Playing doctor

A piece for the Beachwood Reporter about medicine in Indo, and Cook County: http://tinyurl.com/485jlkb

In case you didn't click through before, here's the piece:

A couple weeks ago I got word that my savings had been wiped out in a financial fraud engineered by an unscrupulous and not especially creative hedge fund manager turned thief. If you've read my recent Indonesian Journal missives, you know the details.

When the news of my destitution reached me, I was living in Central Java, Indonesia and working for $1,000 per month as a Fulbright English teacher. My stipend put me well below the U.S. poverty line but in Indonesia a cool grand per month is very decent money and I was living relatively large as an expat - regular cross-country travel by air, dining out a couple times a day, frittering away money on clothes and handicrafts and air-conditioned buses, zipping around on an almost-new Yamaha scooter.

I made a pittance but I was still pulling down more than three times what my Indonesian civil servant counterparts in the English Department earn during a six-day work week, one that features long days and sometimes three-hour high school classes. I didn't plan on saving much of my Fulbright money while abroad - in fact, I intended to spend most of it sightseeing - but I expected to come home to a nest egg that, according to the last fraudulent statement from my now-jailed fund manager, was edging toward six figures.

That financial cushion is what allowed me to pack up my stuff and rent out my house and set off for a year's adventures in Southeast Asia. When it went up in smoke, I had to confront a harsh reality: I was fucking broke. Whatever my level of exchange-rate comfort in Indonesia, I would be facing some tough bills when I got back home in early summer and, earning $1,000 per month, I wasn't going to have the money to meet them. Not unless I returned and started working for real money as soon as I could.

So I made a hard decision and headed back - in the language of overseas posts like the Fulbright or Peace Corps, I early terminated.

I sold my scooter, packed my things into two duffel bags, said some goodbyes, and headed for the airport. I was back at O'Hare about 36 hours later - Jakarta to Singapore, Singapore to Tokyo, Tokyo to Chicago. I deplaned tired, unemployed and uninsured. From Fulbright teacher, informal American cultural ambassador and local minor celebrity to just another jobless mope with student loans and no COBRA. My grad school insurance expired last summer and after that, nothing.

I've spent the first few days home sleeping - a 13-hour time difference makes for some seriously disorienting jet lag - or at Stroger Hospital. I may have deplaned uninsured but I also came back with some kind of exotic Indo bug that I can't shake and that several Indonesian doctors could not cure with their repeated, reflexive prescriptions of antibiotics.

So I've been queueing up before 7 a.m. with several hundred other people outside the Fantus Clinic or inside Stroger's financial screening offices, and I've officially plugged into the county's safety-net healthcare system. Until I find work, this is where I'll be coming for primary care and emergency room visits.

(A doctor friend with offices in Winnetka also has volunteered to help diagnose my illness. "It's a very interesting case," he told me by phone. "The symptoms are unusual. Light and sound sensitivity? That's not really symptomatic of anything. It's . . . interesting." I said I was sorry I couldn't pay him but was glad I could offer something case-study-wise. Maybe we'll write a journal paper about it. Long-term, though, I can't ask him for extended pro bono care.)

I've got the salmon-colored Cook County Health and Hospitals System patient ID, which reminds me to "ALWAYS BRING THIS CARD WITH YOU!," and a Limit of Liability letter that means I get free care for a year, and now all I have to do is stand in lines or have a seat in crowded but orderly waiting rooms and eventually someone will probably poke me or prod me and might even ask a couple questions about how I'm feeling or what might be wrong.

I'm a near-lifelong Cook County resident and always figured County Hospital was where I'd want to go with a gunshot or stab wound, but I never considered relying on it or its doctors for regular care. Earlier in my life, I might have considered that possibility a kind of tragedy or failure, a sign of helplessness. But after repeatedly seeking medical care in Indonesia and seeing that country's hospitals and doctors up close, I find myself feeling just fine about Cook County's.

In fact, I'm pretty sure somebody over on Harrison Street is going to figure out what's ailing me, and when they do I'll gobble some generic medicine, then recover, and move on with my health relatively intact. I never had any similar expectation during my time in Indonesia.

You have a sore throat? A kidney infection? Muscle pain? Fatigue?

Take an antibiotic.

An Indonesian doctor told me not to drink orange-flavored Gatorade because it contained orange juice that might upset my stomach.

What do you mean it contains orange juice? I asked.

Well, it's orange, she said.

Another doctor diagnosed a kidney infection by punching me in the back.

And a third had me sit on a bloody sheet while he interviewed me about my symptoms.

None ever took my temperature or made even a cursory physical examination before prescribing drugs.

What do you think is wrong? they asked. What kind of medicine do you want?

I went to Indonesia as a healthy 30-something guy who didn't think very long or very hard about being anything but a healthy 30-something guy during my time abroad. I got the recommended vaccinations and skimmed the paperwork outlining the insurance coverage we'd have through the Fulbright program and I moved on to other, more pressing topics. Like, should I pack hiking boots or save the weight and room for something else? And how many books could I haul all that way? I mean, we'd have a doctor through the program, right? That was enough.

What I didn't know was that the Fulbright doctor works in Jakarta - a couple hundred miles from my placement site - and her office does not accept the Fulbright insurance plan.

She was occasionally willing to answer questions by phone or by text message but mostly she told us to seek care near our hometowns. If we really needed to see her, we could fly to Jakarta on our own dime and pay her out of our own pockets.

I called this doctor once for a consultation and she text-messaged a long list of laboratory tests she thought I should get at the Jogjakarta International Hospital, about 90 minutes from my home. I took the list to the hospital, where they collected blood and stool and urine samples and did the lab work and handed me a bill for about $150 - a pretty sizable hit, half a month's salary for a native teacher.

And after all that, the test were inconclusive; they didn't find anything wrong with me: no dengue fever, no typhoid, no parasites, no blood worms, no fucking low blood sugar. Nothing. But they did send me off with antibiotics. Take these for five days. And then come back. I soon came to understand that my visits were strictly revenue-generating. Are you feeling better? Some more antibiotics? And you come back next week?

I visited four different hospitals and met with at least seven different doctors during my time in Indonesia and at no point did I feel like I was receiving actual medical care. I was involved in a kind of health care pantomime: Man or woman in lab coat stands across from me smiling; he or she performs no physical examination, makes no diagnosis. That person then walks me to the pharmacy and then to the cashier and I am handed a bill. We are playing charades. I am a patient. She is a doctor. I am an Indian chief. He is a street sweeper. I am sick and not getting better. She is walking toward the nurses' station. The nurses are dressed in nurse uniforms. There is no thermometer in the entire hospital.

Yesterday morning, after more than two hours in a cream and blue windowless waiting area, I finally was summoned to an exam room inside the Fantus Clinic. A stern South Asian doctor who did not introduce himself or ask my name used a stethoscope to listen to my lungs. He dug his thumbs into my lymph nodes, he examined my mouth. He interviewed me about my symptoms and took notes. He ordered blood work. Earlier, a nurse had taken my temperature and blood pressure. The lab tech who drew my blood was unfriendly, didn't look at me, and I couldn't have cared less.

Stroger Hospital is a factory. It's bare-bones, even harsh. But it works. And they're practicing medicine.