“Hi, Mrs. Jones. I’m Marilyn from Griede Healthcare Corporation. We spoke on the phone the other day?”
“Oh, yes, please come in.” The screen door clanked shut behind her and the young nurse entered the house. Mrs. Jones backed the wheelchair away and then spun it around slowly but with deft precision and led the nurse into the cluttered foyer. “You sure don’t waste any time, do you?” she said over her shoulder. “We only just spoke yesterday. But I’m sure glad you’re here, missy. I can’t breathe! And I’m almost out of oxygen,” she said, adjusting the nasal cannula, which had gone askew, back into her nostrils. “Last time I was out of oxygen for two weeks before the insurance company could replace my tanks!”
“Oh, how unfortunate, but you made it through, so whatever doesn’t kill you makes you stronger, right?” said the nurse.
Mrs. Jones thought about it. “Yes, I suppose so, but about my breathing….”
Marilyn interrupted. “Don’t forget, Mrs. Jones, as I said over the phone, this is a wellness visit. I’m here to ask you some questions, so the insurance company can, ah, get to know you better. If we know you better, we can take better care of you. Does that make sense?”
“Okay,” said Mrs. Jones, already breathing heavily from the conversation. “But before we start, can you reach around my wheelchair, missy, and turn that oxygen knob up higher?”
Marilyn gave the knob a crank and frowned. “I’m afraid it’s up full blast, Mrs. Jones.”
“Oh, dear,” said Mrs. Jones, tripoding in her wheelchair.
“Let’s get started, shall we?” asked Marilyn.
“Can you hand me that inhaler over on the table there, missy?” The nurse reached over and grabbed the inhaler. Mrs. Jones shook it, pointed it at the roof of her mouth, and took a puff. When she didn’t get the relief she wanted, she took several more puffs before Marilyn intervened and set the inhaler back onto the table and out of reach.
“As I said, Mrs. Jones, this will only take a little while. If I can just have your complete attention.”
“Sorry. Go ahead, missy.”
Marilyn squirmed in her chair. “Now, have you ever, ah, forgotten anything before, or had trouble with your memory?” She picked up her clipboard and pen and leaned forward, poised to write.
“Sure, just last week I couldn’t find the remote for the TV. Looked everywhere for it.”
“Yes, yes, exactly!” Marilyn printed neatly on an official looking form, under the column “hierarchical conditions category,” the words “Tertiary Syphilis,” followed by “dementia-other etiology.”
“That remote stayed lost for a whole day! I found it hiding in the seat cushion. Missed Oprah and The Price is Right!”
“Have you ever been told, Mrs. Jones, that your lungs don’t work well?”
“Oh, yes. For quite some time now. I have emphysema, deary.”
Marilyn took up the pen again and wrote “COPD,” “Pulmonary Sarcoidosis,” and “interstitial lung disease-etiology unclear.”
“How about a sinus infection or a bloody nose. Ever had one?”
Mrs. Jones was too short of breath to reply so just nodded affirmatively. Marilyn looked pleased and added “Wegener’s Granulomatosis” to her column of diagnoses.
All the talking sparked a long, congested coughing jag that almost toppled the frail woman from her wheelchair. She resumed her pursed-lip breathing and tried to settle herself. Marilyn tapped her pen on the clipboard until she was sure the coughing fit had completely resolved.
The old woman readjusted the nasal cannula and tightened it at the base of her neck, then tried to smile albeit unsuccessfully. “I’m starting to have some chest pain, deary.” Marilyn set the pen down. “Can you get me my nitroglycerin? I think I left it on the kitchen counter. I’ve been having chest pains all day for the last two days.”
With forehead lines deeply furrowed in concentration, Marilyn jotted down “Atherosclerotic Vascular disease,” “Disorders of the Arterial System,” “Hypercoagulable state,” “Thrombosis of unspecified artery,” “Arteritis of Small and Medium-sized Arteries” and “Kawasaki’s arteritis.” Pleased, she looked up and said, “Sure,” and moved awkwardly toward the kitchen, tripping over the oxygen tubing coiled on the floor and yanking it from Mrs. Jones’ nose, wrenching her neck around in the process.
Mrs. Jones yelped and turned blue in an instant. She tried to mouth the word “help,” but nothing came out. When Marilyn returned to the foyer munching a banana and having forgotten the NTG, she noticed Mrs. Jones had taken on an aqua-marine hue, perhaps even a cobalt, she couldn’t decide. She reset the paraphernalia with tempered patience. Mrs. Jones revived, and color returned to her lips immediately. She was now back to her usual, a cool gray, or was it a matted silver, the nurse couldn’t decide.
The NTG bottle was nearly empty. “Under the tongue… that’s right. As a matter of fact, take the last three. Let’s get right on top of this issue so we can get back to the wellness visit.”
“Ah, thank you, missy. The nitro doesn’t seem to work anymore the last few days.”
“Mrs. Jones, have you ever been in a situation where you were in a good mood and then someone got you mad…”
Mrs. Jones put a hand to her jaw. “The pain is going up to my jaw.”
Marilyn tried to ignore the interruption. “Then someone got you mad,” she said again, patiently.... “but then…after a while, what bothered you didn’t seem to bother you so much anymore?”
“My heart is racing, missy!”
“Mrs. Jones. Did you hear the question?”
“Ah, yes, yes, I’ve done that, I suppose, sure. Who hasn’t.”
Bingo! The big kallulah. In her mind she stood up and danced a jig. Or was it a polka? No matter. The nurse took up the pen and wrote “Bipolar Disorder.” Turks and Caicos here I come, she thought!
“I really think I should call 911,” said Mrs. Jones. “The chest pain is still there, and I’m worried about that heart rate, deary, not to mention my breathing.”
“I don’t think that’s such a good idea, Mrs. Jones. First, I haven’t finished this important wellness survey. It’s going to lead to much better care for you and it’s very important to Griede Healthcare Corporation that we do that. And besides, according to my records, you’ve been to the ER a lot lately. Do you really think another hospitalization is the answer? How long did you spend in the ER last time? A long time, right? I bet you were miserable, weren’t you, sitting on that hard gurney, hungry, waiting to be taken to the floor, all that noise and commotion.” She looked around and added, “And missing your cats. And besides, you have to be very sick for Griede Health to admit you. We’re all about prevention and avoiding the hospital.”
“I guess… I guess we can do a few more questions and then see how I feel.”
Marilyn noted the cyanotic fingernails and wrote down “Lung disorder- unspecified,” “Hypersensitivity Pneumonitis,” “hypoxia,” “Hemochromatosis” “Onychomycosis,” and “meiosis” in nicely penned and carefully constructed block letters. She thought about it further and then added “Goodpasture’s Disease.” She surveyed the paper and then looked up, pleased.
“Just what are you writing down, deary?”
“Oh, just diagnoses. The government gives Griede Healthcare reimbursement, say, for certain diagnoses. If we diagnose someone with “Diabetes,” they give us a nickel. But if we are more specific and code “Diabetic Retinopathy,” they may give us a dime.”
“The government is so stingy, giving you nickels and dimes.”
“They sure are, but that’s what we have to work with. Now, I see here you’ve been a client of Griede for only a few months, is that right?”
“One day the phone rang and this nice, sweet girl on the other end told me I could save a lot of money by switching to Griede. Next thing I knew I got a new insurance card in the mail. Of course, seeing the doctor in person can be quite challenging, I've learned, but I can see the doctor over telehealth anytime I want! They seem like doctors at least.” Mrs. Jones managed a smile. The chest pain was going away.
“I’m glad you're satisfied! Our slogan is “An apple a day….” That sentiment goes way back to our founder, Bjorn Griede. He founded Griede Health and then retired just ten years later! I hear he’s in the jungles of Panama now and hasn’t stepped one foot back into the United States since. So adventurous!”
Mrs. Jones nodded. “I’m getting tired, deary. Will it be much longer?”
“No, not much longer. We just need to complete a patient satisfaction survey and then we are about finished.”
“Oh, I don’t know. I can sure use a cigarette and I’m so tired.”
The nurse looked at the oxygen tanks and then seemed to come to a decision. She rummaged through her bag. “Tell you what, we will both have a cigarette and, if you finish the survey with me, and the results are satisfactory, I’ll leave the whole pack behind for you.”
“It’s a deal!” said Mrs. Jones, which triggered another long coughing fit that propelled her unlocked wheelchair backward. The cat screeched as it ran over its tail. “I’ve had such thick, green sputum lately. Much thicker than usual. And the fever started on Sunday and hasn’t left. Do you think I have pneumonia? Do you suppose I’m alright?”
“You HAVE to be alright, Mrs. Jones. You have your first Silver Sneakers tomorrow! Be ready at 9 AM sharp and the limo will be waiting to pick you up and bring you home. I hear Manny, the limo driver, is quite the ladies’ man!”
Mrs. Jones said “Oh, dear,” and primped her hair gingerly with both hands. “A limo, well. But do you think I’m really in shape to do a workout?”
“Griede Health really wants to get you in good shape, Mrs. Jones. We must show the government we’re meeting our metric. You know, “An ounce of prevention….” If we do, they may pay us a quarter. That’s a lot more than a dime or a nickel. And of course, that money comes back around to you. It helps fund all of your generic prescriptions and all our palliative care consultants. They say the hardest thing about working out is just showing up at the gym that first day. And besides, we’ve got it all organized for you and it’s happening tomorrow. Just one hour. We’re going to pack all of you into the same room, put on a Richard Simmons tape, you know that young guy who’s so cute and energetic, and park you right in front of the TV. For those few that can get out of the wheelchair, they can even stand and move their arms and legs a little if they’re up to it, but we discourage that. Hopefully, you learn some of the exercises you see on the TV and start your own home program from there. We will have a table with snacks and water and free pens and key chains that say Griede Health right next to the TV and then it's right back in the same limo and you’re right back home before you know it. They say Griede Health goes the extra mile for their patients.”
“They sure do. How do you pay for all that if you’re only getting a quarter?”
“Somehow we manage.” They smoked in silence.
“Ok. Now, last thing.” She pulled a pink form out of her bag. “Have you ever heard of the words “DNR?”
