Upon a Visit to a Specialist
                                March, 2014

    I think I'm in the market for a quack. No, that can't be what I mean.
    But, seriously, I have not suddenly become redevoted to the wonders of
    modern clinical medicine. Why do I bother? Oh, yeah, because there are
    symptoms. Although the symptoms do seem less onerous than the clinic.

    Upon walking into the office, the very first thing I noticed was that
    all the examination rooms are completely visible from the front desk.
    (The office is newly remodeled and only half built out, so there isn't
    any obvious reason why the exam rooms couldn't have been positioned to
    avoid direct sight lines from the front entrance.)

    After waiting half an hour in the waiting room (which is less visible
    from the front desk than the exam rooms, by the way) a nurse came to
    lead me back to the working area. There the nurse went through a rote
    list of health history questions. These questions presented in arbitrary
    groups of three without any logical organization. In other words, it was
    a CYA list and not a diagnostic investigation.

    Then she said, "There's a gown" followed by other stuff that I couldn't
    hear over the noise of that suggestion. I actually made two attempts to
    be a compliant patient -- again, why did I bother? -- and then I said,
    "The heck with that." I probably said it out loud. Nobody heard me.

    After waiting some more (we are now up to 45 minutes here) the doctor,
    the nurse, and a nurse practitioner who didn't seem to be completely on
    top of the specialty all trooped into the room. Instead of responding
    directly to my concerns, the doctor tiptoed all around. Metaphorically,
    that is; physically he mostly just stood there trying to look earnest.
    Finally I said, or rather I initiated a practice of repeating, "Tell me
    what you want and if I have a problem with it I will tell you so."

    The upshot of this entire 50 minutes is that I'm told that "we" should
    biopsy the lesion. Well, he never used so complex a term as lesion, but
    that would have been an appropriate word. "We" should do some test (he
    said) to confirm the provisional diagnosis (he didn't say). Then if the
    test is positive, we'll treat with an oral antifungal.

    Eventually he did the biopsy. (It's now over an hour and I'm wondering
    how late I'm going to be for the 5:00 pm confirmation class.) The doctor
    continues with instructions for home care until the next appointment,
    most of which I plan to ignore (except possibly for the part that I was
    already doing anyway) because I really don't have a lot of faith in his
    expertise by this time.

    He says he (or "we") put a stitch in, presumably at the biopsy site. He
    says, "It will feel like a thread." I, not able to stand it any more,
    murmured, "Because it is." He chose to ignore that.

    Now that he has the gram of flesh (and how grateful I am that his name
    is Lewis and not Shylock) he goes on to say that because the infection
    isn't very strong -- I think he used some other simplistic term, but I
    could guess that what he meant was that because I had been partially
    successful in beating it down -- "we" might not see the supposed fungus.
    I don't know about other patients, but this patient always becomes more
    impatient with expensive tests that are expected to provide the same
    amount of definitive information as the countdown walklights on traffic
    signals. (Think about it. At any random moment, the signal may be red,
    or yellow, or green. When the count reaches zero, the signal may be red,
    or yellow, or green. Almost no information value at all.)

    As I'm getting ready to leave, the doctor repeated the the description
    of future treatment, which would consist of "oral antifungal medication
    by mouth". I said, "You're being redundant." He chose to ignore that, too.

    Finally, I asked him, "What test are you using?" Apparently he had been
    hiding a frustration matching my own; rather than explaining that "we"
    would stain the tissue and look for fungal cells microscopically (which
    would have been both appropriate and helpful) he said, "A periodic acid -
    Shiff stain assay. Is that something you are familiar with?"

    Well, no, it isn't really familiar to me, but the unhelpful snideness is.
    Only patients are allowed to be snide; on our side it is often the only
    feasible tactic.

    (Did he say "period-ic"? That's what I heard, and it threw me off for a
    while. After I looked it up I felt stupid not to have heard "per-iodic",
    although my West High tutoring student isn't to that level of chemistry.
    Unless he deliberately slurred the word ... nah, his objective snideness
    was quite adequate without imputing evil intent to his pronunciation.)

    The advantage of a thorough-going quack is that, although he wouldn't do
    a bit of good in treating the disease, he would make me feel exceptional
    while he wasn't doing it.

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