i have just established a new relationship with an internist at ucla medical center. in this process of obtaining the primary care physician, i have completely represented myself wrong-- and this was only, eh, partially intentional.
part of the problem was in how the complications in simply being there were tremendously conflicted. i must have appeared very young, as when i did speak, it was labored and precise. one aspect of illness still exists where i refuse to present my own opinion or give out supplemental information which would dramatically change another person's opinion. in the case of this 'meeting' (which was expected to be a routine physical examination, but wasn't much of one) i was simply there. i did not extend *any* information on important health concerns. due to this way that illness functions, it looked like i have quite an involved medical history, but am currently fine. interesting-- considering i didn't suggest i was fine, either.
the last time i was seen in that particular ucla medical suite was ten years ago. my old doctor is gone. apparently my file still states that i have medicare and manage to live off a monthly $600 social security disability payment.
while waiting for this new physician to enter the examination room, i was desperate to pick up my chart and see what it said about my last visit. at the same time, whatever was written down would mean what, exactly? i decided not to care and glanced over it, neither leaning nor lingering my attention. chances are greater i wanted no one else to catch me in anything other than in my state of scripted disinterest.
a referral was listed for the intensive inpatient eating disorders program. arrangements were surreptitiously being made to facilitate my admittance for the following day. i was never presented with the idea, any information, or the referral and had left that appointment agreeing to return the next day to have more blood work done. at that time in my life, inferiority and agoraphobia were profound, which kept me from returning to the clinic. well, obviously the medical center called when i didn't show up. well, obviously i never answered the phone.
it was almost sad to see those notes. they stated i was worth intensive care, and this would have meant that i was 'good' enough to consider calming portions of behavior down. the entire conversation on the drive home from that appointment was rooted in shock. how was it i was still not sick enough to be hospitalized? no one could explain, but understood that validation was extremely important. we always held the idea that the 'validation of severity' would facilitate a change in my perspective in advance of ever having to attend an inpatient program.
granted, we assumed the lack of being hospitalized on the spot was due to medicare, the expense, and in that i was technically an adult. physicians are routinely cautious with how an inpatient experience will effect an adult's independence. also, what would be the point of taking enormous efforts when i wasn't honestly invested and would undoubtedly abandon the program at the first stress?
many 'outpatient' hospitalization referrals (such as 'day treatment programs') constantly fell left and right. these were virtually meaningless to me and spoke of merely one step beyond ordinary. i had started to attend day treatment programs (like, for one day before dropping out) and my family blames their protocol for refueling obsessiveness.
perhaps, to know this information is not 'almost' sad or 'indeed' sad but is another term completely. i have missed a lot of life due to illness and disability... but, have acquired much more life than anyone i know, and this is only due to owning many broken years.
people who have always been well haven't too much of an interest in touching the far out places. they aren't obsessed with which divisions in their lives are restricted. they rarely have an idea to take anything to the absolute end of where it can go for no other reason than 'because it can.' since my health was compromised for an extended period of time, this history of not getting treatment and living in a stuck state is the main reason i insist that when i can get out there, i need to take myself as far as possible.
imagine all of the world i would have never uncovered had i returned to the clinic for the follow up appointment and lab work. those doctors were going to hospitalize me. i wasn't strong then. i wouldn't have fought and certainly could not differentiate between an assumed or true authority. had i spent that summer in the inpatient clinic, i wouldn't be me today. i would have become part of a cohesive safety net; had help returning to and in maintaining gainful employment; would have never found myself in a sick place where i was allowed to become virtually housebound; and...
...how grateful i am right now that this hospitalization never occurred, because i have come to enjoy most of who i am and what i can do.
only because i was ill have i found myself testing limits by jumping out of airplanes... continually blowing the entire wad on foreign investment properties... shooting a machine gun... visiting the most fantastic of places... coming face to face with an enormous golden python while alone in the cambodian jungle. if i had improved right away, i would have had an extremely boring life. only because i was impossibly ineffective do i now demand my own consistent reliability in foreign domains.
i kept thinking about how this new doctor's first impression of me was obviously influenced by the old medical notes. i cared, but didn't care-- somewhat. what did it matter? we only had 10 minutes in an examination room-- he couldn't get to know me even if i articulated myself perfectly. a naked, skinny, 4.0 student on an examination table...
...who now enjoys pissing off small town cambodian mafia... who is also setting up her foreign guesthouses to eventually develop into actual hotels. the impression matters, but not when cultivated by that which undoubtedly cannot grasp full implication. only a portion of me is fragile, but my timid approach with this internist told an entirely different story. i am to return in a few weeks. what i am, and am not, is apt to eventually become evident.
notations in my chart this time will show that body temperature and weight have not, but blood pressure, pulse, and mental health have improved. i would never have had the nerve to predict this. ten years ago, the idea was that i would either be dead now, or at a normal weight, replete with an angry bitterness which constantly labeled ordinary unhappiness as depression.
i felt very fat being in that medical suite. a better translation is that i did not need urgent care and therefore felt 'excessive' to 'waste time' and 'take up space' regardless as to whether or not this was an appointment to establish a physican. i couldn't allow the office visit to function for only an excuse of policy, and so i strategically planned my own evaluation.
i requested he supply me with prescription amphetamines and then accept the position of monitoring my physical health (fail), refer me to someone in the system who was willing to do this (null), or flat out refuse (pass). in order to pass, he was also required to drone on about biochemistry and lowered seizure thresholds.
my file would never suggest amphetamine salts could benefit me, so i recently took the time to justify this request and prove the medicine was previously used in my depression. [AND clerks are reliable idiots, so my prescription history now appears to be, but is not true.] since the appointment was due to formalities in insurance and practitioner, and i had gone through each step to supply ucla with my medical files, it did not appear i was trying to scam anyone or score amphetamines.
well, this doctor didn't know very much about anorexia, but his lack of awareness wasn't offensive. a few pained looks told how he lacked the capacity to even begin to think about how to compute that which he had no idea. he may not be brilliant but did kind of pass the test-- had i received the prescription, i would have never been able to trust his opinion. however, he did supply me with a referral to a psychiatrist who he knew would manage the medicine if i were to insist. is this decidedly different? no, and so he did not fail, but only on a technicality.
i had to hate him most of the day, silently hacking on his physical features and whatnot, and also go through the 'what was i doing having my temperature taken in a crowded nurses station on a random summer afternoon' hysteria before any appreciation could set in. i think it may be easier to talk freely with him next time.
