Thursday, September 3, 2009

Welcome to the Public Health System

The warm sun beat down on me as I parked my beloved beat-up car in the gravely lot.  The lot wasn’t always gravel, but the pavement had started to wear away.  The white parking lines repainted over the crumbling asphalt.

I watched other people walking towards the large building and followed them in through the glass double doors.  And then I was lost.  Signs posted here in there in various different languages said to go this way or that way for one thing or the other, clinics, children’s programs.  I had a 9 am doctors appointment to meet my new primary care provider and there were no signs that said this way for that.

Instructions from a nice lady behind a sliding metal window led me upstairs to a large room.  A giant cube of workstations stood in the middle of the room.  To the right, a large waiting area of chairs arranged in a U-shaped, nearly full with all sorts of decrepit looking people.  People who hardly fit in the chairs, people who sat hunched over, they’re hair and clothes the same shade of rumpled.  No one smiled.  One wore a medical mask.  A couple of cast-off magazines law scattered on the remaining open chairs.  No one was occupied.  All were just sitting, waiting.

I gave my name at the check-in station and settled into a free chair with the book I’d brought along and waited for my name to be called.

It struck me how much this place, this whole scene reminded me of Africa.  I was pondering this, the peeling cream paint on the walls with the equally damaged dark blue covering the metal doors and doorframes, the signs taped to all the service windows explaining what to do or not do, the old-fashioned post office styled windows lining the walls, only one of them staffed, the large waiting room with its myriad of languages floating past my ears, only being able to understand bits and pieces...  And then, the power went out.  “*Sigh,* Africa,” I thought, feeling somewhat comforted at the thought.

Except, this wasn’t Africa.  No.  This was the county public health center.  My first visit.  And of course, in Africa, that 1960s tiled floor would have been smooth concrete, polished to shiny red.  And the police officer guards wandering around the building would have had AK-47s.

I couldn’t really complain, grateful to have any type of medical care.  The county plan was a godsend, thanks to my low income (which I only have thanks to Vanderbilt anyway.)  Yet I felt lost, this place was so different than the cozy, carpeted health center back at Vanderbilt, with its wood trim and shelves decked with informational pamphlets and leisure reading materials.  And unlike my visits to African clinics, I had no body with me who knew the ropes and could help me along.

The lady at station D called my name.  Except I couldn’t understand what name or what letter she said.  I told her this once I sat down at the little window.  “You’ll have to get used to that,” she said.  We filled out paper work since the computers were down thanks to the lack of power.  “What’s your mother’s maiden name?”  I told her.  She looked up, her eyes wide, she seemed unsure what to do next.  Fumbling around on her desk for awhile, she pulled out a post-it note pad and handed it to me.  “Why don’t you write that down for me.”  I wrote it out big and clearly, all 11 letters, and handed it back to her.  She didn’t copy it onto the form, she just stuck the whole post-it note right on top.  Maybe the form didn’t have enough blanks.  (My mother’s side of the family is Polish.)

Without power, there wasn’t much else to do but wait some more.  This was one difference from Africa, I thought.  The exam rooms here had no natural light.  There was no back-up system for the computers being down.  In sum, the center was not prepared to work with just its generators.  Oh well.  I went outside to read my book in the gloriously warm weather.

Mr. Trizzle came over to visit, he works in the court house next to the medical center.  The court house didn’t have power either.  In fact, at least half the city was out.  The lady who couldn’t handle a Polish name came out to find me, to send me home.  No power, no idea when it’d be back, the power company was saying at least 2 hours…  I said goodbye to Mr. Trizzle and headed home, not realizing I’d see him again so soon.

Beep Beep.  My phone zzz’d as I walked in the door to my apartment.  It was Mr. Trizzle.  The power was back on.  I quickly checked my work email for anything important and headed back to the health center.  On my way, I noticed most of the previously out street lights were working again, but not all of them.

The health center was just as I expected it.  Practically empty.  They had sent everyone home.  Well, I didn’t have too long to wait before I was called back to the window, given all my paper work and directed to another room, through some blue metal doors, at the end of a dingy hallway.

I sat and waited for awhile before I realized I was supposed to put my paperwork in a plastic basket near the door.  At Vanderbilt, the nurses and receptionist handled all that.  I sat on those hard wooden chairs, staring at a divider with the same peeling cream paint as the walls, attempting to read signs in languages that were not my own.  It was half an hour before it was my turn to be seen.  A lady had come in without paperwork just before my entrance, demanding to be seen.  And she was seen.  I waited.

Employees bustled in and out and around the different sides of the dividers.  “Look at that birthday party invitation with Elmo.”  “Hey I brought some cookies.”  “What are you doing this weekend?”  I wondered if their seeming to not had any work was because the patients at all been sent home, or if this was normal.  There was one doctor in the room and about a dozen of them.

The exam room was very small.  About the size of a bathroom.  An old computer sat perched on a metal arm extending from the wall.  It appeared to be running some pre-XP version of Windows.  The exam bed was shoved in a corner, the back raised up so it looked like a giant chair.  There was a small sink.  No table of cotton swabs or tongue depressors, or cabinet of drawers for tools.

The doctor was very nice and very helpful, though talking a bit fast and leaving me rather dazed and confused as she left the room.  At Vanderbilt, the doctors gave you a checkout form, or even went with you to give you drugs from the little store room and set your new appointment.  Here, after asking what to do, I was directed simply to go back to those wooden chairs and wait, to stare at the peeling paint on the divider again.

It seemed like a long time before someone finally came around the corner with my papers.  “What pharmacy would you like me to call your prescription in to?’  Uhhh… what prescription?  Where’s a pharmacy?   “There’s a Walgreen’s down…”   “Yes, that’s ….”  Then she told me to go back to the main room and visit the lab window. 

I got a number, 42.  A young woman called my number and then disappeared behind a door that said “restricted access,” the door closing behind her.  I stood there confused.  Was she coming back?  Was I supposed to follow her?  The lady behind the window who had given me my 42 told me to go through the restricted door.  They took my number, took my blood and said nothing.  “Is that it?”  “Yes.”  I left. 

I stood for a moment back in the big waiting room, unsure what to do.   A bit confused, not sure what drugs I was going to get, how or if I’d get results on my blood or if I hadn’t done something I was supposed to do.  Herding cattle seems to work better when the cattle know what’s going on.  I looked around, no one seemed to expect my attention.  I had no paperwork left in my hand, only my new red clinic card, a rectangular piece of plastic emblazoned with my information like a monochromatic credit card.  I shrugged and headed to the door.

It happened to be noon.  Nice, lunch time!  And lunch time for Mr. Trizzle, too. ;)


Jeannie said...

glad my doctor's office isn't like that....

goldenrail said...

but the important thing is, the doctor seemed very good

MaryRuth said...

oh boy....that's incredible! And sad. I hope you are OK. I don't know if you need something totally free or not, but if you just have a cold or something minor--try these "mini clinics" that are sprouting up in big pharmacies like Rite-Aid. They claim to be $40/visit. I know that's where I will be going next time I need to visit a dr. And I even have insurance! (not good though)
I liked the funny part about the Polish name.

goldenrail said...

MR: The plan is just in case I should happen to need it for something. This appointment was just an initial interview because I got accepted into the program. I probably won't go often.