Into the Maze

The Primary Care Physician and I are gazing deep into each other’s eyes, but we are not in love. We are not smiling. I am growing furious. He is growing afraid.

We are in his office this evening because the person I care for most in this life, the person for whom I would most like to make the world perfect and shining and painless and free, is experiencing an exceptionally intense migraine headache.

I’ve never had a migraine headache, so I don’t really know what one feels like. But I have seen this particular person shrug off traumas that would send me whimpering to bed, so the fact that she is now moaning loudly and begging-- begging--for relief has definitely gotten my attention.

And thus we have come to the Pasadena office of our Primary Care Physician, recently selected solely on the basis of geography from the list of Approved Providers supplied by the Employee Benefits Office where I work.

It is our first visit.

It will be our last.

All three of us will be very glad about that.

The Primary Care Physician has just informed us that yes, there is something he could do to make her stop hurting, but no, for some perfectly logical reason I have no desire to comprehend, he is not inclined to do so. Some protocol problem. Some unrequited regulation. How about an aspirin?

I hold his gaze. His matter-of-fact explanation trickles to a halt. He is about my age. Has problems of his own, no doubt, and at the moment I am merely one of them. I am taller than he, though his starchy white lab coat seems to even the odds a bit, authority-wise. I am not a violent man but he has no way of knowing that.

Especially as my right hand slowly begins to rise.

I have not lost control. I am feeling helpless and useless and desperate to stop my loved one’s pain, but I am still well aware that punching out the Primary Care Physician would do nothing to help our cause.

And yet, my right hand continues to rise.

Past my waist. Past my shoulder. Slowly, defying gravity, until it hovers next to my ear. There the index finger stretches out, straight and stern, and slowly homes in on the pink, porous tip of the Primary Care Physician’s nose.

As delicately as a butterfly, it lights there.

“Give her,” I calmly suggest, pressing gently, as if operating an elevator, “the shot.”

He does.

Her pain goes away.

And so do we.

Thank you, doctor.

*

My wife and I agree that it would be wise to shop around for a new Primary Care Physician.

Despite this little encounter, we are the ideal Health Maintenance Organization client couple.

No, really.

We have steady incomes. Except for the occasional mind-bending headache, we are quite healthy. Having learned the drawbacks of picking a Primary Care Physician at random during a crisis, we are willing to invest as many hours and miles as necessary to select one who inspires our confidence and our comfort.

We decide to make appointments with several potential Primary Care Physicians just to meet them, to see if we can detect a flicker of empathy and respect. She makes the calls. I promise not to beep any noses.

In the waiting room of the first, we labor over long questionnaires clamped on clipboards. The receptionist, Our Lady of Prodigious Fingernails, has a little trouble understanding the purpose of our visit.

“We’re shopping for a new Primary Care Physician,” we explain. “We just want to chat for a few minutes.”

Weird. But she accepts our $10 co-payments and, in time, ushers us into an examining room. The doctor breezes in, seeming a bit distracted and harassed but curious about why we are there. We explain that today we have only one medical problem, and that is our desire to make the acquaintance of a Primary Care Physician whom we like and trust and will feel confident in calling the next time we really, truly need help.

She seems to understand, and absent-mindedly praises us for our efforts. But is she actually peeking at her watch every half minute or does it just seem that way? And when we mention that we have come not only to meet the doctor but to size up the office, she laughs.

“We do have a bit of turnover out front,” she concedes. “You know those medical histories you just filled out? I can tell you that, next time you come in here, there’s a 30% chance they won’t be able to find them.”

The doctor is pleasant enough but seems to be warning us to look further. We take the hint.

“What time do you see your first patient of the day?” we ask in scheduling an appointment with our next prospect. “We are both working people who can’t stand to sit around waiting for hours.”

First slot is 8 a.m., and we book the next one available. On the designated day, we arrive 20 minutes early, dispatch our clipboard histories with practiced gusto, turn them in and settle back in our seats with time to spare. At 8:45 I return to the counter and bid the receptionist farewell.

“Did your problem go away?” she asks.

No, I reply, but we have learned exactly what we came to find out.

*

Nobody likes the direction in which medical care is heading. Not patients who can’t get the help they need. Not doctors who hustle people in and out the door and have to deal with anger at the system as one more symptom of nearly everyone who gets sick these days.

This realization deepened as we made our rounds. If the process is so maddening for people like us--relatively fit in body and pocketbook, at ease with being assertive, fully fluent in English if not in bureaucratese--what must it seem like to the elderly, the shy, the fearful?

The world’s most economically and scientifically advanced nation is building the American Nightmare.

Or so it looked from waiting room after waiting room.

And then, a miracle.

Our trail leads us to an energetic, caring woman about our age who runs a thriving practice of her own while raising four young children on the side. She applauds our careful consumerism.

“Medicine is all about how you feel,” she agrees. “If you don’t feel good about your doctor, your doctor probably isn’t going to help you feel good about your health.”

She answers all our questions, turns us over to her office manager for the necessary paperwork and has us on our way in short order--whistling, or so it seems.

And since then, whenever we have needed her, she has been there. Calling with the latest strategies against migraines. Giving me my 40th-birthday head-to-toe. (“This is when you’re glad your doctor has skinny fingers,” she grins, snapping on a rubber glove for my first prostate exam.)

And so it does seem possible to live happily ever after in the age of HMOs--if you have enough time and money and mobility and persistence and luck. At least until one of us gets sick enough to need a referral.

Or until our angelic Primary Care Physician disappears from the list of Approved Providers.

Most people have a recurring medical nightmare. That’s mine.