Medicine At A Distance: My Health Update

My medical interactions were done differently, before the pandemic. Back then (last year), I’d show up at the hospital at least thirty minutes before my appointment and pay my copay at the receptionist’s desk, if I hadn’t done it online, and then I’d sit in the carpeted waiting area, in comfortable silence with my fellow out-patients. Sometimes there were two or three people and I would sit a polite distance away from them, letting them have their personal space, their personal bubble. Sometimes the area was crowded, and we would avoid each other’s eyes, and wait until we were called, each in our own little personal mental space.

When the nurse summoned me, I’d go into the business area, behind the receptionist’s desk, where the doctors see their patients, and I would be weighed. I would always take off my coat or jacket. It added anywhere from five to almost ten pounds, depending on the coat, and that depended on the season. After the weigh-in, I’d be led to a small examining room. he nurse would take my blood pressure – standing, sitting, and lying down – ask me a series of questions about my medical health, current medications, etc., then leave to get my doctor.

I would always wait for her to leave before removing my shoes and shirt. modesty formed in youth and maintained into your 50s is difficult to shake. Maybe five minutes later, but never as much as ten, the doctor would arrive, trailing an assistant, a nurse, usually the nurse who had weighed me. My doctor is a cardiologist, so we discussed matters of the heart. He held a chilled stethoscope to my chest, then my back, to listen to my heart and my lungs (to see if there was any fluid in them). I would lay down and he would press my stomach, tap it, listening for fluid, then he would squeeze my feet, ankles, and lower leg, looking for swelling caused my fluid and asked my if I had been feeling any fatigue in my legs or lungs, especially after an exertion like exercise.

Then we would talk for awhile, him answering questions, if I had any, while his assistant took notes on the computer. He would ask me if I was experiencing side effects from the medicine, change doses if necessary, give me instructions to follow until our next annual meeting and leave, with a firm handshake.

I would dress quickly, pull on my socks and stuff my feet into untied shoes, and follow the assistant to the scheduler’s office, jacket or coat clenched under my arm. I would finish dressing while she (the scheduler has always been a woman) scheduled my next appointment, and my electrocardiogram (to measure how well my heart was pumping blood through my body), and we waited for the doctor’s assistant to print out the doctor’s instructions for me. Then, I would leave.

That was then, before the coronavirus drove the world indoors and changed the way we live, at least for now.

The professional touch of my local medical institution is gone, replaced by the sterile glint of overhead lights off my smart phone’s touch screen. Video visits. That is what the doctor/patient relationship has been reduced to.

One of my doctor’s nurses called me two weeks before our appointment; the coronavirus has created a need for social distancing, even at the hospital, and my doctor, one of his assistants, and I would be meeting over the phone, instead. Someone else called nine days later and changed it to a video visit, said “they” wanted it. “They are probably my insurance company. we set up the app and I confirmed the appointment for 10:30 AM, on the 21st.

I decided to go to work on the 21st.. The campus is almost empty, except for fifteen people, students and dorm directors included. I had time. I would use the warehouse; it’s big and quiet and I wouldn’t be disturbed there.

I am sitting at the medium-sized workstation in the middle of the warehouse, fully-dressed, computer on, reading a story by H.P. Lovecraft, when on of the nurses calls me, a guy this time. This is the first male nurse he has had, as far as I can tell. I tell him my weight as of this morning, the 21st, my blood pressure as of two hours after taking my medication, and my heart rate. We tear though the particulars about my current health, medical history, current medications, and their side effects. There are none, I think. I am gaining weight, slowly, etc. We test my video connection, to make sure it works. He logs off and I wait for the doctor to appear.

As small as my smart phone is, relatively, my face is huge in its screen, huge and pale. I study it for moment, wondering if someone is watching on the other side. The lines across my forehead look like like they were drawn with a black marker. My eyes seem to bulge slightly. My lips are dry and almost peeling, and I don’t have time to dig around in my backpack for lip balm. So, I look away from the screen, in case someone is watching, and try to read a few paragraphs of a news story on my computer…and wait.

And, after a couple of minutes I wish I had decided to search for the lip balm. I had enough time. Then, my doctor appears on my phone’s screen. He’s wearing a blue face mask and I am confused for a moment. First, why is he wearing the mask? Then I realize he’s at the hospital – he’s not calling me from home – and he has to be around patients and staff all day. He is just being safe. Second, I have to watch him carefully, especially his eyes, the only part exposed, for almost a minute, because I can’t tell if he’s my doctor. I see him once a year. I don’t know his voice. But, after a while, he smiles about something and his face becomes recognizable.

So, we talk. This is the examination. I feel good, I have no questions, I am doing some exercise, I haven’t noticed any side effects. This is going faster than any office visit and I am kind of digging it. I had wondered about video visits before, when my insurance company sent me information about them. and wasn’t sure how effective they could be, what compromises had to be made, but this is almost like the live thing. I am expecting, however, to be scheduled, for live visits for…

No echocardiogram this year. My last one was good. I am not having any problems. It can wait. And, no blood test at least for a month, month and a half. They are waiting to see if the government’s shut down schedule changes or solidifies and if I go in for a blood test now, I will have to have my temperature taken, wear a face mask, etc.

This is how the relationship has changed. It’s medicine at a distance, hands off, with faces as close as video technology can bring them. All the medicine that is possible without human contact, without close proximity.

I was relieved. I don’t mind saying that. The echo costs me over a thousand dollars, every time, and I have to pay in full, beforehand. The in-office visit: $250.

The pandemic is costing hospitals some money. I hope they are being reimbursed.

Just like that, in a metaphorical moment, we have gone digital and impersonal. Prescriptions delivered to your home. Video visits. COVID-19 couldn’t have struck at a better time, when we have the technology and the resources to adjust to it, some of us, anyway.

How much worse would our situation be without it?

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