The Story #1: The Beginning
In March 2003, I went to my primary care physician (PCP) with what I thought was my usual annual spring upper respiratory infection. Symptoms cleared following a course of Amoxicillin but recurred two months later. This time I noticed being out of breath after climbing only one flight of stairs. An ardent jogger, I found this sudden onset of shortness of breath quite alarming. For the first time in my life, I was wheezing when lying down at night. I made another appointment with my PCP.
Dr. Rosario Ferrer, who along with associate Dr. Rosario Simpao-Ignacio, had been my PCPs since the 1980s. During this time, I had annual physicals. I never actually saw test results, but was left with the impression that, aside from my lifetime scourge of common complaints of anemia, constipation, tonsillitis, scoliosis, indigestion and painful menstrual periods, I was healthy. I found them both very affable. I felt I had developed a rapport with Dr. Ferrer, who was about the same age and build as me. She seemed to have two demeanors: one as doctor and one as friend.
During the exam, I likened her style to the super fast talking Federal Express representative in the TV commercial. When relaying her diagnosis and recommended treatment, she would step back, pause, then speak in a very fast, robotic monotone as if she had said the same thing hundreds of times and wished she could just punch the play button on a recorder instead. Speaking that fast made the words mesh together for the listener. I got the jest of what she said, but I couldn’t repeat it. At checkout, however, her demeanor relaxed, and she would ask me about my personal life. She even shared similar concerns of her own and was quick to smile sincerely.
I liked Dr. Ferrer and trusted her with my health. I was operating under the notion that doctors knew medicine and that they would spot early warning signs of disease and tell the patient if there was something wrong. I believed they were looking out for the patient’s best interest. After all, the healthcare policy of my medical insurer, Cigna, emphasized the importance of the PCP as the cornerstone for that member’s health care needs. It stated: “For members with complex health conditions, the role of the PCP is essential. The PCP leads the team helping the member to manage his/her multiple health conditions and treatment–often this includes assuring proper access to specialty care and making sure that all of the specialists are keeping one another informed.”Our relationship changed when the antibiotics she prescribed no longer had much effect on my ailments.
During the May office visit, Dr. Ferrer suspected the onset of asthma. She prescribed an Albuterol inhaler and Zyrtec-D. She ordered a chest x-ray and pulmonary evaluation. I procrastinated on seeing the pulmonary specialist as I’d been down this road once before in the mid-1980s without much success. In fact, the pulmonologist I saw then became quite disconcerted at being sent for evaluation a patient with what he viewed as a simple nose infection.
So three months later on August 28, 2003, I was back in my PCP’s office with the same complaints. This time the appointment was with Dr. Simpao-Ignacio, who prescribed Augmentin and Nasacort, ordered a CT scan of the sinuses, and wrote referrals to a pulmonary cardiologist, Dr. Michael Tsun, and to my otolaryngologist, Dr. Laurence O’Halloran. The chest x-ray from Diagnostic Radiology of Northern Virginia showed clear lungs. Fairfax Radiology’s CT scan of the paranasal sinuses was also clear.
On Sept. 5, 2003, I saw Dr. O’Halloran after over a week of antibiotic therapy. Dr. O’Halloran had performed sinus surgery on me in 2000, a tonsillectomy in 2001, a lower lid blepharplasty and botox injections in 2002. He said I showed no sign of sinusitis, but as a precaution, took a nasal swab, I assume, to test for staph infection. He commented that my nose cilia were flattened against the mucosal membrane. When I called back for test results, the office told me the test results were lost. On a follow-up call, the office administrator told me they had no luck locating results.
I liked Dr. O’Halloran. He had a calming demeanor and gave enough information so that you felt you were in competent hands. Prior to sinus surgery, he pointed out areas in my sinuses congested with polyps on the illuminated CT scan. This ability to read radiographs as a surgeon made him appear to me to be more knowledgeable than non-surgeon physicians who typically can’t read radiographs.
At the office visit following the tonsillectomy, Dr. O’Halloran in not so many words told me that the surgical pathologist found actinomycotic granules in the tonsilar crypts accompanied by abundant accumulation of inflammatory cells, consistent with chronic tonsillitis. Since Actinomyces organisms are commonly found in the oral cavity of healthy individuals, I thought nothing of the comment. In hindsight, I should have been more sensitive to the vague ways I found that doctors convey potentially discomforting news — particularly when he mentioned that the organisms could travel down my gastrointestinal tract. At the time, he just looked at me and said, “You don’t know what I’m talking about, do you?”
No, I didn’t. I just sat there with my deer in the headlights look. I didn’t ask him to explain. Perhaps I rationalized that if it was important, he’d explain without my having to ask. Perhaps I didn’t say anything because I was scared that it was something bad that I didn’t want to hear about.
Upon reflection, his statement brought to mind those that physicians had made to me throughout my adult life when I saw them with complaints of tonsillitis. When I asked them about removing my tonsils, they responded with an emphatic no! They said the tonsils acted as a barrier and that it was better to endure infected tonsils and the accompanying swollen glands than to endure the illnesses caused by the pathogens the tonsils were not there to catch. Only this time I was hearing the lesson after my tonsils had been removed.
Looking back, this office visit seemed pivotal in my relationship with Dr. O’Halloran. Each succeeding visit seemed less genuine — the way relationships with friends can turn sour after you lend them money that they can’t or don’t pay back. I didn’t see things this way then, probably for a lot of reasons. I didn’t think I could handle more challenge then. I rationalized without even realizing it that if I kept myself busy enough, I wouldn’t have to face the truth. What I was drowning out was facing my own mortality — that I was seriously ill and probably had been for a long while. I was putting off thinking about how I was going to support myself if the money ran out before I died, and I was too sick to work.
Dr. O’Halloran never said anything. He just gave me these looks.
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