Diagnosis: gallstones


For several years, Stephanie had recurring and excruciating pain in her abdomen. The pain would flare up without warning, and usually faded away a few hours later. It started before we were even a couple — remember, she needed antacids when she first visited me in San Francisco. Well, the pains continued, and Stephanie continued taking antacids.

In Frisco we'd had health insurance, but sometimes she went weeks or even months without feeling these pains, so I'm not sure Steph ever mentioned her abdominal issues to her doctor. When we moved to Kansas City in 2001, we were unemployed at first, which means we had no insurance. We couldn't afford to buy health insurance on our own, and we were confident that we'd soon be employed somewhere, so it wasn't a big worry. We were generally in good health; Steph's diabetes and her abdominal pain was all we had to complain about.

But the abdominal issues started flaring up more often. Instead of going without pain for weeks or months, it was only a few days with no pain, but then, bang, she'd be in agony. We noticed that it usually struck after dinner, often accompanied by intense nausea. Our theory was that it had something to do with what she ate, because the pain seemed to come after eating certain foods, especially greasy foods. We couldn't figure out what to do, so we just worried and looked for work, because a job would bring health insurance. Meanwhile, we bought a lot of antacids, which Steph took as needed. Which was often.

One night, her pain came and it was especially severe. She took the usual antacids, but to no avail. I suggested that we go to the emergency room, and Steph said, "No, we can't afford it, and the pain will pass. It always does." But an hour later, the pain hadn't passed, hadn't gone down, and maybe it was getting worse. A few hours after that, we agreed that she needed a doctor, and as soon as possible. We didn't have a car, and we didn't want to pay for an ambulance, so we walked to the emergency room at St Luke's Hospital, which was only about six blocks from our apartment.

A few weeks earlier, we had walked past that hospital as we were exploring our new neighborhood. That walk had been enjoyable, but there was no joy in this walk. It was late at night, poorly lit and somewhat spooky, and the pain forced Stephanie to stop several times along the way. When we made it to St Luke's, we stepped inside the emergency room, answered twenty questions at the desk, and filled out a clipboard's worth a personal information.

And then we waited. We waited for so long we thought we'd been forgotten, and a couple of times I asked at the counter whether we were still on the list of emergencies. Steph asked me not to ask a third time.

It was maybe midnight, maybe 2AM, so of course the hospital wasn't fully staffed, but the woman at the check-in desk seemed to be the only employee around. Only one other person was waiting for emergency care, an old man who seemed to have a serious foot injury, and he'd been waiting since before we'd arrived.

How long did we wait? Hard to say, but we watched an entire movie in the waiting room, from beginning to end, with commercials. During the movie, the guy with the mangled foot was called in to see a doctor. Steph wasn't called in until after the movie, and after about half an hour of flipping through old sit-coms, so I'd guess we'd been waiting for two and a half hours, maybe longer. Stephanie was in a whole heck of a lot of pain the whole time.

Finally, the woman who'd signed us in yelled from her desk, "Ms Webb, step into the next room and the doctor will be with you shortly." Steph asked whether I could come with her, and the answer was no.

Only years later did we understand that this answer was flat-out false. Of course you can bring a spouse or loved one with you for medical treatment, if you wish. It makes sense, as two brains are better than one at processing medical advice, and anyway, as Steph told me later, she was in so much pain that she could hardly think straight, and she would've liked to have had my help answering some of the doctor's questions.

The doctor was barely a doctor; he was a medical student or an intern, but you can't really complain about that. It's expected, if you're seeing a doctor at two in the morning, that you're probably not seeing a doctor with a great deal of experience. Even a medical student would be an expert compared to Stephanie and I, but this doctor's expert advice was — nada. He couldn't say what was causing her pain, and he didn't seem to have much curiosity about it. I'm not sure whether x-rays were taken; if they were, we never saw them or had them explained to us.

The doctor prescribed an antacid — the prescription-strength version of the same antacid Steph had already been taking, and of course, she had taken several doses of it earlier that evening. Stephanie's abdominal pain began subsiding before the prescription had been filled, so she felt better leaving the E.R. than when she'd entered, but the pain always came and went on its own schedule. Feeling better as she left had nothing to do with the doctor, the hospital, or the prescription antacid.

And then they sent us home, and sent a bill for a little less than four thousand dollars. Later we received separate bills for the doctor's services, and for the antacid, so $4K was the price just for walking in and out of the building.

Stephanie and I were quite poor at the time, and that bill frankly scared the bejeebers out of us. We worried and researched how best to pay it off. The consensus of good advice for dealing with astronomical medical bills is to call the hospital's billing office, explain that you're poor and uninsured, and arrange monthly payments of whatever amount you can afford. Which for us might have been twenty bucks a month, for 200 months, not including any interest.

We considered it, but more to the point, we considered it absurd.

In this world, in this life, the difference between right and wrong is important. It's right to pay your debts, and it's wrong not to. But was this really our debt? We didn't feel that we'd received $4,000 worth of medical services. They were asking us to pay $4,000 for watching a movie. That's wrong, we decided. Morally wrong. Downright criminal.

We decided not to pay. Or rather, we decided to pay what the medical services at St Luke's had been worth — nothing. They sent bills, and we answered with a note explaining that their bill was ridiculous and anyway, we had no money. They sent forms, asking us to quantify our poverty, and we filled out the forms truthfully. The hospital's last letter said that they'd 'forgiven' the 'debt', but that's not really the point of the story.

A few months later we both had jobs, and Stephanie again had health insurance, so she was able to make an appointment and see a doctor about her recurring abdominal pains. As soon as Steph met this doctor and started explaining her symptoms, the doctor frowned and said, "It sounds like gallstones."

Tests confirmed it, and soon Steph was scheduled for surgery to have the gallstones removed. That's a story I'll tell in a future installment here, but for now let's just say that the surgery was successful, and Steph never again had problems with recurring abdominal pain.

Stephanie's doctor said that her symptoms were "a textbook description of gallstones," and indeed, go to google.com and search for symptoms of gallstones, and you'll get almost exactly what Stephanie endured — abdominal attacks occurring every few days or weeks; pain starting shortly after a fatty or greasy meal, sometimes accompanied by nausea, and subsiding within a few or several hours.

When Stephanie said that the E.R. had been stumped by her symptoms, her doctor wrinkled her face, like she was calculating her words carefully. "Maybe you saw a good doctor who was having a bad day," she said, "but this certainly wasn't a difficult case to diagnose."

In hindsight, we were even more flabbergasted by our visit to St Luke's. It's as if your car won't start, and it doesn't occur to your mechanic to check the battery and ignition. How could that E.R. doctor have missed this diagnosis?

The only theory we could come up with was that the doctor at St Luke's had looked through Stephanie's paperwork, and noticed that she didn't have health insurance. He must have suspected that Steph had gallstones, but he knew that she probably wasn't going to pay for the E.R. visit, and that she definitely couldn't afford gallstone surgery.

Is it nuts to think that money determined what that doctor said or didn't say? Maybe. But it's also nuts to think that a trained medical professional could miss such an obvious diagnosis. It's nuts either way, ain't it? So this might have been the first time Stephanie and I pondered just how nuts the health care system is, in America. It wouldn't be the last time.