Tuesday, November 5, 2013
The Difference Between Here and There
I live in New Jersey, a state with world-renowned medical practitioners and facilities that rival even the top hospitals in our neighboring metropolis, New York City. I've always trusted my doctors and I feel they are well-trained and brilliant physicians. But the one common theme I've noticed running through the majority of the office staff and, sometimes, even the doctors themselves, is a complete lack of regard for the patient's emotional needs and an abysmal bedside manner. But, being born and raised in this area, it would concern me more if anyone went out of his or her way to be polite. Especially while doing his or her job! Yes, there are the sparse few who will actually say hello to you when you enter the waiting room. One or two might even crack a smile. But, for the most part, I've only ever been greeted by seemingly overworked and angry staff members who would probably rather be doing anything else than copying my insurance card or taking my blood pressure and writing down my list of ailments for the day.
When Lyndsay came from Minnesota to New Jersey, before the embryo transfer, for her first visit with my fertility clinic, she commented on the attitude of the doctor who had examined her. He made her feel uncomfortable and she insisted that he should not be the one to perform the transfer. When she told me who it was I thought back almost three years to my egg harvest preparation and I remembered that doctor vividly. He was a man of few words. When he entered the room, he didn't speak and he didn't smile. I don't even think he introduced himself before invading my nether region with the ultrasound dildo. But I thought to myself, if he was good at his job, his personality really didn't matter too much since I only had to see him once or twice. I can't say I've had much of a problem with the rest of my doctors. Yes, they always seem like they're in a rush to get to the next patient and I generally have to wait at least 20 minutes after my scheduled appointment time to even get called into an exam room. But I'm sure it's like that anywhere, right? Doctors are busy people!
The real issue I have is with the office staff!
Rude, unhelpful, sarcastic, nasty, lazy. Again, there are the select few who do not fall into these categories but, for the most part, it's impossible to schedule an appointment, leave a message for a doctor or ask a simple question without it turning into a major issue of misunderstandings and double-bookings and forgetting one of the five tests I needed to have that particular day. And forget ever getting a call back from the doctor himself. If I need to ask a question, I have to call the receptionist, explain my problem in detail then wait for her to e-mail the information to the doctor. After he has a chance to review it, whenever that may be, he'll generally have his nurse call me back to answer. God forbid the answer leads to a follow-up question, I'll have to wait for the nurse to ask the doctor, the doctor to answer the nurse and the nurse to call me back again. It's like the most drawn-out and annoying game of Telephone I've ever played.
Which is why my first experience at the clinic in Minnesota was so shocking.
From our first steps into the building we were greeted with friendly smiles and helpful faces. Our appointment actually happened at our scheduled appointment time, then the next one, which was supposed to be an hour later, was pushed up to be right after the first appointment to make it more convenient for US. It had to have been a fluke. After meeting with a super-sweet nurse, the doctor came in and sat with us for about an hour, without ever giving us the impression that he needed to hurry off to another room. The doctor gave us his card with his personal e-mail address and instructed us to contact him with any questions we might have. He also mentioned using Skype for appointments Jimmi and I could not actually attend. I felt like we were in The Twilight Zone. We were probably just there on a rare day, when all the stars were in alignment. But I soon found out, after three separate visits over the last month, that the people at the clinic in Minnesota really are THAT helpful, THAT friendly and THAT concerned about how WE are treated.
And the differences in care didn't stop there.
After scheduling our big anatomy ultrasound for December, we were encouraged by the surrogacy agency to meet with the hospital social worker to discuss our unique situation so Jimmi and I would be known as our baby's parents immediately. It was also recommended that we book a tour of the Labor & Delivery Ward. I mentioned those suggestions to Lyndsay's doctor and he said, "No problem. I'll set you up with the social worker now." He entered the orders into his computer so the scheduler could take care of it on our way out, then he handed me a card with the maternity tour information on it, "Just go to this website and you can book the tour right online." We left the building with the ultrasound scheduled for December 20th, followed by an appointment with the doctor and a meeting with the social working immediately after that. It's close to impossible to book multiple appointments on the same day at home, no matter how far in advance I do it! Was it really that easy?
Once I returned to New Jersey I didn't waste any time in e-mailing Lyndsay's doctor to ask him if we could do a "test Skype" to make sure everything worked before the next appointment. I almost fell off my chair when I received a reply from the doctor - not his nurse - barely 15 minutes later. Through direct e-mail, we were able to schedule a test call for last night at 6:30 PM. Ok, now that I had that under control I figured I'd check out the hospital tour website. Shit! They only offer tours on December 3rd and 17th. We won't be there until the night of the 18th. I wonder if they'd give us a private tour? I shook my head as I sent off the e-mail explaining our situation and requesting a special tour for just Jimmi and me during our two-day window. A reply popped into my inbox a few minutes later and I was already imagining the laughter of the person who had to answer our request, "No way! What makes you so special that we should cater to your needs?" But that's not what the response was. Not at all. "Dear Suzanne, I would be happy to give you and your husband a tour when you are here for your anatomy ultrasound..." What?! Shut UP! Who does that?! Toto, I don't think we're in Kansas anymore. I had to read the e-mail three times before I actually believed that this woman was willing to make an exception for us. The thought of moving to Minnesota to be amongst the friendly people flew through my head for a minute, but I'd never survive winter in the Midwest.
But let me go back to last night for a minute...
The test Skype call was set up for 6:30 PM. Jimmi and I were sitting in front of the computer at 6:25 when I asked with skepticism, "How late do you think he'll be? If he even remembers to call, that is." I knew I should've confirmed the appointment that day but I didn't want to be annoying. We only scheduled it a few days earlier, but there was a whole weekend in between. What if he didn't write it down? What if he forgot? What if he...
Beep! Beep! Beep!
The screen on my computer was lighting up and the clock in the corner read "6:32 PM." Ok, I will never doubt this guy again. "Hello!" smiled Dr. C when his face appeared in front of mine. After I introduced him to Jimmi, he said, "It looks like this will work well for appointments that you can't attend." We all agreed and the conversation developed from there. "I know this was briefly discussed at our last appointment, but can you tell us a little more about the first trimester screenings?" I asked. Dr. C explained, "Yes. There is a blood test used to rule out some chromosomal abnormalities, such as Down Syndrome and a few others. There's also an ultrasound that checks the nuchal translucency of the fetus. That's the amount of fluid around the baby's neck. Excess fluid could indicate a problem. First, can you tell me where the embryos came from again?" I told the doctor that the embryos were genetically mine and Jimmi's so he asked my age. I understood his reasoning, as there's a much higher risk for Down Syndrome when the biological mother is over the age of 35. "I'm thirty-eight," I said. "But I was thirty-six when the eggs were harvested and fertilized. We did PGD on the embryos so do we really need to do extra testing?" I was referring to the the procedure performed on the embryos where a cell is removed to check for issues before they're even transferred or frozen. "Well," he answered, "that's a good start. Of course there is something called mosaic Down Syndrome, which actually occurs at the eight-cell stage. That would be after the PGD was performed. I mean, the chances of that are like one in fifty-thousand, but it does happen." Oh, please don't give me slim chances again! "Ok. I think Dr. R mentioned that the blood test might not be accurate for us because of the twins that didn't make it," I reminded him. "Yes," he agreed. "That could definitely throw off the results. But I think the nuchal translucency screening might be a good idea. It needs to be done sometime between eleven and fourteen weeks, before the baby gets too big." I could see him looking at his computer and calculating Lyndsay's current week. I decided to help him out, "She was twelve weeks yesterday," I said. "Yes," he said, "and the baby was measuring a few days over last time, so we really need to get her in here by the end of next week." Ugh. I immediately felt guilty knowing this last minute change would cause Lyndsay extra stress trying to rearrange working and childcare. "Will Lyndsay still need to come in on the twenty-fifth if she comes in next week?" I questioned. "No. If all is well, there's no reason to come back so soon."
We finished up our call and I texted Lyndsay to let her know about the change. After a few exchanges we realized getting in this week would be slightly easier for her than next week. Based on my experiences at home, I wasn't hopeful that they'd be able to fit her in so quickly. I mean, Hell, my oncologist made me wait a month to remove my rare and aggressive cancer because he couldn't manage to squeeze me into his schedule before then. But tonight, an e-mail from Dr. C proved me wrong, once again. "We've scheduled Lyndsay for this Thursday at 8:15 AM (CST). I will do my best to be in there with the computer and Skype you, but because of the short notice, I am now double booked." Ok, that's understandable. The important thing is that he got her an appointment. The e-mail continued, "Because of the demised twins, we will not be able to do the blood work that normally goes with the screen. Thus, all we will be able to tell is whether the nuchal translucency measurement is within normal limits, but won't get a revised risk of Down Syndrome for the baby." I guess we'll just have to hope the measurement is normal so we won't need the blood test, then, right?
So, once again, here I am asking for positive vibes, good thoughts, prayers, crossed fingers or whatever it is you do when you need something to be ok. Little Baby A has come through so much already. Let's help her jump this next hurdle on move on easily to the finish line.