Sunday, March 31, 2013

The World Seemed Right Again

     Have you ever had that kind of week where the days seem to run together and you just don't know where the time's gone? It's been one of those weeks for me. Even though I slept well every night, I woke up feeling like I was still dreaming, discombobulated and forgetful. Stress'll do that to a person. 

     A couple of weeks ago, we switched health insurance providers from Cigna to Humana, and learned that because Humana considers one of my sons' cystic fibrosis medications a "high technology" drug, it's been assigned to Tier IV status with a 25% out-of-pocket co-insurance requirement. How exactly does
Health insurance: the stuff of nightmares....
that translate into lettuce? Well, for the past two years, we've paid $25/month for this medication, and now, it's over $1200/person/month. It's nothing less than pharmaceutical bureaucracy. Even with co-pay assistance from the drug manufacturer, the out-of-pocket expense is still $600/person/month. There is nothing high tech about the drug itself; it's aztreonam, an old antibiotic. Apparently, it's the drug's delivery system that's the costly culprit. When the initial prescription for this medication is filled, the pharmacy dispenses a little air compressor with a fancy nebulizer, all of which are reusable. I fail to see how a one-time allocation of technology warrants such a high co-payment on subsequent doses of this medication. So, now I've found myself embroiled in an aggressive appeals process with Humana. I am requesting that a) they lower this drug, for which there is no suitable lower-priced substitute, to a less costly tier or b) they waive the redonkulous 25% cash deductible. Believe me, I'm pretty damn confident that one way or another, I will prevail. I don't do "No" very well.

     Against this background of utter frustration over how big pharma and insurance providers are permitted to play such games with people's lives, I found out last Monday that one of my colleagues, an anesthetist with whom I frequently work, lost her 52 year old husband to lymphoma earlier that morning. Just a few months ago, he was a healthy guy, working as a scrub tech at a local hospital. Over the summer, he started experiencing vague symptoms, such as fatigue and shortness of breath, accompanied by dramatic weight loss. His condition deteriorated rapidly and progressively, rendering him unable to work. My friend described him as a proud and private man who had difficulty accepting help from others, even his own wife. Things got so bad that he could hardly perform self-care activities. Despite multiple lab studies and a radiologic workup that revealed fluid around his heart, his docs weren't able to pinpoint a disease. Shortly after the Christmas holidays, he saw a cardiothoracic surgeon who initially thought it might be cardiac cancer. Surgical biopsies finally revealed lymphoma. 

   
Double rainbow on a stormy day
A couple of weeks ago, he underwent his first round of chemotherapy. He was already so weak and debilitated that the chemo wiped out his bone marrow, prompting a hospital admission for platelet transfusions. He went into the hospital Tuesday before last. My friend continued working, in between hospital visits and taking care of their young daughter, and I could tell she was physically and emotionally exhausted. Her spirits were good, though, and I think having the normalcy of work was therapeutic for her. On Friday of that week, she was talking to us about buying her husband some new slip-on house shoes that would accommodate his swollen feet, and was hopeful that he might get to come home on Saturday or Sunday. Early Monday morning, he died in his hospital room.

     
My mom/realtor and me
 Later that same afternoon, I received an e-mail from my mother, who also happens to be my realtor. I've had my house on the market since November, and although it "shows very well" according to the feedback we've received, we've had no offers. Last year, I rented it, but I am tired of being a landlord. Aside from the fact that I didn't profit at all from having renters, it's a liability I just don't want any longer. I'm tired of paying two mortgages. How is it that the banks got government bailouts out a few years ago, yet we homeowners who watched helplessly as our home values plummeted didn't receive a compensatory reduction in mortgages owed?  I feel screwed. Honestly, I'm seriously considering either a short-sale or just letting the damn thing go into foreclosure. Yeah, it'll screw up my credit for awhile, but at least I'll be free of this red brick albatross. 



Mi casa, the one I just can't seem to sell
Anyway, Mom's e-mail included a comment from a realtor who'd shown the house earlier that day. It read as follows: "The painted wallpaper was a turn-off." First of all, there is no wallpaper in my house, much less painted wallpaper. Thinking that maybe they'd mistaken another house for mine, Mom e-mailed to agent to confirm that my house has no wallpaper. The agent responded: "Yes, it was this home.  There were several bubbles in the wall. It was most noticeable in the hallway near the bedrooms and bath. Wallpaper just seemed the logical explanation." Ah. What a strange juxtaposition...the untimely death of someone so young in contrast to the inanity of people focused on such a minor imperfection.

Cheese makes everything better
     I went grocery shopping to take my mind off of everything for a little while. As I was perusing the cheese aisle, I received an alarming text message from my dear friend, whom I'll refer to in this post as "A" for anonymity's sake. Several weeks back, he and his partner, "B", cruised the Caribbean, and got engaged in St. Bart's. During an afternoon hike, A slipped and fell, tearing several ligaments in his left ankle. Those of you who've read my blog long enough knows that A is an anesthesiologist like me. I'll be the first to say that physicians make terrible patients. We know too much, we self-diagnose, and we don't follow instructions.


     Needless to say, upon returning home, A saw an orthopaedic surgeon who determined that his injury had a good chance of healing spontaneously without surgical intervention. She put him in an aircast, followed by a hard cast, and advised him to stay out of work for two weeks. Well, doctors aren't allowed to be sick...EVER. Even though he's on faculty at a large academic institution, he's been required to use vacation time because there are no provisions for sick leave. After two weeks and removal of the hard cast, he was permitted to return to work conditionally, with the understanding that he wouldn't work more than 10 hours per day. 
"A", clearly less than thrilled with the wheelchair
A's first day back at work was last Monday. Instead of being deployed to the intensive care unit where he serves an an attending physician, he got put in the operating room. Navigating the hallways and tight corners of an OR on a knee scooter, especially when you're given rooms on opposite ends instead of adjacent to one another, ain't easy. Sure enough, he was knocked off the scooter not once, but twice. Even before being knocked off the scooter, he started experiencing excruciating pain behind his left knee. Like any anesthesiologist would do, he placed an ultrasound probe behind his knee and discovered four DVTs (deep vein thromobses or blood clots that occur commonly following prolonged immobility of a lower extremity), in one of his calf muscles. My foray into Kroger's international world of cheeses was interrupted by his frantic text message: "OMG, I am back at work and started having severe pain behind my knee. Put an ultrasound probe behind it and have diagnosed four DVTs. What next?" Long story short, poor A is on blood thinning shots twice a day for a few weeks. When he told his sister about all of this, her response was, "This is God's way to telling you to slow down." Maybe she's right. 
Cold beer on a Friday afternoon :-)

     By Friday, I was really out of sorts, feeling depleted from my never-ending battle with health insurance, deeply saddened over my friend's loss, and worrying about A, who's shown no signs of slowing down. Spartacus texted me that he was getting off work early for Good Friday. Having him home so early in the day is a rare treat. "We should have lunch together when I get home from work," I texted back. "I'll be home around 1:00." We were running behind schedule at work, so when I finally got home at 2 o'clock, we moseyed down to our neighborhood pizza joint, sat outside in the warm sunshine, and enjoyed a couple of chocolate stouts and calzones. Man, that beer tasted good. 

     Although we were deeply engrossed in a conversation about polygamy, I couldn't help but notice that our twenty-something year old waitress was paying lots of attention to Spartacus.  "Oh, you like the Boulevard Long Strange Tripel, huh? That's my favorite! Can I get you another one? How about a glass of water?" I may as well have been invisible. Yes, it was that obvious. It's funny...the older men get, they attract women less than half their age, while women forty and up get the old geezers. "I think our waitress has a little crush on you," I said to him, after she went in to fetch us another beer. He paused, looking sheepish behind his Ray-Ban aviators. In a tone of semi-disbelief, he replied, "Yeah, I kinda noticed that."
Me and my old man
Actually, it's kind of a turn on to realize that other women find my husband, whom I jokingly refer to as "The Silver Fox," so attractive. I'm the one who gets to take him home. After having a good laugh about it, we came home, threw our leftovers into the fridge and our clothes onto the floor, and had ourselves a bit of afternoon delight. I can't say with certainty that the earth moved. What I do know is that somewhere between being lost in each other's bodies and the sweet sleep that visited us afterwards, the world seemed right again. 

     

27 comments:

  1. Glad that ended on a high note.
    You'd think a hospital would be a bit better at looking after it's staff though.

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    1. Man, Big D, that's exactly how I feel. I'd love to give that institution a piece of my mind.

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  2. Insurance scams, co-payments, ever-changing coverage issues, it's beyond ridiculous. I have a friend with a similar coverage change that is basically giving her a choice, go bankrupt and get the meds she needs or use a lesser replacement and be in pain. Sorry for your drama, you deserve the rant!

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    1. Thanks, Mike. I've dealt with insurance companies and their BS for so long now that I know all their games. So many people don't understand that these companies back down pretty easily when confronted with a solid case. That's why I think rants like this serve a purpose beyond ventilating; they help educate people who are having similar issues. I hope your friend is able to work out a satisfactory negotiation with her insurer.

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  3. Fascinating post Kris. It's real life, warts and all, but not everyone has the courage or style to write about it. I wrote about the high cost of cancer drugs in Australia in my last post, so I wish you well in your bureaucratic stoush. You also highlight what some of suspected, but only a doctor can fully confirm :- 'the doctor doesn't look after their own health' ........just like 'the builder's house needs repairs' etc.

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    1. Very warty, indeed, Neil. Would love to read your post abou the cancer drugs...can you provide a link? I think that if the culture of medicine changed in a way that permitted physicians to look after their own health, we'd be better at healing others, as well as ourselves.

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    2. Hi Kris,
      Yes it's on my main blog www.lifecycles-by-neil-killion.blogspot.com The second article 'The Fight Against Cancer-Never Give Up' I have written about Kristian Anderson before and his push to get Erbitux on the free list. I believe he's a modern day saint and his blog 'There's A Crack In Everything-That's How the Light Gets In' is one of the bravest, most inspirational blogs I've ever read.

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  4. chemo seems to do much more harm than good to cancer patients, am i right? only weeks after chemo treatment your friend died. again, if i got cancer, i am sure i would not do chemo, because i know my body too weak to resist side effect.
    i like your "casual touches" on the young waitress restaurant. that was funny. i agree, that the older men get, the more attractive they seem. glad you are the one who took the attractive guy home.
    i am sure you felt much relieved after writing down this whole load of trouble...

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    1. Yun Yi, you've hit on a complex issue. Current chemotherapy just hasn't advanced to the point where it's selective enough for cancer cells, so yes, it can do more harm than good. It really depends upon the individual and the type of cancer they have. I'm with you...if I got cancer, I don't know that I'd accept chemo. That's very upsetting to some of my friends and family, but it's an individual decision. On the lighter side, I find that humor gets me through tough situations, like the ones I've been confronted with over the last week. Hopefully, this week won't be so dramatic!

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  5. Wow, Kris. As Shakespeare said when troubles come they come not in single spies but in full battalions. I feel so sorry for your colleague. Her husband's death being so sudden and unexpected, she must be in a state of total shock. Glad to hear you finally got some sweet distraction with your handsome Casanova. A little pleasure and relaxation goes a long way to reconciling oneself to the world.

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    1. Marty, trouble seems to come in threes. I think it's OK for me to exhale now. My friend is doing really well, considering everything that's happened, but yes, her husband's death was unexpected and shocking. She said she felt relieved that his suffering had come to an end. What a difficult admission that has to be. You're so right...a little bit of distraction goes a long, long way.

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  6. Dang, what a week! I hope all ends well with Humana and the sale of your house. Both sound like terrible pains. I'm also sorry for the loss of your friend's husband. How horribly sad. At least you've got your "Silver Fox." Good to see you end your rant on a good note. :)

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    1. Thanks for your good wishes, Janene. I know it'll all work itself out, somehow, some way. The loss of my friend's husband really made me think about what it would be like to lose my own man. I don't want to think about it. Thank goodness for unexpected late Friday afternoon lunches with Spartacus. That bit of togetherness was exactly what I needed.

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  7. Kris, what a week you had! First, I am so sorry about your friend’s husband. What a shock the way he died so suddenly, very sad. I am stunned that his lymphoma could not be discovered earlier with all the lab tests he had. I guess lymphoma must be difficult to detect.

    Re: the govt bailout for banks and not homeowners, we got screwed big time! I hope the RE market picks up, looks like a nice house in your photo. Hard to believe potential buyers would be so focused on such a minor thing. Nice photo with your realtor Mom.

    Best wishes to “A” for his speedy recovery! Nice that you and the “Silver Fox” could finally unwind with a cold beer and calzone. Afternoon delight, well done! (That old song “Afternoon Delight” by the Starland Vocal Band came into my head when I read that line.) :)

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    1. Madilyn, I would have thought that the lymphoma diagnosis would be much easier to diagnose and treat, too. It may have been a matter of its location and the degree of difficulty in obtaining a biopsy. Re: my house, it's a very nice house that's been completely renovated inside. What more do people want?! It's no longer a buyer's market, but the buyers don't seem to realize that yet. Allen is doing much better now. It was the pain associated with those DVTs that was really getting him down. As for Afternoon Delight, that song was in my head for the rest of Friday afternoon as well!

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    2. Kris, I’m so glad Allen is better. I had a feeling you’d remember that Afternoon Delight song! :)

      One more thing I meant to add when I wrote my comment. Yes, insurance and pharma providers play games with people lives. We are just a commodity to them, just a dollar sign. Under your previous plan, you had a lower co-pay for the same drug for your son, it’s not a new drug, so the outrageous cost your new provider is charging is just wrong and unnecessary. Good luck with the appeal! I’ve had battles with insurance companies in the past over co-pays, and after much persistent wrangling, I usually win. I don’t do “no” very well either. I believe you will prevail, you have a good case.

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    3. I agree whole-heartedly on the insurance issue. I think they hope that no one will notice how ridiculous their policies are and do their best to exhaust anyone who tries to challenge them. Fighting with them is draining, but I am not going to back down. Will keep you posted!

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  8. Good Lord. You really had a few stressful weeks for sure. I can't even imagine what I would do if I had to pay all those medical bills/insurance the way they do it in America. I think I would be bankrupt by now. I'm sure that you will sort it out though, in fact, I know you will.

    Sorry to hear about your colleagues husband too, and he was still quite young. My condolences to her family Helena, and I'm sure you will also take great care of her.

    Thank God that 'A' probed himself otherwise things could have been much worse. The normal everyday man would not have been able to do that or have access to that equipment without booking an appointment with a doctor and possibly having to wait weeks for a hospital appt, so it's a good thing he knew what to do straight away. Hopefully he is doing well now.

    Well, you sure did go out with a big bang (no pun intended, ha ha ha). Nothing like a bit of romantic togetherness to relax the mind and body. Let's hope the coming weeks are less stressful.

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    1. RPD, I wish we had a health care system more like Canada's or Great Britain's. The way the insurance companies are permitted to profit from illness here is ridiculous. To me, 52 is quite young. I'm very sad for my friend, and for their daughter to grow up without her father. You're right about A, being fortunate in having the ability to diagnose himself. He went around and around with his physician, who didn't want to treat the blood clots with anti-coagulation, but they finally agreed on the blood-thinning shots. It's Monday morning now. I too am hoping for a calmer week!

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  9. A beautiful ending to a frustrating tale.

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    1. It was a very nice ending to a troublesome week. Couldn't have asked for a better way to head into the weekend.

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  10. I held my breath a few times during this post -trying to will things into some sort of sense (Humana, "A"..life/death, someone, anyone) Smiled at your happy ending. I really hope the coming weeks are much much better!

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  11. So sorry to hear that you are going through so much, but I am glad you were able to find comfort in the arms of the one you love. It is a great lesson that I try to remind myself of when things get rough in my life.

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  12. Sorry to hear about your problems, I think I would be finding alternate sources or countries for the medicine ASAP, is there a supplier in India perhaps? It is amazing how inexpensive their medicine can be, and still at world class standards. I have always been of the mind that if the system is failing you, F^@K the system.

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  13. Gee Kris,
    it's amazing how you get through all that, as I suspect you take quite a bit on board; although caring for your kids no doubt keeps your feet firmly planted on the ground.

    There's also nothing like a death or serious injury close by to put the whole thing into perspective.
    Cheers, ic

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  14. Kris, you and I are so much alike :) One of these days I would love to meet you in person! Your post was brilliant and your writing is wonderful. I could feel your pain, then at the end how you turned it around with your love for your husband is inspiring. Joy in the little things. Through it all you remain positive. Loved it!

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  15. Helena, this one acutely reminded me how close to ashes and dust we are. But like the spider whose relentless uphill crawl moved King Bruce, you never fail to inspire your reader. Thanks for filling in the piece with colours and spices of life towards the end.

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