Below is a true story of healthcare. Names have been changed for purposes of anonymity.
Sifting through the Guatemala travel guide, I thought I might visit Tikal, the ancient ruins in the northeast part of the country, though the book alleged the trip might take eight hours by bus. Do I have that kind of stamina in a “chicken bus?” Copan, in Honduras appeared closer via the map and Dominga and I were investigating that possibility. Though, Honduras held symbolic and very real danger to Juliette, her best friend murdered there in 2001, just before September 11th, so I lightly peddled that with a whisper only hinting it might be a possibility. I left for Guatemala in three days, nearly frantic to learn Spanish, sit at the foothills of volcanoes in Antigua, and sip dark roasted coffee in the cool, sunny air from a Guatemalan roaster. My former colleague and good friend Dominga volunteered her time in “Guaty” and helped me find housing, she was the reason I decided on Guatemala instead of Peru or Chile or even Argentina. Guatemala is also cheap by any standard used in the Spanish speaking world, excited and desperate to leave the states I was walking on air to leave Jersey City. That was until Tuesday night.
Juliette, happy for me to finally abscond on a trip out of the country to improve my Spanish kept to herself and did not let on that something might be afoot, until fright, and insurance malfeasance brought it to the forefront. Tuesday night, November 3rd she looked nervous and angry and needed to vent. “I can’t do this.” she screamed. “What” I said as I shut-off Keith Olbermann. “Nothing, forget it.” “Tell me!” I said. “I am worried about the procedure.” Both of us uneasy, trying not to discuss this subject I said, “Why?” “Because it is surgery and it is scary! I don’t know where to go for the surgery or if insurance is even going to pay. I am overwhelmed!”
In early October Juliette entered UMDNJ, Jersey's premier medical center for her the first mammogram of her life. The pleasantries of aging and turning 40, she took these measures seriously. Only one year before Juliette travelled deep within New Jersey, near her hometown, for a routine eye check-up and found herself on a gurney undergoing emergency eye surgery. We thought she might go blind in the only eye in which she had vision. Thankfully, the eye stabilized, but it was scary and I thought Juliette might be experiencing PTSD and I needed to help.
At the hands of healthcare technicians during the mammogram they shoved her boobs into the machine like an animal. “Please be still” they told her. “Don’t move” as if they were preparing her for the abattoir. She left, somewhat humiliated, but not unlike millions of women in our lagging healthcare system, a system that punishes women frankly, for being women. She received a call, a few days later, the test proved “inconclusive.” “What does that mean?” she asked on the phone to the caller, a technician of some sort. “It means nothing,” she says dismissively, “except you have to come back in the office for another look; we need to do it again.” “Great” Juliette said, at least this time I won’t have my period!” Juliette, back on the train toward Hoboken in late October while I obliviously planned a getaway as far away from health insurance as might possibly be, the poorest country in Latin America the next week.
This time, however they held her in the machine while the radiologist stuffed her boobs back in there, edging closer, focusing a little more intently. They focused on the right breast; clearly called into the office not because the tests were “inconclusive” but instead shades of a “gathering of cells.” “There is a problem area, I see,” the Radiologist indicated. “It makes me curious.” “Well,” Juliette thought to herself, “your language is making me curious.” Juliette anticipated in the waiting room, as she gathered her belongings another “technician” ran after her frenzied before she left.
“We need to do an ultrasound,” she announced to her. “When?” Juliette asked. “Right now! Stay where you are.” Please undo the gown and stick your left boob out please.” she heard not ten minutes later, yet again. This was indeed a cattle call. Instead of being curious, this time he was worried. “You see this area that has a group of cells or in the medical field we call a mass.” As Juliette heard the words ring through her ears the Radiologist said, “You need to see a surgeon right away.” Juliette failed to mention any of this to me when she arrived home.
She left in a dizzying fright. Exactly a year ago she was told she might and likely will go blind until we fought to get the best care money might buy. The diagnosis changed quickly. One year later here we are again. She downplayed the new procedure, in the healthcare field called a “biopsy” as we discussed Antigua and all the fun I will be having in Central America. Juliette didn’t say the word “biopsy” until Tuesday night when she nearly lost her mind.
On Monday her personal physician discussed with her the need to have a stereo tactic needle biopsy all new words in her vocabulary. She recommended a doctor in Hoboken that she thought treated her patients “well.” Juliette called them Tuesday morning. “We don’t take Healthnet,” she said abruptly. Juliette mentioned to her, “Actually we are changing insurance on December 1st, to Oxford. Does that matter?” “Yes, we do take Oxford,” the rude young lady stated. “But, you may have a pre-existing condition now, so you want to check with your insurance company. You might not be able to get the procedure right away; it could take six to nine months.” She hung up the phone without a response. Juliette now in her own tizzy called her personal physician back.
“Don’t wait until December 1st, it is better to do this quickly. You want to find a center that takes both health insurances,” her doctor told her somewhat anxious. She called breast centers, in Hackensack, other parts of North Jersey, some of which took one insurance, but not the other, some took no insurance catering to a more “suitable clientele.” I called one myself after the frenzy. “We don’t take insurance,” they told me smugly. "Our clients submit to their own insurance companies. We focus on healthcare.” “Oh.” I said, ready to lay into her with all the fury of every uninsured American, my words worth the 40 million of us. I hung up the phone without a word.
This is where Juliette found herself on Tuesday night as I sifted through the Guatemalan travel guide. She explained to me, “It is a surgery.” The radiologist told her that about 20 percent of these procedures turn up to be cancer. I said, “What?!! Cancer? Who said anything about cancer?” Wednesday morning I decided Central America will wait, we need to find Juliette a place for this procedure. Juliette found it that morning calling every place she “googled.” St. Vincent’s, the hospital of her birth built a brand new Cancer Center in New York City. First, however I called American Airlines and “postponed” the trip. I called Dominga who understood, but we were both a bit disappointed. I told her, “Tomorrow I have to bring Juliette’s films to the St. Vincent’s Cancer Center.” I hung up the phone and whispered the C word to myself letting out a giant sigh, “cancer.”