Operation Subdue

by R. J. Castille

  Within a few hours, I received an email from the Kellogg Premier patient portal that informed me I had a message. I logged in quickly and realized it had come from the urgent care provider I had seen. It again confirmed that “nothing was wrong” on the treadmill stress test but did identify a Vitamin D deficiency in my blood work. She had put in a prescription in response to my labs and indicated that I could pick up the vitamins whenever I was ready. I rolled my eyes at the screen, realizing that her intention, just like with the others, was to simply gloss over my concerns and ignore them, like the doctors at Kellogg Premier always seemed to do.

  It was disappointing, to say the least. It was the reason I never went to see the doctor unless something was wrong. I was one of those people who had very little faith in the medical community, and with each new adventure to Kellogg Premier, it waned even more. I silently hoped that someday one of them would prove me wrong, that they would acknowledge my concerns without mockery and the look of complete annoyance on their face, but knew that the only thing that mattered to them was the invisible dollar sign that hung over my head. Until something changed and they proved me wrong, I felt more and more like I was just a medical record number and a dollar sign to the people at Kellogg Premier, and nothing more. I vowed to “fire” them as soon as I could afford the inflated rates of the alternate health insurance coverage offered by my employer but knew that I was a long way from realizing that moment. Instead, I knew I would be forced to tolerate the sub-par care I had experienced so far at Kellogg Premier, a thought that not only angered me, but that frightened me down to the core.

  -4-

  Elaine

  I came to the realization that, had that patient not kicked up enough of a stink, her concerns would have been glossed over and vehemently ignored. What concerned me the most was that no one seemed to acknowledge the strange spikes in her blood pressure, they just dismissed it, stating that every single one of them had seen higher. The only thing that did happen in response to her insistence was that she would follow up with her primary and, after I pointed out the seriously low levels in her bloodwork, the urgent care provider had prescribed her a high dose of Vitamin D to combat a glaring deficiency. No one ever informed the patient that the deficiency could in fact be the culprit. A deficiency of the magnitude I had noticed could actually explain some of her issues, but as I stared at the notes, I realized the provider had no intention of telling her that. When I sounded the alarm, pointing out the egregious shortage in her blood sample, the doctor finally relented to something, albeit she was clearly not as concerned as I was. She simply messaged Ms. Jensen, telling her there was a deficiency detected and to fill the prescription upon her earliest convenience.

  Ragan Jensen’s situation was what prompted me to pay more attention to what was going on around me at Kellogg Premier. As each new patient came to the urgent care department where I was assigned, their concerns and symptoms, unless there was something glaringly obvious, were also brushed under the proverbial rug. They were given as little treatment as possible and shooed out the door and back into their lives without so much as a reasonable explanation. It occurred to me that there was something going on that I could not quite identify or explain, and I was inclined to keep digging.

  On the surface, it seemed as though it was the patients who were simply hypochondriacs looking for something, anything to explain why they were feeling the way that they did. When the doctor or nurse told them nothing was amiss, that it was their overactive imagination or something simple, like a Vitamin D deficiency, they accepted whatever they were told and went away quietly with their prescriptions in hand. It took a squeaky wheel like Ms. Jensen to call attention to something that everyone else seemed to be ignoring.

  It was against the rules, but I started doing it anyway. The way I figured it, the only way I was going to feel better about all of it was to keep an eye on that particular situation. I was rooting for Ragan Jensen and hoping that she would find some resolution quickly. In the back of my mind, I imagined an ideal scenario where the doctors found what was ailing her quickly and fixed the problem, rather than drag it out. Don’t bet on it. From out of nowhere, my mind interjected its usual negativity into my thoughts. One could only hope that the doctors would do the right thing and do everything in their power to offer an explanation for how the patient was feeling.

  While snooping around in her chart, acting like I was just following up on something, I noticed that Ms. Jensen had indeed scheduled the follow up appointment with her primary. From the looks of her the other day during my brief encounter with her, I just knew she wasn’t going to take no for an answer, and I was secretly happy. I had become what seemed to be her only advocate at Kellogg Premier as her chart had a history of chief complaints that, for the most part, seemed forgotten. From what I could tell, the only doctor who had ever figured anything out was her specialist from the Physical Medicine Department. She was actually the second provider in that department that she had visited, the first had followed suit with the rest and just scratched the surface of her issues and, when finding nothing right away, had all but ignored Ragan’s pleas for help.

  At some point, Ms. Jensen had seen an Endocrinologist, for what appeared to be borderline thyroid issues. Her primary had started out by ordering the minimal labs for that, the T3 and the TSH. Everyone who knows anything understands that there are a number of things at play with that particular gland and it interconnects with many other bodily systems, so pulling just those two labs was definitely half-ass in my opinion. A full panel was in order and Ms. Jensen knew it, citing her incredible family history of the disease. Her sister, brother, first-cousin and own daughter had all been diagnosed with either Hypo or Hyperthyroidism and were on a barrage of medications to keep the ailment in check. There were a number of other chronic illnesses that others in her immediate family had that were closely related to issues with the thyroid gland. It made sense to me that, with such a strong family history in place, the doctor should have dug a little deeper than just the base test, however, that is as far as it went with that primary.

  Another note in Ms. Jensen’s chart indicated that, at some point she had called and demanded a second opinion. Not willing to take no for an answer and desperate to get to the bottom of things, she had gotten her way and was referred to an endocrinologist at the main facility. That provider did pull the expanded panel used to detect thyroid anomalies and her lab results clearly showed that she was borderline, yet there was no action, not even an order to monitor the levels at three-month intervals, like they should have. After pages of notes in Ms. Jensen’s chart regarding the matter, it appeared as though she finally gave up and yielded to the doctors’ unwillingness to treat.

  I imagined that she argued vehemently with them, her face turning a deep shade of red as she talked until she was almost blue in the face. Her concerns of course fell on deaf ears. Since Ms. Jensen’s blood levels were not off the charts, it was obviously the intention of those at Kellogg Premier to do nothing and that rubbed her the wrong way. Hell, it rubbed me the wrong way. Whatever happened to Live Well and Thrive? The slogan of the healthcare organization floated through my head as I pondered the situation for some time before I had to do my rounds. I was on clean-up duty and was tasked with wiping down all exam rooms after use in preparation for another patient.

  As I wandered through the halls, ducking inside each room that was empty and clearing it of any debris, my mind kept drifting back to Ragan Jensen. For a brief moment, I thought perhaps I was just overthinking things or even imagining the entire situation, but my mind quickly dismissed the thought screaming out that I knew exactly what I saw and there was no way to just dismiss it. I felt sorry for her, but at the same time I had become her cheerleader as she was one of few people who had ever challenged the doctors at Kellogg Premier, of that I was sure.

  Using antimicrobial wipes, I cleaned the surface of the hard-rubber exam table in the room I was working on. As the solution air-dried, I
double-checked the trash cans to make sure there was nothing serious in there that would need to be taken out right away instead of waiting until housekeeping came through to mop. Finding nothing, I straightened the supplies on the counter that had gotten out of whack, checked the stock in the cabinets above the sink and grabbed the soiled linen bag on my way out of the room. It was too full and would not likely hold out until later in the day, so I removed it and carried it to where several other bags waited to be retrieved.

  I went through the motions the rest of the day, my mind stuck on Ragan Jensen. She was probably passed off as that loud and obnoxious patient who always screamed and yelled when they didn’t get what they wanted, like a drug-seeker being denied their opioids, but I saw something completely different. Ms. Jensen’s medical record overall was in fact quite brief. What that told me was that she didn’t just run to the doctor for every little thing. It seemed to me that she was the type of person who would only go to the doctor if something was truly bothering her. There were no annual exams, no well-woman exams, just the visits where she presented with something that she felt was serious enough to warrant the visit. The few times she had been seen, so little was done, it’s no wonder she was never seen routinely. In the end, there was still no resolution for any of her chief complaints and that would be enough for me to lose faith in doctors too.

  When my shift finally ended and I was free to leave for the day, I drove home slowly, my head pounding with each set of headlights that lit up my windshield. It didn’t live that far from the facility, but it seemed to drag on forever, the sea of brake lights stretching as far as the eye could see. I sighed out loud to my empty car and rubbed my temple with the palm of my hand in attempt to alleviate some of the tension. As soon as I got home, I would head straight for the shower, the hot water would no doubt lend me some relief and I was definitely looking forward to sinking into the overstuffed cushions of my couch next to my girl to enjoy the tail-end of whatever it was she was watching that night.

  -5-

  Ragan

  I was completely on edge by the time my appointment with my primary rolled around. The strange sensation in my chest that continued to plague me would not relent, despite them telling me that everything was fine. In all the years I had been dealing with Kellogg Premier, I knew better than to just take their word as gospel and walk away. They may be doctors, but as I well knew, they were human beings, just like me and as such are subject to mistakes like anyone else.

  Avoiding visiting the doctor was not always an option. I did a good job at it, only walking through their double, sliding-glass doors whenever something was truly bothering me. In this case, I had been ordered away from my work and that meant I needed a doctor’s note, so my sick leave didn’t turn into unscheduled sick leave. Too many of those went against you at the end of the year when it came to performance evaluations where I worked, so it was best to get the note and have as little unscheduled time off on the books as possible. I would have otherwise just ignored it as long as I could, as I always did.

  Ignoring medical issues, from what I always knew, was dangerous and not a wise decision. It seemed to me, however, that’s all they did at Kellogg Premier. Unless you were doing something that would directly benefit them, like get a mammogram or other preventative procedure, your concerns were just ignored. That means they do the exact opposite there than we are always taught growing up: never ignore what your body is telling you. Unfortunately, at Kellogg Premier, they do just that and not one issue I took seriously enough to go seek medical attention, had ever resulted in a treatment plan.

  Sitting in the waiting room, I glanced around the space, noting several people sitting uncomfortably and either staring at the cell phone in their hand, had their nose shoved in between the pages of a paperback book, or were scribbling on a clipboard in their lap. Each time the door into the back opened and a nurse peered out, announcing the name of the next patient to be triaged and roomed, all eyes were on her. Sighs of disappointment, followed by the grumblings of those left waiting, followed her announcement when they realized it was not their turn.

  Finally, after what felt like forever, the nurse who had disappointed many as I sat there, finally poked her head out and called my name. I jumped up and followed her into the back where she went through the usual motions as she triaged me. My blood pressure was still “slightly elevated,” but yet again, she emphasized that she had seen higher. To tell the truth, I was getting a little tired of hearing that. I didn’t care what else the staff had seen, my blood pressure was stable and fairly normal or just below normal for decades and now, was suddenly constantly and consistently over. It may have only been ten points or so higher, but it made me feel terrible. That may have been why I got so irritated when they said that. I felt horrible, and no one at Kellogg Premier seemed to care, nor did they do anything about it. They were just going through the motions with one more patient they had to funnel out the door.

  The nurse typed all of my information into the computer that stood at the ready in the corner of the exam room she had taken me to, turned and quickly exited the room after declaring that the doctor would be in shortly to see me. That, of course, was an understatement as I waited nearly another twenty minutes before my doctor presented herself.

  “Ms. Jensen,” my primary greeted me with a plastic smile, “I see you are here for a follow-up on your treadmill stress test results?” It struck me as odd that she would ask that question. It should be quite clear why I was visiting, and she should have no need to ask. For crying out loud, isn’t that what electronic medical records were for? Couldn’t they easily exchange information on the same patient across the various departments? I felt myself roll my eyes as I opened my mouth finally to answer.

  “Yes, that’s correct,” I started off slowly, choosing my words carefully as I often did, “I wouldn’t have, but the strange fluttering sensation is still there and, as you can see, my blood pressure is still elevated.” I held my breath and waited. Dr. Lettie Barbosa stared at the screen in front of her, scrolling through what I could see was a report of some type. Unfortunately, since I was sitting a bit of a distance from the monitor, I could not quite make out what it said. I stared at her, waiting for her to finish and say something back to me.

  “Well, Ms. Jensen,” Dr. Barbosa took a deep breath and let it out slowly before continuing, “your treadmill test shows nothing significant going on, however, that test only tests the blood vessels themselves to make sure there is nothing going on with them. I will need to order another test to rule out anything with your heart itself. That will require an echocardiogram and perhaps a monitor,” she clicked on a few more things on the computer, typed in a few notes and turned her full attention back to me.

  “I am telling you, Dr. Barbosa, I don’t care what your tests say, none of you are in my body, cannot feel what is happening, so it is easy for you all to just dismiss me and move on. I, however, continue to live with the chest pain, shortness of breath and pounding headaches that don’t seem at all concerning to any of you,” by the time I finished speaking, I could feel the rush of blood in my carotid artery and the subsequent pulsing in my temples. I had promised myself I would not lose it and had broken that promise. I was fuming at that point and ready to chew Dr. Barbosa’s head off and spit it out.

  “Ms. Jensen,” Dr. Barbosa lowered her voice, “I am ordering a cardiac monitor that you will wear for thirty days. It is what we call an event monitor, so every time you feel symptomatic, you will press the button. The signal will be received on our end and be recorded. Hopefully, it will help detect what is going on when you feel the chest pain.” She typed as she spoke, never really looking up at me as if I were not even in the room. I waited until she finished typing and her gaze drifted up to meet mine before I said anything else.

  “Will they call me with an appointment for that, or do I get the monitor now?” I was not attempting to get any more information out of Dr. Barbosa as it was quite clear that she had s
hut down already. By the glazed look in her eyes, she was just going through the motions and trying to placate my need to find out what was happening. Not that she was actually trying to find out for herself, just that she was trying to keep me calm and get me out the door as fast as possible.

  “They will call you with an appointment to come in and get the monitor,” Dr. Barbosa seemed far away already, like she had already dismissed me from the room but was still talking to me, “I do want to mention that we can take care of that Pap smear today, however, Ms. Jensen.” I was livid. I knew it was only a matter of time before that came up, it always did, but it still irritated me to no end. The fact that I was there concerned for my heart and that procedure came up again really rubbed me the wrong way. My face must have reflected my anger as Dr. Barbosa took two steps backward toward the door as she looked on.

  “No, I’m good, Dr. Barbosa. I feel like I have told you before, but in case I haven’t, I have issues with that procedure, I know I have told you before and until I can get past them, just thinking or talking about it gives me extreme anxiety. I’ll pass.” I stared at her, my gaze boring a hole right through her as she shifted her weight nervously from one foot to the other.

  “I understand, Ms. Jensen,” she clearly did not care how it made me feel, she was just doing what she gets paid to do, and nothing more. “Please remember, however, it is important that we detect cervical cancer as early as possible and you haven’t had a screening in quite some time,” her words trailed off she grasped the door handle to leave.