A New Piece in the San Francisco Chronicle
When Cancer Strikes, Good Insurance Means Everything — And Everyone Should Have It
My wife, Loren, was diagnosed with metastatic breast cancer late last year. She completed full-brain radiation in October and six rounds of chemotherapy after that. She is now on immunotherapy, once every three weeks for the rest of her life.
None of this is cheap, of course. But with good health insurance, it’s manageable, at least for now. We won’t go bankrupt, and we won’t lose our home.
Loren had to quit her job this winter and go onto permanent disability. With California State Disability Insurance this year, Social Security Disability, and, most important of all, a Long-Term Disability insurance policy from her employer, Loren will receive two thirds of her previous income until she reaches full retirement age.
That’s a $30,000 pay cut. Add to that nearly $6,000 a year in out-of-pocket medical expenses, and, as a family, we’re down $36,000 a year, about a quarter of our pre-cancer income. We can still pay the mortgage and our other bills – thank goodness – but only because we have good health insurance.
Loren’s job offered health insurance through UMR. Loren opted for a high-deductible plan with a generous Health Savings Account because, as we thought at the time, we’ll only be paying for routine visits and her employer’s HSA contribution will pretty much cover it.
Fortunately, Loren’s healthcare policy had a $3,000 out-of-pocket yearly maximum. O’Connor Hospital sent UMR a bill for $64,000 for Loren’s emergency room visit and initial hospitalization. Stanford Health Care sent bills totaling $746,000. UMR paid a total of $332,350 last year and charged us exactly $3,002.05.
January 1st, Loren moved on to my health insurance with Anthem Blue Cross, with what can only be called the mother of all pre-existing conditions. (I can only imagine the celebration at UMR when they heard the good news.) Stanford Health Care sent Anthem bills for more than $425,000 in January and February for chemotherapy and brain and spine MRIs. Anthem charged us $5,670.
Stanford has sent them many bills since then, including ones for a pricey PET scan and another set of MRIs. Anthem and Stanford bicker with each other (I can see their disagreements on the Explanations of Benefits), but neither one has ever sent us a big, scary bill.
I don’t care how we get there. I don’t care if it’s repeal and replace, revise and resubmit, or leave that thing alone. And I don’t care if we call it Obamacare, Trumpcare, Ryancare, or McConnellcare. But everyone in a country as wealthy and blessed as ours deserves to have what we have: good health insurance and the head space to spend every moment as best we can, together and happy, not constantly worrying about medical bills.
Because what really matters in this life is time. Time together on a daily basis to enjoy each other’s company. Time together on weekends and other days when Loren is feeling good to get outside and enjoy the sunshine. Time to eat good food and drink good wine, preferably at the vineyard. Time to enjoy good times with good friends.
Serious illness comes with so many worries, most of them overwhelming. Paying for treatment should not be one of them.
Originally published July 24, 2017, in the San Jose Mercury News.
Copyright 2017. All rights reserved.
#cancer #breastcancer #healthcare #healthinsurance #obamacare
Progression
Progression is not a good thing in cancer treatment. Progression means the cancer has made progress, not we have made progress against the cancer.
That’s the news my wife, Loren, got from her last scans. The scans show progression, which means the cancer has flared up again in spots. Not much progression, but enough for the doctors to change tactics.
Loren’s infusion, once ever three weeks, now includes a targeted chemo drug attached to an immunotherapy drug. The targeted chemo drug is stronger, with more side effects than the immunotherapy drugs, but, hopefully, it will prove to be effective for a while.
I say a while because metastatic cancer is like a fire we can’t put out. We can knock it down, but there will always be embers — until we find a cure — waiting for a breeze to flare up again.
Copyright 2017. All rights reserved.
#cancer #breastcancer #chemotherapy
This, Too, Is Our Life With Cancer
Our life with cancer is not all doctor’s appointments and test results. It’s silly jokes and morning coffee, long conversations and quiet time, slow bike rides and long walks downtown for beer. It’s day trips to the City and longer trips to the mountains and down south to see family and friends.
I now want to write “it’s good times and bad” – for the parallel structure, of course – but I can’t, because it’s mostly good. The bad part of our lives is cancer. Other than that, our life is good.
It’s laughing with friends in Carmel Valley.
It’s wine tasting in the Sierra Foothills.
And it’s fun runs on the beach after one too many cocktails.
I can’t remember the last time we had an argument or disagreed on much of anything. We were in a pretty good place when Loren got sick, and we’re still there today. Loren thinks we should maybe buy a house in a nearby neighborhood, about ten blocks from where we live now. She says it’s an up and coming area, but I’m not so sure. I think it’s still a little sketchy.
Loren retired from her job and is working on projects of her own. She is investing in the stock market and sewing seat cushion covers on the side. She goes to yoga at least three times a week and finds time to play with me every single day.
Our life with cancer is just that. Life. With cancer. With a renewed appreciation for life.
Copyright 2017. All rights reserved.
#cancer #breastcancer #lifewithcancer
Not Good News
But not exactly bad news, either. Just not the news we wanted to hear.
Last week, my wife, Loren, who was diagnosed with metastatic breast cancer late last year, received the results of her latest brain scan. It shows many lesions shrinking, which is good, but others starting to grow again. And, most worrisome of all, a new lesion that wasn’t detectable before.
I got the news over the phone, while Loren was away at yoga. Her radiologist asked to speak to Loren, but she was not home, so I asked if she would like to leave a message instead.
She said, “This is Loren’s doctor, and I’m calling with the results of her MRI. Please tell her I’ll call back tomorrow, maybe sometime around noon.”
I said, “This is Loren’s husband, and can you, maybe, give me hint about what they say?”
She paused for a moment. “There’s good news and bad news. The cancer in her spine is gone, completely wiped out. But she has increased activity in parts of her brain. Very small lesions. I’m going to recommend CyberKnife, which she can do at the main campus. It’s more targeted than what I can do down here.”
I took notes and thanked her for the call. I paused. She paused. I said, “Alright.” She said, “Okay.” And I hung up.
Bad news always seems to come this way. First we learn there’s something wrong, then we get more details, more information. After a day or two, we have a vague sense of what’s going on, what’s next, and what it all means. Not the full picture, of course, because the only real question we have is: How much time does Loren have? And how much of that time is going to be good?
Nobody knows. And nobody can know. We can only guess, and look at statistics, and hope and pray that Loren is an outlier on the good side of the curve.
All we can do is get on with our lives. All we can do is spend every moment we have as best we can, together and happy, with family and friends. Just like everyone else. Just like Oprah says.
I just wish it wasn’t so hard.
Copyright 2017. All rights reserved.
#cancer #breastcancer #caregiving #radiation
Good News
The good news came in response to a non-urgent medical question.
“Good news,” Loren’s oncologist wrote. “I looked at your PET scan results. Everything looks a lot better. Some of the lung nodules have completely resolved, and there is no sign of abnormal radioactivity in the mediastinal and hilar lymph nodes, adrenal gland, and bones.”
In other words, there’s still cancer in Loren’s body, but all the tumors are shrinking. All the indicators are heading in the right direction.
“I’m very happy for you!” the oncologist added.
We’re very happy, too.
Six rounds of chemotherapy did the trick – they attacked all the fast-growing cells in Loren’s body and knocked her cancer down. Six rounds of chemotherapy also knocked Loren down. She lost all of her hair and most of her taste buds. And she slowed down considerably, with barely enough energy to make it through some days.
But if life with cancer were a boxing match, the judges just gave this round to Loren. Most of the large tumors have shrunk by more than half, the oncologist explained on the phone, later that day, and many of the small tumors have disappeared altogether. The tumors will shrink even more, she said, as immunotherapy targets her disease.
There is no cure for cancer, at least not yet. So we all know how this fight will end. The question is: How many rounds will we get, and how hard will cancer punch later in the fight?
Loren’s oncologist tells us that before immunotherapy, Loren might have lived a year, maybe two. But now, she has patients who live on Herceptin and Perjeta for years, ever since this combination of drugs became the standard of care for Loren’s type of cancer back in 2012.
“Nobody knows,” she said.
We certainly don’t.
And we are doing our best not to care. Because our life with cancer is like every other life – sometimes better, sometimes worse – and, at least for now, it’s good. It’s life. With cancer.
And we hope it stays that way for a long time to come.
Copyright 2017. All rights reserved.
#cancer #breastcancer #chemotherapy #immunotherapy
