I Hate Incompetence

If I have to deal with one more incompetent doctor, I might scream. I truly might.
I’ve seen enough incompetence to scare anyone away from seeing a doctor ever again. It’s truly truly frightening.
I spoke with IVF Jen (the name I’m giving to my IVF coordinator – the one who’s personality grates on me the wrong way) last week in my round o’ calls I made. We talked about the meds and starting and such, and after we hung up, she called me back about 2 minutes later.
“You know,” she told me, “in the bloodwork you had done for your [failed] surgery it came back that you have extra antibodies in your blood.”
“Yes, I know,” I told her, completely bored.
I’d heard all this before. It’s due to the two blood transfusions I’ve had during my two different heart surgeries, but mostly from the first one (the horrible one)  when I lost a LOT of blood.  With “foreign” blood entering your body, sometimes it will develop antibodies against it. It doesn’t affect me generally.  But I now need special blood typing every time I have a future surgery. Whenever you have a surgery, they screen your blood for type and stuff, so if you’re O- or whatever, they have something on hand in case you need it.  Well, I’m a plain old O+, which is the most popular blood type out there, and not a big deal, but because of those antibodies I have, I always need a second screening so that I get a more specific bloodtype beyond the O and beyond the +.
I’ve always wondered what would happen in an emergency. It always takes a few days for that second screening – what do you do if you’re in a car accident, God forbid, and need blood in 20 minutes?  Anyway…not that I should be concerned about that right now…
So Jen says to me, “maybe you should meet with Maternal Fetal Medicine to find out if that antibodies could have any affect on a developing fetus? I don’t think you have any clotting factors, and it’s not the same thing, but this way you could feel better knowing for sure going forward.”
I had actually asked a bunch of doctors (my regular OB when we started trying, and even my cardiologist) if those transfusion antibodies could be a problem and everyone said no.  But I thought it was a good idea to talk to a specialist in the area and get some peace of mind, so I went in today.
The MFM had the results of the thrombophilia panel I had done last May under my OB. And today, 8 months later, I learn that I have the MTHFR mutation. I apparently have one copy of the C677T mutation and one copy of the A12980 mutation.  Separately, they mean nothing. Together can be the problem.
In addition to that, as soon as I actually get pregnant (well, maybe not as soon, but at some point in the first trimester) I have to get another titer done.  Because of my transfusion antibodies, I tested positive for Rh(c), whereas most people are RH(a) or (b) apparently. (That’s the more specific bloodtype they’re always testing for).  If the baby is also RH(c), then no problem, but if it’s RH(a) or (b) then I would need additional meds.  Terrific.
I also found out that my OB did not do certain thrombfilia tests – including Factor V Leiden and some others.  Wonderful. I’ve been spinning my wheels for 8 months and now, one week before IVF, find this out?
MFM doctor wants me to go to a very specific lab all the way down in Poughkeepsie to get additional bloodwork done. 2 hours away, ugh. And of course I will do it, because I always do whatever a doctor asks me to do.
But I wish I could stop getting incompetent ones.

MFM St. Peter's

Today I have my first of two MFM appointments. The second is on Monday. I’m hoping I like this guy sufficiently and get enough questions answered that I can cancel Monday’s appt. with the other one.

This guy was recommended by my RE.  I need someone locally to connect with when I’m pregnant.  Plus, maybe he can answer my questions about clotting and tell me what to do. Plus I’d like him to order a karyotype test for me and DH. All this for someone who doesn’t know my history at all. It’s probably too much to ask from the visit.

Maternal-Fetal Medicine

Another day, another frustration.

When DH and I got pregnant the first time, Dr. Mike (no doubt thrown into a tizzy by the news) garnered a much needed lightning-fast appointment with a well-respected MFM doctor in Boston.  Well, at least I presume so. Honestly, any doctor Dr. Mike thinks is good is someone I want to see.
She is probably brilliant, and there must be a reason Dr. Mike recommended her (personal friend? Known miracle worker? No idea) but she did not impress either the husband or me that day.  Granted, we were reeling from batteries of tests, a cardiac MRI for me, Dr. Mike and his people hovering over me like something was just so WRONG, when I felt more right than anything else in the world.  But her callousness about the situation at present, and when she found out my progesterone was low, a dismissive, “Oh well, you’re just going to M/C anyway,” so who cares attitude, in addition with her statement “No woman should ever get pregnant” (Um, hello, you’re a high risk OBGYN?!) just complete bowled us over.  Thank goodness we had Dr. Mike to pick up the pieces for us in the end.

Cut to November 20th of last year (man, I do have a head for dates) in which a much more relaxed Dr. E gave us her “approval” for us to go get pregnant, along with her fellow, Dr. Smith, who was ok, but again, not the warm and fuzzy doctor Dr. Mike is, and things were a little better.  She went from huge concern the previous time to, “You don’t really need to see me” to “I’ll work with MFM in Albany”…and sent us on our merry way.

I saw an MFM in Albany the first pregnancy.  Dr. S didn’t want to do anything without Dr. E’s permission.  It irked me a lot. She went so far as to send us a letter CYA about how she wouldn’t see us unless she had written “permission” from Dr. Mike regarding my condition.

Damn, I see a lot of doctors.

Anyway, when we saw the RE a couple of weeks ago now, she (or rather the PA) didn’t freak when I told her about my heart condition.  Granted, that’s probably because I’m now repaired as opposed to the way I was before surgery.  But she did recommend seeing an MFM.

I don’t really want to see Dr. Samelson again.  So the PA told us about a new MFM at St. Peter’s and since then I’ve been trying to get an appointment with him.

I call up the doctor.  Receptionist is quite rude.  Why are they often so rude?  Tells me if I’m not pregnant I can’t see him.  Um…MFM is for high risk.  I’m not going doctor shopping once I’m pregnant. I’m going to need one right off the bat.  She then tells me I need a doctor referral from my RE (not an insurance referral).  Ok…fine.  So I call up Ali (my personal nurse, I really love that) at the RE office and ask her to send over a referral. She tells me it will be done, and to call back the MFM by the end of the day to make the appointment.

Of course I forget.  And I forget the next day too.  That was Friday. Today I call up the MFM and they tell me, again, quite rudely, they never got anything.  Fuck.  So I call up Ali, and she tells me she has a confirmation of the fax sent the previous Thursday, May 6th at 10:50am.  Great.  She tells me she’ll fax it again just in case.  I give it several hours before calling the MFM again.  She puts me on hold for eleventy billion hours five minutes while she checks all 4 faxes.  Her office has four faxes?  Then she comes back and tells me she doesn’t have it.

I huff and puff and call Ali back, who insists she sent it yet again, but finally offers to call the MFM to find out what the heck is going on.  She says she’ll call me back, and she does, not half an hour later, apologizing because it was all her fault, she was sending the wrong form or something and she says it’ll be done right by the end of the day.

She’s got to have a stressful job.  I like her a lot. She got back to me so fast.  Tomorrow I will call up the MFM yet again to see if they have it. I haven’t even see the doctor yet, and I’m not a fan of the attitude in that office.

It’s all about attitude with me. I don’t believe that in order to be a brilliant doctor you must be House.  You can be nice and caring about your patients and still damn good at your job. I don’t have to put up with your rudeness just because you are smart. There are many smart doctors out there.

Case in point, Dr. Mike.  Columbia undergrad, Harvard Med, director at Boston.  And one of the nicest people I’ve ever met.

So this new MFM better be awesomely nice to make up for his office.  I don’t need the added stress.

Let’s see how it goes tomorrow.