Urgent Care.

I remember when a doctor would return all phone calls to patients and decide over the phone to make a med adjustment. Those days are long gone - in my neck of the woods.

My PCP is a P.A. This summer, I felt very sick and called. My primary's nurse told me to go to Urgent Care. Urgent Care told me to go to the ER. The ER decided I needed to be admitted. (My belly pain was diverticulitis.) That, actually, was a good outcome.

No one at Urgent Care is going to make a dosage change in my antidepressant. They'll tell me to wait to see my primary. If I seem emotionally distressed, Urgent Care would send me to the Crisis Unit at the psych facility. The psych crisis staff would tell me that this is not a crisis and that I should wait to see my primary.

If I wanted to try harder to see my primary, I would have to give a reason to a scheduling clerk. I do not like to discuss a psych issue with a clerk. I could tell the clerk I want to discuss the nature of my request with a nurse. Then I could tell the nurse that I have felt very mentally distressed. Most likely, the nurse would then tell me to go to the Psych Crisis Unit. No pdoc there is going to make a med adjustment without me getting a full psych eval. To get that will probably take longer than to get in to see my primary. Plus, I hate the Psych facility and will avoid that place at all costs.

There is a psychiatrist who does some med management at my primary care clinic. He used to manage my psych meds. In 2020, 3 weeks after my boyfriend died, I contacted him to say I was becoming seriously depressed and intensely anxious. After 5 minutes of conversation, he said that my only problem was grief and that I did not need any further psych help. He was very curt and practically hung up on me. A few days later, police sent by my sister, did a "wellness check." They found me in a mess, crying hysterically, and took me to a hospital ER not connected with where I normally get my care. That ER found that my nervous stomach, which I thought was jittery from grief, was a serious intestinal infection. Plus they felt I was very depressed and sent me to a nice, small psych hospital that I'ld never heard of. Since I admitted to owning 3 handguns, that psych hospital kept me inpatient and treated my infection with two antibiotics. I was discharged 6 days later, feeling much better and able to cope.

To be utterly alone after the death of a spouse or significant other is brutal. Immediately after the funeral in New York, I had to fly back here to empty out his apartment. Out here (in the Southwest) where we both were living, we had no family. After I finished that job all by myself, with some help I hired, I mentally became unglued. The infection probably was a factor also in my coping capacity failing me.

When I lived in the Northeast, I always had ready access to an attending physician and to a consulting psychiatrist. Of course, that was a long time ago. Also, the delivery of medical care in the area around NYC has evolved rather slowly. It is also an area where the ratio of physicians to population is quite high. Out here, in the Wild West, it's a whole other story.

As a nurse working in nursing homes near NYC, I would be responsible for 15 to 30 parients. Out here, I would be assigned 45 to 60 patients. To escape that grueling workload, I switched to working in correctional facilities, where the typical environment was much nicer than in the typical nursing home. (That ought to tell you something.)

Thanks for listening, anyone who's managed to get through this.