Wednesday, March 26, 2008

Becoming the Road Kill of Your Own Life

“What’s a ‘Spasm of the Sphincter of Oddi?’” I was following Daddy up and down the hall asking him questions, trying to figure out how to cope with the incomprehensible jumble of medical paperwork that I was temporarily responsible for.
“What?” he replied.
“A ‘Spasm of the Sphincter of Oddi?’ It’s here in the Medicare codebook. What is it? It sounds awful."
“It doesn’t matter what it is, because nobody here’s got it. How about Mrs. Holloway’s ankle? Did you find the number for that?”
“Maybe. Was it fractured?”
“Is it a ‘pain,’ a ‘strain,’ or a ‘sprain?’”
“A sprain.”
“Okay, then I got that one. But where’s the Sphincter of Oddi?” Too late. Daddy had already ducked into another examining room. He kept doing that, leaving me alone, adrift, in the hall.

It was my first day on my emergency temp job, some 18 hours after Momma’d had a heart attack and extorted a promise from me to leave Washington and my glamorous job as a U.S. Senate lawyer and come home to fill in for her for a couple of days while she recovered.

Only someone who’d grown up in my family would fall for the “couple of days” thing, but Momma’d never missed a single day of work in nearly 40 years. She was the receptionist and jack-of-all-trades sidekick for my father in his tiny Smoky Mountain family medical office. And anyway, even if I didn’t totally buy the extremely short-term nature of my appointment, how could anyone say no to their mother when she was begging them from a gurney in ICU?

There are surely better examples of government programs that started out as good ideas and ended up in a hopeless muddle, but I’d never encountered one as spectacular as the Medicare coding system. When I was a teenager I’d been able to fill out insurance forms easily, but now that I was over 40 and the government had allowed its legions of “experts” to interfere, the mysteries of the new “streamlined” system were beyond my ability to penetrate. Since I was a writer of laws and regulations myself, I found this infuriating.

I waited in the hall leafing through the coding manual, a book as thick as a phone directory for a major metropolitan area, filled with tiny print and even tinier alphanumeric codes waiting for Daddy to come out again.
“You’re not going to believe this! There’s a code in here for ‘Decapitation, Legal Execution (by guillotine)!’”

“Don’t have any of those here today either,” he mumbled.

I pondered what sort of treatment a senior citizen could possibly need after having their head chopped off. I was enraged that some poor schmuck like me in every doctor’s office in the nation had to pass this provision coming and going every time they needed to find the code for a sore throat or a stomach ache.

I stood in the doorway of Room 3 while Daddy looked in Mr. Maynard’s ear. I’d known Mr. Maynard all my life, so I didn’t hesitate to continue my monolog, especially since he was nearly deaf. “I bet none of the fools who wrote these codes have ever had a real job in their lives,” I said. “They’re all a bunch of hogs at the government trough who’ve never worked a single day in the real world. If they ever tried it, maybe they’d actually learn something.”

At that Daddy turned and gave me a deceptively mild stare.
Uh oh.

My august career flashed before my eyes: Special Assistant U.S. Attorney for the District of Columbia, Chief Counsel U.S. Senate Committee on Governmental Affairs Subcommittee on Government Efficiency, Federalism, and the District of Columbia, Counsel U.S. Senate Committee on Environment and Public Works Subcommittee on Nuclear Regulation…
I stopped in mid-harangue and went back to Momma’s desk considerably chastened – until I turned a few more pages.

“My God! They’ve assigned a code number to ‘Accident Involving Spacecraft, Includes Launching Pad Accident, Excludes Effects of Weightlessness in Spacecraft’!”

Although one of my bosses, John Glenn, actually went into space again at age 77, surely such an event was only slightly more common than filing a Medicare claim after getting guillotined. So, why write a specific code for it and kill thousands of trees to print it in millions of code books?

I made a silent vow to myself that the Environment Committee would be looking into this as soon as I got back. But then I wondered if maybe I was kidding myself about my own competence and service to the public.
To the outside world, a return to Washington would look like the right thing to do. Washington was ground zero for public service, right? From Washington I could serve a lot more of the public and it would be a lot more fun to serve them from a Lear Jet while wearing tailored cashmere than it was to have to swab up barf from the working poor while wearing a $19 pair of scrubs that made me look like….a nobody.

What kind of person would give up everything they’d ever dreamed of to work an unpaid job for their cranky father? Apparently I would, because at age 45 I moved into my parent’s basement and embarked on a new life as the world’s most reluctant and inept medical receptionist.

I stepped out of the fast lane, climbed down the ladder of success, and “ruined” my life so a bunch of poor people would have access to medical care.
And, surprise, surprise, it was the best thing that ever happened to me.

Named a Best Book Club Book of 2007-2008 by Book Sense and The Literary Guild.
Honored as the first ever Book of the Month for Family Circle magazine.
Awarded a Readers’ Prize by Elle magazine. Raves in a wide variety of industry publications and newspapers nationwide.

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