Friday, September 30, 2011

"A person's a person, no matter how small." --Horton Hears a Who, Dr. Seuss.

Don't read this. Don't comment on it either. I think it's probably unpleasant and crazy and will make no sense. This is just me working out some PTSD and rage in re today's 18-month-old checkup.

As background, I should say that Kaiser has always been my American healthcare boogeyman. Somewhere I got the idea that Kaiser is better than no healthcare at all, but that they are basically trying to kill you with their negligence and cost-cutting. After yesterday (appointment for myself) and today (appointment for Jackson), I generally accept that they're perfectly good medical practicioners in the comparatively excellent American public health system. That said, it's still a scary place for me to be. I am on edge when I am at Kaiser, hedging against...everything.

Long story short, today's visit to a new pediatrician at a new medical center for Jackson's 18-month checkup wasn't a complete nightmare, but it was a couple notches below that. My family medicine doc yesterday, and the nurse, phlebotomist, receptionist, security guard and parking attendant at today's pediatrician visit were all lovely and excellent, but boy I did not like the doctor one bit.

First failure: I forgot the binky. As the day wore on for both of us, it became harder and harder to watch Jackson helplessly ask for "Niky? Niky?" while doing his little pacificer sign.

Second failure: I was on time instead of 15 minutes early as requested, so I was filling out their developmental checklist while the nurse got started with Jackson. I should have just put that goddamn form aside to help coach Jackson through the process, giving him my full attention, but I'm such a terrible people pleaser by nature I split my time between the form and being like, "Yay! Head circumference!" The form was incredibly patronizing. Overall, the biggest downside to Kaiser (and there are many upsides) is that they appear to be almost entirely focused on mitigation. I mean, I know it's a hospital and they're generally dealing with the sick, but they seem to generally operate on a wavelength that assumes damage already done, and there is no interest whatsoever on health enrichment or optimizing any given dimension of wellness, which is a disappointment. "You don't have walking pneumonia? You aren't obese? FAN-tastic. Next!"

Anyway, after height, weight, head circumference and "Do you smoke?" in the hallway, we were taken to an airless, windowless, dingy exam room where lovely Nurse Estefania gave us the above hilarious baby hospital gown and entered Jackson's immunization record into the computer. She also took Jackson's temperature using a ear thermometer, which caused Jackson to ask me, "Ear?" several times over the rest of the day. Suffice it to say he hated all the parts where he was randomly inspected by this lady he'd never met before. After Stephanie was done with the paperwork, she left us there to wait. And wait we did. Finally I couldn't take it anymore so we stood in the hallway and talked about the printer for a while. We flip the light switch on and off. On and off. We also read letters off the eye chart.

Finally, Dr. S. arrived. Maybe we threw him off because we were standing in the doorway, but he opened with, "Hey, you want a book?" as he jammed a book into Jackson's face. He didn't introduce himself, he just grunted when I introduced Jackson and myself, and then he immediately started glowering at Jackson's vaccination record, puzzling over how to match the vaccines they had available with the ones J had already gotten at our old doctor office.

We eventually settled on a solution--after I noted twice that while I love vaccines, and the polio vaccine in particular since my great-aunt Priscilla was paralyzed from the waist down by polio, I would prefer that my kid not get an extra polio shot--but I got the feeling that we were making his life hard.

He continues studying the immunization record from our old doctor's office. He sees the name of our old doctor. Let's call our previous pediatrician Marcus Welby, M.D., because he is totally as old as that reference.

Dr. S, bitchily: "Wow, Dr. Marcus Welby is still practicing?"
Me: "Yep."
Dr. S, bitchily: "How old is he?"
Me: "We spend a lot of time debating exactly how old he is. He was my pediatrician when I was little."
Dr. S, talking to himself: "He must be like 70."

I already knew Dr. S was awkward and weird, and that he had evidenced no interest whatsoever in either my child, my child's health, me or any other human, but at this point I realized he doesn't listen alertly either. This dude was just not sympathetic, chatty, fuzzy, funny, curious or distinctly smart. We weren't having a conversation. He was saying stuff and leaving pauses where we could pretend something I said mattered. I am a helicopter parent, I am overanxious, I talk too much, and yes, the baby is fine and doesn't need any bonus mama hysteria, but I am also just trying to make a connection, man.

I wore earrings and mascara in honor of today's special occasion, First Appointment with the New Doctor.

My child is wearing a COLLARED SHIRT.

Work with me here. Give me something. Anything.

Keep in mind that up to now, he hasn't made the slightest effort to engage the curious, alert, anxious toddler on my lap. Dr. S has just been futzing around on the computer and avoiding eye contact.

"I want to redo this length measurement."

Uh, OK. So I wrestle Jackson onto the table. Jackson doesn't like it. Big scary weird doctor starts looming over the little guy, using a measuring tape and a pen to figure out how tall he is. Jackson freaking hates it. He's wailing and whining and wiggling, and let me tell you, none of this is necessary: Jackson is one of the most reasonable, non-melodramatic children you will ever hope to meet. He does not just throw random moody temper tantrums. If he is freaking out, it's because he's in distress. Given 30 seconds and a little charm, he would have lain (laid?) down of his own accord and stayed stock still for the duration. But no, the lack of acknowledgment of Jackson's personhood continues, and this guy is assuming Jackson's just a typical bitchy little kid, but the fact is that Jackson has no idea who the eff you are, dude, and you're scaring him.

Dr. S, having gotten his height results, tells us: "Oh, OK, that's better. He was at the third percentile before, and now he's in the 15th percentile. That makes more sense with his weight."

Ah yes, that sounds like my short and chubby baby. The dude doesn't even bother to comment on my chubby little baby, he just continues futzing on the computer.

Upon later contemplation, I decide that the reason Dr. S redid the measurement is because if he enters "third percentile" in the computer, an alarm goes off in some Kaiser mainframe somewhere and initiates a "crisis abatement checklist" that he doesn't really want to deal with.

Then, once again, without preface or preparation, the physical exam begins. There's no introduction. There's no chit-chat. There are no questions about the baby's overall health. The guy has yet to ask if I have any concerns about my child. He just starts the poking.

Without warning, he shines a bright light in Jackson's eyes. Then the lights are off and he shines a bright light in Jackson's eyes in the dark. Jackson is understandably baffled. I am downright disconcerted. I try to narrate the goings-on for Jackson as best I can, but I can barely keep ahead of the doctor, and certainly not enough to make Jackson feel comfortable with what's happening.

Jackson: "Ear?"
Me: "Yeah baby, he's checking your ear for ear infections...oh, OK, yeah, now he wants to check your mouth, your throat."

Jackson will open his mouth any old time you ask (especially if there's some goopy half-chewed food in there), but that's not even a consideration here. Dr. S just forces the tongue depressor in and pokes around, cursorily. The guy just keeps barrelling through his lame checkup checklist. Jackson becomes increasingly agitated and distressed, but there's no opportunity to comfort him and calm him down.

Me: "Oh, OK, that's a stethescope...your heart...he wants to hear you breathe...OK, yeah, he's taking off your diaper to check your belly and your legs."
Dr. S.: "Do you want a sticker?"
Jackson: Hell to the no.
Dr. S., making his most astute observation of the day, and perhaps his only observation, really: "You don't want anything from me do you?...Well, here's a sticker."

ARGH! Finally it's all over. We've settled on vaccines, the doctor pushed all my short-fat-baby buttons which stresses me out, the doctor orders a blood test for anemia and lead screening, I feel incredibly uncomfortable, Jackson's climbing me like a tree and he can't get far enough away from the whole situation. (Right there with ya, kiddo.)

After the ordeal is almost all over, I ask for clarification on what's going to happen next.

Me: "OK, so the nurse will be in with the shots, and then we go to the basement for the lab work?"
Dr. S., exhibiting some enthusiasm and making eye contact for the first time all morning: "Yes! That's an East Coast/West Coast thing. On the East Coast, doctors do shots. On the West Coast, nurses do shots. I used to be in private practice on the East Coast."
Me, starring, speechless: Uh. OK. GTFO.

When the doctor finally left us alone in the exam room it was nothing less than a relief.

Nurse Stephanie brought the shots in, and immediately everything was better. For one thing, she told us, "Don't forget your new book!" Suddenly I realized that the book that Dr. S had thrown at us was not his version of a distraction technique, but a gift designed to encourage reading. WE LOVE BOOKS. As far as I'm concerned he was waving a shiny object us, to make us look away. He never said or suggest otherwise. Luckily Stephanie was there to save the day.

She showed us the labels on each of the needles and cross-checked Jackson's name and the vaccine order paperwork and what the doctor told us he was going to request, and Jackson was rapt listening to her. He also got excited to hear one of his favorite letters: "B!" (As in hepatitis B, doncha know?)

Before we got to the part where I restrained my hysterically crying baby (Jackson NEVER EVER cries hysterically) so we could plunge needles into his flesh, I stopped poor Stephanie.

Me: "OK, I'm usually not this bold, but tell me about Dr. S. This is my first time here and I need to know why I should continue seeing him. I'm very needy and sensitive, so I'm not sure he's a good match for us. This is my baby and he needs to be with someone I feel good about. I'm sorry to put you in this position, but can you tell me more about him?"

Poor nurse Stephanie knows exactly what I'm talking about but is in awkward position. She does her best.

Nurse Stephanie: "Well, he's a pediatric infectious disease specialist. That's what he does. He's very thorough. He always makes me check everything twice. He's very responsive, you can always ask him questions. Um...he's just's just how he is. I've been with him a long time and he's like that with me too. He's just...quiet."
Me: "OK, well, what if I had a nice, normal, boring baby without any diseases. Do you think he's the best doctor here for my child?"
Nurse: "Um..."
Me: "I need someone fuzzy. Do you have anyone who's fuzzy who's taking new patients?"

Nurse Stephanie recommends a nice lady doctor who just joined the practice. We'll be going to see her next time.

On the way out, I asked a desk clerk for Lady Doctor's card. At first the clerk was confused, "Wait, did you just see her or...?" "No. I didn't just see her. I saw someone else."

The clerk immediately realized what was up and got me a card. I learned when I was laboring with Jackson that nurses and doctors are totally aware of which other nurses and doctors don't have a great bedside manner, because that failing becomes their problem all the time. You, the patient, are never penalized for rejecting another practionier. In fact, I think their colleagues secretly enjoy you validating their own dislike of a specific nurse or doctor. (Personality problems are rarely confined to a single domain, like just patients.)

After all the exam stuff was over, we took our Ernie sticker and our paperwork, went downstairs to the lab where we waited for an hour (Jackson kept saying "hot?" when I explained we had to wait, because I usually make him "wait" when the food is too "hot"), and then it was time to draw blood from Jackson's fat little baby arm. Throughout the day, the minute a doctor/nurse/tech put on gloves, Jackson knew something was up and started freaking out. The only blessing is that the very kind lab tech Raymond told me it didn't matter that I'd forgotten the binky because they spit them out at this point anyway, so it wouldn't help. I guess that's something.

After the blood draw--during which there were quite a few eternal seconds when Raymond couldn't find the dang vein--Jackson thought his "band-ah" (bandage) was awesome, and he poked at it for the next 90 seconds until he dropped into such a deep slumped-over sleep I thought he was maybe dead. He slept through both the transfer to the car and then the transfer back out of the car, and he currently curled up in a little ball in his own little crib, safe with his blanky, his binky and his own little secure world. I will make him toast and scrambled eggs when he wakes up.

I, myself, stopped at In 'N' Out on the way home in an attempt to self-medicate.

So. Next time we'll know a little more what we're in for. Jackson will know to be scared of blue latex gloves, and I will know to arrive early, and not trust the whimsy of the Kaiser doctor-assigning system. I strongly believe that any club that will have you isn't worth joining, so I knew that if a doctor had room in his patient roster to see us, there must be something wrong with him, but I like to give the system a chance. Also, I couldn't bear to spend months and years researching the Best Kaiser Doctor in West Los Angeles. I had hope that whatever we got would be good enough. That hope didn't work out, but eh. We survived. We'll do better next time.

Deep cleansing breath.


Elana said...


When we moved back here, we got really stressed out and picked a ped practically at random. (I find the process of trying to research doctors really difficult - there's so little information available to you, and then if you find some, it always has the Amazon Review problem, wherein 9 out of 10 people will be like "This doctor is great!" and then the 10th will be like "DO NOT SEE THIS PERSON, they killed my dog!")

The ped we saw was running an hour late - something I have come to be convinced is a sign of a crappy practice.

And then we waited forever in the exam room. And when she finally came in, no kidding, she basically approached the 10-month-old on the exam table, and, without preamble or acknowledging him, took off his diaper and began to probe his privates.

That's when I knew this wasn't the doctor for us (and it just got dumber from there) - it really bothers me when doctors don't interact with the child. He's a person. Treat him like a person. This is not going to cause some huge drama in your day, I'm not asking you to put on a puppet show. Just make eye contact and greet him and introduce yourself.

Grumble grumble grumble. I'm sorry you guys had a lousy time - bad medical care is one of the most upsetting things, I think, because you feel so totally vulnerable when you're there to begin with, it's really hard to, in the moment, stand up for yourself. Ugh.

So sorry. I hope the new lady is awesome as billed!

habes said...

Aw. Hugs to you and Jackson xo