Inverted reality

I scheduled an appointment for 11:20 a.m. to see my primary-care physician, Dr. U.R. Knotavet, to update my tetanus booster and to ask her a few questions.

My wife and brother-in-law came with me for support, since I usually felt some degree of anxiety in the exam room, which was the reason I was dancing around in it this morning.

"Christian Andres. How are you?" my doctor asked.

"Not so well this morning," I said. "I've been losing some weight, and my appetite has decreased."

"Really?" Dr. Knotavet asked.

"Yes. Since I'm here to get vaccinated, I might as well let you know that I've also had this growth here under my skin; I think it's oozing some pungent material. But before you look at that, do you think you could tell me why I keep having to stick my finger in my ears and relieve the itchiness? I think there was some dark discharge coming out of one of my ear canals this morning."

As Dr. Knotavet placed her stethoscope on my chest, I began talking loudly. "While I have you this close, could you also take a quick glance at my left eye? I've had this yellow discharge every morning, and I'm not sure why. I'm sorry you won't get to see the discharge today, I actually wiped it off this morning."

As Dr. Knotavet finished checking my blood pressure, she grabbed her ophthalmoscope to look at my eyes. Just then, I was starting to feel a little anxious, so I decided to put my iPod on and listen to my favorite dance song, "U Can't Touch This" by MC Hammer.

I politely told the doctor, "You'll have to look at my eyes while I do the windmill and kickworm here on the floor; I hope you don't mind."

I could see her getting impatient, and I think she only spent 7.2 seconds on that part of the exam. Before she could turn off the ophthalmoscope light, my wife asked, "So what's wrong with his eyes? Is he going blind? Can he see? Do you think it's contagious? Is it hereditary? Could the Froot Loops he's been eating have caused it? Will his insurance cover it? Why does Costco sell so much cranberry juice cocktail, and who really makes Kirkland products?"

The doctor gave my wife a phony smile and said, "Uh, I don't really see anything wrong with his eyes, but I couldn't get a good look since he was dancing all over the floor; maybe if you had him take a sedative next time and left his iPod at home I may be able to get a more thorough look. I'm sorry; what was your other concern?"

"Oh," I smiled. "This apparent abscess, would you look at it?"

"Sure," said Dr. Knotavet as she put on some latex gloves. As she gently expressed purulent material from my lesion in my groin, my cell phone rang. "Hold on just a second Dr. Knotavet, I just need to see who's calling." Sure enough, it was my mom wanting an update on what the Doctor had found.

"Uh, Doctor, do you mind telling my mother what you've found so far … here, you can just begin talking." I pressed the green talk button and handed her the telephone.

I heard Dr. Knotavet sigh just before beginning her short discourse on my physical examination. After handing me back the cell phone, Dr. Knotavet explained that I needed to see several specialists, including a dermatologist, ophthalmologist, endocrinologist and possibly a psychiatrist. All this after walking across the street to the phlebotomist to get blood drawn. She informed me it may take several days before I received the corresponding referral information by mail, and I would have to call back in two weeks to listen to a voice message regarding the blood work results.

"How much do you think that will cost, Dr. Knotavet?" I asked. "May I have an estimate for all the tests you think these specialists are going to run?" I followed.

"I'm not sure what they'll do, so that's impossible Mr. Andres," Dr. Knotavet said. At that point, my wife interjected, "Thanks Doctor, you must love your job … you know, helping people and everything!"

The doctor hesitated and just smiled as she said lazily, "Yeah, you could say that."

At that point, I quickly began contemplating the potential costs for all those tests as well as the time involved and decided it was just not worth it. "I'll just take the shot for now doctor. How much will that be?" Dr. Knotavet gave me somewhat of a fizzled, disappointed look as she said it would be $284.56 for the consultation and vaccine. As I rolled up my sleeve for the injection, I realized it was time to maximize the visit.

"One last thing," I said. "I know he doesn't have an appointment, but I brought my brother-in-law here today, because he has some of the same issues except he started vomiting this morning. Do you think you can just take a quick peek at him too? I think he needs his vaccines updated as well. Do you think we can be out of here by 11:40 a.m. since I have a Tai Chi class I need to attend?"

Fifty minutes later after also examining my brother-in-law, Dr. Knotavet was on to her next patient when her receptionist interrupted her. "Mr. Andres says you forgot to look at his ears and is very upset that he's going to miss his Tai Chi class. He says he doesn't know why things always take so long, and he doesn't want to wait anymore. He also wants to know if there will be any additional charges or medications for his ears before you look at them because he may not be able to afford it. Can he just use those tablets you gave him last time for the foot pain, since he still has most of them?"

I don't think Dr. Knotavet heard the receptionist very well since I could see her filling out the insurance form I had given her at the end of the appointment. Ten minutes later, I was handed my completed insurance papers. "Hey, wait a minute …" I told the receptionist. "This is not what I told Dr. Knotavet to write in the insurance form! Could you please tell Dr. Knotavet I just need to have a quick word with her please?"

Just as Dr. Knotavet was walking towards me, I saw the business manager interrupt her. I couldn't quite make out what she was saying to Dr. Knotavet, but she sounded aggravated that Dr. Knotavet had taken so long with my exam. In fact, she had three subsequent patients waiting and wanted to know how much longer it would be. I could see Dr. Knotavet trying to mumble something about scheduling, but it was difficult to understand since she was shoving food into her mouth as she simultaneously tried to write in a chart and respond to the business manager's query.

Just then, I wondered if I ever told Dr. Knotavet that my son always wanted to be a doctor.

Christian Andres, DVM, practices at All Pets Veterinary Hospital in Rancho Palos Verdes, Calif. He is a graduate of Ross University's School of Veterinary Medicine in St. Kitts and completed his clinical year at Louisiana State University School of Veterinary Medicine. Dr. Andres practiced small-animal medicine in Ohio for several years before returning to Southern California in 2003.