fostering the humanistic practice of medicine publishing personal accounts of illness and healing encouraging health care advocacy

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fostering the humanistic practice of medicine publishing personal accounts of illness and healing encouraging health care advocacy

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July 2023

The Black Dog

It was a particularly sunny morning, and golden light streamed through the clinic windows. Seated in my preceptor’s office, I scanned her list of patients for the day. As a first-year medical student, I was to do preliminary interviews with some, and I hoped to find a few cases that would offer a chance to test my diagnostic reasoning.

The list held a lot of the usual–medication follow-ups, annual physicals, well-child checks—plus Ernest, a seventy-eight-year-old man who’d come into the emergency room for a urinary-catheter issue. This seemed promising, so I volunteered to see him.

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It Finally Happened

It finally happened. Three years and four months after the pandemic began, I contracted COVID-19.

I wore a mask longer than most anyone I know. I dutifully received all the booster shots. I was headed to Brazil on a family vacation and decided it was time to relinquish the mask. My teenage daughters had been making fun of me for months. I was more worried about dengue, yellow fever, and zika as I slapped mosquitos buzzing around my ankles on my daily walk by the ocean at the idyllic beach resort of Buzios, a several-hour drive from Rio de Janeiro.

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My Castle

Moving to an independent-living facility requires finding a balance between controlling the things that you can, and accepting help, or changes, with the things that you can’t. It also means striking a balance between being part of a more regimented community and being part of the outside world.

I’m nearly seventy, which is young for this move. But my hearing and balance are not what they were. I’ve had no family for twenty years, having outlived parents, husband and brother. Friends who have helped me in the past are aging into their own disabilities. My apartment of twenty years needed renovations that needed me gone. The timing felt right.

But my transition comes with extra challenges, because I’m congenitally and totally blind.

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Two dreaded words for medical providers and patients: Prior Authorization (PA). For the fortunate few who have not needed to engage in this process, here’s a definition from the American Medical Association website: Prior authorization is a health plan cost-control process by which health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.

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A Big Bag of Pills

He said he wanted to talk to me. He asked for me by name. He was seated in the waiting room, a lone pale face in a room full of brown faces. I asked my medical assistant to query him as to why he was there, while I continued to see patients; he told her he had something to give me—something he could give only to me.

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Letter to the Insurance Company Psychiatrist

Dear Dr. Anonymous:

Are you a Phil, Michelle or Darrell? Two years ago, you booted my seventeen-year-old son out of treatment, signing your denial letter “MD Psychiatrist.”

I understand that you were hired to qualify, or disqualify, patients based on a cost-benefit analysis. Your letter suggested that my son’s condition could be “managed at a lower level of care.”

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