Wednesday, October 3, 2012

Dystopia Redeemed: Life at the Sharp End

In front of the Prague shop where he sold men's and women's fancy goods and accessories, Hermann Kafka, the father of Franz, hung a sign with a jackdaw painted next to his name – “kavka” means jackdaw in Czech. Hermann was a vociferous, selfish, overbearing, self-satisfied sort, and the jackdaw in folklore connotes thievery and vanity.  So wordplay aside, the implied comparison suggests either uncommon self-awareness or beguiling cluelessness. Franz apparently considered it to be the former.

The kavka, or jackdaw, is a member of 
the crow family   
Franz Kafka respected, perhaps even feared, his father yet couldn’t have been more different from him.  He had none of Hermann’s authoritarian and demanding character. His obvious intelligence and dry sense of humor went with boyish good looks and a cool, quiet, if somewhat austere demeanor. Max Brod, Kafka’s lifelong friend and curator, regarded Franz as one of the most entertaining people he’d ever met, someone who liked to laugh and make others laugh.

The writings of Kafka, deceptively subtle, allow for diverse interpretation. His themes of hopelessness and absurdity, for example, are emblematic of existentialism. Albert Camus and Jean-Paul Sartre are among the authors influenced by him.

Yet Kafka’s writing is also relentlessly funny, even joyful – the futility of his characters' “Kafkaesque” struggles bespeaking a surreal sense of  humor. Indeed, Kafka himself used to read drafts of his prose to friends, typically concentrating on the amusing parts which can creep up on you like an ambush.

Much of Kafka's work (e.g., The Castle and The Trial) famously focuses on the struggle of  the individual with bureaucracy. This, along with Kafkaesque comedy, is what came to mind a few weeks ago in the aftermath of a minor incident that occurred in a hospital operating room.

During a surgical procedure, I was accidently stuck by a sharp instrument. Before it got to my finger, the tine of the instrument had to penetrate a double layer of latex rubber, so the latex had probably squeegeed off most of the bad stuff. Still, there’s a protocol for dealing with such mishaps – it starts with discarding the contaminated instrument and changing your gloves – and I followed it.

The first phase of the “needle stick” protocol went pretty smoothly.  After completing the operation, I reported to the hospital emergency department to have a blood sample taken for HIV and hepatitis, viral infections that could result from my type of injury. You need to establish a baseline for the presence or absence of these pathogens even if you have no personal history of infection with them.

There were, of course, lots of forms to fill out – sundry waivers, affidavits, an account of the incident.

Then I was fitted with one of those hospital identification bracelets. I’d always thought of these as being meant to ward off misidentification of in-patients, not out-,  but it was comforting to know I wouldn’t be confused with the guy next door in delirium tremens. What’s more, the ID bracelet gives you a certain sense of belonging, like a gangbanger’s distinctive tattoo or maybe a prisoner’s handcuffs.

A lab tech appeared and took a blood sample. Next came about thirty seconds of bonhomie from an emergency medicine doctor who told me to follow up with Occupational Health for repeat viral titers (more blood samples).

About this time I noticed a large lavender bruise spreading around the site of the blood draw – a consequence of those daily blood thinner cardiac aspirins I take, you see – so I went to some pains to apply more pressure. But to little avail – the bruise got bigger anyway. One of these days, I suppose, I could darken to purple entirely like a vintage Médoc merlot, but hopefully I won’t get a heart attack.

A few weeks later I received a notice to report to Occupational Health. My baseline blood tests had been negative, but I still needed follow-up titers to see if anything would change.  

The hospital in the meantime had expedited an invoice payable for twelve hundred dollars. This caused me sustained apoplexy for awhile until Roxie, my secretary, finally took matters in hand.

“I’ll deal with this,” she’d vowed, through clinched teeth, her eyes narrowing.

And then the bill simply vanished. Did Roxie consign it to sea transit in perpetuity, say, aboard the Flying Dutchman? Its amazing what people can do!

The office of Occupational Health is located on the second floor of a grey annex that could have been constructed of oversized Legos®. The office itself has a glass façade and swinging glass door fronting a hallway just down from the elevators. Straight ahead as you enter, on the opposite side of the waiting room, is a glass partition and a second glass door leading into the patient treatment area. Off to the right is the receptionist’s window where a comely young woman in pink lipstick and smart healthcare livery operates a computer.

I’d visited Occupational Health many times (they do the employees’ obligatory annual TB skin tests) and knew their simple intake routine by rote. You come in, register with the receptionist,  and take a seat in the waiting room. Nothing – nothing – ever happens until, like Beetlejuice, you’ve signed in and been seated.

On this occasion, though, as I was walking toward the receptionist window, a voice chimed out from the door of the treatment area.

“Sir, sir…can I help you?”

“I’m here for a needle stick follow-up,” I replied in surprise,  briefly halting in my tracks.

“Well, first you have to sign in with the receptionist,” said the voice authoritatively.

“Oookay, thanks,” I muttered, already in mid-stride again and a little puzzled at this seeming gratuitousness. At least I wasn’t being ignored.

The receptionist took my information, tapped away at her keyboard for awhile, then handed me a business card from a small cache beside her computer.

“You’ll have to contact this person – Ms. Nina Nullacre, Coordinator, Quality Improvement, Occupational Health,” she advised. “Her number is on the card.”

“Well, thanks,” I replied, and made my way out of the office.

Ms. Nullacre’s business card listed a phone number – let’s call it 915-634-0081 – and an email address. I punched up the number – correctly, too, according to my cell phone’s outgoing calls log – and waited.

“Internal Medicine,” answered a live female voice.

“Oh,” I said, “I’m trying to reach Ms. Nina Nullacre in Occupational Health.”

“You’ll have to dial 915-634-0081 for that,” the voice replied smoothly.

“But I’m speaking to you right now because I just dialed that number,” I insisted.

“Let me try some extensions,” she offered.

The extension search yielded several voicemail greetings, none of them Ms. Nullacre’s.

“Thanks very much,” I said at last. “I have an email address for Ms. Nullacre, so I think I’ll try that.”

Ms. Nullacre answered my email almost at once and instructed me to go to the office of Occupational Health located on the second floor of the grey Lego® building.

I briefly recounted my story for her, then inquired “What do you believe would happen if I returned to Occupational Health right now? When I went there before, they dispatched me in search of you.”

“Call Ms. Josephine Schlitz at this number,” Ms. Nullacre emailed back.

So I called Ms. Schlitz and trusting to fate, trudged off once again to Occupational Health.

Sure enough Ms. Schlitz was on hand to meet me!  She ushered me into a treatment room, handed me several new forms to complete, and then graciously shot me full of DPT and hepatitis B booster vaccines.
As the flagpole-sized vaccination needle bored into the belly of my left deltoid muscle, who should appear but the receptionist with pink lipstick.

“I’m so sorry, doctor,” she said painfully, her face in a grimace.

“I know you’re here just to watch me suffer,” I joked, grimacing back at her.

“No, no!” she cried, her pink lips dancing pale ultraviolet in the glare of the fluorescent overheads. Or so it seemed through the pain – those damned DPT shots hurt!

“Kafka was right,” I thought. “We’re all soddin’ guilty, even the most blameless of us.”

“For irrealisms like these,
With the flow must thou roll,                             
Be it down coil-ed plain,
or up plane-ed col.”

This might’ve been an hallucinatory effect of the anesthetic – if I’d had one.

I left the second time laden with documents for my next visit at the end of October. I never saw Ms. Nullacre.

Is there a moral to this story? Maybe so. America right now is the only First World country on the planet without a national health care system. But there's one in the making, and to get a jump on it you might want to read Kafka.

I’m indebted to Wikipedia for background material.  Names have been changed to protect the innocent, especially the guilty ones. 

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