To prove to someone who loves me and worries about me that I was not depressed, I made a doctor’s appointment I had been putting off making.  

My ailment was digestive, or rather, excretory, and had not been particularly terrible, but was a change for the worse and had persisted for a few weeks.  She kept urging me to see a doctor, rather than find out, God forbid, I had colon cancer only after the disease had too firm a foothold to dislodge.  Since I kept mentioning it, she kept reminding me, with mounting exasperation, that I should see a doctor.

My doctor was on vacation, but his nurse practitioner would be able to see me fairly soon.   My experience with this woman was mixed, she was defensive, short-tempered and had a wavering attention span.  She asked questions and did not listen all the way through the answer.   She scolded and defended herself instead of cutting to the chase and solving the problem.   I’d felt very mature overlooking what an unlikable person she could be on a previous visit.  My gut told me not to bother with her, but my gut was also giving me problems the internet had no ready answers about.  

In any case, I knew my doctor would probably only refer me to a gastroenterologist.  One of my hesitations of getting involved with doctors was paying unknowable fees of hundreds of dollars to a referring doctor, and even more to a specialist, to have a series of diagnostic tests I’d also have to pay for “out of pocket” though I pay a premium to an insurance company every month.

I purchase Obamacare, a small, deeply flawed step towards controlling health care costs and lessening the unconscionable number of Americans who die for lack of affordable health care.  One frustration of this Great Compromise is that a consumer can’t find out the price of an office visit until the office she or he visits submits a bill to the private health insurance company.  The insurance company sends a copy of the claim to the patient and informs the doctor’s office of the negotiated rate and the patient gets a bill.  I have a folder full of these bills, many of which I am not responsible to pay, some of which are in collection against me.  The difficulty of finding out which I owe and which I don’t is a vexation that is bad for the health of everyone effected by this complicated private health insurance law.

The nurse practitioner spent much of our twenty minute meeting searching the internet for information on an odd symptom I had already researched: pink mucus.  She meticulously typed in every aspect of our conversation for her on-line records but, although bowel conditions are often effected by such things, never asked about changes in diet, circumstance, stress, sleep, mood.  She had never heard of pink mucus in the stool.   She was concerned that she’d never heard of this.  

“Shall I do a rectal exam to see if you have a hemorrhoid?” she asked.

“Would an external hemorrhoid cause this symptom?” I asked.  

“No,” she answered, “but an internal hemorrhoid might.”  

“Would your exam be able to tell you if I had an internal hemorrhoid?” I asked.  

“No,” she admitted.  I declined her invitation for a rectal exam.  My rectum was already fairly sore, in any case, inflamed, in fact.  She advised me to use soft, moist wipes instead of toilet paper and sent me for a blood test.

She had no other advice whatsoever, except to get to a GI doctor ASAP.  I reminded her I’d had a recent colonoscopy (a “fully covered” preventive service they are still billing me for…) and that it was therefore unlikely that I’d developed a serious condition in a matter of months.   I also knew, from my research, that diagnosing bowel trouble was a matter of ruling out a number of conditions and a likely diagnosis of IBS which is famously triggered by stress.  

I was also not looking forward to paying hundreds of dollars to have these things ruled out.  In any case, it didn’t feel like an emergency situation and the symptoms had not become any worse over those weeks.

A snippy phone message arrived two days after the visit urging me to get to the specialist ASAP.  A couple more snippy messages followed, one informed me there was an inflammation shown on the blood work.  Each message urged me to go see the specialist ASAP.   I’d been out of phone range, upstate, and didn’t get these until I got back to the city.  I called the office a few days later and had a copy of my blood test results sent to me.  They were mostly within the normal range and arrived without any accompanying comments.

Punchline # 1:  consciously changed my sloppy diet back to a more regular high fiber one, got some more physical exercise, completed some challenging work that had been dogging me, got a few nights of decent sleep: pink mucus and other symptoms gone, problem solved.

Punchline #2:  bill from Patient Protection and Affordable Care Act for twenty minute visit to distracted nurse practitioner, plus three scolding voice mails: $180.  

Everybody’s got to make a living.  God bless America, y’all.