - who was the only physician I was seeing anymore - quit. The last time I saw him was in November. He had a lady with him when he came into the exam room, which was a first … and I immediately knew that something was up, but I wasn’t prepared for what. People, I do not like to see extra, or unexpected, “warm bodies” in the exam room. It makes me want to remove my own warm body from the scene post haste.

He introduced the lady as a fellow nephrologist, and proceeded to announce that she was his “replacement.”

Replacement???

He continued: “I’m changing jobs.”

Puzzled, I echoed: “Changing jobs?”

“Yes!”

I imagined him selling cars someplace in Portsmouth, and tried hard to shake the image out of my befuddled brain as I asked: “To what?”

“Hospitalist. I’m going to be a hospitalist.”

This from the fellow who was so down on hospitalists less than a year before … who bemoaned the direction primary care was taking, and mentioned on more than one occasion: “I used to run into Dr. A**** at the hospital, but now none of them ever go anymore.”

Yah … tell me about it. My long time readers know how I feel about ending up with a hospitalist …

Generally, this fellow did all of the talking during visits, and I seldom had anything to say besides quietly trying to answer his questions. I certainly had never raised my voice, or lost my cool … or, well, you get the idea. This time, I nearly bellowed: “You’ve got to be kidding!!!”

He looked a little sheepish, and admitted that he’d never liked the idea of hospitalists before, but … yadda yadda … he had some good reasons for doing it. I couldn’t fault him … but I didn’t have to like it.

At the end of the visit, he shook my hand and said: “Come to the cafeteria at ***** hospital, and we’ll have coffee!”

Without batting an eye, I replied: “I’m going to take you up on that.”

A momentary flash of surprise showed me that he hadn’t expected that response. *snicker* Actually, that visit ended up being the one in which we focused on him, and I think I did more talking than I’d ever done since I met him - mostly in the form of questions about his chosen path.

I haven’t done it yet, but a bit later in the spring, I will call him, and try to meet with him. He’d never heard of blogs, but I’d sure like to do a podcast interview about his trade of a successful nephrology practice for a hospitalist’s job, and post it on this blog. I hope he agrees! You’ll know about it if he does. :o)

Just as my (now ex) nephrologist walked out of the room, the lady doctor who’d been with him came over for a handshake, and as she took my hand she actually simpered … I tried to control my eyebrows as they flew to my hairline, and attempted to glue themselves into place. The hand she proffered was limp and cold, and made me want to take her pulse. The though that crossed my mind: “Uh uh … this is not going to happen.”

I didn’t allow the desk to make an appointment for me until I’d had a chance to think things through. I thought of going to see a different nephrologist in the same practice … the one my mother-in-law was seeing. She had bright shiny things to say about him, and he sounded like a good person. However - within a month of my nephrologist announcing his departure, this fine fellow did too. He’s now in Texas, nearer to his family.

That narrowed the field substantially. That left Dr. Simper, and one other fellow who was rarely in the office which is nearer to me. I would have to be willing to drive to Portsmouth to see him, and if there were an emergency, I would probably end up with pot luck.

I was supposed to have my visit in February. It came - and went, and I still hadn’t decided on what to do. Meanwhile, my meds were running out on me … and so were the prescriptions.

Deep breathing exercises, anyone? Believe me, they’re not as effective as they’re cracked up to be.

Last week, I tried to fill the real “workhorse” of my hypertension pills. It was past the final date, and the pharmacy offered to call the nephrologist for a refill. I got a call from the nephrologist’s office … they wouldn’t fill it. I hadn’t been there in February, and as far as they could tell, I wasn’t seeing anyone there anymore. Did I want an appointment with Dr. Simper?

Um, no.

The long and short of it - by the time I hung up, I was no longer even loosely attached to any doc’s offices.

That meant no pill refills. It also meant that the UTI I’d had for the last month or so was going to be around for a while.

I considered calling my old PCP and begging them to refill the hypertension meds, but I knew that if I did, he would insist that I come in. Maybe someday, I’ll spell out all of my reasons for not wanting to do that, but for now you’ll just have to take my word that I can’t fully trust him, and I can’t communicate with him, although as I’ve mentioned before, I like him as a person. I’m not saying I’ll be able to communicate any better with anyone else, although I’ll certainly want to try, but there have been so many miscommunications, and things are now so complicated, that I think both he and I would agree that I should look elsewhere.

Over the week, I took stock of my situation. I have stage 4 kidney failure and a UTI, really wild hypertension that the meds don’t always control - the systolic’s been in the lower 200’s off and on for the last week, a PTH that tends to bounce way up, and then way down, other secondary problems … I’ve slowly run out of my meds … and finally found myself without a physician. None. Nowhere to turn.

This was it. The moment of truth. I was going to have to find a new place to go.

Now for the rough part … warning: I’m going to be a bit “naked” here …

I do not not not do well with the physician/patient venue. Baby, I can get on here and write my heart out, but when it comes to the nose to nose stuff, I’m a wilting lily. The very idea of sitting in front of someone who is focused on me, and trying to be open and upfront about the things he needs to know … are enough to make want to run and hide - or worse. If I can write things down for him, great … but then if I have to be there, in the silent oppressive room, as he reads what I wrote … I’m likely to go ahead and have a stroke right then and there, and save him the trouble of having to deal with my issues.

There’s a reason that I feel like that, and now finally I know what it is. I’ve had an ever growing realization since January 8th of last year. The first part of the Emanon’s Journey blog touches upon it, but doesn’t delve into it. I have one more chapter to write before I get to that subject … it’s what that blog is really all about.

They say that knowledge is power, and I’m sure it is. However, even knowledge needs a handle in order to be useful. You have to know what to do with the things that you realize.

A few days ago, I grabbed my courage in both fists, and called a new physician’s office. They told me that the doctor is accepting new patients, but that there always needs to be a “getting to know you” visit first. The earliest date, they said, was sometime in June. I imagined myself with a painful UTI and no HTN meds until June. I started to explain that I had a few extra issues, but before I could get into it, I panicked and hung up.

In shock at what I’d just done, I stood there quivering, squeezing the poor telephone as if it were a poisonous snake, wondering what to do next. I’m telling you, this sort of thing does not come easy for me. After about half an hour, I made myself call the number again, and go through my list of issues, asking if there were a way to have that initial visit just a bit sooner. Humiliated to the core because of the ridiculous, but uncontrollable, shaking in my voice, I gratefully thanked her when she found me a spot sooner - much sooner.

And so - tomorrow is going to be an extremely busy, stressful day. I have to be at the new physician’s office at 7:30 in the morning. I honestly don’t have a clue of what I’m going to say to him. I’m hoping that I can actually go through with it. I need to go through with it. I know that we’re going to be checking each other out, and I find that as the years go by, it’s harder for me to keep a light exterior and bluff my way through that sort of thing. I can’t help but wonder what he’ll think.

Tomorrow is also my husband’s birthday … and the day I take care of the bills … and I also have a midterm this week. Honey, I’m going to need those HTN meds! *LOL*

If I don’t write about how things went, you’ll know that one of two things happened:

1) They didn’t go well …

2) I chickened out …

Wish me luck, eh?

Posted: Sunday, March 25th, 2007 at 10:43 pm under: Health & Medicine, The Nitty Gritty. Comment Feed (RSS 2.0). Interact: Comment or Trackback.