Sue Katz: Consenting Adult

Ever Had a “Wellness Visit”?

Yesterday I had the first of what, with luck, will be a long line of annual Wellness Visits compliments of Medicare. This replaces the sturdy “annual check-up” that those of us who see doctors have come to rely on as the one time during the year that one can arrive with a literal list of issues (I always have a copy ready for my doctor), from new bumps/lumps/discolorations to gassiness to blurry eyesight at the computer. Whatever ails you – put it on the list for your annual.

So what is this Wellness Visit and how does it differ? For one, I see an assistant and then a nurse practitioner – but not my doctor. I have to convince the assistant to check my height after she weighs me. “It was checked last year. It’s not like it’s going to change,” she says. Wrong – one of my concerns is that I am shrinking. Bone loss.

I wonder if she is the same young employee who, when I asked a couple of years ago about a hepatitis inoculation, told me that I didn’t have to worry because it was only for sexually active people! “Let’s make a bet,” I answered in anger, “about who is getting it more – you or me.”

This Wellness Visit involves no physical exam, no taking off of clothes, no touching. It opens with the assistant’s irritation that I have not brought the completed form – a form which I only find in my mailbox back home later in the day. She will not allow me to fill it out on the spot and insists on doing it herself, which, it later transpires, she does very poorly.

When I do see the form later in the evening, I realize that it has nothing to do with wellness and is, in fact, entitled “Medicare Health Risk Assessment Form.” It asks if I’m capable of basic activities – feeding, clothing, and bathing myself; shopping and cooking (not so good). It asks about home safety and falling down.

“Are you afraid of falling?” Of course I’m afraid of falling. Anyone who knows anything about aging knows that falling is something to approach with dread. But they don’t mean that. They mean, Are you walking gingerly, looking at the ground, terrified. Well then, say so.

They ask about nutrition. And about alcohol and drug use. The assistant kindly explains that by drug use, “They mean like marijuana and heroin.” Well, that narrows it down.

And they ask about “Your emotions and social support.” When I am going over the form again, this time with the Nurse Practitioner, I ask her, “And if an elder is isolated and has no social support, what do you suggest that she do?” As someone who has long worked with elders, I am interested in what resources they bring to bear on those with revealing answers.

“Some of them just don’t want to know anyone,” she replies with scorn. “I know all my neighbors. We have coffee together, our kids play together. Some of these patients don’t even know the name of their nearest neighbor.”

“Do you own your own house?” I ask her.

“Yes, in the suburbs. Of course.”

“Well, I rent, and I do not know my neighbors and I don’t really want to.”

“Why not? That’s ridiculous.”

“No, it’s rental. It’s big buildings. Neighbors come and go – they’re renters. There is nowhere to escape from a bad one. I can’t ‘go home’ the way that you do. They share walls with me. I want my privacy.”

I know so many elders in subsidized housing in large buildings who have to weigh how many intimacies to promote, surrounded by old people, many sick and needy, people one sees in the elevator, in the dining room if it’s that kind of facility. One makes choices.

The nurse practitioner lectures me about the function and structure of the ear for too long because she cannot answer a simple question: Should I get a baseline hearing test or not? She says she is not an Ears/Nose/Throat person.

At the end she sends me for blood tests. I warn the blood taker – my regular person isn’t around – that I have rolling veins and that if she misses, I do not want her to dig around in my arm. She misses and digs. I tell her calmly, “Remove the needle now, please.” She does and sulks. “You don’t have rolling veins. You moved. No one can do it if you’re moving.”

“I’ve been told for 66 years that I have rolling veins. Please bring me someone else.”

“They won’t get you either, with you twitching and moving.” She puts the rubber tourniquet around my other arm and then starts searching in my hand.

“Please bring me someone else.” She finally agrees, petulantly, and a man comes, I explain the situation, and although he too digs around, he does manage to extract some blood – although today I find out that it wasn’t enough for one of the tests. That’s a photo of my arm today, by the way.

So if you’re heading for Medicare, let me be your big sister. Be sure to ask for a follow-up appointment with your doctor in light of something or other that you bring up. Then you can actually sit down with her and tell her to check your lumps and pangs.

My Abused Tooth

“We’re going to extract that tooth,” Dr. Lumin said.

“What do you mean?” I had come in, as I had so many times before, for her to do her magic with cleaning and rinsing the infected gum around the abused tooth.

“But I have lunch with Gail and dinner with Barry.” She lets me out of the chair to call them and cancel my plans. I trust her, but I’m discombobulated, have had no time to prepare.

“People get quite emotional about their teeth,” she says. “To me, I work with them all the time. They’re tools. Very flawed tools. Even young people with perfectly healthy teeth have trouble. One patient bit into a hamburger and a piece of gristle cracked her tooth and she ended up with an implant. They’re like knees – we use them a lot but they wear out and often have problems.”

“Why today?” I ask.

“It’s time. I should have warned you. I’m surprised the tooth has held up this long.”

The original insult to this tooth dates back to the 80s. I was living in Israel and looking for a dentist to deal with some inflamed gums. Someone recommended a woman who had newly opened an office in their neighborhood. She looked in my mouth, shot me full of Novocaine, I guess. Did she use gas too? I can’t recall exactly, but I believe she did.

The next thing I know she had my mouth clamped extremely open and she was doing something that seemed awfully involved for some inflammation, but although I was grunting inarticulate questions and waving my hands, she ignored me. The next thing I know, she had amputated one of the three roots of a perfectly healthy, very necessary first molar on the upper left.

“It’s dead now,” she said. I couldn’t figure out what was going on. “And you’ll have to have a root canal next door.” Unbeknownst to me, “next door” was actually her brother and he did some sort of root canal. Was it the same day? After I had healed?

All I can recall is a terrible space where there shouldn’t be one; a murdered tooth essential to good chewing; a feeling of violation. And some time later, hearing that they were identified as scam artists. Perhaps they went to jail – my recall is hazy. I was left with this abused tooth, crippled forever.

I’ve got crappy teeth, overall. Not only did I grow up before fluoridation, but I also moved many times, forcing me to switch from dentist to dentist, each one of whom hated the work of the previous ones. The filling material was out of date, said one. That crown was old-fashioned, said another. Each country used different technologies. Every individual dentist worked with a frequently unwarranted confidence.

This tooth has been nothing but trouble, but right before my recent trip abroad, Dr. Lumin took another x-ray. “The bones around and under the tooth are gone. If you have an implant – a very expensive affair – you may have to have your sinus cavity moved because the bone is gone and the cavity is right there.”

I can’t picture this. I can’t fathom this. I can’t bear the injustice of my face, my food, my sustenance, my chopping implements being at risk because of a scam artist who needlessly butchered me. “Why didn’t she claim to do work she didn’t really do and demand the same money?” my dentist asked. “Why did she do harm?”

It is like a metaphor for our financial lives. We have worked hard, saved hard, and been ripped off by capitalism, by capitalists. Now they want our social security, our old-age health care, our parks and our libraries. Isn’t our money enough? Must they also do harm?