A small, red wound—no bigger than a poppy seed—appeared mysteriously on the bridge of my nose a few months ago. At first it sat there quietly and behaved itself, and I assumed the strange bump would heal steadily and vanish as furtively as it had arrived. Only it didn’t, and pretty soon it started to grow bigger and act out. One day it would bleed; the next it would scab over in a sort of mini, leathery patch; and then, right when it seemed the ugly scab had almost disappeared—when it seemed we’d soon part ways—it would open up and bleed irritably again.
Day to day, I couldn’t predict its mood; it was like living with a touchy teenager.
Eventually, I realized that I would need to make the necessary arrangements to evict the tiny squatter. And so I went to see a dermatologist, who peered at my nose suspiciously and asked if I’d been under the sun much. I thought of all the summers I’ve spent thoughtlessly plopped in a beach chair, toes dug into the warm sand, book propped on my lap, while the sun toasted my skin a rich, bronzed color of rotisserie chicken.
“Umm… not really,” I hedged. I felt a pang of guilt, like I was 17 again and coolly asking our family doctor for birth control pills solely to regulate my periods, when I actually had something more interesting in mind. What is it that makes us want to present a scrubbed, sanitized version of ourselves to those in positions of authority?
Instantly, I recanted. “Well, I usually use sunscreen,” I allowed, rationalizing that “usually” was interpretive enough to make it a true statement.
“Well, we’ll see.” She was brusque—and efficient, clipping off a piece of the angry interloper, which in response promptly bled at her. “We’ll be in touch,” she said.
A week or so later I got a flimsy white postcard in the mail from the doctor’s office. On it were three pre-printed options with open boxes next to them, and one was checked off: “Your biopsy showed a cancerous growth,” it read next to the check mark. “Please call our office to schedule a follow-up appointment.” In ballpoint pen, underneath, someone had scrawled, “Basal cell carcinoma.”
I had to admit: It was efficient. Nonetheless, there was something a little off-putting about it—the healthcare equivalent of a service-call reminder that it was time to rotate my car tires.
My teenage son, reading over my shoulder, snorted and said, “Wait a minute… did you just get a postcard from your cancer?” Immediately I pictured a small skin growth waving to me from the deck of a catamaran in Cancun. “Weather to die for. Sights are gorgeous. Wish you were here!!!” Of course, I wish it were vacationing there, too, preferably on somebody else’s nose.
Basal cell carcinoma is pretty much the milquetoast of the skin cancer family. In medical-speak, it’s not very “aggressive.” It’s small and weak—a pipsqueak—and it generally doesn’t spread to other outposts on or in the body. Even the most ambitious basal cell carcinomas—the valedictorians of their cancerous classes—can usually only ever hope to achieve an ugly disfiguring. “It’s the one you want,” my doctor had explained. Still, I thought, that was kind of a curious way to describe any cancer, even a wimpy one.
And, even so, the news came as a downer, if only for the portended hassle of another visit to another doctor, and then a third visit to a plastic surgeon to re-putty the small but prominent spot in the center of my face.
But I cheered myself almost immediately by considering, still gripping the doctor’s postcard, the idea that this little dot on my nose was so trifling, so insignificant, that it didn’t even warrant a telephone call. Instead, a cheap piece of mail moseying its way to my mailbox sufficed. This pipsqueak was nothing my doctor hadn’t seen before, a million times. There was comfort in thinking that she already had a system, a routine in place to roust it from its perch on my nose, and I was grateful that I was in such experienced hands.
In fact, I kind of liked this process of postcard notification. It seemed an inherently easier, less messy way to deliver news that is otherwise a bummer. Imagine, for a minute, all the drama that could be avoided when the surgeon greets the family after a risky procedure. “Will she live…?” the family pleads, plaintively. And the doctor shrugs, “Go home and you’ll receive a postcard in 7 to 10 days.”
I think of all the unpleasant news I’ve ever had to deliver or—worse!—received. Slacker employees fired. Bad relationships severed. Emotionally wrought times in life when pages and pages of conversation that start with “we have to talk…” and end up, three days later, with both parties exhausted and bleary-eyed and rung out from endless faults, accusations and indiscretions examined and exposed. Wouldn’t it be so much cleaner to just send your once-beloved a white, clinical postcard, with a box checked next to: “It’s over. Don’t call.”
I was still liking this postcard process, because the day hadn’t yet come when I’d face certain realities. I hadn’t yet had the follow-up appointment with a new surgeon, when his nurse would circle the spot on my nose with a purple felt-tip pen and photograph it at pore-close range. Then, as I sat across from the surgeon and his partner and discussed the surgical procedure with a fat purple circle on my face, finally one of them, sensing my humiliation, would lean over and wash it away with an alcohol wipe, like I was a preschooler with some jam left on her face from snack time.
The truth is, when it’s our own health nothing is really routine: no pregnancy, prostate, cancer or canker is much like another—at least, when it’s happening to us, inside our own skins. But modern healthcare—with its postcards, and patient appointments stacked one after another, and whatever other efficiencies administrators can manage—seems to stumble along as if it were… workaday, just plain routine.
In fact, the system seems teed up in way to disrespect both the patient and—at the same time—the physician. The factors that lead to patients in tightly packed queues and diagnoses sent through the mail are the same ones that burn out doctors. Mostly, it’s because of the lack of financial stability and autonomy, says Salon’s medical writer, Dr. Rakul Parikh. And unlike most business transactions, in healthcare the customer is not in control.
“A generation ago,” Parikh writes, “doctors were accountable only to their patients.”
But these days, of course, they are accountable first to insurance representatives and hospital administrators, “many of whom have no direct experience in healthcare but hold power over budgets and reimbursements,” he points out. “It’s that lack of control that has frustrated many doctors and left them feeling pessimistic about the future of healthcare.” And burned-out doctors feel about and behave toward their patients very differently.
If it’s frustrating to be a patient in the system, it’s alienating to be in the doctor’s shoes, accountable to administrators rather than their actual customers. On top of it all: they have to hear folks cop to only two drinks a day when regularly they pour themselves a few more—or swear they take multivitamins, or say they wear sunscreen… when they don’t. I’m vowing to do a bit better there from now on.
This election season, talk of healthcare reform usually centers on access. But I’m wondering if we should also be talking about how to reinsert a bit more humanity—some real caring—in healthcare.
Find more like this: Politics & Society , basal cell carcinoma, cancer, doctors, health care, medical care, modern medicine, skin
Glad to find your great writing via Chris Brogan, and LOVED the tale and what it raises. DON’T love the privacy issue being ignored by your Doctor’s Office — for shame! Your poor mailman must be worrying too!
Oh, does this story get me going.
This past Monday, I went to see my dermatologist for an annual exam. He removed a mole and sent it out for lab tests. He didn’t sound too concerned about it, but you can bet that I am.
But he said that I’d be called if the news was bad and sent a letter if they news was good.
Before I left the exam room, I noticed that the bill said that the fee would be $93. I’m a self-employed person with one of those high-deductible policies that requires that you burn through thousands of dollars before it kicks in. (And that’s another rant.)
When I arrived at the front desk to settle the bill, I was told that I would have to pay a $250 deposit. I was floored. I told them that I wasn’t anticipating that the bill would be that high.
I’ve been waiting for an out-of-state check to reimburse me for an airline reservation that I’d made earlier in the month. And the check hadn’t arrived yet. I told them about the wait for the check, and asked if they could bill me so I could settle up next week.
“We. Don’t. Bill.” the lady said. And she put special emphasis on the word “bill.” Like it was one of *those* four-letter words.
I pleaded my cause further. I noted that I’d been seeing this particular doctor for 16 years, and couldn’t we work something out? I mean, come on. Giving me the opportunity to settle this bill after the check came would have been very nice.
Nope.
They got my credit card, and, after several tries, they dinged it for $100. (Most of what’s on that card right now is the payment for that airfare.)
In addition to Monday’s encounter, something else has been troubling me about that doctor’s practice. Over the years, it has taken on more of a cosmetic orientation.
While I was in the waiting room on Monday, I couldn’t miss seeing the promotional pieces touting some procedure that would soften those wrinkles before that all-important Holiday Party Season.
As someone who has to see a dermatologist for health reasons, I find this focus more than a little offensive. But it explains why I was treated so coldly at the checkout desk. I’m obviously not part of this practice’s target market.
And once I settle the rest of this doctor’s bill, I’m taking my business elsewhere.
Oh, does this story get me going.
This past Monday, I went to see my dermatologist for an annual exam. He removed a mole and sent it out for lab tests. He didn’t sound too concerned about it, but you can bet that I am.
But he said that I’d be called if the news was bad and sent a letter if they news was good.
Before I left the exam room, I noticed that the bill said that the fee would be $93. I’m a self-employed person with one of those high-deductible policies that requires that you burn through thousands of dollars before it kicks in. (And that’s another rant.)
When I arrived at the front desk to settle the bill, I was told that I would have to pay a $250 deposit. I was floored. I told them that I wasn’t anticipating that the bill would be that high.
I’ve been waiting for an out-of-state check to reimburse me for an airline reservation that I’d made earlier in the month. And the check hadn’t arrived yet. I told them about the wait for the check, and asked if they could bill me so I could settle up next week.
“We. Don’t. Bill.” the lady said. And she put special emphasis on the word “bill.” Like it was one of *those* four-letter words.
I pleaded my cause further. I noted that I’d been seeing this particular doctor for 16 years, and couldn’t we work something out? I mean, come on. Giving me the opportunity to settle this bill after the check came would have been very nice.
Nope.
They got my credit card, and, after several tries, they dinged it for $100. (Most of what’s on that card right now is the payment for that airfare.)
In addition to Monday’s encounter, something else has been troubling me about that doctor’s practice. Over the years, it has taken on more of a cosmetic orientation.
While I was in the waiting room on Monday, I couldn’t miss seeing the promotional pieces touting some procedure that would soften those wrinkles before that all-important Holiday Party Season.
As someone who has to see a dermatologist for health reasons, I find this focus more than a little offensive. But it explains why I was treated so coldly at the checkout desk. I’m obviously not part of this practice’s target market.
And once I settle the rest of this doctor’s bill, I’m taking my business elsewhere.
Ann – so glad that you’re going to be OK! How scary and the story you tell is all too real. I think the doctors forget that they are looking at a living, breathing person in front of them (which may make me feel a little better about my OB/GYN appointments). I’m sure we all have our fair share of physician horror stories, but that postcard has GOT to be a HIPPA violation. Honestly, they worry about what line you stand in to check into the practice so you can’t be ‘overheard,’ but they share your deepest test results with Kevin the Mailman?
Oh, I’m feeling another political pundit coming on…
Renee
Ann – so glad that you’re going to be OK! How scary and the story you tell is all too real. I think the doctors forget that they are looking at a living, breathing person in front of them (which may make me feel a little better about my OB/GYN appointments). I’m sure we all have our fair share of physician horror stories, but that postcard has GOT to be a HIPPA violation. Honestly, they worry about what line you stand in to check into the practice so you can’t be ‘overheard,’ but they share your deepest test results with Kevin the Mailman?
Oh, I’m feeling another political pundit coming on…
Renee
Ann,
I loved your presentation of your situation and being in the business of health care, I am appalled by both the privacy issue and the insensitivity.
Many of the comments center around this issue being primarily insurance and administratively driven. I would be remiss not to say that frivolous litigation has damaged the health care system in more ways than either of the above. If only we had a cap on what trial lawyers could make, the need to see more and more patients and the increased paperwork burning out providers would be greatly reduced.
Ann,
I loved your presentation of your situation and being in the business of health care, I am appalled by both the privacy issue and the insensitivity.
Many of the comments center around this issue being primarily insurance and administratively driven. I would be remiss not to say that frivolous litigation has damaged the health care system in more ways than either of the above. If only we had a cap on what trial lawyers could make, the need to see more and more patients and the increased paperwork burning out providers would be greatly reduced.
The good news is that you’re ok! The postcard notification is pathetic. We’re losing those
elements that make us caring, social human beings.
Except for bloggers that is!
The good news is that you’re ok! The postcard notification is pathetic. We’re losing those
elements that make us caring, social human beings.
Except for bloggers that is!
Just a quick one (like the actual amount of time the dr actually spends with you during your exam) to let you know my business uses postcards but in a positive way…every customer gets at least one thanking them for their business. I dont think anything personal like health issues should come on one. Some mail carriers are very gossipy so I give them something nice to think about.
Deb
Just a quick one (like the actual amount of time the dr actually spends with you during your exam) to let you know my business uses postcards but in a positive way…every customer gets at least one thanking them for their business. I dont think anything personal like health issues should come on one. Some mail carriers are very gossipy so I give them something nice to think about.
Deb
I’ve been enjoying your blog very much. You’re a great writer and have interesting insights on a wide range of topics. Glad your cancer scare is under control and that you’re able to put the whole thing in perspective. Thanks for sharing what’s on your mind.
I’ve been enjoying your blog very much. You’re a great writer and have interesting insights on a wide range of topics. Glad your cancer scare is under control and that you’re able to put the whole thing in perspective. Thanks for sharing what’s on your mind.
Ann, how did the respackling of your nose go? I had one removed when I was 28 — couldn’t believe how much skin they take. It’s always fun to walk around with stitches on your face too, lets you work in those domestic violence jokes.
Ann, how did the respackling of your nose go? I had one removed when I was 28 — couldn’t believe how much skin they take. It’s always fun to walk around with stitches on your face too, lets you work in those domestic violence jokes.
Ok, everyone else has said most of everything, so I’m just going to sum up my thoughts with:
a) Thanks again for sharing your stories in such an eloquent, hilarious, and touching manner.
b) WTF is wrong with people?
So glad all is well, but seriously. What a bunch of clownpunchers.
Ok, everyone else has said most of everything, so I’m just going to sum up my thoughts with:
a) Thanks again for sharing your stories in such an eloquent, hilarious, and touching manner.
b) WTF is wrong with people?
So glad all is well, but seriously. What a bunch of clownpunchers.
I like your son’s comment. Glad you issued your cancer a pink slip!
There’s so much room and need for humanity to return to our institutions. We are the only ones who can make it happen b/c the institutions don’t know how. I’m hoping that this election will set the stage for more power to the people – via social media… or postcards.
I like your son’s comment. Glad you issued your cancer a pink slip!
There’s so much room and need for humanity to return to our institutions. We are the only ones who can make it happen b/c the institutions don’t know how. I’m hoping that this election will set the stage for more power to the people – via social media… or postcards.
Ann,
Love! your writing style – hard to believe that I could be lol while reading about the sorry state of our health care system and such a down right ‘cold’ way to inform someone of cancer.
I too get postcards and emails regarding my health care visits, but cannot believe that this is the way one would be informed about something as scary as cancer! What were they thinking?
Glad you’re ok and also glad I found your blog because I really enjoy your writing style.
Thanks,
Robin Ogden
http://www.firedupcareers.com
Ann,
Love! your writing style – hard to believe that I could be lol while reading about the sorry state of our health care system and such a down right ‘cold’ way to inform someone of cancer.
I too get postcards and emails regarding my health care visits, but cannot believe that this is the way one would be informed about something as scary as cancer! What were they thinking?
Glad you’re ok and also glad I found your blog because I really enjoy your writing style.
Thanks,
Robin Ogden
http://www.firedupcareers.com
I can relate to what you went through in terms of discovering an uninvited squatter in the body or in your case on the body. Glad it was low grade.
I kind of like the postcard approach in the absence of a medical system with the luxury of time to call you in for an appointment and tell you your test results. At least know what the answer is rather than having to hassle to get the results and then wait for ever for an appointment (at least here in Montreal its like that).
Glad too that you have a sense of humour – I kind of think its the only way to go on things like this.
Long may you be free of uninvted guests !
I can relate to what you went through in terms of discovering an uninvited squatter in the body or in your case on the body. Glad it was low grade.
I kind of like the postcard approach in the absence of a medical system with the luxury of time to call you in for an appointment and tell you your test results. At least know what the answer is rather than having to hassle to get the results and then wait for ever for an appointment (at least here in Montreal its like that).
Glad too that you have a sense of humour – I kind of think its the only way to go on things like this.
Long may you be free of uninvted guests !
YIKES can’t believe I missed this! Glad you and your mug will survive!!
YIKES can’t believe I missed this! Glad you and your mug will survive!!
You need to write something long and edible. Your voice is excellent, compelling. Write us a book.
You need to write something long and edible. Your voice is excellent, compelling. Write us a book.
Pingback: Refugee At Home
Pingback: ‘What Happened to Your Nose?’