Doctors, Class Status and My Annual Exam

When I moved to Albany from Brooklyn, I left behind my 65-year old Jewish primary care doctor.  His office was in the garden level of his Henry Street brownstone. I remember my final check-up, as I ambushed him with yet another attack of hypochondria: “I think I have a little lump under my ear, like a node.” He took my hand, placed it on his neck so I felt a bulbous growth. “Bigger than this?” He asked.  “I’ve had this for thirty years and I’m still standing.”  Suffice to say, there was no biopsy on the node.

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Indeed, of all the eccentrics I met in New York City, doctors were some of the oddest.  There was my favorite Ear, Nose and Throat doctor, who was also in Brooklyn Heights, but in the upper floors of a building said to be inhabited by Paul Auster down below.   This office was, honestly, the most run-down doctor’s office I have ever been in.  It was like a post-apocalyptic 1970s-scape: square vinyl chairs with rips in the cushions; beige walls that no doubt started out bright white, creeky coffee table offering the same issues of “Highlights Magazine” that I read as a kid in the waiting room of the dentist twenty years earlier. The doors of the packed medical record file cabinets were hanging off.   A sliding glass reception window was smudged with layers of fingerprints and what were, quite possibly, apricot preserves. It was like going to the doctor in a hoarder’s house.  Yet, if it’s possible for someone to have been born to be an ENT, this guy was it.  A warm, always smiling Filipino man, he was great at his job, great with patients, and radiated rightness and talent in his chosen field.  He just had an insanely messy office, which I returned to again and again for my ritual ear cleanings before flying, which I believed helped to keep the plane from falling out of the sky.

So I arrived in Albany doctor-less, and would remain so for eight years. I had tried to get in with a new general practitioner many times, only to be put on hold or told the doctor was no longer taking patients, or I would have to wait six months for a first appointment.  I came to think of scheduling a new patient appointment as an ordeal akin to having a late fee removed from a credit card, or charges taken off my Verizon bill (no, I did not call Guatemala 67 times last month).  It would involve phone trees, using the speakerphone function while I multi-tasked in the house, a resolve to take no BS from nurses giving me the run-around.  In short, I needed to set aside a good two hours to make this happen.  In the end, it took a good eight years.

In the meantime, I made due with the university health clinic, local stop-ins, the nurse hot-line (Always: “it’s the flu.”), and friends whom I would routinely ask to  “feel my forehead” like my mom did when I felt ill. I occasionally saw specialists and did have a phenomenal ob-gyn, but no one knew my baseline body stats, could prescribe an antibiotic, assure me that the possible ear node was nothing.

Over time, what started out as inconvenience became a downright stigma.  When visiting a chiropractor for the first time, I elicited looks of pity and aghast when the medical secretary asked, “Who is your primary care doctor?” and I answered,  “I don’t have one.”  Silence.  Incomprehension.  Then the suspicious look.  My lack of a primary care doctor registered worse than romantic rejection; it branded me as a sub-par patient for all others. I was a ticking health insurance time bomb.  People did not want to touch me.

I became even more motivated to find a new doctor after several visits to the First Stop Health Clinic, where on more than one occasion I was diagnosed by a dandy-esque doctor who never actually touched my body, and somehow managed to make the exam feel, well, competitive.  “Sore throat, you say?” he asked, checking his pocket watch and tipping a top hat (or so it seemed in my fever-raddled mind). “Yeah, I thought maybe strep.” Look of judgment and disinterest.  Throat swab where I almost gag.  Throat swab where I keep closing my mouth before he can get a sample.  Throat swab where I turn the stick to splinters.  Finally, successful throat swab.  Negative for strep, an outcome that he silently gloats about getting right.

This was almost the opposite experience to my going to the clinic in walking distance to me in downtown Albany.  There, hardy women doctors and nurses ruled the roost.  Waiting, I was the only white patient, and one of the only without a child in tow.  It was there I realized as an underpaid, carless graduate student, I was in certain respects socio-economically “black” in Albany, a much-segregated city along race and class lines.  So much so that the doctor, a well-meaning, white Ivy League grad, not so subtly suggested that I might want to go next time to the affiliate clinic in the ‘burbs, where I really belonged.  She did not seem to understand that I had walked there.  From my house.

These visits, and my search for a new doctor, made me reflect on my history with doctors before Brooklyn, before having my own health insurance.  Well, one thing: I never personally knew a doctor growing up, except the doctor I went to.  (Except for a friend whose Dad was a chiropractor.  But this was in the 80s, when chiropractors were considered quacks.) This may not sound unusual, but its actually one of the defining boundaries of social class that I later came to realize.  When I started at elite small liberal arts college, it was the first time I met people my age whose parents were doctors.  Before then, doctors were like celebrities or movie stars to me: they existed only when I was there to witness them.  Where they lived, I did not know.  One family doctor had photos of boats, his boats, in his office that I would study in childhood boredom.  I also did not know anyone who had a boat, or rode boats for fun, or had occasion to be photographed, over and over, on boats.  Doctors seemed to live on either side   side of that glass, either in their white coat in the office, or in the hot, bright sun, surrounded by polo shirt-clad sons, on a boat.

I remember the fist time car-pooling back to school from Thanksgiving break from Long Island to elite small liberal arts college.  My parents dropped me at a classmate Ellen’s house, from where we would take the ferry and drive back with a few others.  Ellen’s house was one of the houses our family would drive past, on purpose, on a Sunday afternoon.  These drives always took us East and North to the Long Island Sound and its quiet, winding, wooded roads that were the routes to houses variously old or modern.  But big.  And different from ours.  I remember walking into her house and saying, at least with my eyes, if not out loud: wow, your house is so nice. And her just shrugging it off, not rudely, because it was, well,  just her house.  And finding out that her Dad was a doctor.  A doctor!  Was he my doctor? I pictured Ellen on a boat, in the sun.

Only many years later, after I left small liberal arts college out of culture and sticker shock, did I think about my neighborhood, and my neighbors growing up.  They certainly were not doctors.  But what DID they do?  Immediately to my left:  Frank was a machinist.  To me, he was just the man who lived next door, always wore a white tee and jeans.  His wife, Estelle, maybe had the most interesting career on our block.  She was an agent for child actors.  Because of this, I subjected her to unsolicited performances of “Memories” over the fence, hoping to be discovered.  She mostly placed kids in commercials, and had arrived there after her own career in regional musical theater.

Next to them:  Jules was a construction worker/contractor.  His wife, and my babysitter Fran, was a nurse who had not practiced in years, because he did not want her to work.  She grew up in public housing on the Lower East Side and attended NYU for nursing.  Mr. McCann, I knew, worked at Grumman with my Dad. They wore suits, carried briefcases, did things with numbers and not with their hands like Frank and Jules.  Mrs. McCann worked part-time as a waitress at Friendly’s.  My mom was one of the only full-time working moms— a fifth grade teacher for 36 years. My best friend’s parents, who lived about a mile away, were a social worker and teacher. We were solidly middle class, but just a generation away from working class, and living in a neighborhood on the cusp between the two.  We simply did not know people who were doctors and lawyers.

When I finally scheduled my first appointment with a new primary care doctor, it was, not surprisingly, anti-climactic.  The office was located in an industrial park swamped by one identical cinderblock building after another comprising “medical suites.”  My doctor, a competent enough woman at least five years younger than me, made little to no eye contact as she entered my generic answers to generic questions into the new Electronic Medical Records system.  She sat on a stool, bringing a stylus pen to a screen as I lied about how much I smoked, drank and exercised a week (I am cutting down on the first two, increasing the third, I swear.)  The place was spotless, punctual, peopled by friendly nurses outnumbered only by the several admins who seemed more like bar bouncers, ready to gently escort me out if I did not show my insurance card and photo ID on cue.  I was encouraged to use their newly revamped website to stay up to date on my own health and advancements in health in general, and to avoid scheduling unnecessary appointments.  I did not get the sense that this new doctor would invite me to feel a bulbous growth on her own neck.  I have yet to see her again, its been over a year, but I’ve got a name to say to other doctors (and more importantly, their secretaries!), to write on forms, that makes me a more legitimate patient in the modern healthcare system.  But I admit, I miss the apricot preserves, ripped chairs, and most of all, the human touch.