Saving My Breath
The neurologist was haughty and young and his waiting-room reading material consisted of nothing but medical journals, which were unintelligible. The art was Miró reproductions, poorly framed. After the first office visit, during which he questioned me and performed a number of simple tests, he recommended an EEG. When that came back fine, he prescribed a sleep-deprived EEG. When that came back fine, he prescribed an MRI.
I earned $13,500 per year in a job with the federal government. My health insurance paid 80 percent of medical expenses, but the remaining 20 percent of my hospital and doctor bills that year, before the seizure, had purged my savings, and new charges remained unpaid. My share of an MRI would cost hundreds of dollars.
“No,” I said. “I can’t afford it. And I don’t need it.”
Some alternative healers call asthma the disease of self-suffocation, a manifestation of the inability or unwillingness to express oneself, to speak up. I had never thought that was my problem (wasn’t I merely saving my breath out of self-preservation?), but then, I was shaking as I contradicted this neurologist.
He looked up from his desk, brow lifted. He stared for a moment.“What state do you live in?”
“You’ve had a seizure. Legally, I could have your driver’s license taken away.”
I stared back.
“What if you were driving a car when you had that seizure?” he demanded. “What if you were driving a car and hit another car? Huh? And what if, in that other car, there was a little baby? And what if you killed that little baby when you hit that car? Then what?”
I tell myself now that had I not felt so ill and weak, I would have laughed at his histrionics and walked out right then. But the truth is I can still picture that imaginary car (a gray sedan), the curved section of road just north of my apartment, woods thick on either side, where the accident would occur, and the way the cars would strike and crumple on impact. I still picture the baby seat (navy blue, upholstered) too, though curiously, the seat has always been empty.
In a 1987 study published in Social Science Medicine, researcher Irena Heszen-Klemens wrote that in taped conversations between physicians and noncompliant patients, physicians relied most frequently on “authoritarian tactics” and “medical threats [to convey] the doctor’s point in an indulgent atmosphere.” She also found that not only were these tactics ineffective but they actually reduced patient compliance. Yet in her study groups, she concluded, the doctors’ “ego-defensive tactics predominated.” In a similar study from that time, doctors questioned admitted that at least 50 percent of the time they relied on authoritarian tactics to urge compliance.
Cooperative, concordant, coordinating, cohealing. These words have been suggested to replace “compliant,” which was introduced into the medical lexicon in the 1970s. Perhaps because of research such as Ms. Heszen-Klemens’s, doctors are now educated in ways of gaining a patient’s trust, like honoring needs and lifestyles, taking time to answer questions, and explaining why a treatment is well advised. All of which seems like plain common sense.
I did have the MRI, though I was in tears when I left the neurologist’s office, hating the doctor and agonizing over the cost. Results from the test showed nothing abnormal. Dr. T. never mentioned the seizure again. I stopped taking the antiseizure medication, just as I stopped taking the antiheartburn medication I’d required because of the antiseizure medication, without asking permission or telling him what I’d done.