Cancer log 35: Time…

Cancer log 35.

Time and money, money and time. There are so many ways in which my upper-middle-class economic status has eased this medical process for me; someday, maybe I'll make a long list. It'd include the little chai lattes I buy to cheer myself up at the hospital between uncomfortable procedures, the fact that I can pay the $5 parking fee without wincing, the tech I bring along (laptop, smart phone) to keep all the long waits from being too onerous, etc. and so on. The fact that I didn't and don't feel like I need to hide my diagnosis for fear of losing a job my rent money is dependent on. I'm certainly not experiencing cancer the way a poor person would, and I'm so grateful for that. But I'm also not experiencing it quite the way a really rich person would.

Kevin and I have been kicking ourselves, a little bit, that we got the HMO insurance our jobs offered, rather than opting for the more expensive PPO. We didn't care that much about which doctor we went to, and there were plenty nearby who took the HMO. We were young(ish) and healthy(ish) -- we were figuring we'd probably switch to the PPO in a few years, when we were older, and serious issues were more likely to come up.

It's now been almost a month since diagnosis, and today I meet my new primary care doctor at Loyola, and next Tuesday I have the last of the biopsies, and next Wednesday I meet with the radiation oncologist to schedule the start of chemo. So let's say 5-6 weeks from diagnosis to start of actual treatment. And some of that time I have to put down to my waffling; if I'd stuck with my original doctors OR gone directly to Loyola, I could've shaved perhaps 2 weeks off the whole process. (I'm mostly not blaming myself for that, because this stuff is hard and complicated and some of it takes time to figure out.) But that still means 3-4 weeks left, from diagnosis to start of actual treatment.

(It would have been longer, except that at various points in the process I pushed, hard, for them to get me in sooner for procedures. They said how about next week Tuesday? I said, "I have to go out of town for four days for a conference -- can you PLEASE fit me in this Tuesday instead?" They said, the referral came through so late (half an hour after the MRI appointment time), and now you've been waiting two hours -- we don't know if we can fit you in, why don't you come back next week? I said I have my book, I'll wait, PLEASE (slightly teary) fit me in if you can. Half an hour later, they fit me in. Pushing helped speed the process -- but having the class privilege that let me feel entitled to push was essential, and that's probably its own entry all by itself.)

3-4 weeks may not seem like a lot of time. But as a doctor friend of mine told me, when *her* friend was diagnosed with breast cancer, *she* went to her fancy doctor, and started chemo the next week.

That's what money buys you -- it buys you the doctor's time, and the hospital's time. (And better MRI machines, etc.) The facilities aren't as crowded, they're not trying to see as many patients (the patients they do have pay more), the doctors are being paid well enough that they're willing to work on their lunch break or come in early or stay late if needed to squeeze you in. An extra measure of service, your money for their time.

Fair enough -- I wouldn't complain about it if I were just buying curtains. I can get behind the free market in most things. I would expect better service at Anthropologie than Target, and better quality curtains too. I don't even mind it for routine health care -- if having HMO insurance means I have to spend an extra forty-five minutes in the doctor's office waiting for my annual exam, or in the pediatrician's office getting my daughter's pink-eye looked at, then fine. I don't have the money (or wasn't willing to spend it), so I'm paying in time (which is also money, in another sense). But it's not urgent, it's not critical, so it doesn't grate at me too much.

But cancer is certainly critical. And it may not be urgent -- after all, if my routine mammogram had been scheduled for April instead of January, I wouldn't even know about the cancer yet. But the little monster will have had an extra month to grow by the time we start chemo. Probably not a critical month -- the doctors and hospital staff don't seem to have nearly as much sense of urgency about all this as I do, and I'm assuming (hoping) that if I had a more dangerously aggressive cancer, even with the HMO insurance, they would all have pushed harder to get me into treatment much faster. Doctors do try to take care of all their patients as best they can, even the poorest ones, and all the doctors I know would move heaven and earth to try to save a life. So probably it's all fine, as far as my particular cancer is concerned.

But maybe it's not. And I would rather not live in a country where people with more money get treated faster for their life-threatening illnesses. As long as America has this kind of insurance system, that equation is what we're buying with our money, our time.

One thought on “Cancer log 35: Time…”

  1. I just have to say I don’t think the delay is all class. My father had very good private insurance and a cancer that was extremely time-critical but there were still the delays you are talking about. The system only has so much capacity and if it isn’t one thing it is the other. It may have been that if you’d had the PPO or already been seeing a doc at Loyola that you would have started right away, but you may well have had the same kind of delays. The delays are terrible, but don’t think that just because you had good insurance and good initial docs that they would have necessarily been much shorter. Part of it is luck of the draw.

    And sadly, you may find yet another delay before chemo actually starts. Have they ever indicated whether they thought it would be an IV chemo vs pills? If IV chemo and they give you the option of a port, take it. If they don’t offer, ask.

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