The Specialist and The Undertaker

“I tell you, the old-fashioned doctor who treated all diseases has completely disappeared, now there are only specialists, and they advertise all the time in the newspapers. If your nose hurts, they send you to Paris: there's a European specialist there, he treats noses. You go to Paris, he examines your nose: I can treat only your right nostril, he says, I don't treat left nostrils, it's not my specialty, but after me, go to Vienna, there's a separate specialist there who will finish treating your left nostril.” Fyodor Dostoyevsky, The Brothers Karamazov

It seems finding the right medical attention would have been easier in 1880 Russia than it is now for my mother in 2015 Western Massachusetts. At least 135 years ago, there was some humor to be culled from the absurdity of the process.

My mother has been ill with a few possibly related symptoms. It’s easy to jump to conclusions, and naturally the worst-case scenarios plague me day and night.

I’m not a doctor, so I cannot diagnose and treat her. The problem is the person “treating” her isn’t a doctor either. Trapped in Western Massachusetts, she is limited by the number of medical practitioners she can chose from without having to travel to Boston or New York, or Paris or Vienna, which she doesn’t want to do, at least not for repeat visits.

The utter incompetence wrangled in outright arrogance of the Western Massachusetts “medical community” astounds me. My mother has been mistreated in so many ways. I’m often tempted to find a lawyer to make the case for medical negligence, even abuse.

Whether it’s personal or just the way this small-town system disrespects the elderly, my mother sees a physician’s assistant rather than a medical doctor. The practice claims this is all she deserves, despite have Medicare along with a pricy state plan my father had paid into for decades as a state university professor. My mother says this non-MD is “nice,” but yet every time she leaves that office her health continues to decline.

Meantime, my mother has been banned from one of the few specialist offices in this insular community, because she went to see another specialist, one time. It is against the “office policy” to “allow patients back after they have left the practice,” say the churlish staff who command the phones and act as gatekeepers for anyone with any potential intelligence.

For my mother, the challenge of finding doctors to treat her among these parochial confines, is complicated and restricted by an abundance of those who have failed to diagnose and properly treat both my mother’s parents, and my father. All three arguably suffered more than required and died prematurely due to a lack of proper medical attention, even negligence. My mother had been encouraged to file negligence claims. If only for fear of being further ostracized from the Western Massachusetts pond of medical professionals, she refused to take any legal action.

Yesterday, when I called her from my office to check on her latest and most alarming symptom, I asked if she’d made a specialist appointment. After enduring inane phone calls with the office that refuses to allow patients who have “left the practice” back, I embarked on a search for an office with any semblance of compassion.

I finally found another specialist practice, with a far less surly receptionist who heard my plea for my mother’s immediate health woes. Her symptoms constitute what merits a 911 call, but she’ll never make the trip to the ER or consider the post-insurance expense of an ambulance. Meantime, her “primary care” office, by denying her visits with a physician, repeatedly dismisses these critical red flags.

In the midst of this painful conversation -- she was choking back tears and riddled with anxiety and I was mustering any ounce of emotional strength to not openly and loudly weep, instead gnawing the insides of my mouth to keep mum – she shifts gears.

“I know you don’t like taking about funerals,” she opens her new train of thought. This has begun many conversations that have lead along a somber path in my mind and heart, and she knows that.

“But I have to make a decision about a pre-payment I made …”

I’ll abort the conversation, as the minutae of this doesn’t add any substance to the story.

Many hours after my unsuccessful attempts to answer her financial advice query, my husband -- who is far wiser and better equipped to advise her on such matters – managed to elicit her sardonic humor as he explained that her pre-payment was “safe.” She joked that perhaps she’d selected the wrong coffin color, as her eyes are blue, and they’d be closed anyway. I lack the disarming charm to win her jest.

As my husband puts it, “all she knows is death.”

From her early childhood, as the sole surviving sibling, watching her youngest peers, family, and other loved ones, shot down, blown up, brutally murdered, or die from starvation or exposure to elements, it’s no wonder this obsession with death seems “normal” to her. Moreover, none of the lives taken during her early years in prison and work camps, and on the run from various enemy factions, have any real existence after death. There are no marked graves. She has vague recollections of which oblast (region) some were dumped into mass graves. There was no opportunity to mourn properly, to practice any ritual, to honor the dead in any way, at the time of their death.

Even in her “free” life as an American, she has witnessed decades of anguish and torment, especially with the extended illnesses of her parents and her husband, all of whom she cared for alone, at home. She spared no expense for their funerals, but is frugal planning hers, aside from wanted to be sure limo services, taking her survivors 180 miles to and from her home to the monastery, are paid for.

To her, the right of burial is a great honor. I just wish I could make it easier for her. Coming from a very different perspective – one of weakness and a lack of the real-life experience that most people in a violent world must endure -- I empathize, but so detest the business of death in the United States, and want no part of it. For her, even the most gruesome of “parlors” offers a dignity that doesn’t exist during war or in death camps.

By the time I was my son’s age, 5½, I’d attended dozens of funerals with open caskets. After all, it’s just an extension of Russia’s death-laden folktales or skazki. And those are for children.

Vladimir Propp's The Historical Roots of the Magic Tale (1946) was criticized for being too dependent on Western scholarship and, worse yet, placing Russian narrative in a global context. Written 18 years after his Morphology of the Folktale, which was panned for being too formalist, Propp aimed to prove that folktales originated in ritual, especially initiation and funeral rites. In order to avoid prison and losing his professorship, Propp’s subsequent work, Russian Heroic Epic (1958), would take on a more Marxian, even Marxist, tone. But seven years before his own funeral, Propp returned to the acceptance and explanation of calendrical ritual in Russian Agrarian Holidays (1963).

To this day, I dream of mass graves I have never seen, but was told about as a young child, as well as funerals, past and future. My science-focused son speaks frankly and openly about death and dying, even as it relates to humans. But he has yet to ask me about a funeral. Trust that with my own myth-steeped experience, that’s the “big talk” I most dread as a mother.