I SHOULD DRINK LESS DIET DR. PEPPER
Every now and then I'll forget that I almost died once -- or twice, depending on your perspective. Then something will happen and I'll be reminded. Like I was yesterday.
I had persistent, flu-like symptoms for almost a month and, although the sniffling, sneezing, coughing, aching, stuffy-head, fever blah blah blah have dissipated, the headaches have remained.
It's those sinus headaches, the ones that feel like you've been blowing your nose every five minutes with sand paper, the ones that make the veins in your temples pulse like Morse Code, the ones that make you snap at cab drivers and waitresses (more so than you, or should I say I, usually do).
So yesterday I decided to go to the doctor.
The problem is, I don't really have a doctor. Actually, that's not true. I have many doctors: a cardiologist; a neurologist; a dermatologist and enough other specialists to start a softball team. Or league. That's the great thing about having survived a life-threatening illness (or two), you make plenty of friends in the medical profession.
But I don't have a general practitioner, the kind of doctor who used to carry a little black leather bag and come to your house when you had a cold, and get paid with a chicken dinner and a cigar (back when it was still socially acceptable for doctors to smoke).
I had a "primary care doctor" for a while, but the problem was I wasn't "primary" enough on his list of concerns. I'd call the office on a Monday morning with an ailment and they'd offer me an appointment on Friday, a year and a half from now.
"Unless you're seriously ill," the low-paid, heavily accented scheduler would say when I called.
Let's ignore the fact that, if I were seriously ill, I wouldn't be going to a general praticioner, I'd be going to an emergency room. But the larger point is this: thanks to the scourge known as Managed Care, many of us who are lucky enough to have health care insurance are forced to use a single, over-worked doctor as the gate keeper for all ailments, great and small.
And that's why, when I signed up for my new Freelancer's Union insurance this year, I selected a plan that allows me to see specialists without the dreaded paper referral. This is good, because it allows me to go directly to the doc who can treat me without passing Go in the way-too-crowded GP's office.
But it's bad when I have regular, old, non-life-threatening ailments like a headache.
So recently I've been going to a walk-in clinic on the West side of New York City, a bustling facility staffed by a team of attractive young doctors who remind me a bit of the cast of E.R. (or Grey's Anatomy, for those of you under 30.)
I don't know if these doctors are all sleeping with each other, like doctors do on TV medical shows. But I hope so. I think frequent sexual congress contributes to a happier workplace, as long as the activity in question does not take place during business hours. (Unless it's happening in a supply closet where, apparently, all doctors like to get busy.)
The only drawback to the walk-in clinic is that sometimes -- like on the morning after an international pandemic has been announced -- lots of people are inclined to walk in at the same time.
Apparently, I was not the only one who added 2 + 2 and came up with swine flu. (cue music sting)
After all, my girlfriend did just come back from Cancun, not far from where those Spring Break kids from Queens stirred up a nice, steaming pot of international contagion. You never know if one of them wandered from the "party" beach to the "family" beach, puked up last night's wine coolers, and left the gift that keeps on giving.
At 11 a.m.I arrived at the office, signed in and made my way to the unairconditioned waiting room, where half the people seated were wearing Michael Jackson germ masks. Sadly, none of them arose and broke into a choreographed Thriller dance upon my arrival.
Good thing they were all wearing masks though, because they were coughing like Typhoid Marys with a two-pack-a-day habit. I wonder if they had the politically correct foresight to purchase their own masks, or if they were politely (but no doubt strongly) suggested by the front desk staff upon their arrival.
As I sat there listening to the cacophony of coughs spewing out into the warm, moist air, I began to feel as if i was in a WW II-era germ warfare study. If I didn't have swine flu, by golly, I was gonna git it -- one way or another!
After two hours of waiting I walked up to the counter and looked at the sign-in sheet.
"Our patient list is confidential," the male clerk scolded, pulling the clipboard away.
"Okay, but why is my name crossed out?" I asked.
"Because your chart has been pulled," he said. "But our patient list is confidential."
"Okay," I said. "So, confidentially speaking, how much longer do I have to wait?"
"There are five more ahead of you," he said dismissively.
"Really? That's funny, because my friend Abe Lincoln told me I was next," I said, slipping a crisp new $5 bill across the counter.
"Sir, are you trying to bribe me?" the clerk stammered.
"Of course not," I said. "I need change for the snack machine."
And then, armed with a bag of Dorito Munchie Mix, I returned to my (potentially) pox-ridden seat.
About thirty minutes later the nurse called my name. She led me into an examining room and asked me to have a seat on the examining table.
"What's wrong?" she asked.
"Well, I went to London about a month ago," I said. "Have you ever been there? It's nice."
"Sir, I mean what brings you here today?" she replied, looking at my chart.
"Oh yeah, anyway, I went to London about a month ago and I came home with a bad case of the flu. And some Cadbury Flake bars, which are delicious, by the way."
"So you have the flu?" the nurse asked.
"No," I said. "Not any more. It's all cleared up."
"Then why are you here?"
"Because I have a headache, which I think was caused by the flu, which I no longer have. Does that make sense?"
"No it doesn't," she said. "Let me take your blood pressure."
She wrapped the cuff around my left arm, placed a stethoscope on it and then deflated the cuff.
"What's my score?" I asked.
"114 over 80," she said.
"Is that good?"
"Do I get a prize?"
"No. Have a seat. The doctor will be in shortly."
A few minutes later a pretty, blond-haired female doctor walked in, looking just like she belonged on a TV doctor show.
"Do you spent a lot of time in the supply closet?" I asked.
"What?" she replied.
"Nothing," I apologized. I have a headache. Sorry."
She asked me what medications I was taking. I pulled out my list from my wallet.
"Let's see," I said." I take Warfarin -- generic Coumadin -- 10 mg, 6 days per week and 7.5 mg one day per week. That's for my two prosthetic heart valves, the aortic and mitral. I also take Toprol XL, 20 mg each day, for a heart arrhythmia. I also take Cozaar, 20 mg a day, for my blood pressure, which your nurse said was very good, so maybe I don't need to take that anymore. That would be nice. Oh, and I also take a little bit of Celexa, for depression. I'm not sure how many milligrams because I cut it up into four pieces, which is better than cutting myself up into four pieces, which I might do if I didn't take the Celexa."
I then briefed her on my medical history: endocarditis, a bacterial infection acquired during oral surgery and undiagnosed until I was nearly dead; open-heart surgery, to replace two of the heart valves that the infection destroyed; non-invasive brain surgery, to repair an aneurysm that was caused by a piece of the bacteria that lodged in my brain. And high blood pressure, primarily caused, I believe, by excessive consumption of Diet Dr. Pepper.
"Wow," the pretty doctor said incredulously. "You should drink less Diet Dr. Pepper."
"Good idea," I replied. "So what about my headache."
She agreed that the headache was most likely a remnant of a sinus infection and offered to write me a prescription for antibiotics.
"When was the last time you had your blood thinner level checked?" she asked.
"Last week. It was high - the INR was 4.2. My cardiologist usually tries to keep it between 2.5 and 3.5."
"Well, as I said, it's most likely a sinus infection," the doctor replied. "But, with an out-of-range INR, there is always the possibility of a brain bleed. Considering your history, I'd like to send you for a cat scan."
"When," I asked, surprised at her suggestion.
"Today," she said. "We do them on 34th Street."
"Right there on the sidewalk?"
"No, in our radiology department," she said. "Come on out and we'll set it up."
Less than an hour later, I was lying on a long white table in a fluorescent lit room, about to get my brain scanned.
This is nothing new for me. If I had gotten frequent flier miles for every cat scan or MRI I've sat through - I mean laid through -- I would be in Mexico right now, which would bring us right back to where we started in this little story.
But the last time I had a cat scan was more than a decade ago, when I went back into the hospital to check on the progress of my brain surgery. Just between you and me, I had hoped never to see a cat scan machine again. Or a hospital, for that matter.
"Okay just lie there and it will all be over in a little bit," the radiologist promised.
"That's what I my wife said on our wedding night," I replied.
"I'm sorry," I apologized. "I have a headache. And I drink too much Diet Dr. Pepper. Oh and by the way, I have two prosthetic heart valves that were put in -- what's the right way to say it, installed? They were installed in 1997. And I also had an aneurysm in the right central cerebral artery which was sealed up with glue, so you might notice that when you do the x-ray. Oh and I also had a little teeny weeny stroke, so you may see a small area of cerebral infarc. So don't be surprised at any of that."
"Wow," the technician said. "You should drink less Diet Dr. Pepper."
And then he walked into his little control room and closed the door. As you know, if you've ever had a CT scan (which I hope you haven't), the radiologist is not in the room with you when the test is being conducted. He is at the command center, taking pictures of your brain, and avoiding the dangerous x-rays that are coursing through your skull.
A few moments later I felt the table rise about two feet in the air, and slowly, pneumatically move backwards. It felt a little bit like lying in the thing that catapulted Spock's body into outer space after he (SPOILER ALERT!) dies at the end of Star Trek II.
In my (brain damaged) head I kept thinking: The needs of the many outweigh the needs of the few. Or the one. Live long, and prosper.
The table came to a halt with my head surrounded by a large, white, plastic oval shaped scanner. Inside the oval, something started spinning, taking multiple images of my brain. I wondered if I should smile, or if this was like when you get your drivers license photo, where they prefer you to look right at the camera without emotion.
The table moved back and forth as the x-ray device spun around me, whirring like a dentist's drill. After about two minutes it was done, and the table zoomed back and down to its starting point.
"Okay you can get up now," the technician said. "When was your embolization?"
"It was in December of 1997 at Columbia Presbyterian," I said, as I stood up. "So how does everything look in there?"
"Well the head of radiology will need to review the films," he said. "And then we'll send the results to your doctor."
This is what always happens. Good news or bad news, the technicians always wear a poker face.
"But I'm not gonna die or anything?" I asked.
"Not from what I can see," he said, as he walked me out to the lobby.
But here's one thing he didn't say: "Good luck." In my experience, if a radiologist says good luck to you after a cat scan or an MRI, you had better write out your will. Because the news is not good.
And now, I wait. There is every reason to think that there is absolutely nothing to be worried about. But when you've visited with death once (or twice) before, you are always prepared for it to return, to complete the job. And it will some day, for sure. I just hope that day is a long way off.
In the meantime, I'm quitting Diet Dr. Pepper, cold turkey. I may be brain damaged, but I can still take a hint.