The Big C and Access to Care Here in America

I have long been concerned about access to care for the poor of our country. The same concerns bother me today.  If you read what follows, you’ll hear an undercurrent of “yes, we can afford this,” as we have Medicare and all the supplements that one would want. I am painfully aware that not everyone can afford supplements and the best of care.  I advocate for universal health care because it is a right, and it is not a privilege for the chosen ones of our society.

What this contains is my own journey through what follows.  While there is certainly healing in the telling, hopefully this is not telling for the sake of mere egocentric concerns.

The X-Rays and MRI Day Has Arrived

The day of deciding had slowly crept up on me.  I knew it was coming.  I’d think about it off and on. Then it arrived.  It arrived in full force. The day had respectfully, so to speak, waited its turn. It knew that there were other things that were the rightful focus of attention. It sat on the back seat.  It waited its turn.  It made little noise.  It seldom, if ever, waived its hands for attention. It seldom, if ever, shouted above the din of the normal days’ activities to assert itself.  No, it just waited and waited.

Until its day arrived.

It caught me off guard.

Since certain specialists live in the Dallas area, we drive there for consults. Though this area has a huge hospital and a not so huge hospital, no one does the sort of surgery that I need. We trek south.

My confidence in the urological oncologist is high.  His style, procedures, and explanations merit trust. Stories of his successes are found in local folk that my wife and I know. 

No food for four hours prior to the MRI.  Answer all the questions for both imaging and the MRI.  Prepare to go from one building third floor to second building second floor. And wait.

Valet parking only.  Crowded with people and cars and attendants.

Check in at the desk. Wrist band.  Bathrooms down the hall. Your name will be called.  Hello, Mr. Hinson, can you tell me your complete name and date of birth. Please take off your necklace. Stand here. Hold your breath.  Now, turn toward that window. Good. Hold your breath. Those are good images.  We are finished. I’ll take you back to where your wife is waiting.

Over to the other building. Downstairs. Across the entry way.  Another set of elevators. 

Another check-in at the desk. Wrist band. Bathrooms down the hall. Wait. Wait. Wait.

Mr. Hinson? That would be me. Come this way, please. He explains the process well.  He is a graduate of Boise State. Had lived a while back in Portland, Oregon.  We had just come from there. Numerous points of connection.

Change in there out of your street clothes and put on pants and shirt that fit you. Bring your key with you.  I’ll insert your port.

Which arm? How about the left. That vein is closer to the skin. Looks good. Done. Your wait will be about 12 minutes and then the tech will come and get you.

I visit with a woman who is from east Texas.  She’s driven almost two hours.  I tease her about snoring in her sleep.  You’re kidding me, she says with a chuckle. Yes, I was teasing. You weren’t snoring. She is alone. 

The tech gets me, takes me into a very, very cold room, only to realize after about five minutes of prep that I am the wrong patient for the room. We apologize Mr. Hinson, but you are supposed to be over in that room, not this one.  He’ll clean up your room and we’ll get you shortly.

I laugh with the woman and now with another gentleman who is there for an inner ear MRI.  He tells a brutal story about a friend and a tumor that is woefully out of place for the spot that I am in.  He is friendly and cordial so I do not tell him that he is an insensitive idiot. The woman leaves. Did I tell you that she is an African American woman? That she is alone? That she has a two-hour drive back home?

My turn. The room is not so cold. The attendants are attentive. I opt not for Stevie Ray Vaughn but for Robert Johnson on the head set. The tube is big and imposing. I am fascinated by it. We’ll have to practice breathing in there so we can get precise images. I’ll be the one guiding you, the male tech says.  The woman tech gets Robert Johnson on the headset for me. Can you do one thing for me? Can I scratch an itch? No, you can’t, but I can. She finds the itch on my right cheek, just below my right eye that is tormenting me.  Relief.

Equipment is placed around me. The IV is now ready to flow with dye. The headset is on. The machine is primed. I am ready for the slow slide into it.

What will the machine find? What is lurking within my body that is prompting this consult on Inwood at the imaging center, that has led to me lying on my back amidst a whirling mass of technology that is more than I can comprehend. I lay aside my fears, apparently, and lean toward fascination and curiosity as we begin. To be centered on the tumor inside my abdomen would lead me down anxiety and fear and worry and panic and inside this tube, there is no room for that.

Clanking. Loud clanking, Robert Johnson is muted to the sound of now breathe in, breathe out, and hold it.  Johnson comes back into my headset. Again, breathe in, breathe out, and hold it.  I soon get the rhythm of the sounds and the verbal instructions. I can breathe again when the machine has stopped its orgasmic sounds and build up and all.

I open my eyes and look around. This thing is small. This tube is not very big.  It is not very long. You could get claustrophobia inside this thing. 

About five minutes, Mr. Hinson. Are you ok? Sure. Rock and roll.

Then I am finished. Pulled out. Disconnected. How long was I in there? About 25 minutes. How many pictures did you take of me?  Liver, each kidney, and other things, oh, about a thousand.

He is cordial, engaging, and now curious that I’d had one of these before while wearing a football helmet sort of contraption several years ago when I was being tested for neurological problems at the time of an ocular migraine thing. We chuckled that he had one of those.

He walked me to the waiting room. I changed clothes and slowly reality came back and with a huge rush of energy and emotion.  I had completed the diagnostic process.  Now I could step outside into normal life and routine and all.  I could now admit that what I had gone through, while shaping it as interesting and fascinating and all, was stress producing.  Those other emotions were a ruse that covered over my anxiety about it all.

I was there, not because all is well with my body.  I was there because all is not well with my body.  There is a thing growing inside my body, attached to my right kidney, something that must be removed.

I am exhausted. Will need some time to process the spoken and the unspoken.

This part is over and done with. Now the waiting awaits. The diagnosis and surgical instructions to follow on Thursday.

Pre-Op With Anesthesia Call Has Arrived

This one-half hour phone call was painless. We just went over the obvious, meds, protocol, procedure. And then there was the, oh by the way, you have to come to Clements Hospital to do the blood work and EKG.  OK, then we’ll do that next week.

The Anticipated Call from the Physician

We are sitting at the breakfast table when the call comes. It is a 214-area code, so I answer it.

Hello, Mr. Hinson, this is Dr. Cadeddu.  I’ll be performing your surgery on June 19^th.  Yes, there is a 95% chance that the tumor on your right kidney is cancerous.  And, there is another one on your left kidney that is 1 centimeter. We’ll just watch that one. OK. Sounds good to me. Thanks for letting me know.

Also, I need to let you know that your MRI has revealed that there are two swollen lymph nodes adjacent to this kidney that the CT scan did not pick up. How severe is this, what are the odds? We don’t know for sure, but I’d say that there is a 50/50 chance that there are cancerous, so I’ll be taking them out. I know this is not the news that you wanted, but I have plans A, B, C, and D and I’ll take care of you.  Even if we wanted to go faster, I cannot get to you until June 19.  I do not want to go any faster.  We have things to do, so I’m happy to wait until the 19^th.  Yes, that is just 19 days from now.  We could not go any faster. Thank you for calling.  See you on the day of surgery.

While this is a blow, it is not an insurmountable blow.  We will handle whatever comes.  Charla and I embrace and tear up a tad.  Maybe more than a tad.

The future has become a tad more uncertain.

I will have to accept the fact that I am a cancer patient.  Yes, that word.  A cancer patient. Then, down the road a piece, I will become a cancer survivor. 

Back to the main point at the lead of this painfully long post, is that I am well aware that I am a man of privilege. There is “Dr.” before my name, or “Ph.D.” after my name, though that is not a card that I play with physicians.  I am a patient, not a colleague.  My privilege speaks loudly: white, male, insurance, physician who calls me at home, automobile to travel the distance to all of the pre-op stuff and then the surgery, family who love me, middle to upper middle-class status, and the list could go on and on.

I believe that all people regardless of race, color, creed, national origin, gender, sexual orientation, etc., etc., should receive the kind of care that I am getting.  Yes, here I take my stand. All should receive the care I am receiving.