Saturday, May 21, 2016

Colonoscopy: Wet Dog in a Rusty Drainpipe

I’m not sure why this is, but leading into any type of medical procedure, rarely has anyone in my life who’s had the procedure adequately describe it to me.  I’ll get rolling eyes, and “you have no idea” and “the pain was excruciating” … which is helpful, but rarely a detailed description.  I think I did a reasonably good job of describing what it’s like to experience a hernia and then have it operated on.  So I’ll do the same with a colonoscopy, which I had earlier this week.

This is a bridge that most of us will cross.  I imagine there are a few folks who will refuse their doctors when they insist on a routine colonoscopy, whether out of financial concern or disdain for the medical profession.  But most of us will undergo this procedure, probably more than once.  My brother told me that when he had his done a few years ago, the doctor sighed and asked, “Why are you here?”  As if this was some passage from Waiting for Godot.  My doctor sent me, said it was standard procedure for someone my age.  Is there anything wrong with you?  No.  Nothing going on with your bowel movements or digestion?  No.  Trust me, then, if there was something wrong with your colon, you would know it.

I’m not sure where the doctor was going with that.  He was getting paid to perform a routine procedure he had done thousands of times and picked this one time to get existential?  I understand the purpose of a colonoscopy: to determine if you have any minor/malignant polyps or warning signs of cancer.  If there’s nothing wrong with you, you wonder what all the fuss is about.  Then again, have you seen someone suffering from colon cancer?  It’s a ragged way to exit the earth, so I’m all for any procedure that would eradicate that living hell.

The family doctor had been suggesting I get this done for awhile now, kept putting it off, but the time finally came in March.  Made an appointment for the gastroenterology office a few blocks away and went.  Another terrible medical office.  Three doctors working out of it, waiting room filled with worried people, fidgety kids, people acting like their time was infinitely more important than everyone else’s, etc.

There must be a small fortune to be made in being a competent, capable medical assistant … because a majority of workers I encounter in doctors’ front offices tend to put off very negative, troubling vibes, as if every patient is a pain in their ass, nothing is going right, and we’re here for them, as opposed to the other way around.  (This is what makes the family doctor’s office so nice: just him and his wife handling the front desk, so I walk in there with a good head and leave with one.)

Long story short, I wait 30 minutes, get in there, doctor takes my blood pressure, quick checklist of basic medical questions, hernia check, and I’m out of there.  Five minutes, tops.  I think the bill was $290.00.  I know because the medical insurance pinged me at work to say they’d received the bill and I’d eventually be charged $90.00 … despite the deductible being waived and the procedure being completely covered according to my company’s and their literature. 

Don’t get me started.  I’m writing this now, before receiving whatever invoices apply to the actual colonoscopy a few days ago, and I’m dreading that they’re going to try to gouge me again for something that should be completely free.  The only reason the insurance company said I would be charged was because the invoice they received was coded incorrectly (a medically necessary procedure as opposed to a routine check-up), and all the office had to do was re-code.  I don’t know if they have.  Or will.  This is the kind of irritating, needless horseshit you encounter any time you set foot in a medical office … again, a seasoned, intelligent medical assistant must be gold in this environment.

So, an appointment for the procedure is made for mid-May, a long ways off.  I gather colonoscopies are money in the bank for gastroenterologists, a revolving door of patients being forwarded by their family doctors.  Nothing wrong with that.  I arrange to have a neighborhood friend accompany me that day as part of the procedure is being put out cold while the doctor loops a cable/camera through my colon to see if anything is amiss.  Time marches on, mid-May rolls around.

I forgot to mention that the medical office issued me a prescription for the drugs to take the day before the colonoscopy – to purge my digestive system.  The instruction sheet they gave me that day as I left was very strict: procedure Monday at 12:30 pm.  No food after 8:00 am Sunday.  Take two stool softeners at 2:00 pm.  Start drinking formula at 4:00 pm.

I didn’t quite get the “formula” part until I picked up the prescription.  Normally, you go to a drug store counter for a prescription, you’re presented with a small paper bag with your vial of pills.  This time, they pulled out a small shopping bag strangely similar to what my Thai food take-out comes in.  What the hell is in that bag, I thought.  It turned out to be a three-liter plastic jug lined with an inch or two of white powder that was the magic potion.  Can’t even recall the name, but the object was add water to the three-liter line the morning of the big purge, shake, then refrigerate until drinking at 4:00 pm, eight ounces every 10-15 minutes until the jug was empty.

A sure sign that this would be a rough day: that Sunday when I add water to the jug and start shaking, this concoction fizzes up like Alka Seltzer.  Highly carbonated, like a witch’s cauldron bubbling.  Downing a glass of that?  Whatever.  A three-liter jug.  Oh, man.

I could drink liquids after 8:00 am, but I figure if I’ll be downing three liters of that fluid, no need to drink all that much before or after.  As usual, I go to boxing that morning, have a good class, make it back before 2:00, then pop the stool-softener pills.

Nothing.  After about an hour, I feel a bit bloated, but nothing terrible.  4:00 rolls around, and it’s time to start downing the contents of the jug.  By this time, any sign of carbonation has dissipated so the jug is filled with a clear liquid that smells vaguely of Gatorade.  It isn’t that hard going down, like a bland-tasting sports drink.  Doing the math, I realize I’ll be doing this four times an hour until about 7:00.

I think there might be something wrong with me as I’m not dumping by 6:00.  Just a slow-build feeling of bloat.  I didn’t eat much the night before, and only a banana in the morning, figuring it was all going to come out in a very bad way later in the day.

Boy, was I right.  The first movement at 6:30 is explosive diarrhea.  Projectile?  Maybe.  Hard to tell when you’re sitting down.  It blows out hard and fast.  This first time is mostly food-based, standard colored, the kind of thing that would happen if you were ill with a case of the runs.

The next one 20 minutes later is another story.  I had pushed out the food-based contents of my stomach and am now working on that concoction I’d been slow-motion chugging all afternoon.  What comes out now is an orange liquid that feels like hot coffee and has zero solidity, just pure fluid, literally like urinating from my anus.  “Squirting” doesn’t do it justice.  Picture a super soaker as opposed to a squirt gun.

And the smell.  Not like fecal matter at all.  More like a wet dog stranded in a rusty sewage treatment pipe.

Come to think of it, that smell is a good metaphor for how I feel: like a lost, forlorn dog hiding from the rain in an abandoned sewage treatment pipe.  This exercise goes on from about 6:45 until 9:30, every 20 minutes with diminishing, but no less tedious, results.  When you dump like that for hours on end, it sucks the life out of you.  Wiping isn’t a problem: there’s nothing to wipe.  Only remnants of warm, brackish orange fluid.  How the clear fluid turns orange in my system, I don’t want to know.

Are you getting all this down?  Because in the entire colonoscopy process, this is the low point, the night before, after you’ve blown out all the horrible contents from your digestive system.  You’re empty inside.  I didn’t weight myself then, but next morning, I had lost five pounds.  I knew from my weight-loss odyssey that this was an illusion, my system completely void of waste material, which is not a natural condition.  In reality, that was about a two-pound loss with extenuating circumstances.  (Sure enough, a few days later I weigh three pounds heavier.)

After 10:00 that night, I give the toilet a few more shots, but only wind is coming out.  Strangely odorless, too, but no less noisy.  My landlord upstairs must have been hearing and vaguely whiffing snatches of this onslaught through the floorboards and thinking, “Ah, poor Billy, he’s not doing so well today.”  She wouldn’t have thought I was dumping; she’d have thought I was harboring a wet dog and tormenting him with a vuvuzela.

The next morning, I have a few more windy but uneventful episodes in the bathroom.  There is nothing in my system, a strange feeling.  More than hungry, I’m thirsty, but the instructions state, no intake of any sort after midnight and before the procedure.  I thought I was going to get a ton of stuff done with all this down time, but I didn’t factor in the complete lack of energy that comes with not eating for a day and suffering from mild dehydration.  All I want to do is putz around on the internet, doze and get this thing over with at 12:30.

As instructed, I get over to the office 15 minutes early for paperwork.  My friend is already there, prepared with Kindle and smartphone.  I stand at the front desk for 10 minutes, alone, before anyone deigns to help me.  Just looking at these folks, making eye contact with them: nothing, like I’m not even there.  I know if I sit down, they’re going to miss me completely.  This is bad.

Finally, one of them talks to me, ascertains that I’m there for a 12:30 appointment and gives me a clipboard with three sheets.  Top sheet is a waiver stating that I grant them to right to charge me any necessary amount up to my deductible ($3,000.00 in this case) for medical services not covered by insurance.  Uh, no.  According to my insurance, the deductible is completely waived for this procedure, and I’m not supposed to spend one dime.  I can’t sign this paper.

And I say as much.  It doesn’t devolve into a street fight.  Frankly, it isn’t even that unpleasant.  I just courteously inform them that I can’t sign that sheet because my insurance is completely covering this process, produce an email from my insurance company stating as much, let them peruse it for a few minutes and bicker amongst themselves, make a copy, and have one of them tell me, OK, you don’t have to sign this sheet.

That’s one thing.  This whole time, there’s a guy standing next to me who has just come in, and he’s at a low boil.  Surely around my age, working guy in jeans and windbreaker with his company name, baseball hat, probably on his lunch hour.  Not angry because I’m in front of him, but because he’s there to pay a $1,000.00 anesthesiologist invoice that he didn’t see coming.  He’s pissed, and predicting bad tidings for me.  “Just you wait and see, buddy,” he barks, “they’re going to tag you the same way they tagged me.”

Son of a bitch.  I’m a patient, minutes away from a medical procedure where I’ll be out cold with a cable shoved up my ass … and I’m being made to feel uncomfortable and paranoid by staff and fellow patients?  What is it with this place?  The waiting room should be a comfort zone where you’re acknowledged and made to feel reassured that all will go well.  I’m seconds from bolting out the door! 

Just then another medical assistant pops through the door, “William Rep-suh-her?”  The cherry on top: my name being mis-pronounced!  But at least my presence is being acknowledged.  “William, where have you been?  We’re waiting for you!”

Like I have any other choice but to hassle with your front-desk staff over signing away my rights to dispute any costly clerical errors they’re sure to make!

I’ll say this after experiencing it a few times: the front desk experience is one thing, but usually when you meet the medical staff, all goes well.  This is what happens.  The woman takes me to a small room with a toilet, hands me paper booties, paper chest covering with arm holes, and the kicker, a paper skirt that looks like something from a grade-school hula dance party.  I guess it gives the doctor the option of rolling it up or just ripping it off my naked body.  She leaves me be, tells me the other door leads to the operating room and to go through when I’m ready.  It feels odd to be naked and only covered with tear-away clothes … my paper kilt.

I get these on and walk through the door.  A chipper guy in his 40’s greets me, Polynesian, putting out a vibe where I’m thinking he might be gay, or a vaguely effeminate straight guy.  It’s him and a woman manning an EKG machine.  I know the doctor’s name is Greek, so I’m assuming he’s the anesthesiologist.  Seconds later he has me on my back on the twin-size bed in the room.  This is much more sparse and low-key than the operating room experience with the hernia.  Gets the needle in the back of my left hand for the anesthesia to follow.   I glance at the EKG machine and see my blood pressure is 110 over 70 … amazing with all the shit going on.

As he’s about to administer the anesthesia, he says, “You have such nice eyes.  What color is your hair?”

Man.  I’m about to be knocked out with my ass exposed … and this guy might be flirting with me?!  I gather he’s just being friendly by keeping up the light banter, but my mind is willing to twist everything around to a negative after the typically bad front-office experience.

I wake up the next room over.  Roughly half an hour has passed.  Much like the hernia, the actual procedure is still a mystery to me.  In this case, I’m perfectly happy not to be conscious for an anal probe!  The strange thing for me this time is dreaming, although I can’t remember the dream.  I suspect it involved me being chased by an anaconda through a tunnel.  But I recall my mind racing through some fantastical situation, whereas the hernia surgery, my sleep was deep and blank.

The assistant does the usual things, asks me to sit up when I feel together enough to do so, and asks me questions to see how present I am.  I’m there.  My ass feels fine, which I had been told by numerous people, you don’t limp out of there as if surviving some prison shower rape scenario.  This is pretty lightweight compared to surgery.  I  stand up and leave to get dressed moments later.

I didn’t want to break wind in front of this woman, although she told me it would be perfectly OK to do so.  Apparently when they thread the camera through your colon, it’s easier to pump the colon with air to lightly expand the walls and allow for easier movement.  Thus you’re left with a gassy feeling … wouldn’t be surprised if I had cracked a few rats while I was out cold.  (I suspect the “flatulence humor” angle wears thin after you’ve had a few hundred bare-assed patients break wind in your face!)

But when I get into the room with the toilet, I make sure to sit down and let go with a few particularly loud ones.  Have to!  As per usual, nothing comes out, no foul odor.  I had been worried that there might still be “stuff” up there, but by the same token, it would have been nothing but liquid and easy to discern from substance.  The assistant hasn’t told me anything positive or negative about the results.

So I get dressed and move out to another small examination office to wait for the doctor.  He turns out to be a friendly Greek guy around my age, not dressed like a doctor at all, in jeans and a black polo shirt, maybe I was his last patient before lunch.  But thankfully, he tells me all is well, asks me a small battery of questions about diet and bowel movements, all checked off positively, didn’t find any polyps.  For all the minor fretting I’d done over the past few weeks, it’s all for naught.  As usual, my advice is to trust your body, although I’ve learned as we get older, bad shit is going to creep up on all of us, and I can’t fault doctors for wanting to intercept one particularly awful possibility in terms of colon cancer.

We shake hands, and I go through the operating area door to the front office.  At this point I don’t want to deal with the front desk, as I’m sure any mistakes in billing are going to be made weeks from now.  My friend sees me, says that was fast, I say, let’s get out of here, now.  And so we do.  I stop to say “thank you” to the most beleaguered point-person at the front desk, mostly because I’m in such a good mood that I have a clean bill of health.  She pauses for a moment, clearly not used to patients thanking her, and says, you’re welcome, with a nice smile.  I figure leave a positive thought in their heads, maybe that and the email from my insurance company will encourage them not to gouge me on the billing.  Then again, I suspect my gesture will be a small, forgettable ray of sunshine before the next hurricane of misunderstanding blows through their work area.

There’s a high-end burger place just up the block, so we go there and feast.  Bison burger, large basket of sweet-potato fries and a chocolate milkshake.  I’m not worried about calories and really need an All-American blowout.  It goes down like a death-row inmate’s last request: man, one of the best meals I’ve ever had.  And we talk about Game of Thrones, the crazy family dog who attacks all visitors, what went on behind the curtain, etc.  I’m glad I took a few minutes to break wind back at the office, otherwise I would have added a horn section to the classic rock songs blasting from their sound system.  Not sure how I held it in while eating, but later in the day I’ll break wind intermittently until I go to bed, about the only bad side effect of the whole procedure.  I make sure not to pig out when I get home and only have some yogurt and cherries later in the evening.

The next day at work, I learn that one of my coworkers has fallen from the roof of his house while working on it, breaking his left wrist and sustaining a concussion/nasty gash on his head requiring stitches.  Out for at least a week. He done stole my ass thunder.

That just about describes the process.  In and of itself, not that big a deal (provided nothing is amiss), the real issues are the mind-bending day before, which might best be described as high anal drama, and the firm belief that my inaccurate billing worries are not over.  I’ll be pleasantly surprised if I’m proven wrong.

Monday, May 16, 2016

Powerball Logic

One of my “Mom” memories was her routine insistence on playing some form of the Pennsylvania lottery every day.  Just writing the words “Pennsylvania lottery” – I can hear the little jingle that used those words as the tag line.  I thought the lottery was ludicrous and poked fun at her for playing it, but she was only thinking, “What if I’m one of those people who lock in, and I can provide for my kids in ways beyond my wildest dreams?”

Well, the worm turns, and I find myself playing Powerball once a week.  Every Friday after work, usually after my long walk back to Queens, I’ll hit a corner bodega and pick up one ticket.  Doesn’t make sense to buy 10.  Or pick numbers that bear some personal significance (as Mom did).  The odds against winning are so astronomically high that it makes more sense to me to be purely random.  But people do win: normal people.  When you read their life stories in brief newspaper articles, people just like anyone, working hard, barely getting by, not going to go crazy with the money, get the kids through college in style, maybe buy a new house and car, then take it from there.

It doesn’t make sense to go berserk and start acting like a celebrity.  For one thing, if you’re working or middle class, you’ll be inserting yourself into a socio-economic class that bears little to no resemblance to your world.  You won’t like these folks, and they’ll look down on you.  Think about that should you decide to take your winnings and buy a mansion in one of the pricier zip codes in the country.  Whether it’s old money or people who are insane about making money, all of them will consider you a buffoon who stumbled into tens or hundreds of millions of dollars.  Their lives are predicated on a profound love of money, which controls every aspect of their lives: yours is never having all that much and getting lucky once.  Your wealth is almost an after-thought: their wealth is the reason to live.

All I’ve just written in encapsulated in the 60’s TV series, The Beverly Hillbillies.

Why do I play?  Simply for the infinitesimal possibility of escaping this lousy system we have in place.  That’s probably why I made fun of Mom all those years ago: I was much younger and didn’t quite grasp how foul our socio-economic system is.  Not quite a caste system, but pretty damn near.  And there’s nothing wrong with going about your life, whatever your station may be, and riding it out.  But I’m looking down the road, even with very healthy savings, and realizing that large sum of money, which I couldn’t have imagined myself having when I was 25, would last me maybe five years the way I’m living now, let’s say 10 years if I really clamped down on expenses.  It’s frightening to ponder … thus the concept of stumbling into tens of millions of dollars just for having a slip of paper in my pocket that I bought for $2.00 at the corner bodega doesn’t seem like such a bad concept.  Highly unlikely … but people win all the time.

I’ve heard people expound on the good they could do with that kind of money: the charitable organizations, the socially-responsible business opportunities, etc.  Nice, but I don’t dwell on those concepts at all.  I dwell on ensuring that immediate family members and myself could live well for the rest of our days.  And I could throw a few hundred grand towards friends who deserve and could use that sort of financial boost.  I’m not playing Powerball for the benefit of the world: I’m playing for the potential benefit of my world.  Not in a greedy way either.  In a way that would allow me a better residence, the ability to, say, have a real apartment in New York City instead of living here by the seat of my pants, the ability to travel and rent nice locations for weeks or months in other countries … all sorts of things that people with a lot of money most likely take for granted, or think is perfectly normal.  I’d imagine we all think we’re “normal” based on whatever socio-economic world we dwell in, and there are plenty of people around us to justify that belief.  It would be nice to live in a world with that sort of freedom rich folks have, without doing some of the heinous, soul-destroying, time-consuming people do to obtain that much money.  Or to live on the assumption of continuous, assured wealth the way people living off old money do.

The ironic thing is that I’ve never been overly concerned with money, based on my working-class upbringing, not pining for things I don’t necessarily want or need.  But living in New York now, coming up on 30 years, all I’ve seen here is the cost of living sky-rocket while wages remain flat, and it’s both spooking and bugging the shit out of me.  It’s a genuinely disturbing experience to live through gentrification, to want no part of it, and to have no understanding of why people would want to live so foolishly, dumping a majority of their pay into their rent, or living like college kids in a dorm just so they could surround themselves with what they perceive as a veneer of coolness.  There have been articles recently about the disappearance of the middle class from cities, and I see it happening every day.  I see it happening to myself, the push to make more money simply to live here.  It seems like a slow-moving but never-ending upward spiral.  I can’t stand it but can see it shows no signs of letting up, at least around here.  Move?  I’ve seen what happens in places where this isn’t happening.  The cost of living is considerably lower, but the shitty cost of living vs. wages ratio is just as debilitating as it is here.

So, with all that in mind, it seems like more of a WTF moment to buy a lottery ticket these days.  It’s not the same world Mom was living in when she was making sure she got the TV set on WNEP TV 16 every week night, right before Wheel of Fortune at 7:00, to see if tonight was her night.  (It was never her night, although I think she once won $100 or so with a scratch-off ticket.)  I usually check the Powerball numbers the next morning, no rush.  Even if by some obscene chance I won, I’d spend the next week contacting the handful of people I know who know or are financial planners and map out a path for me to enter this fray and make immediate sense of the winnings.  The concept would be constructing an annual spending grid for the next 30 years after carving out a few large lump sums up front (new house, a car or two, taxes and health insurance going forward, various funding projects to distribute wealth among friends and families).  Figure out ways to make interest on large savings accounts provide for cost-of-living expenses.  All sorts of things that wouldn’t have occurred to me years ago!  If there’s one thing I’ve learned in offices, it’s that you’re not going anywhere without a sound business plan.  And pulling down an eight or nine-digit lottery winning would entail a large, detailed business plan.

It’s fun to imagine this, but in some strange way, it also helps solidify my reality, which isn’t all that bad.  Although, again, I do fret over retirement, about another 20 years from now, and have seen that Social Security in and of itself is pocket money, and that we’ll all need substantial savings to last for two decades, if we’re lucky.  I guess the lottery, ultimately, is a game of mortality, recognizing that it would be wonderful to at least have the knowledge that financial concerns would not be an issue to fear with the aging process.  I can understand why people want to be rich, but suspect their concerns are far more immediate and grandiose.  If anything, I’d try to make myself less visible with that kind of money.  I’ve seen people with a lot of money, and the smart ones ease themselves into background, let the celebrities and business success stories have the limelight.  The real money, that vague 1% we’re all so acutely aware of, most of those people, we don’t have a clue who or where they are.

These are the kind of things I think about when I lay out that money every Friday for the Powerball ticket.  I never put down exactly $2.00.  Usually $5.00.  I want to have singles so I can tip whichever girl is working the counter at the bubble-tea place I frequent before picking up my usual Thai food after the seven-mile walk to Queens.  I think it says something that I’m just as concerned with having tip money as getting that ticket.  Nothing particularly good or bad about my character, just an indication of how I’ve always handled money.