I have to get a Passport!!

I have a 25 mile commute to work. During non-blizzard season, I drive through one small town before embarking on 20 miles of farmland. In 25 miles I encounter 6 stop signs and one stop light. This commute is so remote that five, seriously FIVE drug reps have reported that their GPS systems failed in our area. I believe them, because my Tom-Tom with the John Cleese voice just curled up and took a major dump trying to get me from work to home.

It is amazing. So amazing that the voices in the truck are distracted by the sights. Springtime is newly sheered sheep with baby lambs. Ducks and hens herding their chicks, trees budding and fields freshly plowed. Horses with colts, cows with calves and so much fertility I’m surprised I’m not pregnant by osmosis.

Now it is August and at 07:00 it’s downright magickal. Ten minutes into my commute I hit a half mile stretch of road that is so dense and thick with trees and foliage that the interior lights come on in my truck. It’s like driving through a green, living train tunnel. At the end of that tunnel is a stop sign and to my left is a most charming house with pea hens and pea cocks roaming the property and out into the road like they own the place. Of course they do.

Then through the most charming little quasi-Victorian town where no two houses are alike, and none are like anything I’ve seen before except in movies, and the landscaping just as lovely. At the next stop sign, there is a STATUE dead center of the main intersection in town. Great skill is required to maneuver around it.

A few more twists and turns and I am on a state highway. Traffic is minimal at this time of day on this rural road. A few miles along and I turn onto Fulton Road and I am driving through a Van Gogh painting. The corn is high now, interspersed with fields of soybeans. There is just enough roll to the land that you can see ribbons of color like you can’t imagine with a grand expanse of dusty blue sky marked with scatterings of clouds that shimmer on the East side of their fluff. The cornsilks are brown now so my biggest challenge is resisting the urge to pull over and take a few ears. I tell myself that it’s probably field corn rather than sweet corn.

In between the crops are large stretches of all manner of grazing animals. The pair of donkeys that gravitate to a huge dead oak tree now have a baby donkey with them.

Then I’m at work. Within 15 minutes of clocking in I am reminded that I am in a foreign land where English is roughly spoken and less understood.

I am from West Virginia, born and raised most of my first fourteen years there. I have trouble with the language here. The doctor I work with was born and raised in Egypt. He has a higher command of English and better diction than 95% of our patients. As I struggle to understand my failing in this situation, I work to put some clues together….

Clue # 1: A recent situation with a middle-aged female patient prompted me to ask the doctor if he had considered early sexual abuse. He responded with a sad smile. Then he explained that he no longer asks about that because 90% of his patients have responded in the affirmative and they consider it normal so you can’t fix what ain’t broke.

Clue #2.. I’ve come to realize that one cannot have a dialogue with most of these people. They talk, and then when it’s my turn to talk, they are thinking about what they want to say next. I know this because their response after my talking is as if they needed to repeat what they had last said because there was a loud noise (me) that may have prevented me from hearing what they had said.

Clue #3 If it’s free it has no value, and if it’s not free, they don’t want it. For those on Medicaid, their office visits cost them NOTHING. So they show up for their scheduled appointments if and when they feel like it. Whatever. They want their free samples, and the state paid narcotics and viagara, but they don’t want to be responsible for their diet, exercise or personal health habits. Just last week a patient was given a prescription for Chantix to stop smoking. On medicaid, her co-pay was $2. She called me and wanted a different Rx because she didn’t have the $2. So I asked her how she was paying for her cigarettes…. “My friends give them to me.” So can I tell her to ask her friends for the $2 so they can save themselves the cost of her cigarettes????? No. That might offend her.

Clue #4 Ask me how many twenty-somethings are applying for disability for the following….”skin rash that makes it too embarrassing to be around people”…….”genital herpes”…..”obesity and fatigue”….”chronic headaches”….. “panic attacks”….. What you DON’T want to know is how many of them have been approved.

Clue #5… In order to responsibly prescribe controlled substances, it is recommended that random urine drug tox screens be run. Medicaid will pay for all the narcotics the patient wants. They will not, however, pay for the tox screen, Even when it tests POSITIVE for Cocaine and NEGATIVE for the controlled meds being prescribed. Your tax dollars at work.

Clue #6….Here’s a phone call I get at least 5-6 times per week….”I’m having chest pain and I’m short of breath and sick to my stomach and pooping green slime and my left arm is numb and tingling, and I just want to know if it’s okay to go to the emergency room.” Invariably followed by the ER reports coming across the fax for the patients that went to the ER for nasal congestion and/or a mosquito bite, and/or lice, or mostly to nab the narcotics that the doctor refused to give without seeing them in the office.

Clue #7…. The message on my nurse line—“yeah, this is John. I need my heart pills refilled. They’re the blue ones. My other doctor, the heart guy, prescribed them but his office is closed (message time stamped at 10:00 PM) so I need you to call them in to my pharmacy. I don’t remember which pharmacy I use but you probably know.” And the next morning I receive an irate phone call from John because it’s not ready at the unknown pharmacy because I did not get a last name, date of birth, etc, even though our answering machine clearly requests that info BEFORE you leave your message.

And here’s the thing. I love my job. The thing is that 10% of our patients consume 90% of our time. So I only get 10% of my day to help the 90% of patients who want, need, appreciate and implement the help.


Where was I going with this?

Oh yeah…. I drive through wonderland to enter the world of people who sort of speak English but don’t understand English.

Every morning I try to focus during my commute so I can determine where the border is. Is it this field, this stop sign, this herd of cows, this dead oak tree?? Where is the gawd-damm border?!!?!?! I need to know. Because I live in fear that one day I will unknowingly reach the border and there will be Barney Fife, because seriously, that has got to be the law enforcement in that strange land. And he will pull me over and saunter up to my window, lean against the door and ask…. “Do you know why I stopped you?”

If I’m lucky I will implode and achieve the eternal peace I have always longed for.

With my luck I will knee-jerk respond with “because the Fuck-Up Fairy landed on my shoulder?” Officer Fife will have NO idea what I just said, and then he will ask for my papers, and my papers will not be in order because I don’t have a God-Damned Passport to Looney Town.