June 09, 2009

COUNTRY CLUB MEDICINE Posted by Sheila Connolly (Sarah Atwell is perfectly health, thank you very much) Medical care in this country is in a mess, no question, and something from on my own recent experience underlined this for me. I am blessed with good health, so I have had little interaction with the medical community. The only time I've ever spent in a hospital (if you don't count my birth and a couple of days when I was two) was to have a baby. I've never had any major illnesses or injuries. My worst problem is hay fever, and I've been dealing with that most of my life–no big problem. So overall I ask very little from the medical community. I even have excellent insurance coverage, through my husband's employer (the federal government). What's more, I keep myself tuned up: regular check-ups, annual mammograms. I get my teeth cleaned twice a year. I am very lucky and I know it. But since moving to Massachusetts, six years ago, I've had some interesting encounters. Newly arrived, we asked for recommendations for doctors who were accepting new patients–not that many. My husband and I found one we liked. Our first doctor was a great guy, just starting out. Sure, he was young, but he listened to you, knew you by name, asked questions. All good. Sad to say, his medical career was affected when his wife had a debilitating stroke before she was 30. That's not something you factor into your career planning. He kept working (while struggling to find support for his wife at home), and my husband and I followed him through three different practices before he just upped and walked away, we don't know where. The last practice wouldn't say, and suggested a few other general physicians who were accepting new patients. We met. I liked her. Again, she's just starting out. She's Filipino in origin, and female–I don't know if that makes things more difficult for her. But she's upbeat, intelligent, and calls everybody "sweetie." When we first signed on with her, she was working in one of the many group practices associated with our local hospital (not one of the big, important Boston-area hospitals, but perhaps the best in this corner of the state). What we found was that this was for her definitely a "starter" position–the umbrella group parked her in an office in an industrial park, just to see how she did. Apparently it's standard practice for that group. Apparently she did just fine, so after a year or two there they "promoted" her to a better office. And therein lies the tale. Medicine ain't what it used to be, folks. For a start, this office (again, a small group) is located in a new development embedded in a golf course. You know, one of those places that tries to look like an old-timey town? There's a bank, an art gallery, a flower shop, and a dynamite café with excellent croissants. The doctors' offices are discreetly nestled upstairs, with a small sign around to the side. Inside, there is sunshine and fresh flowers and pretty views of pine trees (and all the busy gardeners manicuring the green lawns). Okay, she's definitely moved up in the world. The physician's assistant arrived first, clutching a laptop, which she parked in the cradle waiting in the examination room. What, no clip-board, no paper trails, I asked? Nope, she replied, we do it all electronically now. But what if there's a power failure? No problem–we have our own generator. Welcome to the new world. I have to say that the blood pressure thingy (I refuse to try to spell the technical term) was still manual (and my blood pressure is just fine), but she used a cool blood oxygen monitor that clipped on my finger. That was a first. My blood oxygen is good too. Then my doctor arrived, on time (how rare is that?). This was just a check-up, so I reported that, no, I had no new or special problems; yes, I'm still taking all the same medications, and they seem to be working. She listened to my heart and my breathing, but I never took my clothes off. She was out of there within ten minutes, and I left clutching the paperwork to have my blood drawn at some later date. I came away both impressed and troubled. I mean, this looks like a fine practice, and I have no complaints about the medical attention I've received. They report lab results promptly, and refill prescriptions over the phone. The staff is courteous, and the place is immaculate. So why do I feel unsettled? I suppose because it all feels kind of fairy-tale-ish. What is wrong with this picture? Aren't emergency rooms across the country swamped with people with what should be minor ailments, simply because they can't afford health insurance, even for their children? If the emergency rooms are open at all? Maybe it's some lingering Puritan ethic: I'm healthy and I'm insured, so why should I be enjoying this bucolic setting, followed by a cappuccino and pastry? I felt guilty. And I also felt (in hindsight) that maybe the money could be directed to something a bit more useful. This country's medical system needs fixing. It will cost money, but don't we owe it to our citizens (and everybody else) to keep them healthy? We all benefit in the long run. Wouldn't you rather pay for promoting and maintaining good health, than for treating emergency situations that shouldn't have been allowed to go on so long? So let's see if we can get it done. Our President is pushing for this, and maybe if we all get behind it and urge our elected representatives to get behind it, something will happen this time around. * * * A quick update on last week's church fire: the steeple has been removed and is now lying next to the church, but looks to be in surprisingly good condition.
Seduction, Back-Street Abortion, and the Unpunished Guilty Posted by Kate Flora The murder of Dr. Tiller has been much on my mind this week. I expect it has been on many minds. I came of age in the early years of MS magazine, the second wave of the feminist movement (the first having brought us the right to vote and a few other good things) and women's struggles for birth control, the right to seek any job they were qualified for instead of being confined to "HELP WANTED MALE" and "HELP WANTED FEMALE," and the right to own our own names rather than lose them automatically upon marriage. For years, I've been embarrassing my sons by asking their girlfriends how young women on college campuses are dealing with the abortion issue. I've been repeatedly shocked to learn how indifferent they are, how casually they assume that the battle has been won, our rifles stacked in the corner, and that there is no need to even think about such details as access and training. Perhaps now, in the wake of this taking of a life in the name of preserving life, there will be more discussion. More concern. Perhaps women, who now are the majority in most medical schools, will wonder why so many schools are refusing to teach the basics of performing an abortion to their students. Perhaps our daughters, our nieces, our daughters-in-law, the women for whom we fought the battles, will look around and realize that there are issues of particular concern to women, and those issues will not take care of themselves. I heard a doctor on NPR today talking about how she has performed perhaps 30,000 abortions over the course of her medical career, and she has not encountered a single woman who was casual about the process. It isn't something to be casual about. Like marriage, it is not to be embarked upon unadvisedly or lightly. Those friends who have embarked upon it did it with trepidation, deliberation, fear, regret, and a great deal of pain. What I was thinking about today in the car, listening to the stories on NPR, were the revelations about abortions past that I've only learned about recently, as there has finally been enough time past for people to discuss them. Both cases involve young, naive, innocent girls away from home for the first time and at college in the sixties, and older boys--or men--who set out to get them intoxicated and then seduced them. At least one of the seducers was a law student, the other a graduate student, perhaps a medical student--the story does not say. In both cases, their immediate and selfish goals achieved, the men--who had failed to take any precautions about the risks to their prey, the women they'd targeted and seduced--walked away without knowledge, guilt or regret. Even hearing these stories after forty years, I get angry. Part of it is sisterhood. It could have been any of us, naive, innocent, and trusting, unused to drinking and being plied with lethal punch. Part of it is the mystery writer in me, knowing that many times what drives the plot in the present are secrets from the past, or acts committed by someone who believes they've gotten away with it, when suddenly, it rises up to smite them. Part of it is in the thinking that these men have probably never known the pain, disruption of lives, and the subsequent distrust of self and others that their casual, selfish pleasure seeking at the expense of others, wrought. So I sit here in 2009, thinking about how much people are still trying to control others' decisions, and I imagine a terrified young Catholic girl in the late 1960's, seduced and pregnant, calling her big brother for help because she cannot tell their parents. I hear him recount the details, this responsible brother, of using the underground college networks to help him find a doctor who will "help." And I think of the pain and anguish of these young people, and the lasting damage done by one young man's selfishness, and I wonder. Did the men who used those girls to satisfy their momentary lust ever wake up and feel regret at what they did? Would they today, if they knew?

Lorraine Bartlett

Five women, five weekdays, many surprises.

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