by Susan Morse
David had to learn ballroom dancing for a TV movie he did during a hiatus from St. Elsewhere, and we bought a series of lessons. Tango, cha-cha, swing, mambo. We weren’t bad. The best was when we went to the final party at the end of the show’s last season—I wore a fire engine red dress with a short skirt that flared out when he spun me around.
We eventually forgot most of our moves, but we can still pull off a few at the odd wedding. David’s a good sport about helping me find chances to satisfy these urges I get, but I think it’s a little tough on him—he’s shy and thinks he’s a dork on the dance floor, though he’s not. We don’t go to clubs because we get self-conscious about people looking to see what that actor dances like. We mostly stick to private parties and weddings, and there aren’t really enough of those for my needs. If David isn’t there, I get lucky sometimes and find a kindred spirit. I struck gold once when I spotted a cousin of the bride who used to dance with the Joffrey. That guy really knew how to jitterbug.
And then there was Uncle Tommy.
David’s nephew was getting married in Maine. David was in the middle of a six-episode gig on House, so I flew the kids up to represent his branch of the family, and see his sister Diane’s son Nathan tie the knot with Tiffany at a picturesque inn on the coast.
Diane was in rapture—this was her first time as the mother of the groom. She’d been broadly hinting about grandchildren since the first time Nathan showed up with Tiffany, who is not only sweet, but drop-dead gorgeous. The whole family was there—David’s mother, his three sisters, the husbands, most of their grown kids, and lots of cousins we didn’t know.
The kids and I were delighted to see Uncle Tommy. He’s not related to David by blood; he’s actually Diane’s brother-in-law from her second marriage. You can tell right away that our backgrounds don’t quite overlap, but the first time we met a year or so before, we clicked. Uncle Tommy is the kind of guy who can click with anyone. He’s a cheerful little fellow, kind of runty and he walks funny—he wears a back brace and collects disability, but he’s got a great attitude and rather nattily groomed facial hair, like Al Pacino on a good day.
Oh, and there’s this thing nobody told me: Before the whole disability business, Uncle Tommy had a brief career as a male stripper.
It was great to see him again, and we sort of hung out together during lunch. When the music started, I was on the edge of the dance floor with the kids. I wasn’t aware of Uncle Tommy at my elbow—he’s not very tall. But then he began to shimmy, and I grabbed him.
Of course, I had no clue about Tommy’s dance background, but he seemed surprisingly loose for a guy in a back brace and it was clear he had some moves. In ballroom dance, you are trained to assess your partner’s style and adapt. Tommy seemed to be having a very good time, so I pretty much went with it.
Actually, my mother did teach me some useful rules of etiquette: Bring a hostess gift when you come to visit. Send a thank-you note. There are a few she forgot to mention, like no dirty dancing at an in-law’s carefully planned New England wedding.
Nathan and Tiffany’s nuptials were memorable for the whole group of in-laws and friends. Not just for the pleasure of seeing this picture-perfect couple joined in holy matrimony against a magnificent ocean backdrop, but because it was the exact moment that the mid-life crisis David’s wife was apparently having finally found its peak.
I don’t have much recollection, but I hear Tommy and I pretty much cleared the dance floor. I think we kept most of our clothes on, but they say we were at it for hours. Cell phones came out; videos were messaged instantly to David. His mother seemed politely impressed. Our children were mortified.
When we’d just moved to Philadelphia, I found a Saturday morning tap class for our kids. On the first day, I sat in the waiting room with another mother listening to the music and the beat, and again I felt that hound-dog urgency. I kept tapping my feet on the floor in front of the bench where we sat and saying to this other mother (who had never met me before in her life), isn’t this great? Don’t you want to join them?
By the end of the class, my new friend was as jazzed as I was. When the teacher came out with the kids, I told her how we wished we could tap, too, it sounded like so much fun, and the teacher said why don’t you? And I looked at my new friend and said, I will if you will, oh, please . . .
So for about three weeks, this lady and I joined a class of kids who came up to our waists. We were going to be in the recital and everything. I tapped all the time, disappearing for hours to practice on the concrete floor of our unfinished basement. The kids refused to participate; I think they were sort of upset. I was so disappointed when they staged a minor rebellion: One day I just couldn’t get them to go, and that was the end of my tap career.
It was devastating. I still wonder if that lucky woman actually got to be in the recital without me. . . .
Lately, I’ve had to be satisfied with Dance Dance Revolution in the arcade when I chaperone the twins and their friends at Dave and Buster’s. I’m terrible at it. Ben says I drew a crowd once, but I think they were probably the type of people who like to make fun of early rejects on American Idol.
I’ll get back to tap some day, but right now Ma needs some tests.
I found one other thing Ma and I have in common: We both think there’s something fishy going on at Stone Mills Hospital.
I’m pretty much okay with the whole HMO-referral thing now that I know what we’re supposed to do. I get that the insurance companies don’t want to pay for unnecessary treatment. Ma inherited Daddy’s health insurance: Medicare with a supplemental policy for former employees of the state of Pennsylvania. When the supplemental’s premiums began to go way up several years ago, Ma opted for a cheaper HMO. One big difference between traditional Medicare and an HMO is the HMO has a list of approved primary doctors, one of whom she had to sign up with. All medical decisions start with that doctor. This is supposed to keep Ma from running around willy-nilly wasting insurance money having expensive unnecessary things done to her.
Getting the hang of the system was intimidating at first. I was so afraid Ma would go to a specialist she needed without remembering to get approval from her primary doctor, and then we’d have to pay for it in full. But from what I can tell so far, doctors won’t let this happen to you. Even if you are sitting in their waiting room, if they don’t have the referral from your primary, they will make sure you know it, and tell you what to do to fix this before they’ll let you in. I guess they know you’ll be reluctant to pay the bill if the HMO balks.
We know what to do now anyway. If Ma wants a cardiologist, say, she calls some friends and gets a few names of doctors they like. Then I call one and ask the office if they subscribe to her HMO. If they do, I make an appointment and ask for their subscriber number. I then call Maxwell, her primary, and give his office the name of the doctor, the subscriber number, and the time of the appointment. Maxwell’s office is supposed to know us well enough to decide whether or not she needs this appointment, so there may be a little chatting about her symptoms first. When we get to the specialist, they generally have received Maxwell’s referral through the computer. If they haven’t, things tend to work themselves out.
What gets Ma and me apoplectic is when we have to deal with outpatient tests at the dreaded Stone Mills Hospital.
Maxwell’s practice is a valiant little one-man outfit right in the neighborhood. His HMO patients are therefore capitated to Stone Mills Hospital. Capitation is apparently a word invented in 1983 especially for HMOs, and it is just beginning to make sense to me. I understand now that it means certain tests may only be done at the primary doctor’s nearest hospital.
For a while I had to play mind games with myself to keep from forgetting the word, and I would say to doctors’ offices she had her CT done at Stone Mills Hospital because she has that thing that sounds like decapitation but it isn’t.
The Huntingdon Cancer Center, of course, has all the CT machines you could wish for. I
f Ma was allowed to do the tests there, then Pete, her surgeon who is right down the hall, could have the results in a twinkling. But no, these monthly tests to monitor the cancer must be ordered not by Pete, the guy at Huntingdon who actually wants them, but by Maxwell in Stone Mills, who is not really in the loop enough to know exactly why they need to be done.
And not only that: Instead of having the order, tests, and results all in one hospital system from start to finish, the patient (or her daughter) must trudge back and pick up the results at Stone Mills the day after they are given, so she can hand-deliver them to Pete’s office all the way across town. This is supposed to be in the interest of curing a sick person who needs every chance she has to rest. Does it make sense to anyone at all?
The procedure is this: Pete Johnson at Huntingdon tells Ma to get a CT scan and a chest x-ray before her next checkup when he’ll see if the tumor has grown. I call Maxwell’s office and tell them to take my word for it: Ma needs these expensive tests. They take my word for this and call the scan and x-ray in to Stone Mills Hospital via their computer network, and I call Stone Mills Hospital to schedule the tests.
And Stone Mills is where the whole thing gets bollixed up.
Ma’s been dealing with an unfortunate affliction, which may or may not be a side effect, depending on who you’re talking to. On certain random days when I call her, it’s:
—I’d better stay home today; I’m having the fiery tail again.
Radiation’s been over for a couple of weeks, but the side effects linger. It’s still pretty hot down in places we won’t mention, and the sensation can be very hard to ignore. We’ve tried all kinds of remedies from ice packs to a strategically directed portable fan; nothing provides much relief for long. They say this will pass, but for now, outings have to be timed between Ma’s unpredictable attacks, and must be kept pretty short. Fiery tail is not at all compatible with Stone Mills Hospital’s current system for processing prescribed, pre-approved outpatient tests.
Today, we have no discomfort so far. This is good, but it takes time just to get Ma there, so who knows how things will turn out. We find a parking spot close to the outpatient testing entrance, which I take as a good omen. We plod inside, sign in at the desk, and wait. It doesn’t take too long before someone in a cubicle calls us in. She (usually, it’s a she—today it is Ayesha) takes the insurance card and looks Ma up in the computer. I tell Ayesha we need a CT and an x-ray, and I have the prescriptions right here.
Usually from there, we totter around the corner and down the hall to the x-ray waiting room, turn over our paperwork, and settle in for another wait. No good, Ayesha tells us today. We’re all set for the CT, but we can’t have the x-ray because the thingy isn’t in the computer, which means the doctor hasn’t called it in. The thingy could be pre-approval or pre-certification or pre-authorization, I forget which—they all mean something different believe it or not, and it doesn’t really matter because whatever it is, we don’t have it and we won’t get the test until we do.
I sense a monkey fit coming on. I sprint outside and call Maxwell’s office to see what’s gone wrong and ask if he can send this thingy over pronto.
Ring. Ring.
—Hello, this is the office of Doctor Andrew Maxwell. We know it is a Friday afternoon, but we have decided to take an unexplained vacation just to inconvenience you. We will be out of the office until Tuesday. If this matter cannot wait until then, Doctor Suchandsuch is on call at . . .
I call Suchandsuch’s office and, of course, they will have to see Ma before they can prescribe an x-ray. We might be psycho-deviants hoping to get see-through pictures taken of our chests to share on the Internet with a global ring of perverted x-ray fiends.
I call Pete, the surgeon at Huntingdon, and get his assistant—can they help us?
—Why doesn’t the hospital just do the test and get the authorization later when your primary’s in the office?
—Good question!
She says she’ll try to pull some strings and get back to me, but we wait and wait and the strings don’t work.
What it boils down to is we can’t have the x-ray today no matter how hard we try. So Ma does the CT scan and we have no choice, we have to give up on the x-ray and hope another nonfiery tail day turns up soon.
Now, here’s the part that makes me mad:
I call Maxwell’s office when they all (all three of them) waltz in from their long weekend (mental note to revisit the group practice idea, we love Maxwell, but honestly since when does an entire office get to go on vacation at the same time?) and they tell me they actually did send the x-ray thingy in, at exactly the same time as the thingy for the CT. So it was the hospital that lost it. If I had just insisted last week, we might have that stupid x-ray behind us. Now we have to go back.
I’ve run out of old New Yorkers to read while we wait, and lately I’ve found solace in Sudoku. It’s actually a bit of a problem. Addiction runs in our family. Instead of losing myself in a bottle or pills, I tend to get overinvolved in things like Spider Solitaire on the computer. I once had to see a chiropractor because I got too compulsive with a little hand-held game of Tetris.
I have a nice pocket version of Sudoku, not too easy and not too hard, and I remember to bring it with me the next time we go over for the x-ray. We park near the entrance, lumber in, sign the clipboard, and wait for our turn in the cubicle, with Irene this time. Today is unfortunately a fiery tail day for Ma, but Pete needs this x-ray now, so she waits standing up. I sit with the Sudoku. We tell Irene in today’s cubicle what we’re there for, and:
Still no thingy in the computer.
This is not good because Ma can’t put up with this too much longer. We don’t have the patience to call all the doctors and wait for them to resend the thingy. Anyway I know it’s there; I just have to get the hospital to admit it. So I ask Irene to look again. While she looks and Ma hovers, I fill in a few numbers: a 2 and an 8.
—She’s not in here, says Irene.
—That’s impossible, I say. Why does this happen every time we come here? It’s like your computer system’s a black hole. Does this happen to everyone? How do you get anything done?
—No, says Irene. This never happens. Your doctor must have messed up.
We’ve all heard that before. I know Maxwell sent in that darn thing. This is crap.
—How about try under M instead of V—her last name is two words. (I fill in a 6.)
—Not there under M.
Ma is beginning to pace up and down the hallway outside the cubicle.
—Look, I say, and I’m barely even looking up from the Sudoku.
I was one of those decent students who did their homework in front of the TV. It’s best to multitask because I bore very easily. It’s a little rude, but I’ve been through this so many times. The process is fairly mindless, and I spend so much time at it between my mother’s appointments, orthopedic people for my athletic children, orthodontists, pediatricians, vets for the pets, and on and on. For my own sanity, stimulation is essential if there’s a wait. This woman has her screwed-up computer to keep her entertained, so I get to play with my Sudoku. It’s part of my battle plan. With Sudoku to keep me occupied, I figure they can’t bore me out the door, and we will get the x-ray even if it takes all day. But each second that ticks by may bring us that much closer to a fiery tail attack, and there’s no way of knowing how long Ma can hold up. Well, we’ve been through this. Maxwell’s office assured me the authorization is in there this time. We are not leaving until Ma gets her x-ray.
—Look, my mother is in real discomfort and can’t be kept waiting again. You are obviously trying hard, but this seems to be beyond your scope. Who can I talk to get this done? (A 3 and a 3 again.)
Irene seems completely stumped.
So often we assume the people behind the desks know their jobs better than we do. It can be liberating when you realize it’s time to make a stand.
—Okay, forget it, I say, raising my voice a fe
w notches.
Step. Slide. Heel-ball-change.
People in the waiting room can hear us and are looking.
—Maybe we should just go home, stop monitoring the cancer and DIE. Let’s go, Ma.
—No, no, Irene says, I’ll take you to the manager.
So we box-step around and around, past stacks of file cartons and other mess that’s not for public viewing, to this tiny office with one extra chair. There’s a lady sitting behind a desk who looks somewhat startled to see us. I plunk myself down in her one chair since Ma can’t possibly sit still and she’s shifting her weight from one foot to another and sort of squirming. I still have the Sudoku book in hand as I speak to the woman:
—My mother has a rectal tumor, which is being monitored monthly. We were here last week for a CT and an x-ray, which were prescribed, pre-ordered, pre-authorized, pre-approved, pre-certified, and called for by her primary doctor. Ayesha couldn’t find the thingy. We went home because we believed the hospital. Now we know the thingy has been here all along. My mother is very uncomfortable and needs to get this test done and go home as soon as possible, and Irene has tried very hard and she can’t find the authorization any more than Ayesha could last week. But this time, we aren’t leaving until she is x-rayed because she has to bring the results of these two tests to her surgeon’s the day after tomorrow. Can YOU find my mother’s thingy?
Ma is pacing again, and she is beginning to slap her hips. I take a moment to fill in a 9, a 4, and a 2.
The manager gets it, thank God. She scoops us up and leads us through to the x-ray department where there are about six people ahead of us. We all promenade around them into the work area, where the manager collars an x-ray tech holding a clipboard. He looks like he is in the middle of something.
