"The doctor says Mrs. Hudson does not need blood.
She's 8.3 and that's high enough."
    "Oh, okay! Well, I'll let her sleep and we'll see you next Wednesday!"
    My mother will not appreciate this for another couple of hours (since she retired at about 2300 last night, I'll probably be awakening her around 1100 today, it'll be the first 12 hour sleep night she's had in three days) but, despite her belief that she definitely would be going in for blood, despite her seeming eagerness to do so simply because she likes this doctor, I think she'll be very pleased when I awaken her. She will feel rested, she will not fight arising more than usual and I know that she'll relax, internally and externally.
    I didn't bother to ask for copies of those tests that have already been processed. The hospital lab told me which results will not be available until some time early next week, as they are sent out, and, frankly, that includes most of the tests. Here's a list of what tests were requested:

• CBC-PLT
• CMP
• Erythropoietin Level
• Serum Protein Electrophoresis
• Quantitative Immunoglobulins
• Beta-2 Microglobulins
• Type & Hold
• Ferritin

    Of these, only the first two and the "Type & Hold" were required to determine her need and readiness for a transfusion. I'll get them all of a piece next week from the doctor's office and enter them over in the tests area then.
    Although I'd like to see her hemoglobin boosted as quickly as possible, since all the other tests are designed to determine her elligibility for other methods and we seem to have had, so far, some success at keeping her hemoglobin in the 8's, I'm satisfied. She'll remain wonky and a bit weak for some days, but I'm okay with that. We've gotten used to it.
    The blood draw for yesterday's tests was massive. Although I immediately began building her back from the time I rolled her out of the lab and into the cafeteria, including giving her an extra iron pill with dinner, which I may also do today, after her nap she admitted to feeling "weak" (which is to say, weaker than either of us is used to) and had a bit of trouble "depending on [her] legs." The last half of the day became a wheel chair day. However, after a snack of peanuts and V-8 juice, which she did not refuse, dinner (a hearty, ham-filled bean soup with MCS's home made Bread & Butter Pickles), lots of liquids, some movies and scintillating conversation, she almost completely revived. She insisted on walking, aided by only the walls, counters and banisters of our snug, close home, into the bathroom and into bed on her own. She did pretty good. She refused, though, her usual nightly leg rub down. She was so tired that she was afraid she's fall asleep in the rocking chair, to which she had moved about an hour or so after dinner. Since we've learned that moving her after awakening her from dozing in her rocker is a tricky procedure, at best, the last thing either of us wanted was to have to call the paramedics to pick her up off the floor on the way to bed.
    I am, frankly, fairly exhausted, myself. A wheelchair evening is rigorous. As well, I was so keyed up after Mom retired that I stayed up until 0100 watching Law & Order, et al repeats, then tossed and turned in bed past 0230, the last time I looked at the clock.
    Despite Mom's low hemoglobin, she has followed her newly formed habit of awakening on her own after a nap of 1.5 - 2 hours, which continues to surprise and delight me. Her spirit remains high, her will remains strong. Her right eye continues to swim in white, which is common when she is sick or her anemia is challenging. I expect that her "stupid silly" behavior will continue until her anemia is addressed, but that isn't a problem for either of us. If anything, it's actually fun because she spends more time than usual striking up old songs and playing with the words; so there's a lot of singing around here when she's running low on hemoglobin.

    I want to take a moment to address Novabella's much appreciated comment on the immediately previous post. She makes an excellent point of which I hadn't thought and I want to underline: Why are we soooo astonished when we receive decent medical customer service?!?
    Funny, too, that when one complains about service or products from just about any other business (unless the business is clearly fraudulent) the purveyors are not only expected to step up to the plate and correct the situation, we assume that they will try to please us. In medicine, my experience tells me that we can't take this for granted. Sometimes the business of medicine does this. My experience with the Mesa, AZ, hospital in 2004 follows this example. However, more often my mother and I have been ignored, pushed back or dismissed (literally: Two doctors have dismissed my mother because of my efforts to get information, my refusal of procedures that were advised against by second opinion physicians and my insistence on pointing out deplorable service).
    At least in this community in which we now live permanently, the situation is getting worse. A couple of weeks ago, after cold calling physicians from the phone book, calling recommendations from friends and from Mom's hematologist and still having my mother end up empty-local-PCPed, I finally called the local hospital physician referral number. Turns out, in Prescott and Prescott Valley there are only three physicians who are still taking new patients whose primary insurance is Medicare. They don't even want to hear what a Medicare client's secondary insurance is. Of those three I was warned away from one by four different people. We are on wait lists with the other two. I asked the hospital referral person why this situation had developed here. Her response was the same as the lecture I received from Dr. Seller's Market on July 30th, 2004: That Medicare doesn't pay enough. I mentioned to her that this doesn't seem to be a problem in "The Valley" (The Phoenix metrocomplex) and asked if this had anything to do with the possibility that Medicare pays less in rural communities. She offered a verbal shrug: "Probably."
    Then, on Wednesday while we were sitting in the hematologist's examining room waiting to be seen, I overheard an interesting conversation just outside the door. One of the office personnel was asking an older couple if they'd secured a PCP. They responded that they had and proceeded to give the name and address of a doctor in the Phoenix West Valley. No one expressed surprise. I studied the couple and noted that they appeared competent to travel back and forth, if necessary, although I assume that much of the treatment they are seeking will take place up here through this consulting physician. This is, apparently, a typical situation, up here. Oddly, upon realizing this, I felt a bit less desperate. It seems we will not be bounced from this hematologist's care if we are not able to secure a local PCP "immediately".
    Thus, despite all the propaganda being disseminated through organizations like and including AARP, becoming a better informed patient and "taking control" of one's medical care remains a slippery slope and it appears as though it's going to get worse for awhile. The medical-industrial complex considers itself under siege and is trying to preserve its power. We, the clients, consider ourselves under siege and are trying, with sinking expectations, to find adequate medical care that doesn't bankrupt us. In the meantime, we all expect to be treated badly, from both medical and service perspectives, and remain "astonished" when we receive "good service".
    How in the world can we ever say, at this time, that we have "good" medical care in this country and, apparently, others, as well, when Medicine is afraid of us and we are afraid of Medicine?
    I know this above rant doesn't add much to what Novabella said, but, at this time, I think it needs to be repeated, over and over and over. Thank you, Novabella, for striking up the chorus once again.
- posted by Gail Rae @ 08:26   email  this post