This article is part 3 of a series. Part 2 is here. Part 1 is here.

Pants Down To My Knees In A Closet

There I am with my pants down to my knees, a syringe in one hand, antiseptic swab in the other, and this strange guy sitting in front of me, casually acting like he’s guiding me through the simple procedure to truss a chicken for roasting.

I have a terminal dislike of needles. I began giving blood originally as an exercise of will, to do the right thing that I didn’t want to do. However, as I sat there with a hypodermic in my hand and my pants around my knees, the suggestion to self-administer an injection on no notice, with zero mental preparation, reached a roadblock.

I alternated stares between him, the hypodermic, and my naked, white, hair-mottled thigh for several minutes, while he coaxed and coached. On a blank paper, he scrawled a description of the B12 product I’d be receiving at the pharmacy.

Unreal

Most often at the doctor’s office, they’re good about giving professional looking printouts with more information and the office information on the paper. It was interesting to me that there was little of that formality or professionalism in this experience. Later research into the number of endocrinologists in the Austin area, made it clear the (lack of) competitive environment apparently hadn’t motivated endocrinologists to be concerned with minor concerns like how the patient perceives the experience. If this is best practice for the specialty, there’s miles of room for improvement.

No Plan B For B12 Injections

I asked him what’s our back-up plan: this didn’t seem like it was going to work. I’m a little taken aback by this whole situation, that this isn’t even the real deal with B12, and the surprising way the office apparently failed to communicate or perform this sequence of events in the “standard” way that might actually work for me, the patient.

He said there really isn’t a Plan B. We could consider orally administered B12, but that’s not standard, and it’s not certain to work.

He added the words to look for on the over-the-counter bottle of oral B12 at the store, 5,000 or 10,000 mcg, to that briefly scrawled paper, reiterating that this isn’t the recommended protocol and it’s against doctor’s orders. I wonder if the doctor has an incentive for pointing the patient to the prescribed injection instead of the over-the-counter oral supplementation route.

Plan C?

Finally, he appeared to give in. Apparently I hadn’t reached the stage of suffering, or zen-like self-control, to self-administer an injection with an inch-long needle. I handed the hypodermic and the spoiled gauze package.

My experience in this situation was not one of winning. I felt surprised, toyed with, manipulated, shanghaied. There I sat in a tiny room the size of a closet, with a middle-ages or modern-style confessor. It was as if his job was to talk me into giving up my personal rights in the name of the state to avoid the vaguely implied threat that might befall me if I don’t.

He said I’m welcome to call if I have any other questions. I asked him his name and how to spell it, and I wrote it on the paper with the pen he’d left on the counter. I could get a generic business card at the front desk on my way out.

Winner!?

I took the oral B12 for a month, then I re-tested. The doctor said I had to stop immediately because my B12 level was 4 times the highest acceptable normal level.

What Next?

This story continues here.

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