Friday, October 07, 2005

People Watching at the Doctor's Office

Over the past two days, I have spent nearly 5 hours in doctors' offices -- mostly in waiting rooms.. During the time I spent waiting . . . and waiting . . . . and waiting . . . . I observed people contemplated a few of the circumstances in their lives, which were in evidence. In many cases, I was moved to compassion for them, and found myself frustrated that I couldn't do something for them. I wanted to help them through their challenges. In the end, I found myself offering prayers in their behalf, because I didn't know what else I could do.

My first doctor's office visit was to my internist. I waited about 45 minutes to be taken back into the examination room. I took a seat directly across the room from the entrance door. I could plainly see everyone who came in through the door. The waiting room was not that large, and even though I hadn't planned it this way, I could hear the conversations between the receptionist and those who came up to her desk. There was a TV that was turned on in the room -- to one of those CNN health type channels - scintillating TV to be sure, but something to break up the silence, and to provide a little white noise. Actually I found the drone of the TV to be nap-inducing.

Wheelchair Grandma
Shortly after I arrived an elderly, wheelchair-bound, woman was pushed into the waiting room by her companion. The elderly lady, I would estimate, was in her late 80's, or early 90's. You could tell that the years had taken their toll on her. There was a fogginess to her eyes, perhaps cataracts. Her hearing was impaired. Obviously it was hard for her to get around, since she remained in the wheelchair the entire time I saw her. Despite her aged condition, she had a sweet countenance about her. I got the impression that this woman had served faithfully and well. I imagined that she had lovingly given of herself to others throughout her life. She had a smile on her face, even if she wasn't always fully aware of her surroundings.

Her companion, I believe, was her daughter, some 20 to 30 years her junior. There was a certain family resemblance between the two of them. The daughter was inspiring also. She so carefully, and lovingly looked after her aged mother. She took care of all the business for her mother at the receptionists desk. She kindly and patiently answered questions that her mother had in a most reassuring way. She lovingly ask questions, and pointed things out to her mother. When questions were asked by the staff, the daughter would make eye contact with her mother, and speak slowly and a little extra loudly so that her mother could not only hear, but also so that she could read her lips. It was clear that the daughter really cared for her mother. She was so patient and so kind with her, even though now her mother was old and infirm. What a great example of care and loving kindness she set. I would not be surprised to learn if the grandma, now in the wheelchair, had not done this herself for her own mother years before. Now her daughter is following the example possible set years before. That is how it should be.

I could imagine that the daughter's service was not limited to taking her mother to the doctor's office. I imagine that she would need help with feeding, bathing, getting dressed, and companionship in general. Even though the mother was in so much need of care, I could tell that the daughter still respected her mother, and wanted to help her maintain her dignity as well.

I was grateful to witness this great example of love and service to one another. Both mother and daughter are well blessed to have each other.

Whooping Cough Granny

A few minutes later, another elderly woman (probably in her late 70's or early 80's) came into the waiting room. As she came through the door, she broke out into a deep, hacking cough, which nearly made her stumble as she walked. This coughing fit lasted for 2 or three minutes. She made her way to the reception desk, but could hardly get any words out for the coughing. She managed to get out that she had Whooping Cough. A lady, who was the office manager came forward to assist the coughing granny. The office manager was kind and patient with her. She asked how they could help her today. She took control of the situation by giving this lady multiple choice answers, to which she could nod her responses to, between coughs. It took them a while to find out just what she needed. It turns out, that she had an appointment to see her Dr.

She took a seat just inside the entrance door. A few moments later, another coughing spell seized her. I noticed that the Wheelchair Grandma and her daughter had pulled their sweaters up over their mouths and noses to protect themselves from any expectorated germs, while the Whooping Cough Granny was in the midst of her coughing fit. Whooping Granny noticed the other two ladies covering up, and tried to eke out, between coughs, that she was past the contagious phase of the disease. Nonetheless Wheelchair Grandma and daughter were not taking any chances. I can't say that I blame them really.

After the coughing fit subsided, the daughter of Wheelchair Grandma turned and spoke to Whooping Granny. She said, "You must really be sore from all that coughing." Even though Wheelchair Grandma and her daughter were trying to protect their own health, they made an effort to be kind and reach out to Whooping Granny. They wanted to make sure the Whooping Cough Granny did not feel ostracized, or uncared for. The medical staff put Whooping Cough Granny at the top of the queue, and got her back into an exam room, and away from the other patients, -- much to the relief of those in the lobby. Sometimes the most unhealthy place you can be is the doctor's office.

Oxy Gal

A few minutes later, an younger woman came into the office. I would place her in her mid to late 30's, although she looked hard around the edges. My internist office is a medical office building attached to a hospital. This younger woman, I'll call her Oxy Gal, had been with someone else who had been admitted to the hospital earlier that day. Now she stopped by the internist office on her way out of the hospital to pick up some prescriptions that she had previously called earlier in the day to have renewed. It turns out that she was seeking prescriptions for Oxycontin, Lortab, and another heavy-duty pain medication.

She said that she knew her prescriptions were still a few days away from expiring, but she would really like to pick them up now while she was here. She made it clear several times that she didn't have any means of transportation, and that she was only here today because her parents had given her a ride. The office staff said they would check on the status of her prescriptions, and Oxy Gal took a seat just inside the entry door.

A couple of minutes later, Oxy Gal had taken out her cell phone and began talking away. Apparently it was someone with whom she was well acquainted. The waiting room was not that large, and everyone in the room could hear her conversation. Have you ever been in a situation when you hear parts of a conversation that are too personal to be said in public. She was not saying anything gross or vulgar, but she was discussing intensely personal things. I became uncomfortable hearing the things she said. Unfortunately, there was no way to avoid hearing it. I could sense a desperation, and a pleading for acknowledgement in her voice. You could tell that she was not too sure of herself -- probably not too sure of anything at all. There was emotional pain in her voice as she pleaded for love, attention, and reassurance.

Finally the office manager, the same one who so kindly helped Whooping Granny get settled, informed Oxy Gal that she needed to turn off her cell phone. They have medical equipment that is adversely affected by cell phones. I'm sure she was just enforcing the office policy, but I was grateful

Oxy Gal sat quietly for a few minutes, and I pondered her situation. I first thought how she must be in great pain of some kind to require such heavy duty pain killers. Some of which are the most powerful pain medications that you can get without being admitted to a hospital. I could see the instability in her life. I could see that she felt lonely, desperately lonely. Finally, she got up and announced to the receptionist, that she had to go out to the parking lot to let her mother know that she would still be awhile before getting her prescriptions.

A few minutes later, Oxy Gal returned to the lobby, but this time she came over to my side of the room, and sat about 3 chairs down from me. There was a land-line phone there in the lobby for patient use. She picked up the phone, and dialed the person she had been talking with earlier, and continued the same plaintive conversation. Now she was closer than ever to me, and even more audible -- and right next to my one good ear! Several times, in the midst of her conversation, she exclaimed: "Don't say that, it makes me sad to hear you say that." It sounded like to me, that the relationship between Oxy Gal, and this other person, (I'll call him "Oxy Guy"), was not very solid. It also sounded like Oxy Guy was not a very stable person either. It was painful to listen to. I just looked down at the floor, not wanting to make eye contact with her if at all possible.

Oxy Gal went back to the receptionist, gave her story about waiting for her prescriptions, and not having a way to get around except from rides from her mother, and wondering if her prescriptions would be ready any time soon. An office person went back into the nurse's area to inquire. Shortly thereafter, a nurse came out, and said that they had printed out the prescriptions, but that the doctor had not yet signed them. The doctor was with a patient, and it would probably be another hour before he would have a chance to look at them. They told her she could wait if she wanted to, but that was all they could do. I was feeling sorry for Oxy Gal. I wanted to help. I thought of maybe suggesting to either the office staff, or to Oxy Gal to have them mail the prescriptions to her, and spare her having to make another trip to the office. Oxy Gal was hoping they would just call in the prescriptions to a pharmacy. However, the types of medications she was seeking are "Schedule One Narcotics". They cannot be called in or mailed out. These are the drugs with high potential for abuse, and with a high street value on the Black Market.

Finally Oxy Gal had to leave. Apparently her mother could wait no longer.

At first, I felt badly for Oxy Gal. She must be in great pain to require such strong pain medications. That, combined with instability of her life, and her emotional fragility caused me to feel compassion toward her.

But now, after thinking about the situation for a couple of days, I can see that there might be a whole other side to this story.

It is possible that Oxy Gal is a substance abuser. I always like to thing the best of people, so this hadn't occurred to me right away. In a normal situation, the doctor could sign the prescriptions between patient visits. I doubt he was in with one patient the whole time (there are 3 doctors working out of this office.) The whole story about wanting to get her prescriptions early would be classic for a substance abuser. Substance abusers are great about concocting, great lies and fabrications to get what they want. They will try to create the most sympathetic stories to play on the emotions of others. They will do anything, say anything, lie, cheat and steal -- even from their own families to get what they want.

Was there really a mother waiting for her for nearly an hour out in the parking lot? Or did she just need to go outside for a smoke? Unless she lives way far out of town, there is a bus service that drops people off right at the front door of the hospital. Looking back, its hard to buy the lack of transportation story.

The office staff handled things quite smoothly. The didn't want to create a scene, but they weren't going to placate her manipulations either. Looking back on the situation, I would say that there is a good chance that there was more going on here than meets the eye.

Doctors' prescription practices nowadays are closely monitored by the DEA (Drug Enforcement Administration). Doctors who prescribe heavy duty pain killers, such as Oxycontin, are closely watched. Check the next time you get a prescription, you will find that in addition to a Doctor's scribble signature, you will find a DEA number as well. Each time a prescription is filled, it is filed under the DEA number. Later the DEA can generate tracking reports regarding the type and quantity of prescriptions a doctor is making. Any sign that they are being extra liberal in prescribing Oxycontin, and other controlled substances, will bring forth a certain investigation.

So now I don't k now what to think of Oxy Gal. Is everything as she says, or is there more here than meets the eye. I hate to be judgmental of her. I can tell that she has not had an easy life. Again, all I can do is pray that she may get the help that she truly needs -- whatever that help might be.

To Be continued. . .

Update: Here is the follow up Post to this one.

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