A Soap Opera: As the HMO Turns

Here's the latest episode in the soap opera that life around here has become:

You probably remember that Ed has been working part time for a grocery-delivery service because the awful economy has meant that his cabinetmaking clients aren't spending much money. On February 6, while checking out the back of a different kind of truck that he was to be driving that night for the deliveries, he gashed his forehead severely. He went to the local hospital's emergency department for stitches. The physician had him undergo a head computed tomography (CT) scan just in case there were internal injuries. There weren't, but the scan turned up a brain colloid cyst. These cysts are always benign, never malignant. But they are always located just where, if they are large enough, they can block the flow of cerebral spinal fluid, which can result in odd symptoms and even unexpected death because of high intracranial pressure.

Of course we were scared. We tried hard to get Ed's primary-care physician's office to get Ed a referral to a neurosurgeon, which is what the hospital suggested we do. (We couldn't just go back to the hospital and request to be seen by the physicians who treated Ed the night he injured his forehead, because that first visit to the emergency department was a worker's comp issue, whereas this brain tumor is not.)

But as I just now wrote only somewhat coherently to update a friend:

Grrr! Ed's physician's front office is incompetent! The doc looked at Ed's brain CT scan film yesterday, before Ed's appointment with him today, and saw the colloid brain cyst that the hospital emergency-department radiologist spotted 3 weeks ago. Today, the staff can't find the film! Idiots!

Ed was just now at the doc's office now for his postponed physical exam. These staff members are the same idiots who refused our request for a referral from the doc to a neurosurgeon before the originally scheduled exam date of February 18, which they rescheduled for today and said no referral before today, even though I told them it was regarding a brain tumor. If Ed were dying, would they have moved any faster? I doubt it. This is a #(*^$@ HMO.

So now Ed's doc has to call up the hospital to order another set of CT scan films stat, so that he can look at them with a neurologist. He told Ed (who called me during a break during his physical exam) that the cyst is "only" 3 mm and should probably just be watched at this point—no brain surgery to remove it for now—with Ed getting a new MRI scan once a year. But I want to hear this from a neurologist, dammit! The HMO is supposed to call Ed within a couple of days with arrangements for him to schlep halfway across Long Island (sigh—the local HMO practice facility doesn't have a magnetic resonance imaging [MRI] scanner or a CT scanner) to get a series of baseline MRI scans with (radioactive) contrast dye so that it can have plenty of info to compare against future annual MRIs.

I told Ed that if he didn't emphasize to his physician that a member of his front-office staff caused us lots of mental anguish by making us wait for 3 weeks for this appointment, despite my telling her about the brain tumor, that I was going to get on the phone and raise hell. The dimwitted staff member should have at least performed triage by putting me on hold for 30 seconds, telling the doctor about the situation, and then getting Ed in for an appointment before other patients with less scary ailments. Luckily for that staff member, Ed did what I asked, and the doc says that he'll get to the bottom of the situation. You don't let your patients sit around for 3 weeks in an agonizing knowledge vacuum. You just don't.

Anyway ... no brain surgery for Ed as of right now. Thank goodness.



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Still Waiting, and Not Patiently

It's Friday—how the heck did this Friday manage to show up so quickly after the last one?—and I'm hoping that our health-care providers have actually done their job.

Ed and I have been waiting for what seems like forever for a referral to a neurologist for him, so that we can get on with the process of figuring out what to do about the colloid brain cyst that a hospital radiologist found on the head computed tomograpy (CT) scans that Ed underwent way back on February 6 when he gashed his forehead at work. The last we heard was that the hospital was in the process of acting on our request to send the CT films to Ed's primary-care physician at the HMO's local group practice.

If he were dying, would the bureaucracy move any faster? I doubt it. It's not the bureaucrats' lives that are on hold.

I'll keep you posted.



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An Upside-Down Flamingo in the Office

I have to have my office in my kitchen because there is no other available space in my home. But there are occasional compensations. This was the view in my office midmorning today, just about two feet away from my desk:



















That fine physique—though my crude art-program drawing doesn't do it justice—belongs to my husband, Ed, who is never one to sit still or ask others to fix things for him. (If only I'd thought to take some photos using my cell phone!)

I had been editing in a desultory fashion, wanting to find an excuse not to be working today. Our 25-plus-year-old clothes dryer, which we inherited from his parents, obliged. It began squeaking a bit as it was drying a load of clothes. Then it squeaked more and more. Finally it was squawking so loud that I truly could not concentrate. I buzzed Ed on his business phone's intercom (in an earlier incarnation, his wood shop was the two-car garage that is attached to our home) and begged him to come do something abou the awful racket.

He came upstairs, figured out that the dryer's tensioning pulley needed lubricating, got the tools he needed to do the job, lubed the dryer, then assumed the "upside-down flamingo" position, as he calls it, to reconnect the dryer's vent hose on the back of the dryer. There's not enough room behind the dryer in which to stash a long vent hose to make the flamingo position unnecessary, so every time he has to do something to the dryer, he must turn himself upside down to connect the short hose while the dryer is close enough to the wall for the hose not to disconnect itself again.

Here's a side view of the upside-down flamingo in action:
























Life is rarely dull when you're self-employed.



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Heavy-Duty Cell-Phone Clip-On Pouches

If your job keeps you out and about enough that you're not really a desk jockey—or you have a friend or family member who has a very physical job—you would probably like to have a much tougher cell-phone case than is sold to the general public, at least in the United States.

My husband, Ed, is a cabinetmaker who is always on his feet and wears his cell phone on a belt clip. But with the wimpy cell-phone cases that most cell-phone stores sell, his poor phone was pretty much unprotected when it was perpetually knocked against workbenches and other hard surfaces, which can shorten a phone's life considerably. He wears through those cheapo covers faster than small children outgrow clothing. So I searched online and found a web site that sells the kind of cell-phone cases that police officers, firefighters, and other really physical workers like to use.

Yes, the site is ugly, but it sells good items. Ed bought the Amorcase-SP1 (enlargeable photos here) for his small LG flip phone that he'd bought through Verizon. It's heavy-duty nylon, and the belt clip on the back side is very heavy duty. He's happy with it.

Ed is not affiliated with the company and neither am I. He's just a satisfied customer, and I'm just passing along potentially helpful info.



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Online Friendships Can Bring in New Clients

Sometimes the best client referrals come from colleagues you've never met.

One listmate from an e-mail list for editorial professionals and I corresponded offlist a few times when times were tough for her. When I was recently worried about income in my household because the poor economy has made things difficult for my husband's relatively new business (and that's still an ongoing concern), that listmate e-mailed me and gave me the name of one of her most lucrative clients, plus contact information for the person there whom she deals with. She also e-mailed that person and recommended my editing services. I took the company's editing test, and yesterday I received a message from that person welcoming me to the company's pool of freelancers.

A male listmate from that same e-mail list has kindly given me several referrals to new clients in the fairly recent past. One other female listmate from the same list, with whom I developed an offlist friendship a few years ago, for a time held an in-house position at a publishing house. While she was there, I did a few projects for her as a freelancer.

By referring me, these folks have helped out their clients/employers, helped me out, and renewed my faith in the kindness of my fellow human beings. There are lovely people to be found everywhere, and it pays to get to know as many e-mail listmates offlist as possible. Don't be afraid to strike up offlist conversations with them, no matter how little or how much (like me) experience you have. I don't mean that you should start out by asking for work. Develop a friendship, which is valuable itself even if you never get a referral. We all need friends.

You never know who will be in a position to help you out or how much satisfaction you can feel when you have a chance to help someone else out.



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Granddaughter Blogging

My beautiful granddaughter, Ana, 21 months old, fresh out of bed this morning and jabbering away:
























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A Few Kind Words Go a Long Way

What a nice way to begin a workday! I got this e-mail this morning from an author for whom I edited a large chapter in his autobiography:

Thank you for the final version. I have never seen such a thorough editing job in my life. I wish that I had the means to afford your services for my entire book, but unfortunately I spent too much money on other editors who did a very superficial job.

I'll be working with a huge smile today.



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Editing Déjà Vu

I edit so many medical-journal articles that I forget each of them very quickly after having finished them. I guess that that's my brain's way of clearing space for incoming details that must be stored.

It's crunch time for one of the journals I edit: Another issue is coming up soon, so I have all of the issue's articles on my computer's hard drive, ready for me to start editing. So this evening, wanting to quickly get that feeling of relief at having made progress, I chose the shortest article, a 7-page case history report, from the "unedited" subfolder of the "issues in progress" folder, copied it to the "edited" folder, and began working on it.

Hmmm, I thought after a while. Didn't I recently work on a manuscript about an unusual presentation of hypotension? ... Nah, probably just remembering another hypotension manuscript. But I kept having that same nagging sense of déjà vu. So I opened up the "edited" subfolder within the "issues completed" folder, and lo and behold, there was an article with a similar file name. I had already edited the manuscript ... at the beginning of January. Ah, well, not much time wasted, as my time clock told me that I'd spent only 15 minutes reediting.

Curious, I split my computer screen and then opened up the previously edited version of the file next to the newly edited version. I was surprised to find that I had made almost exactly the same edits to both documents. I guess that means that it's possible to identify an editor's editing style. But that just felt so weird. I'd never realized that I'm so predictable. ;-)



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"Freelance National Anthem"

Hee, hee! It's sing-along time. If you edit or perform another editorial task instead of writing, just adapt the lyrics where necessary. Enjoy!





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Getting the Health-Care Bureaucracy to Care

So, annoyed with the front-desk staff in the office of Ed's primary-care doc dragging things out regarding the newfound colloid cyst in his brain, I had Ed try calling the doctor's office instead of me doing so again. This may have gotten people moving; we'll see.

Whoever he spoke with there had him call the hospital to get the appropriate person there to fax the records from Ed's trip to the emergency department on to Ed's doc. So first, the hospital faxed a consent form to our house. Because Ed's out in the field installing cabinet doors today, I filled it out, faked his signature, and faxed it back to the hospital. Then I typed up the following note as if I were Ed, faked his signature, and faxed it to the doctor's office so that whoever gets the hospital medical records will know what the heck they're about. Let's hope this works and Ed gets a referral tomorrow or the next day.

Hello, Dr. C_____.

You will soon receive, by fax, medical records from Huge Teaching Hospital. I was treated in the emergency room there on Friday, February 6, 2009, for a gash that I sustained (while at work) to the left side of my forehead; I required stitches. To check for additional injury, the hospital staff had me undergo a CT scan. I had no internal injuries to my head.

However, I received a call over the weekend from the hospital informing me that the scan had shown that I have a small colloid cyst in my brain. I was told that I should see a neurologist as soon as possible. I need you to provide a written referral to a neurologist, preferably one who has privileges at Huge Teaching Hospital, so that I don’t have to travel across the county or into Queens for treatment. I would like to have the referral very shortly, despite a woman who works in your front office having told my wife that I would have to wait until my February 27 appointment with you (for a physical exam) to request a referral. From what I have read since the weekend, a colloid cyst is not something to be taken lightly.

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Colloid Cyst in the Brain

Things have taken a bit of a soap-opera-like turn in our family.*

Friday, Ed had just arrived to work an evening shift for his part-time job with a grocery-delivery service. (You'll recall that he had to take the job because the economy has messed with the pocketbooks of his potential clients enough that he's getting very few cabinetmaking gigs lately, meaning that we're barely affording our mortgage payments these days.) The truck that he was scheduled to drive that day was different from the ones that he usually drives for the company, so he went to the back of it, while it was being loaded with groceries that he was to take to customers, to check it out.

The mirrors positioned on the back end of the truck were apparently placed lower than what he is used to dealing with, so when he went to pull himself up into the back of the truck, his forehead slammed into one of the mirrors, putting a big gash in his head and knocking him to the ground. He bled profusely and had to go to the local hospital emergency room for stitches.

In the course of making sure that Ed had no internal injuries to his head, the hospital had him undergo computed tomography (CT) scans. The physicians found no internal injuries, so Ed was sent home, having already been stitched up.

The next day, we found a message on our home answering machine for Ed to call a specific nurse at the hospital for follow-up. We thought that she was just checking to see if he'd had any ominous symptoms (you know, dizziness, passing out, etc.) overnight, which is always a concern with any head injury. Ed called back, prepared to say that he was fine but was surprised to see that the blow to his forehead had caused him to have two black eyes. (That was caused by all the blood from his wound dispersing internally.)

The nurse told him that the radiologist, looking at the films from Ed's CT scans, had found a small colloid cyst in Ed's brain and that Ed should call the hospital's neurology department on Monday for an appointment.

We checked out colloid cyst online and found that it's a benign tumor that usually shows up at about the age Ed is—47—if it's going to show up. The part that has us frightened out of our wits is that what we've read seems to say that most of the time, neurologists do brain surgery to remove these cysts because they can grow and block the flow of cerebrospinal fluid, causing swelling and sometimes coma and death.

Ack!

People with these cysts sometimes have symptoms such as headaches, limb weakness, and loss of consciousness. Ed has had none of these. We've discussed the situation, and Ed says that he'd rather just go in for periodic scans and leave the cyst alone until it absolutely must be removed. I'm not happy about the prospect of brain surgery, because despite the many advances that there have been in the field over the years, messing around in the brain can be tricky and can unintentionally cause neurological damage. Plus, there's recuperation time. Both Ed and I are wondering how in hell we would afford for him not to be working while he recuperates from brain surgery. We'd lose our home for sure.

Of course, all of this worrying may be unwarranted; the neurologist might say that the cyst is very small and in a location where it's unlikely to cause problems, making brain surgery unnecessary. Ed's annual physical exam is Wednesday next week, and while he's there, he'll ask his primary care physician to provide him with a referral to a neurologist. Then we'll have to see how soon he can get an appointment with the neurologist.

All of this waiting and not knowing is paralyzing for Ed and for me.

If you've had any personal experience with colloid cysts or a member of your family has, please tell me about it, especially if you or your family member underwent brain surgery.


____________________
*Ed, my husband, gave me his permission to tell you about all of this.



Updated at 11:42 a.m., 2/10/09: Of course! Ed's physician's office calls and leaves a message saying that his 2/18 appointment (originally to be for his annual physical exam) will have to be rescheduled. I promptly get on the phone—because Ed is en route to a client's home where he'll be installing cabinetry—to reschedule the appointment for him. I ask if it's possible to get the required referral to a neurologist before the newly rescheduled 2/27 appointment. Lots of being put on hold while I wait, wait, wait. Finally, the woman gets back on the line and says no, Ed will have to wait until 2/27 to get the referral. I explain that Ed is walking around with a potential time bomb in his brain and that sooner would be best. She puts me on hold again. When she's back on the line once again, still acting as if she really doesn't give a damn, she still says no. More waiting without any information—just what we don't need.


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