Captains log. Star date: Sunday, 2/22/26. I pick up my parents from the airport, who are coming in town for a cousins wedding. We travel into the city with some flurries and a predicted forecast low of 25F. I had purchased a new longer coat in anticipation for the snow and cold. I was looking forward to the time with my father and his side of the family (Irish). The crowd is loud and lively, full love. Family, friends, new family, wine. I sat next to one of my many cousins. Her husband was unable to attend due to illness. She of course was then by proxy, a carrier. This was the first time in a long time I was unmasked in a dense public space. I’d say a wedding party of 150 people. Nothing to exorbitant, but that number doesn’t include staff. I wanted to look nice, have a good time, for her sake, and my deceased uncles sake (her father).

Waking up on cold days, the pain and fatigue is normal.

At least, that’s what my husband had accustomed me to. He’s a chronic sufferer of sinus pain and headaches. So I assumed it was merely dry, cold, and something that would pass. (He also ended up going to the Doctor and getting the same diagnosis as me, by the way). Coupled with this, I had been ignoring ongoing heart palpitations, skips, arrhythmia. The week passed, and by the time the following Saturday had come, I was waking up feeling hollow, heart skipping, and now had ear pain. Having already established with work that I needed to visit the USA’s favorite attraction: the DMV to renew my license; I took the liberty to contact the boss and say in advance I would take the full Tuesday off instead to visit the doctor. I had another doctor’s appointment that day anyway later in the evening.

Walk-in

Unfortunately the DO I scheduled with ended up being out of the office. I saw a nurse practitioner instead. Totally fine. It’s been a while since I had an EKG, and the test came back okay. So I just need less coffee, more activity I suppose. I mentioned minor congestion and a feeling like I had to cough, too. I had also woken up with minor ear pain as well. Further inspection revealed fluid behind the ear, inflammation in the sinus. Expected, but severe enough to where the nurse said I was at the tail end of fighting something viral, and wanted to put me on antibiotics. The last time I was on antibiotics like this had to have been over a decade ago. Reluctantly, I listened to nurse and took the meds.

A meeting with the APN

After that, I had one more stop for the day. A regular meeting for medication management with the psych. I’m very stable, and my (new) psych is happy with me, blah blah. You see I had a change of insurance last year, and since then I’ve had to shop around for a psych. Yes, shop. Budget expenses. All that. Unfortunately, my insurance informed me that any in-network discount would be coming from some sort of hub outsourced and ran through Texas. It was impossible to get humans on the phone, I was back and forth with voice mails constantly. Even when the issue was resolved, I got calls back asking if I had an issue still. I thought “this is just what I have to do to remain stable”. I paid $200+ per visit, out of pocket, for three months attempting to get information about decreasing visits and reducing costs. To no avail. My psych was honest and very empathetic. However, I was clearly trapped in the system. Due to a C IV RX, I was instructed the 30 day visit cycle was necessary. Even though I’ve never been an abuser. Been sober. Been stable. I had only seen my former psych every 6 months. I informed my psych these visits were not tenable. They were upset, maybe a bit too emotionally attached. This is for the best then. I scheduled the follow up in case, stating I was willing to get off of this med if I had to in order to make my care more affordable.

Shopping with symptoms

Four pills and a little over 24 hours into my round of antibiotics, I started to feel off. At work, abdominal pain crept up. I assume it was due to having to take the meds with food, and went about my day. During slower moments, I emailed different psychs, shopping for a new one. It’s impossible to get in touch with offices after 4pm, sometimes 3pm. Some days they are closed entirely. So I let my co-workers know I may get some calls I had to take. One call back was from an older lady. She sounded like one of Marge Simpsons sisters. An audible nihilist, she asked me “what I wanted”. I simply stated medication management, and wanted to confirm insurance and office visit costs. $495 to establish myself as a patient, and $160 for every visit after. The number of visits required would be variable per psych as well. I thank her for her time, she wished me luck. Another offered free consultation… my request for billing procedure going unheard. I was losing hope fast. My insurance gave me a list of providers in network. I printed it, and was going down the list. The prospects were harrowing. The first dozen doctors listed all were in the same office, all used the same mental health hub I was trying to escape. One web page even 404’d. No dice. My abdominal pain continued. A low fire began searing my flesh. I saw blood. It hit me like a ton of bricks. This is why I hated being on antibiotics. It had been so long, I forgot. The woman debuff.

Second visit

Now I was stuck messaging my primary care and women’s care hospital about side effects of my antibiotics. I had my suspicions as to the cause, but I am not a doctor (and neither is Google). To my surprise, both offices replied to me quickly, and both wanted me to come back in. My anxiety sky rocketed. I left work an hour early. The doctor I was supposed to meet with on Tuesday replied first, and was primary care, so I thought it was better I go to a catch-all scenario. That night, I went back in – last call. I’m lucky to have access to care like this. Sincerely. The staff are generally younger, and mostly women. I think that… yeah it’s true sometimes, the older male doctor crowd is still kind of old school. It’s not that they don’t take women seriously, it’s that “this is just something women have to deal with”. More science, less problem solving. Don’t get me wrong though; every surgeon I have had has been male and they have all been excellent. But you are just a body to them, and you are one of dozens of procedures they may do that day. Anyway. I got the usual temp, BP, blood ox check in with the young nurse who commented I looked “cozy” (some fuzzy slippers, flannel pants, a hoodie) I thanked her and said “well I’m a bit sick and not dressing up for the doctor” jokingly.

Stickers

While I waited for the DO, I noticed a tiny basket of stickers off to the side. Most were rather silly. This seemed like… something juvenile. A childish thing. Yet it struck me. Some were flowers, or a brain that said “mental health matters”. Some were in Spanish. It opened the floor for conversation. It made me comfortable. I took some silly ones for my spouse (a cartoon possum hissing about stress in a live laugh love world) and I took the mental health brain for myself. The DO entered, I said “don’t mind me I’m looking through your stickers”. She was excited and insisted I take some. She was also a much younger woman. I said I had taken some, and thanked her. I explained my short journey through a diagnosed URI, and sudden side effects. She confirmed my meds with me, typed on the computer, usual things. She turned and asked me if I had heard of prebiotics, probiotics, and the bacteria balance after taking antibiotics. The bacteria thing yes – that was my primary concern; my immune system was more vulnerable to a different type of infection. Maybe I had the wrong antibiotic. She did not mince words, using the nomenclature verbatim about the science of the situation. The prognosis was good, the diagnosis normal, the cure over the counter. Another prescription just in case. I was relieved.

Is there anything else I can help you with?

In hindsight, this question is rarely – if ever – gets asked to me in a doctors office. Not that I end up there often. It’s usually cut and dry. Here’s your diagnosis, feel better. Right? Well, the floor was open. It had been open since I saw the stickers. I jokingly asked “Well, can you make psychiatric care more affordable?”. Her immediate, nonchalant, serious reply: “Yeah, sure. I can manage your mental health.” In disbelief at such a claim, I said I was on a controlled medication and the psych had to see me every 30 days or they wouldn’t give me refills. She glanced back at the PC. “For Bipolar Disorder? You’ve been treated with this since 2021 and have been stable. It’s no problem. I’m on Adderall for ADHD, it’s C II. I understand.” She confirmed the pharmacy and wrote a 90 day RX on the spot. Stunned, I thanked her again. I cried for a bit in my car, then left for the pharmacy. I found the specific prebiotic and went home. I sat in the driveway for a bit, thinking.

Has it always been this way?

Reflecting back on the past 20 years of mental health struggles, I could only remember one situation where a PCP was willing to write a prescription for a mood stabilizer. Never the C IV, and the C IV is new to me too (on it for only for 5 years or so). The office was a private office too, one I had to move from due to the American healthcare system and ever morphing insurance policies, and me aging out of dependent care. I recall paying out of pocket a lot for my meds. Upwards of $100 for 30 days on just one med, sometimes the pharmacist being pretty useless, not explaining insurance issues that came up, changes in manufacturers. The psych not offering generics. Maybe the insurance not offering discounts on generics. Maybe you can only go to a certain pharmacy. This isn’t something taught. You have to learn the hard way. For that matter, mental health has caused instability in my employment. I’ve gone years without insurance, or with limited insurance networks. I’ve been on my spouses insurance for so long. It’s so expensive, it cost over $18,000 per year to cover the both of us. That’s not including co pays, prescription costs, emergency visits… Now, on my own insurance, the costs are supposed to be reduced. It was supposed to be easier.

The American healthcare system, particularly with mental health, is a massive moving labyrinth. So I guess sometimes you just get to ask your PCP and they’re comfortable managing all your prescriptions? Skip the regular visits? It’s even potentially easier since some meds they like to monitor blood levels? Then everything gets to be in the same office? Surely I lucked out. The back and forth for the past 8 months with my insurance and doctors offices begging for coding, billing policy, just to stay sane. This is one big blessing to count, and I’m afraid I’ll lose it. I lucked out.