Thursday, February 28, 2013

Floating

     It is four weeks since my clinic closed.  It is one week since the last vestiges of clinic activity were swept from the 810 NW 16th Avenue building, which now stands hollow and forlorn.
     I should feel forlorn, too.  But instead, I am lighter than air.  I am floating, weightless, relieved, imperturbable, and strangely elated.  I have not felt like this since before I began taking care of patients, twenty-five years ago.  I had forgotten what life without responsibility for the welfare, health and survival of other people feels like. 
     I don't think most people appreciate how weighty the mantle of physicianhood is.
     At all times of the day and night, sometimes waking me from sleep, the collosus of responsibility for what was happening to my patients, whether they got better or not, whether I had diagnosed them correctly, chosen a good treatment, acted in their best interests, avoided dire consequences which could cost them their lives, or spoke the right language to their deepest psyches, pressed in on me.   It was pressure which, like the atmosphere pushing against our physical bodies (14.7 pounds per square inch, or one ton per square foot!) becomes the norm, not registering as "pressure," until at last it's lifted and the person, or doctor--for instance, me--is released like an astronaut on a long tether into outer space.   
     Now, I see, this is life.  This is how other people live.
     Weightlessness is an extraordinary phenomenon.  Perhaps it's what we experience at death, our spirits wafting into a great beyond where we float like dirigibles and wave to one another, grinning and holding up two fingers signifying, "Peace."
     Perhaps what I'm experiencing, the death of myself as a doctor, isn't so bad.  Perhaps I should be grateful to the FBI agents and prosecutors who made my clinic an impossibility.  Thanks!
     I am imagining long kayak trips on the Santa Fe river, and hikes through the woods, and sprawling days in my garden in the sun.  I will actually get to see the sun, because I won't be burrowed in the clinic from early morning to long past dusk using every erg of my imagination and ambition to figure out what might be wrong with people who have come to me for help--or what might go wrong, and how I should intercept, or heal them, or lift their weight of worry, sidestepping disaster, making the treatment look like nothing, nothing at all.
     Add to the weight of responsibility for thousands of people's health the fifty insurance companies whose clerks refuse to pay for the work a doctor does, and the barrage of requests for copies of office notes as "proof" the patient was seen;  add to it a subset of patients who have been propagandized, in recent years, to doubt the medical profession and therefore threaten to sue;  add, also, the government's "crackdown on doctors" (one in four doctors will be audited by Medicare this year, and many of those will be targets of investigations, required to defend themselves against accusations of "fraud," a poorly defined federal crime, allowing many entryways for prosecutors, who know little or nothing about medical billing, to accuse, steal, demoralize, and attack);  add to that hundreds of faxed notices that pharmacies won't fill your patients' prescriptions unless the doctor prescribes what they say the patient needs;  add to that the 90,000 new ICD-10 codes that have to be learned by October this year, and the penalties for not installing electronic records;  add to that an FBI raid--without cause!--and its incalculable harm to a doctor's reputation, and the dozen or so lawyers, after the raid, whose fear-ridden warnings, projections of future disaster, and perpetual invoices are like an army that turns war machinery against its own country... add all that up, and you get what we refer to in medicine as "multi-organ collapse."
     I was on the brink of multi-organ collapse.  I was irritable, sleep-deprived, depressed, unbalanced, betrayed, infuriated, confused--and most of all, worried about whether I could continue making sound decisions about patients, whether I would be able to make them better, or at least try.  The raid, a public phenomenon, has cast my reputation into question--and a doctor's reputation is everything.
     The dozen lawyers are still in the wings of my life, and so is the "investigation," if that's what you call it, and I am still stuck with my calumny--courtesy of the FBI raid.
     I'm still avid about medicine, with its many twists and turns, and the thousands of research studies that inform it, and how they ought to be applied, when it comes right down to it, to the patient sitting in front of a doctor, two people in relationship, a sometimes sacred thing.
     But nothing, not even being relegated to government-attack-limbo, not even being in the throes of consolidating a class-action lawsuit, not even dealing with clownish Fallgatter--whose ego makes him a contestant for the circus, as the man with the biggest-head-in-the-world, and who represents one side of America, a shameful side, the one that sacrifices ethics for money, and will kill for money, deserved or not,  Even these hefty circumstances can't match the pressures inherent in practicing medicine every day, and caring deeply and without reservation about patients, their suffering, their outcomes. 
     None of my other difficulties matter, the ones having to do with fallible people like FBI agents and lawyers, or misguided aims like those of the DOJ.  Those things are like pieces of matter following their elliptical orbits, way far away, and I am at the center, released, floating, euphoric.
     I am raising my hand, and giving all of you the peace sign.
       

3 comments:

  1. sounds like real good pot....peace be with you

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  2. If there is one person in the world deserving of a piece of peace...I vote for you...enjoy your peace!

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