As I write, my left arm aches. Not so much pain as soreness -- tendinitis, cardiovascular troubles, bone cancer, who knows? It won't go away. Do I make a doctor's appointment? Of course not! I'm no girlie man. I'll just gut it out until it's time for my annual physical at the Greenbrier Clinic.
Like most men, I prefer denial when it comes to health. When you're sick, the body isn't you. It's somebody else. That person should go to the doctor, not you. By the time I had reached 50, the only comprehensive medical exam I could recall having was the pre-induction physical when I was drafted during the Vietnam war. I secretly desired to be declared sick -- classified 4-F, as they put it -- so I wouldn't have to go.
Now I'm afraid of being sick, because actuarially that's the way I'll go. It's a very personal war that every aging body will one day, inevitably, lose. So the question becomes how much in time and resources to invest in whatever "actionable intelligence" can postpone the inevitable.
That's where the Greenbrier Clinic comes in. It's become my CIA. The mission is to search out (diagnose) and destroy (cure) any cancer or other terrorist cells lurking in my body.
Because this mission is conducted at the luxurious Greenbrier Resort in White Sulphur Springs, W.Va., I can fool myself into thinking it's a vacation -- and not a dreaded poking-and-prodding physical examination into the state of my aging male body. For my younger wife and very young son, who sometimes accompany me, it really is a vacation. Plus, if I'm to be diagnosed as having some terminal illness, better it be done here, amid the transcendent beauty of the Appalachians, than closer to my home, in a windowless cubicle on the 12th floor of a self-styled medical arts building in Northern Virginia's sprawl.
I've been coming to the Greenbrier for my annual physical since 1995, when I turned 50. By merely monetary measures, it's a self-indulgent habit: $1,500 minimum for what the clinic terms its core exam.
This 11-part battery of tests and consultations includes: electrocardiogram; complete blood count; lipid profile; panel of blood chemistries (e.g., to determine kidney and liver function); urinalysis; chest X-ray; tests for pulmonary function; screening for glaucoma as well as other eye and ear tests.
Over the years I've been going to the clinic, my bill (not including accommodations) has ranged from $1,121 to $2,230, varying with the level of testing my doctor has recommended. Health insurance covers only a fraction; CareFirst, my insurer, has paid no more than $300.
Then there is the cost of accommodations at the resort, which can easily top $1,000 for a two-night stay.
For a tightwad at heart (the last suit I purchased was for my wedding almost 20 years ago) to spend that kind of money says a lot about the Greenbrier Clinic -- or my age-impaired judgment. My clinic treatment is just like the fleet of small boats (from kayaks to sail) I've accumulated over the years: It's not about spending too much on things that aren't necessary, it's about investing in exercise and health!
And it's not simply about ensuring my physical well-being. My mental health, the psychological support, is probably what I'm really paying for. The lab technicians at the Greenbrier are not grumpy after having battled a two-hour commute on I-66. The country-born-and-bred nurses are not unctuous; I caught one blissfully leaning against a majestic oak outside the clinic on a cigarette break.
Most important, the consulting physician is the next best thing to a good old-fashioned family doctor, never looking at his watch while you ramble on about your medical and family history. He's conversant in the forgotten art of small talk while exploring all the unspeakable crannies of your body. On subsequent visits, he remains your consulting physician and actually remembers you -- enough to make courteous inquiries, as a friend might, about the smallest details of your life and weirdest symptoms presented during your last exam.
Sign In, Please, Sir
Thomas Mann is my doctor. How fitting, I remember thinking when told his name by the scheduling nurse. I love Thomas Mann the author, and the Greenbrier is not unlike "The Magic Mountain." Both have their rituals, or leitmotifs. When you check in to the hotel prior to a clinic visit, you're not just another guest; you receive a packet of instructions, the most important of which is to "take nothing by mouth after 8 p.m."
And so it is that the five-course, five-star dinner in the elegant dining room assumes special meaning, like a condemned prisoner's last meal. In the morning you'll learn whether you're about to die.
The clinic is a short walk or elevator ride from your room. The first order of business is business: You visit the reception desk with insurance and credit card in hand.
Then metaphorical money (blood) is drawn. Another blood draw is done a couple hours later, after you've consumed a number of pastries (the number depends on your body weight) in the clinic's lounge. The two blood tests -- one while fasting, the other after eating -- indicate just how detailed the Greenbrier regimen is -- in this case, to determine blood sugar levels.
With the pastries and the fresh (but, alas, decaffeinated) coffee, you also get a literal taste of the Southern hospitality for which the Greenbrier Resort has long been known.
Southern, but by no means slow: The longest I've ever had to wait for any test was five minutes. Indeed, the scheduling nurse displays Yankee-like efficiency in the way she dispatches patients (an average of 35 a day) up and down the corridor to the various testing sites.
Between the tests, you pay your first visit to the doctor, usually in the morning of the first day. That's when I met Mann. He is one of 10 board-certified internists at the clinic, which also has two radiologists and a psychologist. When you schedule a visit, you're asked if there is any particular doctor you would like see. I said no. Mann happened to have an open appointment on the dates I wanted to visit. I said fine. Of course, I liked the sound of his name.
I'm confident all the other doctors (with medical degrees from places like Cornell, Vanderbilt, the University of North Carolina and West Virginia University) are equally good. But I like to think I got the luck of the draw, and I'm now proud to be considered one of Mann's regulars.
I had expected that all the Greenbrier doctors would be avuncular, golf-playing semi-retirees who had fled hectic big-city practices for the good life at a renowned resort. Mann was younger (by about a decade), shorter and trimmer than I, who unrealistically still expects my authority figures to be older and bigger. His specialty was lipid disorders and metabolic heart disease. His passion was fly-fishing.
"So, tell me, what brings you to the clinic?" He greeted me in the corridor, smiled, shook my hand, and led me to his office. Though he sat behind an imposing desk, I soon found myself talking -- sharing -- as if with a friend on the banks of the nearby river, him casting a line, me fooling with a canoe, about to run the rapids.
I allowed as how I had long heard of the Greenbrier Clinic, even knew a bit of its history. The clinic was created in 1948 by former Secretary of War Edward R. Stettinius Jr., at the time a board member of Chesapeake & Ohio Railway, which then owned the Greenbrier. Stettinius was concerned that America's corporate executives weren't taking care of themselves; the clinic would cater to their needs.
I was a boss but hardly a corporate chieftain, and my own small business didn't have the wherewithal to pick up the tab. In that respect, I was in the majority of the roughly 5,000 annual visitors to the clinic nowadays. Only about 40 percent can be classified as executives with corporate health perks.
A combination of guilt and fear, that was real reason I was at the clinic. Mann gracefully listened. My mother had died recently of colon cancer. In retrospect, the symptoms were obvious, but she avoided doctors, didn't trust their medicinal approach to life and over-prescribing ways.
No doubt this had something to do with her marriage to a doctor, my father, whom she divorced when I was a teenager. Finally, she consented to let me take her to the Greenbrier Clinic. I never followed through.
Mann promptly ordered up a colonoscopy. I preferred to endure this ordeal closer to home, so he referred me to a gastroenterologist there. But as we talked, other things were revealed that I had to worry about, things I had never suspected. Noting my slouching posture, for instance, Mann suggested a bone density scan.
Altogether that first meeting with Mann took two hours, most of it talking, so that the actual physical exam, including the always dreaded prostate probing, seemed incidental and painless.
Then it was off to the nurses station to resume my battery of diagnostic evaluations. The most perversely satisfying was the ear exam, culminating in a high-pressure wash flushing out decades of accumulated, hardened ear wax. Suddenly, magically, I could hear, really hear, again. Before the Greenbrier I must have been slightly deaf, and hadn't even known it.
Most tests are complete by the early afternoon of the first day, so guests may partake of the countless amenities the resort has to offer. I took a swim and a long hike. It was November and -- I couldn't help thinking -- the autumn of my life. The looming mountains were not so much beautiful as sublime, casting mysterious, X-ray-like shadows that only a radiologist could read.
Back in the hotel room, I dressed for dinner, which I would take by mouth well past 8 p.m. I don't remember the delicious details of my meal except my imbibing a full bottle of the perfect cabernet. Red wine is good for you, right?
Now Let's Review
The 10 o'clock meeting with Mann the next morning to review the results of my tests was -- thankfully -- anticlimactic. The only thing out of whack, just as Mann had suspected, was my bone mass. It was troublesomely low, a condition not usually associated with men. He suggested I start taking an over-the-counter calcium supplement.
My colonoscopy, on the other hand, would turn out negative. Physicals often provide such ironic twists: The thing you're most worried about turns out to be a phantom; then you discover new problems.
In subsequent visits to the Greenbrier, I would learn my PSA had become high and my "good" cholesterol was much too low. Most alarming, an EBT (electron beam topography) scan, whose purpose was to detect coronary plaque or hardening of the arteries, found something it wasn't even looking for: "two non-calcified pulmonary nodules in the right anterior chest."
For a week I lived with the possibility that I had lung cancer, while Mann scheduled a spiral CT scan at Alexandria Hospital. Mann's bedside manner extended to e-mails and telephone calls, reassuring me that the risk of a malignancy was low.
He was right. The radiologist's tentative conclusion: The nodules were benign. I say "tentative" because he and Mann recommended that I have a follow-up scan in several months.
So I still have something to worry about. And I'll still keep coming back to the Greenbrier Clinic, as half its visitors do.
Provided that whatever is causing the pain in my left arm doesn't kill me first.
Walter Nicklin is a publishing consultant and writer based in Alexandria.