The actual questionnaire, two pages, was a list of statements – I’ve had trouble focusing on tasks, I’ve had difficulty sleeping, I’ve tasted water as the color yellow – next to four columns labeled: Not at all, Several Times in the Last Two Weeks, More than Half the Days in the Last Two Weeks, The Whole Two Weeks, and I was expected to put a checkmark in the column that applied. Except the first column was labeled, Not at all don’t know, one phrase like that. One of the items was “I’ve thought of harming or killing myself,” which the doctor had not asked about once so far.
I found my way here at the end of nearly two months, could be longer, after a labyrinthine trip through what I have come to call the Appointment Industrial Complex.
I must have been ten the first time a doctor asked a question during an appointment and instead of answering for me, my mother turned to the doctor and said, “Why don’t you ask him?” Later, she explained it like this: one day, I was going to be older and I would have to book my own appointments and talk to the doctors myself, though amid the endless consequences from birth heart disease, nothing about one day seemed worth counting on.
But one day came and went. Normally, I get along fine, with minor hiccups – doctors refusing to refill medications out of nowhere, pharmacies giving me only ten pills of one-thousand-and-eighty pill prescriptions. Until about two months ago, when my therapist, a woman I see in a windowless broom closet in the pediatric building, agreed that the recurrent bouts of depression I’d been describing had been around long enough to make an increase in my SSRI worth exploring.
I was stupid, to think it would be so easy. But how could I have seen it coming? That white card in my wallet with the suitcase logo works so well I forget to bring it with me half the time, because the hospital has it on file. A nice perk of my dad’s job. For the first eighteen years of my life, I lived within an hour’s drive of the best hospital in the world for my disease.
My therapist would make a dosage recommendation in consultation with some other doctors, she said, but still another doctor would have to write the prescription. Luckily, I have a doctor who’d written me the drug in the past. He was comfortable with this only because the dose had been prescribed by an actual psychiatrist, years earlier. But his office refused in an email: “Restrictions are getting tighter and tighter.”
Then I tried my cardiologist, sending emails to my therapist and messages through the hospital’s patient e-system to my cardiologist, and each telling me to have the other one call them.
With this finally resolved, I turned next to the hospital’s outpatient clinic.
“We don’t take your insurance.”
“…Excuse me? ”
Disbelief; more calls. I called the first number back just to be sure.
“So, you’re telling me that no psychiatrist in the entire hospital takes my insurance?”
“Yes. That’s exactly what I’m telling you.”
I went back to my therapist’s office and showed her two PDFs on my laptop, over 100 pages of names provided by my insurance company’s website. Criteria: psychiatry, zip code radius, depression, adult, in-network.
She scrolled through on my hour.
I started calling her recommendations and was denied with lines each more ridiculous than the last.
“Okay, so… she’s actually a neurologist. Do you have seizure disorder?”
“He’s not seeing patients anymore.”
“Hello, you have reached the Department of Gastrointestinal Disorders.”
By this point, weeks had gone by. With each fruitless phone call, the problem that had caused me to begin the search in the first place seemed to metastasize.
I tried Columbia.
“We only take Aetna.”
“No one takes your insurance. And no one is taking new patients, anyway.”
“This is the main line…” after calling the number specifically labeled Outpatient Psychiatry,“… But if you hold, I can transfer you to outpatient psychiatry.”
A click. Ringing. Another click. Chaos.
“Hello, Emergency Room.”
This is one of the problems of depression. Simple tasks like phone calls become impossibilities. An email is advanced trigonometry. Leaving a message feels like trudging up a great mountain in one of those weighted vests CrossFit guys wear to train for their jobs in influencer marketing. I could make only a few calls each day.
After each episode of being transferred back between the same two numbers for thirty minutes at a time, the effort would feel so crushing and so designed to break anyone foolish enough to attempt it that I began to wonder if I was not in the midst of a delusion already. Perhaps I was already snug in a bed at Bellevue, playing out a fantasy of another life wherein I still had some control.
On the phone, my mother said something about hospital systems locking in with one insurance provider, creating monopolies.
Late one night, I scrolled ZocDoc. The screen loaded a weak less-than-one-page of results calibrated to my insurance. There was not a face under sixty. The soonest appointment was in a month.
I texted with a friend who lives three thousand miles away, who is the only friend I can really talk with about this kind of stuff and for whom I am the same. I told her that I was thinking of self-medicating and she–who texts me jokingly about all kinds of whatever drugs she is doing or how many bottles of wine she has consumed in one sitting–replied “No, don’t.” The best friends are the ones you know so well that even over text, you can understand the tone in which they’ve said a thing. I understood No, don’t to be serious even through the screen.
I can SEE the bottle. It’s right there.
What I meant was that I was going to take my nightly ten-milligram pill, put it inside the pill-cutter and slice it in half, then pair a half with a full and up my dose to fifteen milligrams to start. It seemed perfectly reasonable, and probably what a doctor would say to do anyway.
I get it
But please, don’t.
At our next appointment, my therapist suggested going out-of-pocket.
“If that’s something you can handle… it might not be a bad idea.”
I could, or more accurately, my family could. You know, only on special occasions. I was grateful for this.
That brought me back to the beginning. I redialed my hospital’s outpatient psychiatry department and when a woman asked what insurance I have I cut in quick.
“But I can pay out-of-pocket!”
“First appointments are $650 to $950, depending on the doctor. Followups are $200 to $600.”
After just two more days of being passed through different doctors, I finally landed an appointment.
In the lobby, instead of taking my ID, the security guard said, “Do you have the code?” I recited the five-digit key which had been messaged to me within the secure hospital email system—separate from the regular e-system—along with the explanation, “This is your code.”
“Bring that with you every time,” the guard said.
Once in the office I asked the receptionist about the out-of-network benefits form I would need to send to the insurance company to recoup 40% of the $650 appointment fee, which I was only eligible to receive because my family had already spent several thousand out-of-pocket since January.
“After you see the doctor, he’ll send us the diagnosis code. I’ll give you the form on your way out.”
When the doctor—absurdly young, nervous, wiggly like a baby just learning to stand—opened the door to the hallway for me and I saw the rows of cabinets and little rooms, I felt again-ness, like I’d been there, and when we were almost at his door I spotted it: the conference room, the very same where I’d nearly failed a class in college called “The Science of Happiness,” two times a week, plus a lecture on Mondays.
On this doctor’s questionnaire, I selected Several Days in the last Two Weeks to the question “I’ve thought of harming or killing myself.” It was a lie, because I’d thought of killing myself more than half the days of the previous two weeks.
When he took the sheet back, he added up all the corresponding numbers dictated by my checkmarks as if it were a BuzzFeed quiz. I can handle it, doc. Am I a Costanza or… a Kramer?
“Okay…” he said, without mentioning any answer to any question. “I just like to get a baseline.”
He recommended that instead of getting a new prescription, I begin that night by taking my ten-milligram pill, putting it inside the pill-cutter and slicing it in half, then pairing a half with a full to up my dose to fifteen milligrams. To start.
“When you run out of that, call me.” From there, he would send in the new script.
A week later, my therapist would say casually, like she was no part of it, “It’s a terrible system. It’s incredible to see what doors open as soon as there’s some money.”
“I’d like to see you back in a month,” the baby-doctor said.
I stood up, expecting to be ushered back to the front desk. Instead, he pulled out an iPhone.
“When works for you?”