12/28/13 CT Scan Efficiency

I have written before on the inefficiency of the check-in process at my local hospital for a CT scan or even a simple x-ray. Hemosapien had scheduled one for me for yesterday to have a look at these swollen lymph nodes. Since my blood numbers all looked good, and they didn’t seem nearly as swollen to him as they did to me (fancy that!), there was no rush for the CT scan.

I had dropped by his office earlier in the week to pick up the delicious barium contrast bowel cement they make you drink…one pint the night before and one pint the morning of. I had failed to remember to ask for the Berry-Smoothie flavored kind. Because of that, I was presented with the revolting Banana-Smoothie flavor. Who do they think they are fooling with that smoothie nonsense? It’s smooth, all right, as smooth as liquid porcelain before it’s been fired, tasting about like liquid porcelain that has had a bad banana mashed up in it, then set up in your digestive tract like porcelain having spent six hours in a 2,000 degree kiln.

“A laxative may be helpful after the test is completed,” it says right on the Banana-Flavored Barium Smoothie label. “A jackhammer might be more helpful, but is not recommended,” it should also say. A pint of milk of magnesia, the mint flavored kind, is the smoothie of choice this morning. Why not? It may indeed be helpful and doesn’t taste a bit worse.

Usually, when checking in for the CT scan, there is a litany of forms, questions, redundant questions, the presentation of various documents, and the discovery of multiple accounts, none of which suffice to get on with prompt registration. I always admire the inevitable question when they can’t seem to locate me in their system, “Mr. Sharp, are you sure you’ve been here before?”

“I was born here in 1957, had my tonsils out here in 1960, had a couple of broken noses repaired here, delivered kidney stones here, been stitched up more times than you can count here, had several lithotripsies here, had a couple of skin grafts on a burned foot here in 1974, had several knocked out teeth surgically re-implanted here also in 1974, had an out-of-joint knee put back in place here in 1974, successfully determined to stop being so accident prone on my last visit here in 1974, had a couple of bone-marrow biopsies here, had chemotherapy here, and dozens of x-rays, CT scans, and an MRI here, been recklessly punctured by dozens of phlebotomists here, and been a guest here for several days in your comfortable, well-appointed facilities on more than one occasion,” is my standard smart-assed reply when all the clerk was looking for was a simple, “Yes,“ which I was absolutely incapable of delivering. Yesterday, I was spared all that.

I approached the clerk’s counter in ER/Admissions about 30 minutes before my appointed time. I gave the clerk my name.

“Mr. Sharp,” she said, “Please tell me your birthday.” which I did.

“Your address still the same?”


“Your insurance still the same?”


She pressed another button on her computer and the printer spit out a piece of paper which she whisked over to me on the counter, which was my permission for treatment. “Sign here,” she said, pointing at the place for me to sign. She then prepared my arm band and asked me to hold out my arm so she could fasten it, which she did, and being thus fastened, I was invited to go straight back to x-ray.

I was still in shock that I had not been sent to the waiting area to only be called into another back office and asked all those redundant questions by clerk #2. The clerk at the front desk had done everything in about a minute. Now, I was sitting in the waiting room waiting for the X-ray folks, not waiting for clerk #2. This was a very pleasant and interesting development.

Before the seat I had selected had warmed to the temperature of my backside, the CT operator came out and called my name. I was escorted back to the CT machine me and my insurance company had dutifully helped pay for, given one more cup of the barium smoothie, this time the preferred berry kind, and put on the table, stripped of my overalls (Debbie had frowned at me when I put them on to go to town), and was computer tomographized before I could get the first blueberry barium smoothie burp out, overalls-rebuckled, and escorted out the door.

I had to think about this increase in efficiency as I drove home. There weren’t many patients there, so perhaps the inter-holiday period is a slow time. That could be part of it. There could also be many employees on vacation, so they might have consolidated duties and eliminated the back office trip. The computers may have me flagged as a regular customer, consolidated all my accounts, and realize that I actually have insurance and will pay them the balance that I owe them, which I have always done though I will admit it has not always been timely or easy.

Maybe it’s all of those things. Maybe it’s none of those things. Maybe the hospital will think that something went wrong and chastise their employees for their too-efficient admission which violated their control procedures. Maybe the ACA’s electronic record/paperwork reduction is taking hold. Maybe they just thought that any CT Scan business the week between Christmas and New Year’s Day was worthwhile, so don’t rock the boat. I don’t know what they were thinking, but the entire process took less than 30 minutes, and that included finding a place to park.

Is this the new normal? I hope so…but I am very suspicious. When I go back in the future and it works like its former efficiency, I may remind them of how it worked yesterday morning. They, though, will likely have no memory of that, and will look at me like I am an alien, speaking a language not from this earth, and tell me all the things I will have to do before I can get to the next checkpoint, much like a bored TSA officer in a small-town airport.

I sound like I am bitching. No…I am recalling the bitchings from previous visits and declaring that the difference in them and this one is remarkable. I expect the radiologist had the CT scan read before I had left the building. Now, I can wonder about what he may or may not have seen. Of course, they comment on things they may not see if they have been instructed to look for something in particular.

I am going to take my chances and write what I think the radiologist will write. We’ll see. If I am wrong, I will promptly report back to you on it.

“Stable 2mm right renal calculus. Stable benign left adrenal mass. Stable slight splenomegaly. Slight lymphadenopathy in groin area, 9 to 10mm, stable. Remnants of too much turkey, ham, and dressing from Christmas dinner, which combined with the Sackrete smoothie barium contrast may cause temporary discomfort, but otherwise unremarkable”

He may say some other things, but these are the things I am looking for. It will say what it will say. The lymph nodes have seemed swollen and painful to me, well, they haven’t really seemed painful, so perhaps painful is not the right word…more like tender with the occasional fleeting pain. The blood numbers tell a story of their own, which is a good one. If the lymph nodes are enlarged, it could simply be because of the Methotrexate I am taking. It has me a bit worried, but not too much. Of course, the radiologist could also say some surprising, dismaying, bewilderingly remarkable things; I can’t be sure, but my money and my hope is on the things written above.

Sometimes our fears get the best of us. Sometimes it is a misplaced confidence that gets the best of us. From day to day, we never quite know which one it will be. Today it’s confidence. Tomorrow may bring something completely different…well, not likely tomorrow, or the day after. It‘s Saturday and deer season and Hemosapien is hunting and most likely will hunt tomorrow. Monday he’ll get the radiologist’s report, but he’ll probably be hunting then, too. He will not call me unless he will need to see me about something he didn’t like in the report, and if so, he’ll likely call me from the hunting camp, or from up in a tree stand. If it reads like I think it will, he will just send me a copy for my own reading pleasure.

It’s like he told me one time, handing me a copy of my CBC or the results of a flow cytometry, “You can look at this yourself. You are pretty good at reading one.” And I am…pretty good at reading one for a layman, that is. But I have learned to be pretty good at it since it‘s my body and my illness.

That’s enough, now. I had so many things to write about, rant about, and even whine about, but they are all gone. A review of what I have written may read like the radiologist’s report.

“Unremarkable,” it might say. Boy I sure hope so.

Now, on this rainy, cold, late December day, I may just get my .338WinMag and head down to the woods to a shoothouse, take my journal, and write until I fall asleep nearly immediately, lulled by the rain-drop’s pitter-patter on the rusty tin roof. If I do, when I awaken, I’ll likely see several deer…maybe even a big buck. Unless it’s a monster, or perhaps even if it is, I’ll likely just put the scope’s crosshairs onto the spot slightly above where I intend for the bullet to strike. Knowing that the bullet would strike exactly where I intend it is very likely to be enough as I carefully and lightly caress the trigger, slowly exhale, and about midway through the exhale simply whisper, “Boom!” removing my finger from the trigger having never taken the rifle off safe. They say never point a weapon at something you don’t intend to shoot. Well, I’ll just declare that I intended to shoot but changed my mind. It’s a useless mind that can’t change.

The deer won’t even know how much danger he was in, or not in. He may hear some noise in the shoothouse, raise his head, twitch his ears towards me straining to listen, or thrust his nose in the air sniffing it for any sign of a threat or danger and then return his head to the ground and the green ryegrass planted there, taking bite after bite as he grazes it down to the ground to his satisfaction, taking in as much as he can as fast as he can so he can bed down and ruminate over it later, thinking of me to himself about his recent suspicions, in the language of the radiologist, “Unremarkable.”

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