July 31, 2011

Whose Health Is Important?

Approximately 28 years ago, a single mother raising three children far from their abusive father had a small work accident. She fell from a short height and landed badly on her heel. She ended up with a bone spur, then one on the other foot from compensating for the first. Because her job involved standing all day, she needed a new job.

She became an independent contractor, taking a job that allowed her flexibility for her feet, then for her volunteer job facilitating support groups, then for her volunteer job running the nonprofit that sponsored those support groups, then for her granddaughter when her son wasn't able to effectively parent, then for her town government, then for her county libraries, then for her father in his last days. Working as an independent contractor gave her the opportunity to give and make the world a better place for many people. What it did not give her was affordable health insurance.

That single mother is my mother, and a couple months ago, she surprised me with some news.

So, it's been over two months now since I got health insurance and started setting up appointments. Much has happened since then, and much not. Most has been written about, but one thing not. Yet.

The allergist diagnosed my dermatographism as a symptomatic expression of underlying allergy(-ies), tested, and found a bundle of things to avoid. Some of that is possible. Most, not so much. After some thought, I decided to go for the allergy shots, which actually start tomorrow morning, and go Monday and Thursday mornings for a while. Three shots per visit. Wheee.

They cause their own "little" side effect, and I'm not talking about the possibility of reaction to the shots, or even my decreasing availability for work causing lessening of income. After ordering having them made up, I was discussing with their office how much individual shots would cost if the ever-looming possibility of a government shut-down becomes fact on July 1st. My insurance is, after all, sponsored by the state. (An alternative scenario is I could get kicked off any insurance if the legislature budget goes through as written.) She thought about thirty bucks a piece, which is a strain but doable, especially if any shutdown is brief. Then she threw the zinger at me: it's formulating the shots themselves that costs thousands.

Thousands!?! Oooohhhh. Ummmm, maybe it's time to check how much of my $10,000/yr. insurance budget I have left. I figured this was one of the two things this year that I could take care of. There are already enough dead ends.

Getting the fibroid evaluated cost a visit to the OB-GYN, an ultrasound, having a radiologist read the scans, and an option for shrinkage treatment with surgery to follow in a few years when Medicare kicks in. The main problem with that treatment is that it is standard for it to require an overnight stay in the hospital, a very sensible precaution in case the wrong arteries got blocked somehow, but all by itself busting my budget. So, no go there. Keep carrying that football around, watching it grow. Meanwhile, a nice chunk out of that ten grand.

Oh, hell. Not only was there her health to worry about, but there were decisions to be made about money. At least with my cancer scare, I had the luxury of focusing on my health. For the woman who has put in almost three decades of unpaid (or barely paid) public service, there is a constant calculation of how much attention she can afford to pay to hers.

It's almost funny how everybody else freaks out by the word "cancer". I think folks fear it more than another 9/11. Me? Not so much. It's just not something that's been on my radar. Even a request for a repeat mammogram for better detail doesn't phase me. I don't worry about it. I know people who've had breast cancer, died from it. I know people who've died from liver cancer, and I'm aware that my years in the dry cleaners puts me at elevated risk. But, so? I'm just thinking finances.

Well, I'm also wondering what I'll do with my "hair" for the wedding if I'm bald from chemo or radiation. C'mon, something to think about.

There's grim irony in finally having health insurance but with such a limiting cap, and such narrow qualifications regarding my income level. Suppose I cash in some of my IRAs to help pay the bills. The money then counts as income, puts me over the amount to qualify for my insurance, and off the plan I go. So, pay my bills, and wind up losing the house or the insurance or both. Don't pay, declare bankruptcy... another undesirable end. Can we make it not be cancer or not grow fast enough or metastisise so that it can be ignored for two more years? I can afford it better then.

OK, dream on.

I made two phone calls this morning. The first was to my insurance plan, asking just how close to my annual cap I was. There was good news: the $10 grand limit is for inpatient treatment, and since everything I've done so far has been outpatient, I still have $10 grand left! Plus, I can still keep on with the other things I'm dealing with, like the allergy shots and the diabetes.

Whew! It's not a complete solution, but takes care of a chunk of the bill. It's enough that I feel better, irrational as that is. There'll still be tens of thousands of bill to pay afterwards.

A biopsy was good but insufficient. She can't wait until she can retire from work so it won't matter that she doesn't get disability insurance. She can't wait for the Medicare that her taxes have paid to support even as she supported others. She has to do what she can do now and figure out how to pay for it later.

I was the only one in the waiting area when I arrived. Another woman showed up and was quickly escorted back, and then three people came in together. They were there "for _____", who apparently was the woman just sent back, and were told to wait a few and they could go back and talk to the doctor. When it was my turn, among the long list of questions I was asked was whether I was (actually!) there on my own? It was said in such a concerned tone of voice that I gathered it was usual to bring a cheering squad/support group to these visits. Hadn't occurred to me. Been doing my own doctors' visits since, what? forever? Well, adulthood, anyway. Apparently I was supposed to be overwhelmed, distraught, incapable of digesting information, whatever. This was supposed to be scary.

Oh shucks, sorry to disappoint. Scary is facing the bills, and I've developed a plan, including checking myself back out of the hospital after two days to keep the costs down. There are enough healthcare professionals wandering through my house on a daily basis these days. I'm sure they can change a dressing, note inflamation, reassure me whether symptoms are normal, etc., if needed. Scary was not going to be something the doc said that day about what I was carrying around, since I already knew what it was or could be, and there would be no real news until after the surgery when my "football" was examined by the pathologist. That might or might not be scary then, but it'll be dealt with on an outpatient basis, and the insurance kicks in again.

What's your choice of "-oma"? I heard about five different terms, or at least I think there were five. He rattled them off so fast. It could be a myoma, a jargon-jargonoma, a jargon, a jargon-jargonoma, or carcinoma. I caught the first and last for sure. Actually, it helped that he wrote them down. The myoma is what this started out as: another word for fibroid, the "my" part of the word referring to smooth muscles, what the uterus is. Carcinoma, of course, is the worst possible case, and is exactly what you think it is. There are other levels and varieties in between of what stage it might be. They won't pull any lymph nodes until they get the pathology report requiring it, and that means I'll be "open" on the table while they wait. Hope they pick soothing music. Just not too soothing. I shouldn't have any problems with lymphodema (fluid buildup) if they do pull them, but on the rare occasions that happens (you hear about it with mastectomies) it's usually in combination with radiation therapy.


After he examined me, I asked him how much weight he thought he'd be cutting out. Since I'd just lost a bunch, may as well take advantage when I can to lose more. He thought 10 to 15 pounds. See? That's another good thing. Of course, I may have to throw out more pants that'll suddenly become too big to stay up. Or just sew in darts and wear them out. Not like I'll have money to burn for a while. He said I can be out in 2-3 days - I told him 2 - and can drive again in 2-3 weeks. That will also be 2. There'll be weight restrictions for lifting at first, till I'm fully healed. Doable.

Surgery is early tomorrow. How strange it is that anesthesia and surgical complications are the least of our worries. How bizarre is it that we have taken all her service over the years and repaid her with this? How does any society survive by treating its useful members this way?


Jodi said...

I don't even know what to say (as is often the case) but know that you have my support in what little way I can give it.

Greg Laden said...

That sucks. Typical catch 22 unfair idiotic bullshit. Didn't this get fixed?????

Let me know if you need to reschedule.

D. C. said...

Best wishes, Stephanie. Just that.

Stephanie Zvan said...

Thanks, everybody.

Greg, that should fall right in the middle of "can't do anything right now," which makes it perfect.

Kelly McCullough said...

Argh! Also, hugs from both of us.

Heather M. Rosa said...

OK, now you're making me cry.