Weekly Roundup: Your Permanent Record Edition

The envelope from my orthopedist could have contained any number of things which would have in no way surprised me: a treatment summary, an appointment reminder, a "balance bill" for the additional X-rays I had this past Monday morning. This is what it actually contained: the half-completed "Medical History Form" that I'd passive-aggressively shoved into the hands of my X-ray tech on the way back to the machine. There was a Post-It attached.

"Fill this in the rest of the way and bring it with you next time, or mail it in."

At my age, I have to be grateful for each and every genuine surprise, even if it is unpleasant. I clenched the folded eleven-by-seventeen and summoned up my best Sean Connery voice:

"Then the game is on."

Strictly speaking, the game had started on Monday when I'd fetched up at my ortho's office with photo ID and current insurance card in hand. This place, by the way, has swollen like a Connecticut tick over the past few decades to the point where I've now had two surgeries, with anesthesia, right here on the premises. When I met my bonecutter-of-choice in March of 1988, he was a late-twentysomething who shared a hospital broom closet with an older and profoundly unpleasant fellow. Then he got an office of his own, then a practice of his own. Now he has thirty-ish surgeons doing work in a bespoke outpatient facility with a waiting room the size of an elementary-school gymnasium. Setting an appointment with the man himself requires the patience of Job; he only comes in once or twice a week and he cherrypicks his procedures. My broken leg of 2015 got re-bolted by one of his many associates; the fractured arm and torn rotator cuff in 2017 he examined personally.

Our current subject of discussion is a radial meniscus tear in the right knee, coupled with various degenerative diagnoses and some frustrating femoral edema. I've been limping around ever since I tried to show my son a 360-degree spin at a skatepark only to stop abruptly at the 330-degree mark. Now I can barely get my bike off the ground, and every landing feels like I am using stones to grind the insides of my knee. This directly affects my last remaining personal goal in life, which is to ride BMX and mountain bikes with my son until he turns thirteen, at which point he's going to want to ride with his friends and not his lame old dad. I don't care what it costs or how painful it is. I don't really care what the long-term consequences are, up to and including amputation. All I want is to have these few years, stored like dried provisions in the attics of our minds as a bulwark against the conflicts to come. My narcissistic little theater-in-the-mental-round has created a play in which someone offers my seventeen-year-old boy crystal meth or black tar heroin or Cole-Haan shoes and he Just Says No because he can remember a tiny piece of desiccated wisdom about "being true to yourself" or something like that, delivered and received on the top deck of a quarter-pipe somewhere, father to son.

Stress and nervous tension are now serious social problems in all parts of the Galaxy, so I'll mention up front that my current treatment plan, as delivered to me after a bit folksy catching-up on the part of my venerable old ortho, is that we have to let the swelling around the femur end die down a bit before we undertake any further surgery. The problem with this is that the ski lifts are about to open for this year's downhill MTB season, so I will no doubt have more swelling, not less, when we have the follow-up. The alternative is to just stand there and hold the camera like the rest of the middle-aged fathers, which is the same as being dead.

In order to get that cautious diagnosis, however, I'd had to run the gauntlet of the various administrative personnel manning the front lines of the orthopedic practice. The first one I'd met had grudgingly accepted my ID and insurance card before saying, "We need to get a complete medical history on you before we continue."

"Nothing's changed," was my deliberately chipper response. "The last time I saw a doctor besides my annual checkup was... right here."

"Well, we still need a new one."

"How old is the last one?" She'd poked at her keyboard and her annoyance had echoed with every click.

"July of 2017."

"Well there you g---"

"So we need another," she'd growled, before shoving the paper at me.

"Let me get this straight. You have a medical history of me from the last time I was here. Nothing has changed. I've been a patient of Dr. So-and-so since 1988. Your own records are going to be more accurate than my vague recollections. Why am I doing this?"

"We. Just. Need. It." she snarled. So I'd taken the form, poked away at it until I got bored, then I'd left it in the X-ray room. At which point someone must have decided to put it into an envelope and mail it to me.

Now, as they say, it's personal.

The obvious course of action is to fill out the form and send it back. I don't know if I can do that. It feels too much like what pickup artists call a "compliance exercise", where you ask your date to perform a few minor tasks on your behalf so she internalizes a bit of subservience nice and early in the relationship.

"Get me that napkin, would you?"

"Look up the hours and make sure they're still open."

"I'll get the car. Here's my card. Go ahead and pay, then come out."

Ridiculous stuff, right? Just like the "Best Friends Test" from The Game is ridiculous, just like doing magic tricks at a bar is ridiculous, just like pretending to take astrology seriously during a first date is ridiculous. And it all works. It's all so murderously effective that near the end of my dating days I made it a point of pride to not do any of it, the same way my son insists on fencing left-handed. So it would mean more when I won.

This, too, is ridiculous.

In any event, I will be God-dammed if I am going to be compliance-exercised by an orthopedic practice. The whole experience of seeing a doctor is one big exercise in psychological manipulation anyway. Until seventy or eighty years ago, it simply didn't exist. Before then, you either visited the doctor at his home or he came to you at yours. This whole pro-wrestling rigamarole of multiple waiting rooms and endless forms and physician's assistants and whatnot is a modern invention designed to maximize a doctor's income. I'm not sure it's working for anyone, including the doctors.

The entire process has become financialized --- from the loans the doctors take out before med school to the tombstones handed out by investment banks when they "assemble the package" for something like my ortho's outpatient-surgery cathedral. When I pay for whatever surgery I wind up getting, I'll be using a Health Savings Account, set up to be tax-exempt by lobbyists who envisioned massive interest earnings on the accumulated capital. The actual payment will be processed by Visa, which will take its cut as well. We are all just puppets dancing at the ends of long strings made all the more odious for their convenience.

Back to the form. The worst part of this whole thing is that there is no way my doctor is going to actually use anything I write down. What if I tell the form that I'm chronically depressed, that I'm tired most of the time, that I often find myself frozen in bed because I don't see the point in leaving the house? Is that going to affect the shape and size of a plastic knee implant, or the volume of the platelets injected between femur and meniscus? I've been sick something like a dozen times in the past year, mostly because of travel and various periods of confinement in the flying typhoid tubes operated by Southwest Airlines and Korean Air. Is that going to make my femoral edema easier to understand? (Well, that one might actually be relevant, I don't know, I'm only a doctor of the human heart.)

Alternately, what if they take it as gospel? I don't know when my femur nail was removed. I think it was June of 1991, but it could also have been June of 1990. If I put 1991 but their own records from the procedure show 1990, are they going to wipe that out and replace it will my subjective recall? I can't remember how many surgeries I've had on my right knee, either. Why am I being asked to provide this information for the guy who did all the procedures, and who took copious notes besides?

My current thought is that I'm going to mail the form back to them --- without completing it. Which is a completely juvenile thing to do. I don't mind that. One nice part of getting old is the gradual loss of contempt for the attitudes, and behavior, of one's youth. Even as one gains a greater understanding into what you saw, and heard, and read, as a child. When I was twelve years old, I read Ahab's line as through a glass darkly:

Talk not to me of blasphemy, man; I'd strike the sun if it insulted me. For could the sun do that, then could I do the other

I understand what the old bastard meant now. Oh yes, I do. If they can mail a form, I can mail it back.

* * *

For Hagerty, I discussed my wife's latest competitive mishap.