Cancer log 20: Choosing…

Cancer log 20: Choosing a hospital / medical team.

Okay, this one is just fraught. Here's the thing -- my family are all doctors, right? My dad's an internal medicine doc, my sisters are pulmonary / critical care and infectious disease, my brother-in-law is an ENT, one of my best friends is a pediatrician, her dad is a radiologist, and I've got a few more cousins who are doctors too. It is an embarrassment of doctors, and it's sort of funny that none of them are oncologists, but they ALL are willing to give extensive medical opinions and show my case to their oncologist friends and deluge me with information. With love, of course.

So, one of the opinions that was clear pretty much across the board is that if they were undergoing treatment in Chicago, they'd go to either Northwestern or University of Chicago. Those are the most advanced, shiniest, researching-est university hospitals, with the fanciest doctors in the area. Okay. They sent me a bunch of names.

But as it turns out, breast cancer treatment is fairly straightforward right now, according to a national protocol, and my type is the most common type. So there's not nearly as much urgency as there might be to getting the most cutting-edge care, and several of my family members said that it was worth prioritizing a medical team I was comfortable with and someplace close by, because the treatments would be fatiguing, and if I were dreading an hour commute each way, I was not going to want to go and get treated. I mean, I'd go anyway, because I am dutiful like that, but it would be adding misery, probably to no good purpose.

A friend of mine, Anne Marie Murphy, is Director of the Chicago Breast Cancer Quality Consortium, a project of the Task Force that is a collaborative of healthcare providers dedicated to eliminating racial health disparities in breast cancer in the Metropolitan Chicago area. She recommended a doctor at Loyola who she said was just excellent, top of the game. So I put that doctor on the list -- Loyola is a teaching hospital too, and one that's much closer to me than U Chicago or Northwestern. It's about 15 minutes' drive away. I also decided to try the place that diagnosed me, the River Forest Breast Center, and their oncologist / surgeon.

Now, the River Forest Breast Center is cozy. I went there first. It's a little set of small buildings nestled right between the Whole Foods complex and the Jewel complex on Lake, about an eight block walk from my house. I've had a bunch of appointments there in the last two weeks, and going there and stopping for groceries on the way back felt reassuring. Their rooms are nice and clean, their staff are courteous and kind; it doesn't feel particularly high-end, but it feels good and comfortable. I really liked the oncologist I met with, and the surgeon and I did have bit of a political disagreement, but I don't really care about that -- her main job is the meticulous cutting and I have a recommendation that says she's excellent at that. I was comfortable going with them, although I was somewhat thrown by the MRI -- it was done at their affiliate, West Suburban Hospital. Here's the politically difficult part.

West Suburban is in Oak Park, but it's right at the eastern edge, the Austin border, with a primarily African-American patient base, and I would guess, mostly poor patients. When you walk in, you can tell the hospital doesn't have a lot of money -- the decor hasn't been updated in decades, and while everything is clean, it's dingy and worn. Everyone was super-nice, but when I needed a copy of my MRI to take to Loyola for the second opinion, their CD burner was down, and it them three days to get it repaired. That was frustrating (necessitating multiple extra trips out there) and just unsettling. They only do breast MRIs on Fridays, because they only have a female MRI tech that day. Like that.

I know doctors who work at that hospital, and they're great, conscientious people, and undoubtedly excellent doctors. I'm guessing they do their best to keep up on their research and provide the best care to their patients. But I also know, from seeing the difference between how adjuncts and tenure-track faculty are treated, that money matters. Someone who's being paid significantly more and allocated time in the workday to keep up with their research is much more likely to be *able* to keep up, regardless of their passion for the field or for their students/patients.

Then yesterday I went to Loyola. And it was bright and shiny and white and clean, a huge teaching hospital complex, stretching for many blocks, with schools of medicine and nursing attached. I walked in and I immediately felt comfortable. Some of that was, I think, that I spend most of my days in a teaching institution, and there's a certain feel to that kind of place -- the rush of harried students hurrying by, the spaces dedicated to research, a very mixed demographic in terms of race and age and class backgrounds. It's not cozy, but it's the kind of place I feel very much at home.

And then I met with the doctors, and it quickly became clear, though they were tactful about it, that they didn't consider the West Suburban MRI machine quite up to snuff -- if I went with them, they'd want to repeat the MRI with their own equipment. And they had me do bloodwork, which the other doctors hadn't, and they hunted down records of my 2011 breast reduction to compare, ditto, and they're ordering a bone scan and a CAT scan. All of which can be done on Tuesday and Wednesday next week, instead of waiting 'til Friday, because they have the resources.

Possibly these other tests and records aren't necessary -- probably they aren't, actually. My cancer is, as I've said, the most common sort of breast cancer, and the treatment protocol is standardized, and they're probably going to end up doing exactly what the other practice would have done. But they're being much more thorough, they're consulting with each other and acting in the way I'd expect from an experienced, research-oriented team. They feel like academics, and that's a feeling I'm very familiar with. So I'm going with the Loyola team and hospital.

Now, I really don't want to knock the other practice. I've gotten recommendations from people who were treated there and loved it, and I honestly think it would've been fine. And there's a level on which I hate that the place that has more money and spends more money is the one I'm choosing to go with. It should not be this way -- every American should have access to equally good hospitals, equally good doctors, equally good MRI machines, regardless of ability to pay. Patients in poorer African-American neighborhoods should not be stuck with understaffed, under-supported hospitals -- when we see the disparities in health outcomes and survival rates between different racial groups, we should be focusing the microscope right there, on the money.

"There is a large and growing disparity in breast cancer mortality between Black and White women in Chicago. An African American woman in Chicago is more than twice as likely to die of breast cancer compared to white women; but it has not always been like this. In 1980 there was little difference in death rates between the two groups. While a decline in breast cancer deaths among White women is a notable success in the fight against the disease, the simultaneous increase in the death rate among Black women implies that advances in breast care over the last 28 years have benefited some, but not all." -- Breast Cancer Task Force

One way to address these issues is through projects like Anne Marie's, the Metropolitan Chicago Breast Cancer Task Force. They take donations, small and large. I'll be sending some money their way.

Last thing -- I have HMO insurance. We were kicking ourselves, a little, that we didn't switch at some point to the more expensive insurance, the one that would let us go anywhere we wanted. I'm not sure if I *could* have chosen U Chicago or Northwestern; in the end, I didn't check. Thankfully, it does cover Loyola. But that's frankly a scandal too, that every American doesn't have the simple ability to go to the best hospital available for their life-saving medical care. Single-payer health care, folks. It's the only way forward.