This morning I’m going to hospital to see if they can help me figure out the cause of my dizziness, which I have been experiencing most of the day for most days over the past year. As I have been instructed many times through robocalls and automated text messages, I arrive half an hour early and park in the garage under the building, then take the elevator to the third floor. After checking in, I sit in what is basically a refrigerator with a TV until 7:45, at which point, encouraged by a poster on the wall, I alert the staff that it is now 15 minutes past my scheduled appointment time. They inform me that my doctor is being held up at the moment, but should be done anytime.
At 8AM, someone calls my name, walks past my outstretched hand (admittedly, one that I extended last minute), and leads me into an even colder set of rooms. I am beginning to realize why some of the text messages recommended that I wear pants — tough spot for rebellion. We proceed through the first room containing an L-shaped desk and some monitors, into the second with fancy equipment on the walls and a lone chair in the corner.
“Some fancy equipment you have here,” I say in an effort to — well, say something.
“Uh-huh.”
She is looking over the paperwork I was instructed to fill out before my visit. Regarding my dizziness and medical history, basically. I decide this would be a good time to size her up, too. She strikes me as a cross between a drill sergeant (cropped, graying hair; strict posture) and hawk (piercing eyes, sharp nose). Now finished with the paperwork, she begins to explain what is going to happen.
“I’m going to put these in your ears,” she says, flashing a set of earbuds in front of my face before proceeding to put them in my ears.
“What are they for?”
“They are intended to put pressure on your eardrums. Don’t worry,” she says as an afterthought. “It won’t hurt.”
She initiates the machine on the wall. I feel a faint pressure in my ears for about ten seconds. Then she turns it off.
“Eardrums are fine.” She takes the earbuds out. “Now I’m going to put these in.” A fuzzier set of earbuds is presented for my brief consideration before they, too, go into my ears. Similar to when I’m at the dentist’s office and my tongue follows the dental hygienist’s hand, I feel guilty that my ear canals seem to be so oddly shaped. I can only imagine it’s things like this that make these types of doctors — audiologists, I think — tired and bored with their daily routine. I continue this line of thought: how strange it is that after all those years of schooling, these people —
General Hawk is snapping her fingers. “Are you listening?”
“Yes, sorry.”
“I’m going into that room back there” — she indicates the one we walked through — “and will speak to you through these.” She indicates the fuzzy earbuds. “When you hear me say a word, please repeat it.”
“Before we do that,” I say quickly, “can you tell me the purpose of all this?” Because of the earbuds, it is difficult to tell if I’m speaking loudly or softly.
“To assess your hearing.”
“Oh, sorry — I meant of this whole thing.” I move my hands around as if I’m massaging invisible walls.
She picks up her clipboard. “To assess deficits in your vestibular functioning.”
“To figure out why I’m dizzy?”
“To see if vestibular deficits are causing your dizziness, yes.”
“And if they aren’t? What else could it be?”
“There are three areas that regulate balance: vestibular, visual, and proprioceptive.”
Based on the mixture of impatience in her voice, I make a snap decision to look up ‘proprioceptive’ later. I’ll do it right after ‘vestibular.’ Maybe from her perspective I’m supposed to know this stuff already — a bad student. Or maybe it’s irrelevant that I know: pointless to explain steak to a cow. Or is the plan for someone else to explain it to me later, once the results are in? I can’t be sure and nobody has told me and all of this is going through what is called the the back of my mind while in the front I am scrambling to ask one more question that will add some clarity amidst the pressure in my ears.
“Final thing,” I say. “What’s the second part of this? Like my second appointment?”
“That is where the doctor will explain the results.”
“Oh — the results will be out?”
She looks at me like that accountant in The Office after Michael asks him to “crunch the numbers again” on an Excel spreadsheet.
“Yes.”
Back in the other room, her voice comes through loud and clear. She says words like “railroad” and “speedbump” and “highway.” Except she emphasizes both syllables, so it’s more like “RAIL-ROAD,” “SPEED-BUMP,” “HIGH-WAY.” For some reason I cannot bear to repeat them this way. “SPEED-bump,” I say. “Rail-ROAD.” “Highway.” It’s the shorts situation all over again.
A few words in, I experience more dizziness than I have in months. I get excited to think that this might be significant. I set a reminder in my brain to tell her once this exercise is done. Soon the words become fainter, more distant. Some of them I cannot hear, but I know she must be saying them because of the cadence of the exercise. I begin to relax in my chair. Am I, after all these years, suddenly hypnotizable? That would be nice.
As the words become softer, so does my reply. I begin to whisper: mailbox, waterski, notebook…
* * *
After the hearing portion of my test, GH takes me to three more rooms: one with a shifting platform to measure my balance; another with a chair facing a screen on which a small smiley-face zooms around as I try to follow it — “without moving your head!”; and a third with a chair that can be rotated to induce dizziness. Before leaving each room, she wipes down the equipment as if I’ve been sweating profusely.
I’m feeling quite sick by the end of it. After the final room, she brings me back into the waiting area, to the check-in people, and leaves so abruptly that I only have time to shout “Thank you!” to the back of her head. To my surprise, she turns around — still walking away — and says “You’re welcome,” gratitude written all over her face.
I shift my attention to the check-in people, who for some reason remind me of the staff at Dunkin Donuts. They give me some paperwork to fill out and ask that I take a seat until my name is called. I find a chair as far from a TV as possible (there are four TVs in a room that can hold about 75 people) and begin to read. Even as cold as it is in here, I’m beginning to thaw out. I notice that everyone else is wearing pants and this makes me want to sigh, audibly enough that maybe someone in a wheelchair will ask if I need a lift.
The first page is entitled “Financial Responsibility.” It tells me, in legal language that I am barely educated enough to parse, that while their “billing is complicated,” I am ultimately responsible for understanding how it works and paying whatever accrues.
I survey the room once again. What is it about these pants-wearers that makes them seem so docile? I return my eyes to the paper, experiencing the dizziness I am accustomed to by now. This has to be the most ridiculous thing I’ve ever read, except for the fact that people are shifting lazily in their chairs and watching Pawn Stars on TV. Basically what I am being told is that it will be very difficult to figure out what I owe until I receive a bill in the mail, and that despite this (and before I receive services), I must promise to pay it, whatever it happens to be. Maybe there’s a good reason people don’t read these things.
I sign the form with as much silent resistance I can muster. I’m now kind of glad to be wearing shorts, if only to feel the grass on my ankles. The next few pages ask me questions I have already answered multiple times: mostly medical history stuff. The final page asks if I would consent to being a participant in their research. Here it seems they are banking on people not reading the form, because if you do, you’ll see that participating “offers no benefit and may contain some risk.” That’s a good definition for something, just not sure what exactly. I sit up a bit straighter and check “No.”
After another fifteen minutes, a nurse calls my name and takes me into a typical doctor’s office. She leaves the door open a crack; I can’t see anything, but noise filters in softly from the hallway. I offer a silent prayer that at least there isn’t a TV in this room. Soon, an older patient comes down the hall:
“There was a little war when I was growing up called ‘Vietnam,’” he is saying, “and one of the ways men used to get out of it was — ”
His voice becomes too muffled for me to make out the words, but I can hear enough to tell that the woman he’s talking to — probably his doctor — keeps trying to get a word in edgewise. I feel for her and every doctor that must contend with these old bags of wind. It is at this moment that I notice the results of my hearing test lying open on the table. I take a shot at deciphering them, to no avail.
Another nurse comes in and reveals the hallways scene that is still taking place. I see an older man in a white coat and black stethoscope speaking to a middle-aged woman and an older lady who I presume is her mother and the patient.
The nurse closes the door and begins taking my blood pressure. I am taken aback when she asks how I’m doing. “Well, I’m still dizzy,” I want to tell her; but then I catch myself and mention that I’ve just come back from my honeymoon. She brightens at this and asks where I’ve gone.
“EastAfrica.”
“Oh, how nice is that? Plenty of people around here have been doing safaris.”
I have to swallow before asking her how she is doing. We pass a few more minutes in light conversation before she leaves with a smile. As she opens the door, I can see the doctor — the old man — entering another room. Oh well, I think. Probably stuck here for a while. I check my watch: 10:30 AM.
* * *
While I’m waiting for the doctor and trying not to freeze my legs off, I notice that the computer, activated by the nurse touching the mouse, contains an open Word doc. Upon closer examination, this is a summary of my condition.
My first impression is that there are a lot of squiggly red lines. Many words are either misspelled or not recognized by Word as words. I get a little judgy — I do — and wonder if General Hawk is responsible. It doesn’t strike me as likely. That bird has her nest in order, let me tell you. But I also cannot imagine who else would have written it. Regardless, I find it to be mostly accurate despite some spelling mistakes and a few other points, which I proceed to scribble on a sticky note on the table. While I’m at it, I include a few things I want to be sure to mention to this next doctor, as well as certain terms from the balance test that I have been keeping in my head, like ‘vestibular’ and ‘proprioceptive.’ Most importantly, I must mention my extreme dizziness during the earbud phase of the balance test, since I never got around to telling GH.
After this, I just sit on the table and swing my legs like a little kid, the paper sheet crunching idly beneath me.
At 11AM, Vietnam bulls into the room, touches the mouse, and begins reading my summary aloud. A logical starting point, I think to myself.
“Patient is referred by PCP for concerns of lightheadedness and sensation of backward pulling which began 1+ years ago. No changes in medication. Sx are described as chronic sensation of rearward pulling and lightheadedness which is primarily present. Symptoms occur when standing or walking.”
As he reads, he pauses to correct typos. This pleases me a great deal. He chuckles at the next sentence, “Exacerbating factors include noisy, crowded spaces, and changing into his work clothes.”
“Me too,” he says.
I’m too slow on the uptake to be properly offended, plus he’s moving on. He becomes indignant at the phrase, “Motion intolerance as a passenger is endorsed.”
“Sounds like you’re signing a check!” he shakes his head, changing it to ‘admitted.’
When he reads that I have no history of head trauma, I interrupt him to say that I’ve had 2–5 concussions growing up, mostly in high school. He looks at me with a mixture of surprise. I cannot quite tell if the information or a reminder of my presence has startled him, but he writes it down and soon makes it clear — he’s convinced concussions are the culprit.
“AND migraines?” he asks, now doubly sure of himself as he bends even closer to the screen and starts clacking like mad.
“Well, mostly only when I have beer.” I immediately cringe in anticipation of his response — “they call that a hangover” — but it never comes. Instead, he asks me if I’ve seen a neurologist.
“If the person who conducts an MRI is a neurologist, then yes.”
“That would be a radiologist.”
“Then no.”
“And the MRI?”
“Nothing.”
“Well, you don’t have vertigo,” he says, standing up and approaching me, “because vertigo is the ‘hallucination of movement.’” You can tell he’s quite pleased with the phrase. “And that’s not what you have. You don’t have a ‘hallucination of movement.’”
“I agree,” I say. “Vertigo is an inner-ear thing, right?”
“No. Vertigo is a symptom.”
“But it’s caused by inner ear stuff?”
“We’ll look at your results in a moment.”
He is busy doing the normal doctor routine now: peering into my ears, shoving a stick down my throat, blinding my eyes, taking my pulse. “So what do you do for a living.” Very much a while-we’re-grazing question.
“I’m a therapist,” I say between sticks. “Mental health.”
He considers me meaningfully. “Good. We need more of you around here.”
“Thank you.”
“Seriously, stick around and you’ll see.” I realize he means here, specifically, like in this wing of the building. “So I guess you’re part of the team?”
“Part of the team?”
“You’re one of us.”
“Oh — yeah, I guess so.”
“Are you a psychologist or psychiatrist?”
“I’m actually a counselor,” I tell him. “I only have my master’s.”
“Still,” the doctor says after a pause. “You’re one of us. So that’s good. We want to get you back out there. You’re like family. We have to get you back on your feet so you can keep doing the work you do.”
I feel a wave of gratitude toward the old man. I want to call him “Father.” He’s back at the computer now, typing. “Your test came back clean. We’ll go over the results in a minute, but there isn’t anything to suggest peripheral labyrinthine etiology. Now, is this impacting your ability to do anything?”
“My dizziness?” I sit up. ““No, that’s the funny thing. I can walk in a straight line, ride a bike, even play hockey. Physically, I can do everything I want. It’s only impacting…my subjective experience, I guess.”
“I find that to be just as important, don’t you?”
I swallow and nod my head. “I wanted to mention, before I forgot: I was incredibly dizzy during the hearing portion of the test. Do you think that means something?”
“It might,” he shrugs. “Impossible to tell.”
“Ok — well, I’ve also been taking Zyrtec — I think it says it on the form there — and that seems to be helping a lot. Do you think that has anything to do with it?”
“And why are you taking it?”
“My mom — well, my mom’s friend had dizziness for a while. She said she started taking it and it helped.”
He continues typing. “No, it shouldn’t have any impact.”
“So, placebo, you think?”
“Could be,” he says distantly. “Alright —” he snaps to attention. “I’m going to put you in for a neurology consult. I’m concerned about this 3–5 concussions, not to mention a history of migraines.” I think he can tell that some anxiety is rising to my eyes, because he begins to use his hands in a calming gesture, almost like bench-pressing air toward his feet as he rolls his way toward me. “Now now — if they don’t fix you up, you come right back here in about six months, and we’ll go from there.”
“Do you know about triple-P D?” I blurt out. I had plans, good plans, for how I wanted this conversation to proceed. But I suppose this was the one question I wanted to make sure I asked, and the clock in the wall was beginning to pound in my ears.
“What’s that?”
“It’s also called Chronic Subjective Dizziness. It’s like an anxiety-induced thing?”
“Neurology will know more about that.”
He slaps his thighs and stands up, indicating that he is needed elsewhere. Doubtless there are other patients in other rooms, sitting on wax paper and swinging their calf-covered legs like children. He extends his hand, promising once more that “we’ll getcha fixed up and back out there, don’t you worry.” And he’s right about that: worry does seem to be at the root of it.
I take his hand and ask him how I should leave. He gestures toward the doors I came through.
“And be sure to schedule your neurology consult with the check-out staff.”
On the other side of the doors is the waiting room. When the next staff member becomes available, I go over and tell him about my neurology consult.
“You have to do that downstairs,” he says.
“Downstairs…”
“That’s right, second floor is neurology. They’ll be able to set you up there.”
“Ok.” I stand up to go, then sit back down. “Oh, what about my appointment here in six months.”
“That’s what I’m putting you in for.”
After he and I find a time, I stand up to go again. Then I sit back down.
“What about payment?”
“You’ll receive something in the mail.”
“Do you know if my insurance has covered it?”
“We don’t answer billing questions here.”
“How about my copay?”
“Let me see here…” he scrolls. “Nope, looks like you’re good to go.”
“But something still might come in the mail…”
“That’s right.”
I stand up for a third time to leave before having my most brilliant idea yet.
“Do you validate parking?”
“Sure.” He takes my ticket and punches a stamp on it.
Feeling pretty okay, I descend to neurology a floor below and ask their check-in people for an appointment. They are very nice and tell me kindly that they don’t make appointments. But if I call this number — the woman hands me a card and highlights the number — they can take care of me.
“But they told me upstairs I could schedule something here.”
“I’m sorry,” she says, looking genuinely put out.
As I reach the lobby on the first floor, I realize something I didn’t quite up on the third — I am severely younger than most of the people here. The presence of elevator aides, whose job is to assist people in boarding the elevators, brings home the reality of what this place is: a farm for the aged. And what is being harvested, I think with heavy feeling, but the bulk of their life’s savings?
Down in the garage, I am able to find my car because I sent myself an email with its location — genius. When I reach the exit, the machine doesn’t recognize my validation, so I summon the guard.
“I don’t know where you got this,” he says, “but there’s no validation here.”
“ENT,” I tell him. “On the third floor.”
He shrugs and looks genuinely apologetic. “I’m sorry, but there isn’t validation. I can’t let you through until you pay.”
“Strange that they have a stamp for validation if there is no validation,” I say as I reach for my wallet.
“I don’t mean any harm.” He sounds exasperated already, and it’s not even noon. “I just can’t let you through.”
“I know you can’t let me through. I’m not upset at you. I’m just saying it’s strange that they have a whole stamp for something that doesn’t exist, don’t you think?”
“I wish I knew what to tell you. I don’t know what they do up there.”
“Ok,” I say. “Alright.”
I drive off.
* * *
On the way home, I call my wife and use the words “processed,” “demoralized,” and “confused” to describe how I am feeling. As always, she shows me kindness and care, but for some reason this doesn’t help. When I get home, I realize I’m starving — probably because the calls and text messages urged me to eat a very light breakfast. But I push off lunch for a few minutes to do some research.
Regarding the three areas that affect balance, I learn that vestibular basically means relating to balance and the inner ear, whereas proprioceptive means sensations connected with the position and movement of the body. Also, turns out that a major contributor to the literature on PPPD (persistent postural-perceptual dizziness) was once a professor of the department I just left, so now I’m pissed at Vietnam for not knowing anything about it — and I begin to worry that neurology won’t have a clue.
Throughout all this, of course, is dizziness. Just relax. Breathe. Everything will be okay, I tell myself. I try to let my wife’s voice take over. I try to imagine what my mother would say, not what her face would reveal. I try to feel the calm pulsing of my father’s stomach, the only cure for when I was young and worried sick about my homework. Best thing you can do now is to eat. That’s my grandma’s voice, carrying from the grave. So I order a salad and turn on a show, promising myself that at 2pm, I’ll start being productive.
2pm rolls around. I feel a freight train of anxiety about to arrive. 2pm and you haven’t done a single thing with your day? And you have no idea what that bill in the mail is going to be. You’ve got to get working, you should have been clearer when you called and asked about the cost, you shouldn’t have taken “no” for an answer. God, I fucking hate the American medical system — criminal — people worse off than me — can’t pay too much for your health, though — lucky we have the money, but still — should have utilized the services — like a big state school, need to advocate for myself — something Dad always said — keep up hope, that’s the main thing —
I am beginning to spiral when a thought materializes like a gavel.
You have to learn how to manage this. The thought drowns out all others, and I close my eyes in order to listen to it. You can’t let things like this affect you so deeply. You can’t wait for things to be perfect. Think of everything that you have. So what if you have dizziness, too? So what? You have to learn how to manage it. How to live with it. Otherwise, your whole life is going to be blown off course. Just remember, just continue to remind yourself that everything is going to be okay. Everybody has something, right? Nobody is perfect, are they? So it’s okay — everything is okay just the way it is.
I open my eyes, my resolve set. I’m going to move past this and be productive before my first client.
As naturally as water flows downstream, my mind turns next to the question of what I will do. My favorite past-time. Well, I want to get some reading done. It’s been a few days and it steadies me. Would also be nice to write about this experience, especially while it’s fresh on my mind. Might even be a good starting point for that book, the one about being a therapist in Philadelphia with dizziness and a lot of existential anxiety. Could also use some relaxation. I really ought to take it easier on myself — maybe I can start this afternoon. Though I did just get back from vacation. But vacation doesn’t really relax me. Ok, so I’ll read. Then maybe write a bit, if I have time. Hour of reading, hour of writing. Yes.
After a few hours of scattered attention and pathetic production, I hop in the shower, change, and begin walking to work. My office is about twenty-five minutes away, the entirety of which I am wriggling uncomfortably in my clothes, unable to dodge the absurd conviction that they are trying to strangle me. I show up a few minutes early, ascend three flights of steps to my office, and switch on the lights. It’s a bit hot out — still, in September — so I turn on the fan. The pillows need rearranging and there are some crumbs on the floor, maybe from another therapist having lunch. Then the chair seems a bit askew, so I shift it straight. On the way out, I nudge the noise machine with my foot. Moooooooo!
My client is in the waiting area when I come back downstairs. It is 5PM on the button. We proceed upstairs without a word, me trailing her by half a flight to give her cadence space. She enters the room and sits lightly on the chair, watching me intently as I close the door and sit down myself. Notebook in hand, I open to a clean page, click my pen, and look up, smiling gently.
“How have you been?”
