If you wanted any further proof of the broken American health care system, you should have come with me yesterday to the hospital where I had a biopsy after my annual mammogram showed something troubling.
First of all, the volunteer who checked me in, took my information, my health care card, and had me sign forms acknowledging the receipt of information I had not been given, was in the early stages of Alzheimer's. The signs? Fixation on certain phrases ("why," she kept mumbling, "do they have two pieces of paper when they could have one?"), hostility, lots of fumbling around to explain simple things I already knew, like how to find the parking lot in which I'd just parked.
But the centerpiece of the failure to create a system that works for its patients was the biopsy itself. A room that was neither a doctor's office nor an operating room, the chosen site looked like a mop closet that had been converted temporarily and hurriedly into a spot for this procedure. There was a stain on the floor where water appeared to have leaked. It was messy. The machines — and there were several because the biopsy is guided by an ultrasound — did not really fit in the room. The general feeling was of something furtive and slightly shameful. But then that could just have been my own anxiety about my mortality speaking.
The worst thing of all was that the procedure was conducted with so little regard for the patient, and by people of such good will, that in the end I concluded they could only have set things up like this because their workload was utterly crushing and they simply didn't have the luxury to consider how they might have made the process something other than dehumanizing and humiliating for the patient.
Some of the features of the biopsy that were particularly humiliating — you are asked to lie face down, for about an hour, on a hard table, without moving. There is a hole cut out in the table where the suspect breast is placed. It dangles in space. Out of your view, something like a vise is put around your breast. And then, when you are in a position of what I think we'd all agree is maximum discomfort and unease, the doctor comes in and introduces himself. I don't know about you, but it doesn't make me feel great to meet, for the first time, the person who's going to make a cut in my body when I'm face down with one breast through a hole. And one other thing — the table is jacked up, kind of like a car at the oil changers, so you're hanging there in the air while you're being worked on from below.
The doctor was a nice man — someone who clearly wanted to connect with his patients and comfort them. He kept patting me on the shoulder and he was good about saying when he was about to do something. So I do have a tip for him. Sometimes, in women's magazines, you run across this piece of advice: spend a night in your own guest room. See how the light is, how the mattress feels, that sort of thing. I think if he really wanted to lower the difficulty of what was, going in, already a difficult experience, he might have tried lying on that table for an hour without moving — only with his penis through the hole, since he doesn't have breasts.
We do our best work for other people when we forget ourselves and think about them. This is obviously not easy to do. But perhaps if this doctor had spent an hour on that table in the broom closet, he would then have felt it more urgent to come up with a better way to do his work.
And that, I'm pretty sure, is the last time this blog will ever discuss the human breast. Tomorrow, it's back to food.