Whenever the rainbow appears in the clouds, I will see it and remember the everlasting covenant between God and all living creatures of every kind on the earth." Genesis 9:13

Saturday, September 13, 2008

Yet again

One of the things I've written about many times is the value of having a good doctor. If you have a serious illness that is going to affect how your life goes, you need to see the absolute best doctor you can find. If you want to have the best outcome you need to make sacrifices, whether these are financial, time, or distance. On some level I make each of these with my doctors and I have chosen to not do this at other times, so I have a good basis to speak.

One of my greatest sacrifices is that my psychiatrist is 2 hours away, is an expert and wildly popular (although I'm booked around that issue), takes immense amounts of time with people so that each visit is literally a whole day with travel and waiting. I pay quite a bit because I have crappy insurance and if you see someone that good they tend to charge (or rather the hospital does).

However, there are so many benefits. She knows me in and out. She knows my wishes if I am sick. She is available readily in emergencies because I'm a high risk patient. And she's experienced enough to try things not usually done (ie subtherapeutic dosing with certain drugs combined with technically over-therapeutic doses of others). She also has access to many other experts and that has resulted in positive changes to my meds and a guess at what my body does that seems to have helped change my life. (Seriously, just look back at a random post from one year ago).

There's also the benefit that I get around being treated by medical students and residents at a teaching hospital. I was a student, I'm all for students and in all other areas I am very willing to be assessed and treated by them. In this area it is too dangerous. This is one reason I've always refused hospitalization. Now, because I am an attending's patient, I won't avoid them if I'm hospitalized, but my chart has some very specific directions, both things I want and from her. They also will consult with her.

And today I found out another benefit. When I accidentally overdosed 4 weeks ago (at a safe level) I did what I have never done before: called the on-call beeper. I have never had a crisis so severe I didn't feel it could wait until morning, but this time I needed to know I was safe. Instead I was rather surprised that nobody answered. Being that this is a psych pager I figured many calls are of the "I'm going to kill myself" nature, and while my belief and what I hold myself to (you may disagree; what works for me regarding suicide has been blunt honesty and heavy demands on myself-it's not everyone's cup of tea) is that there is a level of personal responsibility even then on the patient's part to try repeatedly to get help. Still, I know how hard it would be for me to call once and calling twice would be 10 times harder. Anyway, I did my own research on what dose had been tolerated in suicide attempts and figured I was ok and that I was better off to sleep than to try to stay away calling and drooling everywhere. (I was really out of it).

I mentioned that to her today and she discovered the person on call was someone she's been aware has been not doing much work if he can avoid it. And while I personally don't care that my call wasn't taken and I wasn't complaining, just mentioning it, I do think that once again, I like having her on my side because if he can't explain that kind of thing then I don't think he'll do it again...

Since with this disease the next person to want to die may be me, this makes me glad again that I drive 4 hours every month. And it appears now that my insurance seems to think it's run out, pay over $225/month....But that's another panic attack.

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