In the Greater Picture

It was a few weeks ago when I told Ashley Peterson of Mental Health at Home that I’d have this blog post ready soon, and just yesterday that I got it done. It still only says about one-third of what I’ve felt is needed. But that’s a good thing. There will probably be a couple sequels. 

Much as I hesitate to draw from immediate personal experience in order to support any greater social theories of mine, I can’t help but have noticed how the events surrounding my difficulty in getting my thyroid medication point to a larger phenomenon.   In this case, I’m going to forego my usual hesitations, on the basis of reasonable suspicion that my hesitation could be lifelong if I don’t speak up at some point.

Besides, the “larger phenomenon” to which I allude may have a lot more to do with my personal development than with anything universal.  So if I focus on how I personally have been affected by certain perceptions and expectations of the medical industry, I can only speak my truth at this time.  How my personal truth may reflect a greater reality is a matter for one’s searching.  I can’t claim to know – only to search.

The Story

When I received my retirement income, I noticed a very nice package combining two forms of insurance: MediCare and MediCaid. At the time, I was also somewhat disappointed with the treatment from the local low income clinic (where the doctor I had was only a P.A. – a Physician Assistant – not a full-fledged M.D.)  It occurred to me a while later that the low income clinic was geared toward those who may not have any insurance at all, and that maybe now that I was more fully insured, I ought to find a small family practice center, and hopefully a more knowledgeable doctor.

While I believe I did find an extremely knowledgeable, experienced doctor, I have noticed over the past few months that the people at the small family practice center seem more stressed in general.   Waits are much longer, which one might think would be the other way around.   While they still smile and try to comport themselves professionally, one does not get the feeling that they enjoy what they are doing.

Often I waited a very long time, and sometimes the doctor himself seemed hurried when he did see me.  But when it seemed to take a lot longer than it should have been taking for me to receive my levothyroxine, I returned to the low income clinic to see if I could get a quick scrip from the previous doctor.

As I entered the clinic, I was immediately greeted with the warmth of familial recognition.  They shouted out: “Hey Andy!  How’s it going?”  There was something distinctly genuine and caring in their vibration.   They weren’t just smiling because that’s the professional thing to do.

I quickly got a hold of the doctor there, who wrote me a prescription after a single meeting.  Then, ironically, when I went to pick up the prescription, it was blocked because the doctor at the family practice center had finally filled the prescription two days beforehand.   I not only had received no notice from either the pharmacy or the doctor’s office, but how was I supposed to believe that the prescription would even be filled at all, if this had been going on for over two weeks?

While the wait at the low income clinic’s pharmacy would have been less than five seconds, the wait at the Walgreens where I had been getting meds from the family practice center was well over an hour.   Also consonant with this theme is that no one at the family practice center other than my doctor himself ever learned my name, even though I’d been going there for months.   The people at the low income clinic remembered me even though I haven’t been going there at all, and in fact went there as infrequently as possible, when I did go there.

Throwback to Homelessness

What this all flashes me back to is an experience I had when I was homeless, which recently has been on my mind because of developments in the musical — things that Kelsey and I have been trying to illuminate in the weekly podcasts.   The experience was that of having found a nice “wellness center” in a low income district in Oakland CA where almost all the patients were African-American and where I was treated very kindly — with true caring — despite long waits and a generally congested staff.

At the same time, if I showed up in the Emergency Room in the hospital in Berkeley, and it was known or determined that I was a homeless person, I was given distinctly less preferential treatment than the person who lived indoors.  Sometimes, the medical problem I came to Emergency for was overlooked completely, as they proceeded to give me all kinds of printed information on where the shelters and services were — as if I wouldn’t have known all of that stuff already.

So naturally, my mind has drawn a parallel.  I’m not homeless now, but I am low income.   My insurance isn’t exactly Blue Shield – it’s the kind people have who are elderly or disabled.  Family practice?  I wondered if I even belonged there.  My mind began to imagine what they might be saying about me:

“We’re a respectable family practice!!  This guy doesn’t have a family, he’s just a transient, there’s substance abuse on his medical chart, he’s probably just passing through town . . .” 

Of course, they probably weren’t thinking that.  The point is that my experiences would be such that I would even think that they would be thinking it!

A Theory in the Making

It seems that there are institutions populated by people who are naturally compassionate and even empathetic towards those who are down and out.   There are also institutions where such people are given lower priority.   This present situation may or may not exemplify this phenomenon, because it could easily be a function of the two individual organizations I have described.   That specific family practice center may be particularly understaffed or otherwise swamped due to the pandemic, and this particular low income clinic may happen to be expanding, and gaining more personnel, and apparently State funds of some kind.

Still, the thing that intrigues me is that, whether or not the recent experience exemplifies a larger phenomenon, it was brought to mind in my interactions with the people involved.   There could have been a kind of confirmation bias going on.   But if so, what exactly is the theory I am trying to confirm?

Only bits and pieces of this “theory” are in place.  That’s why I haven’t been writing.   But I am beginning to believe that my intellect alone is insufficient to piece the entire theory together.  And that’s why (if this makes sense) I finally am writing.

What is being brought to light in the podcasts is how, when we were homeless, we were not in the position to be able to distinguish, among all the authority figures and “pseudo-authorities” in our midst, who were the ones who represented benign agencies whose role it was to assist us, and who were the ones who represented more-or-less adversarial institutions designed to investigate and incriminate us.  All these “higher ups” were relegated into the box of our “observers from inside” – and thus it was difficult to distinguish them, one from another.

In a corresponding way, it was difficult for those who lived indoors to discern from among those who were outside who was a legitimate candidate for genuine assistance, and who was of a criminal bent.   Those in the latter camp often feigned a need for assistance in order to gain benefits.   They were also often very good at it.  Whatever the case, I can assure you that I didn’t look much different than any other person on the streets — at least not at first glance.

Unfortunately, that first glance often seemed to be the only glance I got.   Even if the glance became a stare, or a series of stares, I felt like I was being observed with an ulterior motive.   I felt as though people were watching me, just waiting for me to somehow screw up and incriminate myself.    Years of living with that feeling seem to have led to years of trying to find a feeling to replace it.

So I still resort to ways of dealing with feelings that don’t differ widely from how we approached the matter when we were homeless.   How does one, after all, deal with the inner feeling of being dismissed, overlooked, disregarded?   On the other side of the coin, how does one deal with the feeling of being embraced, respected, and accepted — especially if one is not accustomed to it?

When we were homeless, we lived with eyes in the backs of our heads.  We couldn’t drop our guard long enough to process difficult personal feelings.  So instead, we looked for the larger phenomena that they might represent — and we analyzed, and drew conclusions about society.    We conducted such conversations vocally, publicly — encouraging others nearby to join in.  We were a lot more powerful that way, and much less vulnerable, or at risk.

In a way, this doesn’t seem like all that bad a thing to have been doing — in the greater picture.

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Gratitude List 1648

(1) Really nice talk with my friend Danielle on the East Coast this morning over coffee.   Hadn’t talked with her for a while.  It was good to catch up, and it helped energize me to make the trek to the pharmacy and back in the cold.

(2) Was able to get my thyroid medication squared away at the new pharmacy near to the new doctor’s office, though it took three visits and an odd period of “without.”  More importantly, I really do like the new doctor, whom I saw for the third time on Thursday.

(3) Grateful for the unexpected three and a half hours of sleep that struck me as soon as I got home from the pharmacy.  Having conked out at high noon in my executive chair, and not awakening till 3:30 in the afternoon, I am now smelling the coffee.  I feel as though about five wayward parts of my brain have suddenly been reactivated.   I’m grateful for the restorative power of sleep.

(4) I must add that I’m grateful to have a place to sleep.   I flopped down onto the couch from the chair, right near the open window, jacket still on, and no heater running.  The cool air blessed me whilst I slept, and the sense of safety and comfort — no doubt magnified due to my experience of years of sleeping outdoors — was huge.

(5) When I mentioned this morning that the new musicians and I had settled on a weekly rehearsal time, Danielle commented how great it is: “It’s great that it’s no longer just you.  There are actually other people learning your material.”   This is coming from someone who knew me when it was “just me” — for years, it seemed.   Days may be dark, but one must remember where one has been, and take the compass thereof, and point it to the future — with strength and hope.

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Tuesday Tuneup 82

Q. What’s happening now?

A. Just waking up.

Q. Now?   At 9 in the morning already?   Don’t you usually get up much earlier?

A. Usually at around 4:30.  But lately I’ve been getting up at 3, and this morning it all caught up with me.

Q. Why have you been getting up at 3?

A. Not tired anymore.

Q. What time are you going to bed?

A. That’s another thing.  It used to be, I’d go to bed at 9:30, and get a good 7 hours sleep.  Now, I don’t go to bed till 11.

Q. And you sleep till 3?

A. Yes.

Q. No wonder you’re so tired.   But doesn’t this remind you of something?

A. Yes it does, now that you mention it.   It reminds me of the time I always used to go to bed at 3, and get up at 7.   Very similar dynamic.   

Q. And when was that?

A. It was in 2003, right after Mom died.  Every night I stayed up till 3.   Every morning I got up at 7, and drove to the private school where I taught music.   That was the job that I lost in 2004.   I mentioned it in an earlier tuneup.

Q. Weren’t you having a first-time manic episode at the time?

A. Yes.  

Q. Are you afraid of having another one?

A. I don’t think “afraid” is the right word.   But I’m concerned.   I’m always concerned about this, as well I should be.   

Q. Is there any medication you can take to address it?

A. Perhaps.   I’m a little sensitive about it, being a runner.

A. What’s being a runner got to do with it?

A. My physiology is a lot different than someone who does not run.   So medications don’t have the same effect on me as they have on people who are more sedentary.

Q. Can you document that?

A. I can try.  I’m only stating my experience.   

Q. You haven’t always run, have you?   You’ve gone through periods when you don’t run much at all, right?

A. That’s right.

Q. How do medications affect you when you’re not running?

A. More like they’re supposed to, I think.  But check it out.  I didn’t run from about 2000 to mid-2003.   And I got super fat, by the way.   I was on 2400 mg a day of Gabapentin.

Q. Whatever for?

A. They believed it would be a good replacement for the Klonopin I had been on earlier, and less habit forming.

Q. But the Klonopin did not make you fat?

A. Not at all.  In fact, I requested they return me to the Klonopin, after I’d gained approximately 75 lbs.

Q. Did they accommodate your request?

A. Yes.  And then my Mom died, later that afternoon.

Q. So you think the combination of the medication switch and your mother’s death triggered the episode?

A. That’s my thinking, yes.   And psychiatry seems to agree with me, by and large, on this one.

Q. Does psychiatry often disagree with you?

A. I cant say that, no.   What I can say is — as a runner — I am always engaged in an experiment with my own body.   George Sheehan, in his book Running and Being, called it the “experiment of one.”  Since I continually experiment with my own body — that is, I develop theories, test them out, and draw conclusions — it disturbs me that someone who doesn’t know my body as well as I do should be experimenting with it.

Q. You don’t like doctors, do you?

A. I didn’t say that!  I just went to one yesterday, and I liked him very much.

Q. So what are you saying?

A. That I just have to hold this thing in check.

Q. You?  All by yourself?   Don’t you have a therapist?

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A. That’s right, I gotta find a good one.

Q. Were you going to a bad one?

A. Can’t exactly say bad — he just seemed, kinda like, he thought too well of me.

Q. Can you clarify?

A. I think he thought I was a lot more on the ball than I actually am.  First session, he kinda looked down as though guilty, and said: “You’re about twice as intelligent as me!” He said it in a tone of great self-pity, as though he were about to quit his job or something.

Q. He was insecure?

A. Yeah.  And now we had TWO insecure people in the room.

Q. So you left that guy?

A. Actually, he eventually quit the job.  And when he was leaving, he told me I should open up a private practice.

Q. And where did you go then?

A. To my pastor.   

Q. How did that go?

A. It was different.   Extremely intelligent, insightful, compassionate.   But somehow I felt as though something was cutting into my core — almost as though trying to create a disruption within me —

Q. Why would he have wanted to do that?

A. Oh, he wouldn’t have wanted to do it — not intentionally, not by his own self.  It was just an inadvertent effect of the logical progression of our mutual thought.   I left eventually, once I felt that something sacred within me was about to be desecrated.

Q. Sacred?

A. Yes.  Like an inner temple.  An adytum, if you will.   Something inside me that is so critical to my being, that no other influence has any business there.  Nobody, not even me, ought to tamper with that inner temple.

Q. So you felt threatened by the pastor, and you left that room as well?

A. You have such a crude way of putting things.   Yes, I left — but only because I then found a Masters Candidate who could see me for free, three times a week for five weeks, in order to fill out her hours for her Masters Degree.

Q. How was she?

A. Excellent!   I learned a lot in those five weeks.   But then she was done.

Q. Can’t you continue to see her?

A. Do I have $150 an hour?   

Q. Well then, what are you going to do?

A. I believe there are psychotherapists in my vicinity who accept MediCare and MedCaid.

Q. You gonna look for one?

A. It seems the humble thing to do, yes.

Q. Whoever called you humble?

A. No one yet.   May I be excused?

Q. Why?

A. Time for my morning run — and half the day’s gone already.  

The Questioner is silent.

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Gratitude List 1568

(1) Made it to my new doctor for the first time this morning.   He’s knowledgeable and respectful, which is what I was after.   Had all the lab work done, and was diagnosed with “nausea.”  (Unsurprising, considering all that’s going on in the world today.) 

(2) Got up a little early today – 3 am instead of the usual 4:30.   This enabled me to get more work done on the arrangement of the third number in my musical.   It’s coming along.    I’ll post it (along with the lyrics) once I’ve gotten from A to Z with it.

(3) The running’s been better than ever lately.   Got weighed at the clinic, and I’ve lost 11 lbs since last time I was at a scale.   No need to provide the exact figure — let’s just say I’ve got 24 more pounds to go.

(4) Did all the wash.  It’s not only nice to have clean clothes, it has a way of motivating me to clean up the rest of the house while I’m at it.

(5) A young journalist who has a job with a certain newspaper is urging me to apply for one of a couple positions they have open — and I’m following through, so wish me luck.  I’m grateful for the positive impression I’ve managed to make on everyone I’ve met in journalism, and for the sense that out of all the times I’ve lived through in my relatively long life, these times are the most worth writing about.   

“Be as you wish to seem.  The way to gain a good reputation is to endeavor to be what you desire to appear.”
— Socrates

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