Pulmonology Redux

Hopping out of a cab in DC mid-March into a spring sunshine is elating. 244 Elm St. NW. That elation quickly disappeared when I called my doctor's office to find out why their eight story office complex was not readily apparent down this quaint, residential street near Howard University.



"For our address, please press four." Remove phone from ear. Press. Replace. "We are located at 2440 M," with a popping M-phasis, "street." Oh. That's about 24 blocks from 244 Elm St. and there aren't many cabs around.



Twenty minutes later, having paid double the cab fare for my error, I entered a pretty packed waiting room. My first impression was that people in their late twenties don't suffer many pulmonary disorders. Looking around the scene from a well-populated motel-lobby, I calculated I was the minority by about ten years.



If the decor was off-putting, the rest of my stay in purgatory wasn't. The forms were clear, bolding and underlining the quirks of the office so they pop out at you -- provide a CC number so we can charge that if you don't send a check to cover that which your insurance won't, and so on. All the while that I was printing, scrawling, and dating my name, nurses shuffled over to waiting patients. They knew their names. They spoke in a soft, familiar tone, and they genuinely hoped the elderly woman or the lightly wheezing man felt better between this and the next visit.



"Mister Cohen!" This would be the first of many sharp reports from deep within a Caribbean matron behind the desk. "C'mon back," pronounced "bock," and I was in.



I haven't disrobed for a doc since my physical, and that, at least, was expected, so when I was handed a gown and told to unbundle to the jimmies, I was put off. Exam rooms are stuffy with a minty, electric air anyway. This one was a little older, a little more used. The mintiness had gone stale. I obliged and draped my clothes on the chair, the scale, my shoes. Just as I finished the doc knocked. He is one of those people you don't really see as they wander by down the street. Not invisible, just unremarkable. Still, this was "Washington's best" pulmonologist of 2005. By the time I left, I counted at least seven lexan awards and several framed announcing the same peppered from room to room.



He took a history, jotted a bunch of notes, asked what seemed to be right questions, and, most important to my taste, didn't rush the experience. "Did the Advair work?" Kinda. "Like this, or like that?" More like the second thing. "Ah hmm." We ran through a test pattern of noises that I might have made. Yes, I hack. No, I don't snort or wheeze. My throat closed up when I ate spicy food. No, I don't have any symptoms of heart burn. Scratch, scratch, scratch. "Great. We'll get you a chest film and a breathing test."



"Mistah Cohen!" I donned my pants as instructed and headed for the x-Ray room. The only light in most of these rooms comes from the protective portal to the operators booth. That is, until they turn on the machines cross-hairs. This one stands up and looks like a robot about to give a mechanical hug. You lean into one of the arms. The other holds the xRay gun. You end up facing a wall two feet away that contains the developing machine, the power supply, and two heavy chemical resistant gloves. They look like hazmat gloves and the spray of brown fluid on the wall below them creates an unsettling combination. A Lysol spray-can completes the tableau. "Shoulders forward." A quiet instruction followed by the unease of cold metal. She steps into the booth. "Dip Breth!" The sharp report at four times the volume would make you gasp involuntarily anyway. The gurgling sound starts behind me and trails off a wet exhale. One more from the side and I am back putting on the rest of my clothes.

I thought going in that I might like the breathing test. I am a big fan of breathing and a big fan of computers. I figured doing one and seeing it plotted in real time on the other might be neat. Problem is, you don't go for a breathing test when you can breathe, you go when you can't. That, and the mechanical arm with a variety of hoses hanging off of it is reminiscent of the scream sucker from Monsters Inc. My Caribbean commandant tells me to sit and explains that when she stops cooing "nooormallll" and barks "Dip Breath!" I should suck and then blow until I am blue in the face and not stop until she instructs me to do so even though it feels like the last ounce of humanity is now seeping into the breathing tube.

It took me three or four tries. I took two breaks as I lost the ability to breath. Turns out that if you don't blow hard enough or long enough, the test parameters are no good.

More waiting. The doc comes back to get me. Chest films are clean. Breathing looks normal, perhaps slightly asthmatic, but this is most likely post nasal drip. He concludes that we take the Veramyst and Claritin D for three weeks and we'll see where we are. I ask if it is normal for a cough to last this long. He says it's possible. What about developing asthma in your late twenties. "It is not rare." Personally, I hope it's rare enough, but I guess we'll see in a month. Right now, I have drugs six and seven of my progression to get me through the day.