The Gizmo That Worked

Jimmy Bartlett considered Dr. Davis’s words. He had doubts. It wasn’t that Jimmy had never heard the term “sleep apnea” before, but he was certain he did not have such a condition. He wasn’t obese. Sure had a few extra pounds, maybe 10 tops, but he wasn’t what he thought of as fat. He was sure only those who struggled with weight issues had sleep apnea. He never had trouble breathing, another condition that he had heard leads to sleep apnea. He wasn’t sure what to say and for a moment he didn’t think Dr. Davis was would say anything at all. So he just stared and tried to ignore how awkward he felt.

“Jim, Jimmy, do you understand?” Dr. Davis said, breaking the silence.

“Doc, no offense, but there is no way I can have sleep apnea,” Jimmy said. “I’m not obese, my nasal passages are all good, and I mostly sleep through the night.”f

“That isn’t how it works,” Dr. Davis said. “The issue you have is a short throat and small oral cavity. Remember when you had to have 4 teeth removed before your orthodontist would give you braces?”

“Yeah, they said it was because my mouth was too small for all my teeth,” Jimmy said.

“Well, I showed you in the mirror,” Dr. Davis said. “That fleshy part of the back of your throat shouldn’t be as visible like it is. It means your airway can get blocked and you stop breathing. You said you snore, right? And it has woken you up?”

“Yeah,” Jimmy said. He felt defeated. He still didn’t understand, but Dr. Davis had been his doctor since he was 4 years old. He trusted him. It was just hard to understand why it hadn’t come up before. He had to ask. “Why is this the first I’m hearing about it?”

“I’ve noticed it, Jimmy, but that alone doesn’t guarantee a patient will suffer from sleep apnea,” Dr. Davis said.

“But you’re sure I do?” Jimmy said.

“Yes, but I want you to get a sleep study to confirm,” Dr. Davis said. “It’s easy, you just go there and sleep. There is an option to have it done at home, as well. They just send you a device to wear overnight.”

“A device?” Jimmy said. Next to the word moist, device was his least favorite word. The only reason he had a cell phone was because his job forced him to carry one. He only used it for calls. He was aware of things called apps, but he didn’t know what they were and didn’t want to know. He considered himself old school. His watch was a wind up. The alarm clock on his bed stand was a wind up. The hardline phone at his house was just like the cordless he had in the 80s. As far as he was concerned, the last greatest tech he had seen was the microwave. Most of his meals were prepared in the big microwave his daughter had given him for Christmas 15 years ago. If he wanted a home cooked meal, he drove to Mama’s Café. Not even his car had any of that computer crap in it. He wouldn’t buy anything built after the 70s.

“Yes, it’s a simple little device that monitors your pulse and breathing as you sleep,” Dr. Davis said. “You won’t even realize you’re wearing it once you put it on.”

“I doubt that, Doc,” Jimmy said.

“Look, I can’t make you do this, Jimmy,” Dr. Davis said. “You told me you sleep 8 hours, but never feel rested. You said you’re tired all the time. I think the cause is sleep apnea, but the only way to know for sure is a sleep study.”

“Ok, ok,” Jimmy said. It was true. He slept more than 8 hours some nights, but never felt awake in the mornings and would doze off during breaks. He was a union carpenter. He supposed the power saws and lathes and mills he used were advanced tech compared to hand tools, but it was different. They didn’t have computers. He knew there were machine shops that had computerized lathes and mills, but he never used them. He didn’t trust computers. He had seen plenty of sci fi movies where they came to life and tried to wipe out humanity. He wanted to be sure if that happened in real life, nothing in his home would be connected to the big AI or whatever it was called.

“Good, now take this to Brenda up front and she’ll get the referral for you,” Dr. Davis said as he handed Jimmy his chart. “Get this done ASAP.”

“I will, Dr. Davis,” Jimmy said. “Thanks.”

“No problem,” Dr. Davis said. “Brenda will call you when the results are sent to us and schedule a follow-up.”

“Ok,” Jimmy said.

Jimmy left the exam room and walked around to the checkout desk. Brenda was on the phone, so he waited to for her to hang up before saying anything. He liked her. She had been there something like 10 years. She reminded him of his Aunt Eugena, always smiles, always that pleasant, calming voice. She even had the same salt and pepper bob cut. He opened his chart to see what the doctor had written.

“Jimmy, how are you?” Brenda said in such a way it was like running into an old friend you hadn’t seen for years.

It startled Jimmy, causing him to slap his chart shut as if the teacher had caught him writing notes. “I’m good,” he said. “How about you?”

“Fantastic,” Brenda said. “You got something for me?”

“Doc says I need a referral,” Jimmy said. “Some kind of sleep thingy.”

“Oh, sleep study, yeah,” Brenda said. She reached out her hand, “well, give it, let me see what he wants you to do.”

Jimmy handed the chart to her and she flipped it open. He watched as she read the first page, the referral request, then flipped it over and read the examination notes. She was nodding just a bit as she read. He could see passed her into the waiting room from where he stood. It was a full house. It always was. Dr. Davis was well liked and most of his patients were second and some even third generations deep. Jimmy’s entire family saw the doc. Even his ex-wife had switched doctors after meeting Dr. Davis. She still went to her lady doctor.. OB something, but for colds and such, it was Dr. D.

“Ok, Jimmy,” Brenda said, looking up from his chart. “I’ll send the request to the North Main sleep clinic. They will reach out to you. Looks like Dr. Davis is requesting the in home study if they have it so you may not get a call, but receive the monitor in the mail.”

“They won’t call to tell me how to use this thing?” Jimmy said.

“No, it comes with instructions,” Brenda said. She turned her attention to her computer screen and started tapping away at her keyboard.

Jimmy felt a knot in his gut. Instructions. He didn’t do well trying to read instructions for this new-fangled computerized stuff. He lost himself in the thought of trying to put this contraption on before he went to bed. There wasn’t a clear picture of what this device may look like or how it would attach to him, but he was sure it would interrupt his sleep, which would then give the docs the impression he needed more tests or whatever.

Noticing the uncertainty in Jimmy’s face, Brenda said, “They have a number on the instructions if you need to speak with someone. It’s really easy to use. There’s as strap and it wraps around your chest. That’s pretty much it.”

Jimmy nodded. “OK”, he said. Brenda did ease his mind a bit. He would try to keep his anxiety to a minimum until he got a look at the thing with his own eyes. Then he wondered and said, “How long before it would deliver?”

“Let’s see, today is Monday,” Brenda said. She looked at her screen and then back to Jimmy. “Probably get it on Wednesday,” she said.

#

A week after Jimmy strapped the gizmo to his chest, certain he wouldn’t fall asleep but glad he did, he was sitting in the waiting room at North Main Sleep Clinic. He was anxious. His legs were both bouncing and he noticed the woman next time seemed to be annoyed. He stretched both legs out and crossed his ankles. It would stop the bouncing, but his top foot would still waggle back and forth. He felt too warm and could feel beads of sweat on his forehead. He wiped them away. He was happy to hear that the gizmo was able to provide enough information to the sleep doctors that no further tests or study or whatever they called it would be necessary. His anxiety stemmed from them advising that he did have sleep apnea and needed an in person visit to discuss treatment. He looked up each time a nurse opened the door leading to exam rooms, expecting to hear his name. He felt as if it had been an hour, but his watch told him it had been 20 minutes since he sat down.

“Mr. Bartlett?” A nurse announced as she opened the door Jimmy had been staring at for 5 minutes. She looked at her chart again just as Jimmy stood and said, “James Bartlett?”

“That’s me,” Jimmy said as he crossed the waiting room to stand accounted for.

“Follow me, sir,” she said.

She led him down a hall that looked like any other hall in a doctors office, but halfway there was another waiting area that was more like a lounge. There were comfortable couches and snacks and drinks. There were no patients there, but it looked very comfy to Jimmy. Further along, as they passed rooms, Jimmy peeked inside those that were open and saw they had regular full sized beds with night stands. They looked like hotel rooms more than treatment or exam rooms. They turned the corner and the nurse opened a door, smiling.

“Have seat, Mr. Bartlett,” she said. “Dr. Ross will be with you in a few minutes.”

Jimmy chose the chair closest to the round stool that was typical in most exam rooms. He surveyed the room and saw nothing that indicated it was any different than the rooms at Dr. Davis’s office. The exception being, the posters on the wall were all about adequate sleep rather than high blood pressure or cold and flu prevention. One poster did catch his eye that was more medical in appearance. It showed the inner workings of the throat and nasal cavity. The poster begged a question in large, bold print along its top – “What causes sleep apnea?”. He figured the wait would be another 10 minutes or longer so he stood to get a closer look and read the smaller print. He took one step when he heard the sound of his chart being pulled from the holder on the door. He sat back down just as the door opened.

Dr. Ross was younger than he expected, but his demeanor was calming. Jimmy was surprised by the effect the doc had on him without saying a word. The Dr. Ross said, “How are we doing?”

“I’m good,” Jimmy said. “I just want to get this over with to be honest. I don’t like the sound of any of this. That do-dad you all had me wear was stressful enough.”

“Oh, How so?” Dr. Ross said.

“I don’t trust gizmos,” Jimmy said.

“Well then, Mr. Bartlett, I’ve got good news and bad news,” Dr. Ross said. “The good news is that your sleep apnea could be much worse. You stop breathing 15-20 times an hour in your sleep. This isn’t horrible, but not great. I want to get you on a CPAP for a bit, to see if that will help.”

“Is that some other wacky device?” Jimmy said.

“Yes, but one that could prevent you from dying in your sleep,” Dr. Ross said. “It will also help with a lot of other health issues. I’m going to give you some information on that. I don’t want to keep you here longer than you’re comfortable.”

“Ok, doc,” Jimmy said. “I appreciate that. I gotta admit, I’m feeling anxious and would like to get home.”

“ I understand,” Dr. Ross said. The door opened and a different nurse than the one who led him back came into the exam room. She was holding a what resembled a camera bag. “Hi, Claire, would you take Mr. Bartlett to a consult room?”

“I sure can,” Claire the nurse said.

“Jim, this is Claire, she’s going to explain what a CPAP is and how it works,” Dr. Ross said. “Then she will fit you with a mask. Shouldn’t take more than 15 minutes and then you can ask her any questions.”

Jimmy stood up, his legs felt weak. He felt light headed, but shook it away. Nurse Claire reached for him out of concern. Jimmy held up his hand and said, “I’m good. I’m fine. Lead the way, young miss.”

The rest of his visit was a bit foggy. The room Nurse Claire led him to was much more relaxing than the exam room. The light was softer, the furniture more comfortable and there was no exam table present. Nurse Claire pulled the CPAP out of the bag that looked like a camera bag and showed Jimmy what the buttons did and what the readings meant. She told him he would need to get distilled water to use and showed him how to fill the reservoir. She showed him in the instruction book where it explained the displays in more detail and why the water was needed. The readings would be sent via cell signal to the clinic where they would review it each day and determine if the CPAP was helping.

Next, Claire pulled out a few different types of masks that would push continuous airflow to the wearer. This was to keep the throat open. There was more to the explanation, but Jimmy zoned out. He focused more on the comfort of the masks they tried on. He wanted none of this. He had his mind set that he would not wear this thing on his face. How would sleep even be possible? How could such a contraption help… just blowing air into his nose? It had to be a scam. It was bunk and a way to charge his insurance more money. This was what most technology was. A way to make the rich richer.

#

Jimmy took the device home and called his daughter to try his best to explain what happened at the sleep clinic. He was surprised that she knew what a CPAP was and that she could help him with it. When he told her he wasn’t going to wear the damn thing, she scolded him. It was an unnatural feeling to be scolded by his daughter. His normal reaction would have been to “put her in her place”, but on some level he guessed she was right. He promised to use the CPAP.

#

It took some time for Jimmy to get used to using the CPAP. He went back to the clinic two more times. He didn’t like how the mask fit, how any of the masks fit. He knew the reason he didn’t like how the fit was that he didn’t want to wear any of them. He didn’t trust that a machine blowing air into his nose or mouth or both was going to solve any sleeping issues for him. He made a promise, though, and was determined to keep it. The sleep clinic wanted to see him in 30 days, but they would receive data from the machine every morning. It was another feature Jimmy disliked. It felt like he was being watched and he didn’t need one more piece of tech monitoring him in any way. It was bad enough he had a “not so” smart phone that received texts and calls from people wanting to sell him car warranties, sign him up for college courses, or help him pay off his non-existent student loans. The worst calls were from the IRS, DEA, or FBI claiming he was in big trouble and he needed to provide information or pay a fine over the phone to prevent agents from coming to arrest him. He knew it was all crap, but wondered what new hell the info on the CPAP would send his way.

There was one mask that fit comfortably. Jimmy refused to admit it to the doctors or his daughter, but he didn’t mind it so much. He could roll over one way or the other and not get tangled in a hose as long as he didn’t try to roll over in the same direction. When he woke up in the morning he found that he liked the machine told him how many hours he wore the mask during the night and how many events he had… which meant the average number of times he stopped breathing per hour. He liked what he saw. According to the digital readout, he was average 2-3 events per our each night. This was a huge difference form 15-20 per hour. He even noticed that he felt better in the mornings. He felt rested. His friends and family noticed the difference as well. They would comment on how his eyes weren’t so puffy and his attitude was more lively and upbeat. As much as he wanted to tell the docs at the sleep clinic they could shove their damn machine, he knew when he returned for his follow up, that it wouldn’t be easy to convince them he didn’t need the machine. He had already convinced himself that he was better when using it. He had 3 days before the appointment when he settled his mind to be honest and admit that he felt better than he had in probably 10 years.

#

The day came that Jimmy returned to the sleep clinic. He sat in the familiar waiting room. He had spoken to Dr. Davis the morning before. Dr. Davis wanted to know how he felt and to remind him that he wanted to hear from Jimmy after his follow up with Dr. Ross. He stared at the TV. CNN was on, but it was background noise to Jimmy. He was preoccupied imagining the conversation with Dr. Davis. His eyes registered what was on the screen, but in his head, he was at home on his cordless talking to his long time family doctor about a stupid machine that turned out to be not so stupid. He felt a tinge of embarrassment that he pushed back so hard about using it. He had gone so deep into the imagined conversation that it wasn’t until the nurse tapped him on the shoulder that he realized she had been calling his name. He looked at his watch, only 10 minutes waiting. He hardly noticed.

The nurse led him down the familiar hall, passed the lounge area, and to the same exam room he was led to over 30 days ago. She had him sit down and took his BP and temperature then gave the standard “the doctor will be with you shortly” speech. It surprised Jimmy when Dr. Ross walked in almost as soon as the nurse had left.

“Mr. Bartlett, how your feeling?” Dr. Ross said.

“I’m good, good,” Jimmy said. “Feeling better, really.”

“Good to hear,” Dr. Ross said. “I reviewed your stats from the last month and looks like a huge improvement in number events per hour. Have you felt more rested? Any problems with the CPAP or mask?”

“Doc, I gotta say that I’m embarrassed about my attitude before,” Jimmy said. “I was so sure this was a load of crap and wouldn’t work. I was wrong. When I wake up I feel like I slept all night… I mean I’m not tired at all. This thing is great.”

“Glad to hear it, Mr. Bartlett,” Dr. Ross said. “So, I have nothing new to recommend. You already know that you could stand to lose 15 lbs and that it would help with the apnea. Any other concerns your family doctor can review with you, but as far as we’re concerned here at the sleep clinic, you’re doing well and no need to follow up. We will reach out when it might be time to replace tubing or mask parts, but other than that, you won’t hear from us.”

“So, will you still be getting data every day?” Jimmy said.

“Nope, no need,” Dr. Ross said.

“Ok, then,” Jimmy said. “Um, one last question. Why did I need to come here to for you to tell me this?”

“I like to see faces when I talk the patients and I don’t care to see them on video,” Dr. Ross said. “It is easier for me to see if you appear well rested.”

“Fair enough,” Jimmy said with a chuckle. He stood up and shook Dr. Ross’s hand.

“Make sure you stop and talk to Becky up front to settle any billing,” Dr. Ross said.

“Will do,” Jimmy said.

Jimmy was annoyed that he had to come to the office to tell the doc what he could have told him over the phone. He decided he wasn’t going to let it ruin his mood. When he approached the payment desk he smiled at Becky as he reached for his wallet. “What do I owe?” he said.

“Oh, you’re good, Mr. Bartlett,” Becky said. “This is a follow up. Already covered in your first visit charges.”

Jimmy smiled and gave a quick wave salute and made his way to the exit. By the time he had left the building and was sitting in his car, he was no longer annoyed that he drove to the clinic. He wanted to call his daughter, but thought he would wait until he was home. He didn’t want to use his smart phone. It was a glorified portable answering machine as far as he was concerned. He would call her from his cordless at home. The thought made him chuckle to himself. He was willing to accept that a machine blowing in his face helped him get a good night’s sleep, but still felt smart phones were a waste of ingenuity. He would have rather had one of them communicators from that sci fi TV series back in the day. Damned world moved too fast. Jimmy wasn’t going to move with it, but he supposed he could learn to accept some tech. If he could get along with his annoying blow hard machine, he could probably learn to like his smart phone. Even so… there was no way he was going to talk to the damn thing. He didn’t care what it called itself. He could dial a number on his own.