My “Big Ben Parliament” Loop

I’m starting to get very Chevy Chase “Big Ben Parliament” vibes about the patient’s healthcare journey in America. Much like Clark Griswold’s unfortunate loop around the rotary in European Vacation where he just couldn’t get off the circle, patients here are finding a similar struggle just exiting the administrative and medical loop of getting to a treatment that fixes their symptoms. My dad’s 5-month caper is as good a case as any as a lesson that sometimes…time is the best teacher:

Clark Griswold’s famous loop

Loop 1 (Mid January): 80, severe pain, shooting up leg into groin and lower back, crawling in the house like a toddler, which is super humbling for the guy who used to whip me in tennis. Pain medications and 4 weeks of PT do not move the needle. Loop 2 (Mid February): A PCP prescription of Hydrocodone, while addictive, eases dad’s pain like a Ray Kinsella roadtrip, but he runs out of pills before President’s weekend making it one of the toughest in his life. Plus the pills cause constant shortness of breath, which worries his cardiologist who runs a few tests just because of dad’s recent history, just 2 years removed from a quad bypass and stents. I tell the doctor he isn’t drinking water or eating nearly enough but that doesn’t make it into the notes. Loop 3 (Mid March): An MRI is approved by Aetna Medicare and at the scan there’s a holdup because the imaging center can’t do the MRI unless they have verification of the type of stents used. Eventually, the MRI is done and the PT refers us to the spine surgeon to gear up for an L4-L5 spinal fusion to fix what looks like a jelly donut squished on the image. Dad starts to worry about the surgery and Aetna seals it by denying it on account the images do not clearly show degenerative disease requiring surgery. Loop 4 (Mid April): The spine surgeon agrees to meet with us to talk options, didn’t know about the insurance denial, calls it “bunk” but agrees steroid injections are a good option.” The insurer was probably right all along as by month 3 dad’s level 10 pain is now down to a 3. He's able to walk again in the driveway and even chip golf balls in the yard. I see him shank a few off the slider. “You look like Tin Cup pops - back to your old self,” I quipped. Loop 5 (Mid-May): We meet the pain doctor today, a gem of a physician who takes the time to get dad’s full story, caution about the risks, and sets a plan to do the epidural in June as long as the cardiologist okays 5 days without blood thinners pre-procedure. “I won’t do it without the 5 days, too much risk,” he says. At this point, dad’s pain level is a 2 and the pain doctor says it may just be that despite the degenerative disc disease he is now okay to manage, with some ibuprofen and maybe the epidural can get him over the top. “I’m 80 and don’t want surgery,” says dad. “I just want to feel good enough to go play 9 holes once in a while.” What the doctor didn’t flag was dad’s 150 over 47, which tells me he isn’t drinking water and eating enough salt, that his exhaustion to bend over and pick up the golf ball isn’t so much butt pain but just dehydration. But I’m not a doctor. As I write this I feel like the last 5 months have been a constant struggle to get a solution with a lot of stress for what I’m guessing has been around $5,000 without any real progress and, if you ask me, we’re back where we started, after 5 loops around the rotary like Clark Griswold. An old guy, who misses being active, who like me finds the patient’s journey almost as exhausting as walking to the kitchen. I suppose if dad does go through with the injection at the hospital in 3 weeks he’ll feel better. I doubt the insurer will give much hassle for the injection’s site of service at least this time, namely because they prevented the surgery. But I’m sort of seeing the whole experience as further evidence that time is the best teacher, and sometimes, maybe a lot of the time, it’s just good to let things be and eat some pretzels…because last I checked, pretzels make you thirsty, or so says Kramer.