I have had the privilege (or misfortune, I suppose) of receiving medical care both in and out of the United States. When I was fifteen years old, my left index finger was badly lacerated. Two tendons and the digital nerve were severed, and it required extensive reconstructive surgery. Since I was a fairly serious musician, and the index finger of the fretting hand is rather important to us guitar and bass players, I was extremely worried. While I still have some scarring, as well as numbness on the side of the digit, I can still play guitar, even barre chords on a 12-string acoustic.
That would certainly not be the case had I been in Bakersfield at the time of the injury.
Every single person at that Beijing hospital spoke at least two or three languages, even the custodial staff cleaning and sanitizing common areas. The surgeon I had, the woman who sewed over 170 tiny stitches into a single finger, was trained at the Mayo Clinic, and was in the process of publishing original scholarship about the impact of rapidly initiating physical therapy after digital reconstructive surgeries, studies my case even wound up in. When I began seeing a physical therapist in town on my return, everyone there commented on how amazing and unusual the degree of function I retained and my rate of healing were, considering the severity of the injury.
I have always, when able, paid a premium for insurance that allowed me to choose my healthcare providers, as I have seen firsthand what incompetent or apathetic healthcare looks like. In spite of this, my experiences with American for-profit health care have been grim. I first really encountered it when I was an acne-riddled high school student in a dermatologist’s office. When the physician came into the room, before even looking at me, he brought in all the paperwork for Accutane, a drug that was later pulled from the US market in 2014. After looking at the paperwork (that even back then he was obligated to give me) I expressed concern, as I had, at minimum, two or three contraindications based on the front page of the liability notice alone. He assured me that, because Accutane is a vitamin A derivative, it was water soluble, and if I had any side effects I could simply discontinue the medication and flush everything out by drinking water. I told him that vitamin A was fat soluble, and he looked sheepish and attempted to backtrack, but I told him that I was done and would be leaving.
I was reminded of this when I saw a local neurologist who came highly recommended. After waiting nearly two months for insurance and scheduling difficulties, this specialist diagnosed me with brain inflammation (and prescribed oral steroids) based on a ten second motor assessment, decided not to look at the MRI (his assistant’s laptop was being slow and he didn’t have time) and tried to prescribe my Bipolar Type 1 ass Elavil as a sleep aid, which was not the issue I was there for. When I expressed concern due to my diagnosis and the contraindications that the psych meds I already took represent, he told me it would not be an issue. Since I was seeing my psychiatrist the next day, I left it at that and paid my $55 copay before leaving.
I told my psychiatrist, whom I respect immensely, and who has put in a good deal of brainpower over the past five years getting me stable and able to manage the side effects of my medications. Specifically, I only told him that I had some concerns about medications prescribed to me this neurologist (I used his name) and my psychiatrist interrupted with a question:
“He didn’t try to give you Elavil, did he?”
He told me that I would have kicked off a major manic or mixed episode before settling into a nasty bit of Serotonin Syndrome, and that my psych meds would have taken months or years to re-balance. He also implied that, had this happened, I would not have been the first patient destabilized by Elavil prescribed by this specific neurologist.
These kinds of situations are very likely to arise when conflicts of interest are as pervasive as they are in the for-profit American medical system. Many doctors push specific medications, not because they are what the individual patient needs, but because they are being influenced by pharmaceutical reps, or by manufacturer kickbacks, or simply for reasons of liability. I have been fortunate in that I have been able to avoid some seriously dangerous consequences: 20% of men with Bipolar 1 die by suicide (more than 60% attempt,) and a bipolar person in a mixed episode is three times more likely to kill themselves.
In order to avoid being such a statistic myself, I have had to regularly vet and second-guess people with far more expertise and access to information than myself, because, in spite of everything we tell ourselves, this system we exist under in this country is not a system for helping sick people.
It is a system that hoards wealth for investors and owners, at the expense of both patients and the people working in the field.
(Follow my thoughts and experiences regarding Long COVID recovery in my SubStack email newsletter: https://substack.com/profile/58917637-sean-vansickel?utm_source=user-menu)
