Busy signal

Back pain is no guarantee your doctor will see you, even at the best clinic.

Published October 7, 1999 4:00PM (EDT)

Four years ago, I'm packing up my stereo, putting it into a cardboard box, back arched, arms outstretched like I'm giving parking directions to a 747, and I think I hear something snap in my lower back.

This is not some muscle you pull while trying out Position 62 of the Kama Sutra. The pain comes from deep within the core of my spinal cord about five inches north of the crack in my buttocks. I drop to the floor, feeling like a deer walloped by a semi going 60 mph.

Still on my back two hours later, I'm finally able to inch my way to grab the phone. The University of Iowa Hospital and Clinics (UIHC), one of the largest university-owned teaching hospitals in the United States, is about a mile away from where I live. This medical center is no doc-in-the-middle-of-the-cornfields. It employs 7,000 doctors, nurses and professional staff. U.S. News & World Report ranks the department of orthopedics eighth in the nation.

After getting a busy signal for 15 minutes, I finally get the orthopedic clinic. Actually, they spell it "Orthopaedic." "This is an emergency," I croak. "I must get in to see a doctor. I can't move."

I momentarily imagine the voice on the other end responding, "Poor baby, come in immediately. Back pain is simply horrible. We can give you drugs, shots, lotions, anything to make that terrible ouch go away."

Instead, this is what I get: "Have you lost control of your bowels?" from a woman who sounds like the thin-lipped Frau Farbissina, the evil henchwoman in the Austin Powers movies.

Come again?

"Have you lost control of your bowels?"

Despite the agony in my back, I keep repeating to myself, "Remember this, because no one will ever believe you."

"No," I answer, getting Frau's drift about how far the needle must go on the Pain-O-Meter to merit an appointment. "But if losing control of my bowels is what it takes to see a doctor, I will climb on your desk, squat over your appointment book, and let loose."

Click. I imagine Frau's lips turning upward to form a satisfied smile.

My next call is to a physician friend, suitably sympathetic, who calls in a scrip for Tylenol 3 to the local Walgreen's, although I'm uncertain how I will get there to pick it up.

"Bed rest, that's what you need," my friend prescribes. "Lie flat on your back for the next week. Don't move."

That's what I do, and sure enough, the pain disappears.

- - - - - - - - - - - - - - - - - - - - -

Flash forward four years. At 5 a.m. one Tuesday last April, I awaken and my lower right leg has gone totally numb.

"God, could this be a stroke?" I ask myself, my heart racing like I have won the trifecta. From knee to big toe, you could stick in long, sharp needles and I wouldn't feel a thing.

I tap my wife on the shoulder. She is snoring lightly.

"Am I speaking clearly? Is my speech garbled?"

"Go back to sleep," she says, hugging her buckwheat hull pillow.

"Kaan yu oonderstund da wurds I um saaaayig?"

"Go back to sleep," the wife advises again, this time more sternly.

So, I'm not having a stroke. But my right leg and foot are still numb, and the moment the clock radio goes from 7:59 to 8:00, I call my internist over at the University of Iowa Hospitals and Clinics, rated by U.S. News & World Report as the nation's sixth best medical center for primary care.

"He's out till tomorrow," secretary Denise says. "But he'll call in for messages, and I'll ask him to call you."

"But this is an emergency, Denise!"

"He's booked until next Wednesday, his clinic day. That's the day he's reserved to see patients."

Where does the hospital get these people? The reject pile of token-takers at the New York City Transit Authority? The motto seems to be, "How can't we help you?"

"You can always go to the emergency room," Denise offers cheerfully before hanging up.

Like an idiot, I actually think the doctor will call back, so I sit -- actually lie -- on the floor by the phone, all the while the pain still radiating from my lower back, shooting down my right leg like I stuck my big toe into a 220-volt electrical socket. The doctor does not call.

I call Denise at 8 the next morning. "Oh, he's in clinic," she says as though I should know better. "But I left a message with him, and he should return your call."

Another day goes by. The doctor does not call. The pain gets worse.

I call Denise. "Doctor is still in clinic," she tells me as though that explains everything.

If they treat me like this, and I'm a tenured professor at this hallowed institute, how do they treat a pig farmer from Sioux City? Then again, I wonder, how would they treat a University of Iowa tight end with back problems, starting in this Saturday's game against second-ranked Penn State?

Used to be your doctor would see you the same day. That was his responsibility, his oath to serve you, the patient. He (and it almost always was a he) was your private personnel manager. You had a relationship with him.

Next time you're at the movies, try shouting, "Is there a doctor in the house?" and see if anyone but a pervert comes to offer you mouth-to-mouth resuscitation. These days it takes papal intervention to set up an appointment with your physician six weeks in advance.

I am desperate. I want to know what's happening to the trusty body that has given me prime service for 47 years. For Christ's sake, I can hardly walk, and my own physician is too busy to see me.

I turn testy. "If the doctor is in the clinic, could you give me his pager number?" I ask Denise in a tone she is unaccustomed to hearing.

I page the doctor, and seconds later, hallelujah, praise the Lord, he calls back.

I am in agonizing pain, but I need to talk like I'm in agonizing pain, which I do. "The pain is ex-cru-ci-ating," I tell the doctor, pulling out the word like Atlantic City taffy.

"How fast can you get over here?"

"Any time," I answer breathlessly. Do with me what you will, but do it now.

"I could see you -- but only if you can get here in the next 15 minutes."

"OK," I answer, thinking I've scored an audience with John-Paul himself.

I tear over to the hospital complex and whip into a parking spot; all the while my right leg feels like a fully operational cattle prod. I go through the rat's maze of the hospital complex and find the internal medicine clinic. After I wait 10 minutes, a nurse checks me in. First she weighs me (180 lbs.) and then takes my blood pressure (143/83).

"Is your blood pressure always this high? This is something you might want to talk to Doctor about."

I guess we call him Doctor.

I demure from saying, "Your blood pressure would be high if a couple of days ago you thought you were having a stroke, and now you feel pain that possibly rivals childbirth, and you've called the doctor three times and each time you've been lied to, and now, miracle of miracles, the Holy Shaman deigns to see you."

Doctor comes into the examination room. He lifts my leg. I respond accordingly, which is to scream, and he says: "These things usually go away. Rest, and if it doesn't get any better in a week, call me. We could give you an MRI and an X-ray, but all that would do is cost you and your insurance company $1,500. And whatever you do, don't see a chiropractor."

I don't want to see a chiropractor. I want to spend the $1,500, but am not given a choice. Within 10 minutes, Doctor is out the door, and I am alone again with my pain -- and a prescription for Darvocet.

Exactly seven days later, the agony hasn't gone away, so I call Doctor, and it's back in the ring again with Denise.

"Doctor can't see you today."

"But he told me that if in a week I didn't improve, I was to call and he would see me."

"Doctor is on rounds today. He can't possibly see you."

"But I'm still in ex-cru-ci-ating pain."


This has gone too far. Fortunately, I'm a packrat; I find the crumpled piece of paper with Doctor's pager number on it, and call him, punching in my telephone number.

Doctor calls back, sounding annoyed. I go into my song but not the dance, and Doctor tells me he'll call one of his friends at orthopaedics, but gives me precise instructions.

"Wait five minutes. Then call this number. If the line is busy at first, call back. They will answer." It sounds like Doctor is setting up an undercover drug buy.

I wait the prescribed time, call orthopaedics, and finally no Denise. A dulcet-toned woman who sounds like Jaclyn Smith in the 1985 made-for-TV movie "Florence Nightingale" tells me to get over right away. She thinks she may be able to squeeze me in.

I race over to the hospital, park, pull my peg leg out, hobble through the maze to orthopaedics, only to meet the Jaclyn Smith clerk, who summarily waves me toward a waiting room. All seats are taken, which is just as well, because sitting is too painful, so I stand.

Twenty-five minutes later, another clerk shows me to an examination room. It is now 10:15 a.m., and the pain is shooting from hip to toe. My leg feels floppy, like an electric eel about to impress the kids at the Shedd Aquarium. This isn't altogether bad: I want to be experiencing intense pain when the Holy Shaman arrives so that he can properly diagnose me. The worst thing would be to tell him that the pain comes and goes, and it just went.

So I sit down; this increases the pain. I'm in this tiny room, writhing in agony, waiting more than an hour, flipping through old issues of Field and Stream, when a guy in a white coat who looks about 12 years old comes in.

Ah, the medical student, aka the warm-up act.

He pushes and pulls my legs and seems nice enough, jotting notes on my chart. The warm-up act informs me that the Holy Shaman will "be with you shortly."

"Shortly" turns out to be 70 minutes. Back to the Field and Streams. Gore-Tex waders are in, by the way, but expensive.

Finally, the H.S. comes in, and introduces himself as "Dr. Found." I'm tempted to ask if he got lost, but I demure. He is the doctor, after all. Found manipulates my limbs, writes something down, pulls at my big toe, then says, "Let's schedule an MRI, X-rays, and a test to see how the nerves in your leg conduct electricity."

At X-ray, I wait 15 minutes before they take their photographs, and after that, I'm afraid I'll be late for the MRI, so I tell the X-ray people that I want to take my X-ray films with me. The secretary looks at me like I've lost my marbles, but after 30 minutes, hands over the X-ray.

I find MRI. I slide inside the MRI tube, which makes me feel like I'm in a straitjacket, but I handle it by repeating a mantra I learned in transcendental meditation class in 1972. When I slide out, the technician tells me that the MRI people won't have time to read the MRI because it's too late in the day, but he promises to keep my X-rays and MRI together for the Holy Shaman's mystical circle-reading tomorrow. By 3 tomorrow, X-ray and MRI will be in my file at orthopaedics. "Guaranteed," the technician says with a smile.

Friday, I get the conductivity test, called an electromyogram or EMG. Another warm-up act, about 14 but not wearing an identification tag or white coat, comes into the examination room.

"Who are you?" I ask. "And how do I know you're a doctor?"

"You'll have to trust me," he says, looking like Frau Farbissina's colleague, Mustafa, without the fez.

"What are you going to do?"

Mustafa disappears without answering. He returns with a thick maroon medical textbook. This is not reassuring.

Mustafa starts poking my back with electrical probes, which make my legs jump when he turns the dial on high. "Yeow!" I scream. He is not impressed.

Mustafa leaves, and this time returns with a guy shuffling in Haflinger clogs, who starts pushing the needle into my lower back, each time saying "Aha!" whenever I yell "Yeow!" After 15 minutes of making my limbs twitch, Mustafa tells me, "Wait there," pointing to another room.

After 20 minutes of nursing my burns, I tiptoe into the office area, where Mustafa and Clogman are huddled around a computer. Mustafa looks menacingly at me and points me back to the waiting room. "Sit there," he commands as I slink back to the Naugahyde couch.

I make my way to ortho, and ask about my MRI and X-ray. The Jaclyn Smith clerk smiles warmly, but says my MRI and X-ray are nowhere to be found. "We've checked with X-ray and MRI and they say we have them." She shakes her head, tossing her springy hair. "We could always put a trace on them, but that's likely to take a couple of weeks." She smiles.

Within the recesses of my brain I hear the voice of Mrs. Torresee, my fourth-grade elementary school teacher, saying, "Act mature. They might not remember you, but they'll remember your manners."

Out the window with Mrs. Torresee. These are desperate times. I place my palms on Jackie's desk, lean forward as far as my back allows, and say to Jackie in a low but steady voice, "I want you to listen to me very carefully. I want you to get up slowly from behind your desk. You're going with me to MRI.

"That's right," I say. "I mean what I'm saying. Get up, now!"

Jackie is not alarmed. She deals with back-pain lunatics every day. "Sir," she says calmly, as though she's the one on Darvocet. "I can't leave my post at ortho and go with you. You can understand that." Jackie's eyes squint, showing emotion. She tilts her head and frowns, her pink lips producing a slight pout.

Smooth. Very smooth. If only Jaclyn Smith could act this well.

"Please," I say. "I have been in ex-cru-ci-ating pain for three weeks. Can't you please, please help me?" Tears miraculously well up in my eyes.

Mao said all it takes is one person to start a revolution. Before my eyes, Jackie transforms herself into Tania, the hospital guerrilla.

She looks me in the eye, nods her head, and rises from behind her desk. Together, as comrades, we troop down the long coordinator to MRI.

Standing in tandem in front of the MRI desk, I say defiantly to the clerk, "Ten minutes ago, I was told that ortho had my MRI. Ortho doesn't have them."

"You must be mistaken, sir," the clerk informs. "Ortho does have your MRI."

At which point, I lay down my royal flush.

"Well, this is ortho," I say pointing to Tania, "and ortho doesn't have my MRI."

Tania smiles smugly. "He's right. You never sent it to us."

A stalemate of sorts for a minute or two. The clerk's eyebrows go haywire. She starts to say something, then looks to her right and left. The other clerks have retreated, abandoning her. This could be a postal situation.

The clerk disappears and ducks behind the Great Oz's curtain, into the Holy Shaman's offices. In five minutes, she returns with a large envelope, and ignominiously hands over my MRI.

I look at Tania, wanting to give her a high-five, but instead we smile at each other dreamily like in a Correctol TV commercial.

As we're walking back to ortho, the thrill of victory coursing through my veins, I ask Tania when Dr. Found will be able to look at my newly discovered MRI.

Poof! All traces of Tania are now gone. "Oh, he can't possibly review them today. His wife just got a new job and he's home looking after the children."

"Could he perhaps look at them Monday?" I venture timidly.

"I wouldn't count on it. He's very busy, especially since his wife got the new job."

Over the weekend, while I'm waiting for Dr. Found's wife to adjust to her new proletariat life, the back pain gets so bad I think that maybe a chiropractor wouldn't be such a bad idea. Could I possibly be in worse pain? But the thought of someone manipulating my back makes me wince. Instead, I dose up on the Darvocet. When I'm not on my back, I pace around the house stiffly, as though I have a pole stuck up my butt, making my posture resemble Al Gore's. To bide my time, I read a book my wife buys, "The Mind-Body Connection," by Dr. John Sarno, a runaway bestseller that says my back problem is in my head.

At 8 Monday morning, Dr. Found does call with the results of the MRI. It shows a "significant" herniated disk between my fourth and fifth vertebrae. He suggests I get an epidural cortisone shot. He says he can get me into the steroid people at 3. "If that doesn't work, we may be thinking of surgery down the road."

Waiting for 3 is like waiting for the Venus space shuttle to launch. The pain has come back with a vengeance. Sitting is impossible. The only thing that doesn't hurt is lying flat on the floor, which I do as I count down to 3.

At the appointed hour, I queue up behind another aching back. When it's my turn, the receptionist is busy talking on the phone. Jackie is nowhere to be found. The check-in lady continues yakking as though I am invisible. The shooting pain has me going through the roof, so I lean against her desk, but this time, I am in no mood to play the hostage game.

Instead, I lie down on the floor in front of her desk.

"Please help me," I mumble from the textured maroon carpet.

But the check-in lady continues gabbing on the phone.

Could this be Frau Farbissina, the woman who four years ago asked if I had lost control of my bowels? Again, I say to myself, "Remember this, because no one will ever believe it."

After a minute or two, while I'm collapsed on the floor, Frau -- still on the phone -- gets up from her ergonomic chair and peers down her half-glasses at me. She puts the caller on hold and dials the PA system: "Nurse: Stat to front desk." Then she goes back to her phone call, for all I know talking about last night's episode of "ER."

A nurse shows up, bless her heart, and wheels me on a gurney to a sterile-looking cave where a doctor who goes by the name Tartar sticks a needle in the base of my spine, injecting a steroid into the fluid surrounding my spine.

In another five days, I have another injection. That seems to do the trick.

- - - - - - - - - - - - - - - - - - - - -

Five months later, I am following the recommendations of my physician friend. I have given up golf. No raking leaves this fall, and come winter, forget shoveling snow. Too much cross-body movement. I try giving up making the bed, taking out the garbage and emptying the laundry hamper, but so far, the wife has not bought these precautionary measures.

About 43,000 patients a year have the stamina and perseverance to get an appointment at the world-famous ortho clinic, which makes it among the top 10 busiest academic orthopedic centers in the United States. Back pain is the leading cause of disability for people between the ages of 19 and 45, and eight out of every 10 Americans have severe back pain at least once during their lives.

But what good is a back doctor if you have to lose control of your bowels before he or she will see you? And if you just have ex-cru-ciating pain, then the next available appointment isn't for another five weeks.

I guess it comes as no surprise that today when I call to see how long the wait is for a new appointment, I get a busy signal, and when I finally get through, the clinic is so busy that I have to leave my name and number on an answering machine, and six hours later, no one bothers to call back.

If Frau and her troops haven't already put me on some internal hit list, then I'm sure my name will be on one soon. I can hardly wait for the next time my back goes out.

By Stephen G. Bloom

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