A BURDEN ON THE HEALTHCARE SYSTEM

A change of pace for this blog post. I have written plenty lately from a woe-is-me perspective over having been dumped after a two-year relationship. Still going to focus on woe, only this time the setting is a health clinic and the circumstances humorous, at least to me. I'm not going to seek quotes from the professionals who had to experience my quirky trauma. It should be a relief that patients going to clinics don’t get reviewed on Yelp. 

 

 

I had to get a blood test as part of a standard procedure. But before getting that done, I started experiencing a spike in my eating disorder behaviors and decided I needed to access services and supports. I had been out of programming since 2019, so I needed a new referral from my doctor. This included another blood test along with an ECG.

 

Not gonna lie...even Googling
photos for this post proved 
challenging. So sad, I know!

One blood test, maybe two. The woe begins…

 

I have a fear of needles. It doesn't make sense, even to me, but isn't that the nature of phobias? We can't explain them. We struggle to overcome them. Usually, we don't. We cope through avoidance and crossing our fingers the phobia doesn't come up much. 

 

If I had arachibutyrophobia (fear of peanut butter sticking to the roof of my mouth), I would pass on any immersion therapy and forgo PBJ sandwiches. Not much of a sacrifice. Any inclination to enjoy the taste wouldn’t match the fear and the public spectacle of squirming and screaming with a mouthful of Jif while seated in a cafeteria. Taphophobia is the fear of being buried alive. It might mean doing away with that shovel in the garage (bury it?). Hire a gardener and plan to be off site when they show up. Mageirocophobia is the fear of cooking. So eat sandwiches…but maybe avoid that PBJ if it’s an issue.

 

If I could avoid needles, I would be ecstatic. Is there a medical researcher working on how to X-ray blood? I’ll opt for the oral version of every vaccine. 

 

I live in a sketchy area and I’ve seen many people sprawled on the sidewalk, shooting up. I do my best to look away, but I’ve witnessed plenty. This is as close as I’ll ever get to exposure therapy. It hasn’t made blood tests and dental freezings any easier for me…or for the poor soul tasked with stabbing me.

 

I put off the first blood test for eleven days after contacting my doctor’s office and explaining that I needed the requisitions for both procedures to be done at once, with only one stabbing. 

 

I showed up at the clinic when it opened. Already, ten people were in line in front of me. Great, I thought. This would mean I would have to take a seat and wait, the whole time obsessing over what was to come. I suspect the others who showed up early had to get to work or wanted to get the blood work over with since many of them had fasted and probably wanted a Boston cream and an apple fritter from Tim Hortons afterwards. No food reward dangled as a carrot for me. With my anorexia in high gear, food restriction would not be compromised. In fact, I worried more than usual, knowing there was a greater possibility of fainting since my fasting had far exceeded what was required.

 

The requisition forms for my blood work were supposed to have been emailed to the clinic, but only the more recent one showed up in their system. Thus, I had to search through my emails and access a medical portal to find the other requisition. It took six attempts for me to send the document before they had something that could be opened. In the meantime, I fell further behind in the queue. It's true that the e-mail conundrum served as a distraction, but it also triggered a desire to flee the building and try again some other day far, far down the line. 

 

Maybe I could do without the referral I thought I needed so much. A fear of needles—trypanophobia—has real consequences. Why couldn't I just be afraid of using my oven? I could munch on salads whenever I finally nurtured an urge to eat. A quick Google offered nothing for “fear of E. coli.” I think I could take my chances.

 

I used to have to lie down for
blood tests. I tell myself this
is progress. 

The real fun began when my name was called and I was instructed to go to Room 3. It was an actual room as opposed to Rooms 1 and 2, each of which was nothing more than a cubicle. Room 3 even had a door. As the clinic was very small, I could hear everything said within Rooms 1 and 2 during the wait. Presumably other people waiting would be able to hear me in Room 3 if the door wasn't shut. If I persuaded the practitioner to shut it, I could wail and whimper away. If it stayed open, maybe I’d behave, fearing the snickers among people in the waiting area.

 

I recognized the male nurse from the last time I had to get blood drawn back in August or September of last year. I realize these nurses stab dozens, perhaps hundreds, of patients every day, but it still stunned me that he didn't seem to remember me. I am exceptionally memorable in medical spaces.

 

The door stayed open. Okay, self. Behave.

 

The global crisis may have
passed. Now, it's just me!

I did my normal thing where I stare at the linoleum floor, always a dull white in these settings. I know that, if I glance to my left or to my right, I will see needles, vials and other medical equipment that could put me in a panic. I explained to the nurse that I am afraid of needles and blurted my usual refrain, “I'm sorry that you have to deal with me. Thank you, in advance.”

 

He laughed which is a typical reaction from whoever is tasked to stab me. He probably nodded as well, not that I made eye contact. Yeah, yeah... No big deal. Many people are afraid of needles. Poor guy didn’t know what he was in for. “I’m sorry,” I repeated. 

 

“I may yammer on about nothing in particular,” I said. “You don’t have to listen.” (How many people in the waiting room were listening?) He laughed again. This is good. Usually, nurses are amused by me. I’m terrified but manage to convey I know how ridiculous I am. 

 

My right arm assumed the position on the armrest, as ready as it could be. I made a fist; he told me not to. He kept moving my arm, extending, a little this way, a little that. “Relax,” he said. 

 

Why do they always say that? People are NOT relaxed when confronted with a phobia. 

 

“Make a fist,” he said. It was confusing. Hadn’t I already done that? I did it again, but I wondered if he was talking to himself, patience lost. Then he alarmed me. “It’s hard to find a vein.” 

 

Whaaaaat?

 

This was a first. My anxiety went into another gear. 

 

“Let’s try your left arm.” I tensed up, I made noises. Muffled? Were the people in the waiting room entertained? 

 

I’ve never had blood drawn from the left. Always the right. I’m left-handed. I always get it in my head that my stabbed arm might be out of commission for the rest of the day. It’s not like I had a big assignment lined up that required handwriting, but I didn’t want my left arm to be vulnerable if something should happen. What? I don’t know. Don’t expect me to come up with a rational explanation. This is a phobia, remember?

 

He asked, “Are you taking any medications?” I named one, then struggled to remember the other. It wasn’t what he needed. He helped me along: “Heart medications or what?”

 

“For depression,” I said. “And anxiety.” It made me laugh. “I guess you knew that.” He laughed, too. 

 

“The right arm, please,” I said. He tied the rubber band tighter, I made a fist. 

 

“Tell me 1, 2, 3 before you do it,” I said. (My dentist tried the SURPRISE approach once. That did not go well!)

 

“Sure, sure.” 

 

The countdown.

 

The poke. 

 

Really, that’s all it was. That’s all it ever is. I know this. It’s never ever as bad as I think. It’s not worth the anxiety I feel or the agony I put the nurse through. But phobias will be phobias.

 

He said, “Oh, dear.” 

 

What?! 

 

Just finish, cover the wound—yes, “wound”—with a cotton ball and tell me to press.

 

But no. “I’m not getting much,” he said. The extraction took longer than ever before. I kept still. I gritted my teeth. I closed my eyes. Please, vein. Give it up! Be a geyser. (If it keeps gushing after the needle is withdrawn, I’ll deal with it. I can always faint. The chair has arms. I won’t crash to the floor like that time or that other time.) 

 

I couldn’t message my vein to behave. I heard, “It’s…not…enough.” I got to press cotton but this was not the end of the ordeal. 

 

“I have to try the other arm.”

 

I cried. Seriously. Tears. No wailing but my face was wet. I covered my eyes. It didn’t cover my shame.

 

I told myself it wasn’t just about this faulty vein of mine. I’m going through a lot right now. For weeks, I’d been wondering when I would cry. Anxiety notwithstanding, I didn’t expect it to be in a blood clinic.

 

“Let’s stop,” I said. “I can’t do this. I’ll come back tomorrow.” (Or never.) I finally made eye contact. “I’m so sorry. Thank you for trying. You’re very good. I’ve taken too much time. People are waiting. I just can’t.”

 

“Really?” he said. No sarcasm. No mocking. He looked let down. My anxiety may have been out of control, but I couldn’t stand to think I made him feel like he’d failed. “Did you drink any water?” he asked. 

 

No. I didn’t think I was allowed to. “That helps with the vein.” That didn’t make any sense to me, but I wasn’t going to go home and Google it. I once fainted onto my laptop while researching injuries for a character in a novel I was writing. 

 

I surrendered the left arm. If things went terribly wrong, I could learn to sign things right-handed. Chicken scratch…like a doctor. Ironic.

 

Another poke. Another excruciatingly long time. Slo-mo blood withdrawal. Finally, I got to press cotton, that gesture that conveys to me, It’s all over. You did it. Not pretty but your walk of shame exiting this place is moments away. My little round bandages made things look balanced. As far as my personality…not so much.

 

I still had to do the ECG. Piece of cake. Shirt off, lie down, a bunch of sticky things applied to my chest and midriff, a cable placed on each sticky spot. (Still, I didn’t look.) I could do dozens of ECGs. Like that’s a badge of honor. 

 

He stepped out, flicked a switch or something, then looked at the results on a what I presume was a monitor. Not looking. This room still has needles, vials and whatnot, possibly all over the place. (I once fainted after seeing a poster of a diagram of an ear during a hearing test. Yes…very sad.)

 

“Oh, dear,” he said again.

 

What. The. Hell?!

 

He said the numerical result aloud. “Does your doctor know you have a very low heart rate?”

 

“I think so.”

 

“With a result like this, I’m supposed to call your doctor.”

 

What? Call?! Why not just email the result? Text message maybe. “Why?”

 

“Your result is critical. I’m supposed to make you stay while I get in touch with your doctor. Then you have to be transported to the hospital.”

 

Nope. Not happening! Let me just do my walk of shame.

 

“He knows,” I said with conviction. You’re just very fit, my doctor has told me. That was his same response when I told him I thought I had an eating disorder twenty-nine years ago. Should I trust him? I don’t know, but I did know I was not going in an ambulance. I was not going to ER. I just got stabbed…twice! I could not start fretting about my heart giving out now. 

 

Whenever I’ve been in the hospital, nurses always freak out about my heart rate. I see it on their faces. I’ve had cardiologists visit me in the psych ward and on the eating disorder ward. I get another ECG and the doctor eyes me up and down, stoically. I imagine him thinking, He looks to be alive. He exits. 

 

I’m a medical marvel…in a number of ways.

 

Nope! No sticker for me.

“It’s fine,” I said. This poor nurse had been through enough with me. He was only seventy minutes into his shift. Long day…

 

I’m still alive. Didn’t sleep well. Sudden worries about my ticker. I’ve been meaning to get a referral to a cardiologist. I don’t have any phobias about my heart. Not yet, at least.

ISOLATION, THEN AND NOW

A year ago this week I entered a different type of social isolation. After sixteen months of various outpatient interventions that I mostly fought against, I was admitted to hospital for what was supposed to be a seven-week stay to deal with my decades-long eating disorder. From the outset, I’m not sure if I was committed. I didn’t tell them at the time, but I didn’t plan to stick around for the full term. I’d already booked a trip to Vegas and the Grand Canyon for the beginning of the seventh week. Anita Baker was on a farewell tour and Vegas was the closest stop to Vancouver. Eating disorder treatment be damned; I was going.

I knew prior to admission that the first week would be the toughest. I would be in Phase One of the program, a period during which I’d receive no passes. I’d be stuck in the hospital wing, one so small nurses barely had to raise their voices to call out “Snack time” from the dining area on one end to be heard deep in the activity room on the other end.

Yeesh. Just recalling snack time makes me cringe. Three times a day, in addition to three meals. It felt they were intent on fattening me up, something I’d clearly stated would be a no-go during several pre-admission meetings. I wasn’t a stereotypical skin-and-bone patient with an eating disorder. I just needed to tweak some “bad” habits involving food restriction and overexercising. I was a skeptic who’d given the people running the program a challenge: show me I can eat more regularly and exercise less without gaining weight. If I gained as much as two pounds, I’d decided I would check myself out. I had a foot out the door from Day One.

In fact, I almost packed up before I’d fully unpacked. On my first afternoon, there was some confusion about the number of times they would take my blood. To call it confusion is being kind; they’d flat out changed the rules. A blood lab technician came by and took my blood that morning, twenty minutes into my admission. I have a serious phobia about needles and blood and all things medical. I’d forewarned everyone. Four nurses stood around trying to distract me and ready to deal with my dead-weight body if I fainted. According to the “agreement” I’d made with my assigned psychiatrist, I’d forego the twice-a-day blood extraction routine and I wouldn’t be stabbed again (yes, that’s how I see it) for four days, and then only if something abnormal came up in my initial blood work.

Logically, there’d be a picture of a needle or taking 

blood here. I couldn’t do it. Started to feel 

light-headed Googling images. Honestly. When I 

experience medical trauma, I picture

 my schnauzers. Isn’t Hoover cute?

And yet, sometime around two in the afternoon, a technician with a blood cart strolled back into my room. I panicked. I made a stop sign with my hand. “Oh, no!” I said. “It’s not happening.” The poor technician’s eyes popped out—Drama queen, he probably thought. They don’t pay me enough. He and his little cart switched to reverse gear and I was alone again. It was a good kind of social isolation. I really didn’t need to chat about the weather or Easter with a stranger in a lab coat siphoning my blood. Five minutes later, my assigned nurse and the psychiatrist were pulling up chairs, intent on doing an intervention—Thou shalt give blood, again and again.

It’s exactly what I didn’t want. I had consented to treatment for an eating disorder. I knew frequent blood tests would be an overwhelming distraction, spiking my anxiety, bringing extremely negative associations to the whole program. Like an ornery child, I folded my arms and said, “No more blood or I’m leaving.”

Sometimes little brats get their way, even when they’re 6’1” and fifty-four years old.

I’d “won” but the tantrum took something out of me. I’d warned staff ahead of time that I might be a difficult patient. Having an “entrenched” eating disorder, as several professionals had called it, I knew I’d do a lot of resisting. I was also coming in with negative feelings—even trauma—from two past involuntary admissions to psych wards in the same hospital. I was a nice guy but this was definitely not my happy place. And so I spent most of my first day in self-imposed isolation, in my room, door barely ajar (I wasn’t allowed to shut it). Sometimes I’d sit in the old wooden chair that came with the minimalist décor, but most of my day was spent in bed, the thin blanket pulled all the way up to cover my body, my head turtled under the pillow I’d brought from home.

What have I done?

Do I really need to be here?

How can I put up with this for seven six weeks?

My anxiety triggered many more times that first day. The bathroom was public with two stalls and a nurse barged in during my first visit, telling me I wasn’t allowed to close the hall door. (I learned later that everyone felt she had a particularly abrupt manner.) It freaked me out that, while I was in one stall, a female patient used the second stall. From then on, I planned my bathroom times, counting flushes during prime times so that I knew I was the only one left.

No more water. Please!

The meals and snacks seemed too large and too frequent. My stomach hadn’t digested one before I was having to chew down another. We had to completely finish everything on our institutional food trays, with nurses checking to ensure we’d scraped out every bit from our butter and peanut butter packets (both “never” foods in my home). Even the amount of water I had to drink at every sitting caused stress. (We were forbidden from using the bathroom for the first hour after each meal or snack; hence, those built up prime times.) In the dining area, where I was assigned a seat that would remain my spot for the duration of my stay, I couldn’t keep track of the conversation from the seven other patients and the nurse assigned to supervise the meal. I found myself staring at a whiteboard completely covered with rules about eating. Too much to digest, indeed.

Couldn’t they fix her hair 

for the cover photo?

I combatted anxiety by falling into a depression. Sometimes I can avert this by asserting even greater control over my body, kicking food restriction up a notch (or more) and further increasing my exercise routines. Of course, these weren’t options in hospital. I stuck to my bed whenever possible, sometimes staring blankly at my newly purchased copy of Olivia Newton-John’s memoir, Don’t Stop Believin’, a guilty pleasure that, as it turned out, offered no pleasure. The only other distraction was a Sudoku book I’d packed. I urgently scribbled numbers in little boxes, attempting to blot out harsh self-criticism and a nagging inner voice telling me this program was futile.

In groups, I tried to be compliant or at least silent. I didn’t want my shit to bring down others who actively participated and seemed to be getting something out of this experience. In time, I came around. My mood lifted, my voice returned to normal volume instead of the faint whisper that comes when I’m at my lowest. I adjusted to the mundane aspects of being stuck in a tiny ward smaller that a “Big Brother” set, my discharge date seeming so far, far away. There was some sense of camaraderie that comes with being in a confined, alternate realty together, just the eight of us. “It’s like camp,” one patient said who had been through the program before. “You become besties in the bubble and then you get out and never see each other again.” True enough. We’re not even Facebook friends.

Just like I’m seeing today, confinement led to the creation of routines we never did in that world Beyond the Unit. One cluster took to jigsaw puzzles, imploring visitors to bring thousand-piece forest scenes instead of bunches of tulips. Others passed the time doing some crafty task called Diamond Dotz. A couple others paired up to do New York Times crosswords. With my laptop confiscated, I spent “free” time determined to be productive, revising printouts of aging manuscripts I’d never dared send to agents and publishers.

Pictured, clockwise from top left: 

Chris, Chris, Chris and Chris.

During the evenings, there was a regular Chip and Dale-style “battle” for viewing choices on the only TV screen on the ward. A year ago, hockey was deep into the NHL playoffs, while “Jeopardy” had a smug guy vying to break Ken Jennings’ records. Meanwhile, the younger twenty-somethings on the unit had a constant supply of DVDs from the library...always some new-ish romantic comedy with young actresses who didn’t seem the least bit memorable and one of those Chris actors (Pratt? Hemsworth? Evans? Pine?--could one of them at least have a different hair color?). My room was unfortunately adjacent to the TV lounge, but I holed up there and tried to tune everyone and everything out, revisiting a blog of mine about children’s books and slogging through Olivia’s knack for making anecdotes from the “Grease” set and the making of the “Physical” video as spicy as, well, Sandra Dee.

It was a constant challenge to stay busy, knowing that time continued to tick by in the real world beyond the locked door at the end of the hall. People had freedom to eat what and when they wanted. They could go wherever they wished. No one monitored their movements documenting everything in hefty binders. Imagine.

A year later, I’m back in some form of isolation. I see tweets every day from people struggling with boredom, with lack of human contact, with closed gyms, restaurants and salons. Pardon the food reference, but this is a cake walk. I find the current situation exponentially more tolerable than what I experienced for six weeks on a locked hospital ward. Sure, we have to socially distance ourselves and do without services we’ve always taken for granted but, as the saying goes, misery loves company. We’re in this together.

One of the many murals popping up in Vancouver’s 

Gastown as owners temporarily board up businesses.

The weirdness of the moment goes so far beyond a shared experience of eight patients whose damaged pasts have manifested themselves in tenacious eating disorders. In the present, I spend much more of my time appreciating what’s come of this coronavirus crackdown. I love how the streets of Vancouver are clearer and how bike trails are getting more usage. I am heartened when I see families on leisurely walks. (I smiled broadly yesterday while I biked along a forested path and passed a father flanked by four children, one in a Spiderman costume, all carrying big sticks to fend off pirates and whatnot. Memories.) My daily scroll through my Facebook feed lacks the typical travel photos, but I see fewer blatantly political posts being shared and many more memes spreading humor, kindness and a greater regard for our eldest citizens. I find myself being especially courteous to grocery clerks and it warms me that others are doing the same. I step out on my balcony at seven every night, a little too reserved and musically insecure to bang on my own pots and pans, but soaking in the din intended to express gratitude for health-care workers (and, just maybe, to let out some built-up steam).

Yes, I daresay, there’s much more to like about the present “isolation”. In some ways, I feel more connected to humanity than ever.