Lemon to Lemonade

Background

For the last seven years I have had a high-stakes gamble with the US health care system. Eight years ago, since losing my fat corporate job, I was paying $320/month for $5000 deductible insurance. I was a basically healthy person, and it seemed that I was p–ssing away my retirement savings with nothing to show for it. That plus my Mill Valley rent was burning through my retirement savings at a unacceptable rate.

For instance, I broke my hand playing basketball. That cost me a total of $700-ish, which I had to pay in full, in addition to the $320/month!  Health maintenance – getting checkups, expensive treadmill tests and such for my known heart murmur — I had to pay for all that crapola because it cost way less than my deductible.

So I just stopped — all of it. I stopped the monthly payments.  I stopped getting checkups. I basically just stopped all involvement with the health care system. I’ve been in Reno for 4.5 years. I have been to the dentist and to the optometrist, to maintain obvious pieces of external functionality, but I’ve been nowhere near any kind of doctor until the events below.

The bet was that I would stay basically healthy and functional and avoid having anything expensive happen to me until I turned 65 and became eligible for Medicare. And sadly, last November I lost that bet.

The Event

For almost two weeks last November I felt really, really lousy. There was a long list of symptoms that I won’t bore you with, but after a particular scary Wednesday night, on Thursday morning I drove myself up to the St Mary’s Emergency Room. They kept me for three days.

It turns out I had had a little heart attack, and even more to the point of this story, I had a severely underfunctioning mitral heart valve that needed fixin’.

If you know me at all, you know that I was bitching the whole time about how much this was costing me — I had to be frightened into not walking out of the emergency room the first afternoon, and seriously convinced to stay each of the two nights (cost seems to be roughly $3,000/day). The on-staff heart doctor wanted to crack me open and operate right then, but I had a hissy fit about the cost, so we postponed it.

Followup 1

The “physicians group” with whom I was by default hooked up has a strange system. There was nice old Dr Noble at the hospital, but when I went back for follow-up three weeks later, I was seen by a nurse.  She was much more upbeat than Dr Noble.  She reinterpreted the data for me with the message that I did indeed have a messed up heart, but it was not so messed up that we had to Operate Now. That was a much more comforting message, and it fit with the narrative that at the hospital you get a crisis mode interpretation, but when you come for a checkup you get a maintenance mode interpretation, which made sense. I felt greatly relieved after that.

Then according to their strange system, at the end of the checkup I was assigned my actual doctor, the person I would see the next time and thereafter, and the person who would perform the operation. Dr. Noble’s dance card was full, so after a strange little verbal dance where the nurse determined that I was neither sexist or racist (that is, I would accept taking advice from a non-white woman), I was assigned to a Dr Kedia, who I would meet at my next check-up in six more weeks.

Followup 2

Flash forward to early March, for that second check-up, my first meeting with Dr Kedia. This went very, very badly. Her very first sentence was to ask why I didn’t have health insurance yet.  I started explaining my theory of the universe as stated above, but she cut me off and started trying to intimidate me about how I needed an operation yesterday, and in her third sentence told me memorably that if I delayed, “no doctor would touch me because I might die in the operation“. Even though we stayed in the same room and did our business for another 15 minutes, it was already over for me and Dr Kedia; negotiation by intimidation is a big turn-off for me.

But she did succeed in scaring the crap out of me, turning my world upside down, inside out, etc. I accepted that I needed to make getting the operation Job Number One henceforth. To those of you who talked to me in the weeks after that, thanks for your caring – I was pretty shook up.

A small but interesting point is that all these different opinions come from exactly the same data.   The only actual new datum from each of the $136 follow-up visits was a blood pressure reading.  Other than that, the doctor/nurse look up the records of the electrocardiogram and blood tests done back in November, read from the screen and offer their extemporaneous opinion of What Does It Mean. So Dr K didn’t go off on me because my data had gotten worse, she went off because she had a worse interpretation of data from two months ago.

Anyway, I thought about all this stuff all the time, and gradually my thinking clarified.

I investigated Washoe County social services – the bottom line was that they would not take my house, but they would suck every bit of my retirement accounts to pay for it.   Ironically turning me into the indigent that I was not before the operation.

I eventually realized that since I was paying for it, I did have a lot more power in the transaction than the “lucky” smuck who either has insurance, or is so poor that the gov’t pays for it. I resolved that I was not going to let Dr Kedia touch me. I understand that pleasant interview manners do not relate to surgical skill, but on a purely karmic basis, I didn’t want to be operated on by someone with whom there was mutual “dislike at first sight”.

So that was the state of things — I was stressed, I knew I had a lot of unpleasant calls to make and unpleasant decisions to take, and I was procrastinating like a champ about each and every one of them.

Interlude

Over the course of this, I have gotten more and more comfortable just blurting the whole sad story out when someone gives me a simple “how ya doing?”. Sometimes I do, and sometimes I don’t, depending on who’s askin’ and how I feel that minute.

Before the event, I had been quite attached to my self image as the happy-go-lucky old guy who was the only old person I knew who didn’t take any pills – none!

Getting used to being just another old dude with a row of pills to take twice a day was humbling, and at first I felt like I had lost some kind of “health contest” with the other old dudes, but I realized that nobody else but me gave a s–t about that. If fact nobody else but me cared about any of these internal issues.  All my fine Reno friends were as caring and sympathetic as a person could be.More than one took my phone and entered their number and said “call me if you need anything”; very touching.

By April I was way past that, I was totally comfortable with my new narrative of happy-go-lucky old guy who’s doing great except for a bad valve in the ole ticker, and who has a plan for fixing it.

I even decided to gently “go public” on Facebook — for a few days my status was John needs health coverage, which stunningly became the key event of this whole on-going saga.

Now

In response to that status, my friend Haley sent me a link – Lower costs lure U.S. patients abroad for treatment – an idea that absolutely had never  even occurred to me.  That night I googled overseas heart operation, and here I am, planning my trip to Turkey!

This gets us more or less to “today”, and having laid out the background here, I plan to blog more frequently going forward.

I imagine the actual trip will happen in late May-June. I’ve sent off for an up-to-date passport, I’m getting my medical records transferred to Turkey, I getting very excited about the adventure – library books on Turkish history, novels happening in Istanbul, travel books.

Finally, I’ve always thought of myself as a lucky guy.  I’ve had crap in my life like everybody else, but I choose to focus on how well in general things work out for me.  Some combination of good karma, good planning, right thinking, born with advantages, and just plain luck.   For a couple of months here I have wondered if the string had finally run out, but now I am able to get back in my comfort zone of happy-go-luckiness.

Two “karmic” observations:

1. When I asked the universe for help (facebook status about health), the universe answered (link to overseas operation).  The answer will come, but you gotta ask!
2. I am pleased to become an actor rather than a victim relative to the current geo-economic situation.   The Best Country Ever (as Hannity would have it) chooses not to take care of the health its citizens – law-abiding, highly productive members of society like ME.  It was looking like my only two choices were to submit or die, but now I appear to have a third option, take a reasonable amount of my life savings and take it out of the country and fix myself.  The fact that I am spending it in non-US hospitals on non-US professionals could not be more perfect in my opinion.