Wednesday, September 2, 2009

Laughing at the monster

None of us is immune to what we fear most.

I’ve seen enough of death to know that it’s the biggest fear behind all the others.

Our soldiers and their families have certainly seen enough of it to know the worst: Limbs torn asunder, eyes splintered and hearing lost in roadside explosions, sacrifices beyond measure—and reason.

So it seems silly to complain about a little cancer.

I look at myself in the mirror and roll my tongue between my gums and cheek. A sore. Where did that come from? I don’t have any dental insurance. My only medical comes from the U.S. government.

I floss my teeth the way I was taught more than 40 years ago. At 51, I’m reaching that age where I’m going to need some dental care soon. My thoughts take me back to this morning’s dream:

It’s my birthday. I’m 86. I'm amused, bewildered. How did this happen so quickly? I share my feelings with other dream figures, friends, it seems. They’re amused too, on the verge of laughter.

Getting older really is a joke. It’s a wild bet against the monster demon of the Forgotten, the mythological beast that swallows you whole and no one remembers your name. There’s nothing you can do with the monster but laugh.

The number in my dream probably has as much to do with getting 86’d from life as it does with age. The joke, as older people know, is that, sooner or later, you’re gonna die.

I’ve had two melanomas removed from my body, one of which I still haven’t paid for. Not long after the second surgery, I lost my job along with the company-sponsored health insurance plan. I haven’t had a personal plan since.

I’ve visited the doctor enough to know what to watch for, but lately just about every little bump, bruise and mouth sore alarms me. I’m a hypochondriac, for sure. Adding years to my lifespan doesn’t seem to help.

So far, the Veterans Health Administration has been a godsend. I’ve kept my regular appointments and checkups, and the doctors are happy to advise. I’m in good health, they say. Plus, I’ve had some of the best group counseling a vet can get for grappling with the angers and frustrations that come not just from military service but more often from life itself.

Only once have I panicked over my government-sponsored healthcare plan.

The artful young private doctor who removed the slab of skin from my leg, which looked like a strip of pork with hair on it, ordered me to come back every six months. “For at least five years,” she added.

I wasn’t going argue with her.

Then I lost my plan. My bill went unpaid.

Without medical coverage, I wasn’t sure how I’d get to see a doctor to prevent another mole from turning into a massive cancer. Melanoma, one of the deadliest and most aggressive cancers, and least likely to respond to chemo, can best be fought with early detection, which also reduces healthcare costs.

A friend, who also served in the army, told me to check with the VA, and qualify for periodic checkups.

Being poor, I qualified. For now, I rely on the government to help me in time of need. It’s not what I’d choose if I had the means, but it’s a helluva a lot better than nothing. How it compares to private insurance for emergency or intensive care remains to be seen. I hope I’ll never need it.

But in the U.S., if you’re going to see a doctor or stay in a hospital for treatment without going bankrupt, you need insurance, a plan to underwrite expenses that few American families can afford.

The sore in my cheek, bumps or discolorations in the skin, which more often than not turn into pimples, and every little change in my body, sends a little shiver of panic.

What if it turns into something? I look in the mirror and scold myself for letting my cheeks turn pink from too much sun while riding my bicycle yesterday.

I don’t surf as much since the little lamb chop was removed from my leg. I stay protected from the sun as much as possible and avoid too much exposure. At my age, it probably doesn’t matter. The damage is done.

A soul-surfing friend, the Kahuna of Cayucos, told me: “You can’t stop doing what you love; you gotta enjoy life.”

He’s right. But it’s hard to avoid the image of huge chunks of skin or flesh being removed from my body to prevent a disease that medical science hasn’t completely fathomed, not enough yet to find a cure. At least cancer treatment in the U.S. has advanced to give us an uncertain hope, which is better than a death sentence.

I got an appointment at the VA clinic downtown, a 20-minute drive from home and easy to access. I went to see my assigned physician’s assistant to request an appointment with a dermatologist.

The young, pretty, distracted, overwhelmed PA sat at her computer and asked a lot of questions in a detached, robotic manner, as if she found it much easier to run on autopilot and read the script.

I wanted her to look at me and talk to me in the way a patient needs, the way my personal doctor did: I’m listening. You’re in good hands. Don’t worry. I wanted her to give me a pat on the hand, a signal that she was doing more than just plugging data into the computer. But I could tell that life had been hard for her and I didn’t want to bother her with my own problems.

She seldom looked at me, and asked the usual questions for VA quarterly checkups: “Do you have any allergies? How much alcohol do you drink in a month, a week, a day? Are you still smoking marijuana?”

This was one question where she’d break from her computer screen, look me in the eye and press home her point: “Let’s try to bring down your marijuana intake, OK?”

She checked my vitals, made me touch my toes, tapped my back and listened to my bronchials. “When’s the last time you had a blood test?”

I always manage to skip the blood test until the PA tells me to visit the lab on my way out.

She continued to go down her rap sheet until finally, frustrated that she wasn’t paying attention to me, I told her this wasn’t supposed to be an ordinary checkup. “I’m here because I need to see a dermatologist.”

“Let’s see….” She went back to her computer, as if confused.

“I’ve had two melanomas,” I explained. “I’m supposed to see a doctor every six months.”

“Well, we can put in a request for you to see one in about a year. I’ve just checked you out and you look fine.”

“Yeah, but you’re not a dermatologist,” I said. “I have a couple of spots I want checked out.”

She came over, I lifted my shirt, and she inspected a suspect mole. “I can’t promise you anything; it could take up to a year.”

“I don’t want to wait that long,” I said.

“We’ll make a note that it’s urgent.” She tapped something on the computer, assured me that it wouldn’t take long to get an appointment, and opened the door for me to leave. “Don’t forget to do your labs,” she said as I made a turn for the exit.

I drove over to the County Medical Service Provider, a locally run program for the indigent, worried that I’d be dead or ravaged with a fatal disease, by the time the VA’s dermatologist put me on his schedule.

The CMSP portables were located across town, sitting on the backside of what used to be General Hospital, shut down years ago by local taxpayers and used for other services. The waiting room was filled with Spanish-speaking moms, a pregnant woman, children playing with toys and another veteran.

The receptionist slid a clipboard with pen-on-a-chain through the window and asked me to fill out an information sheet. I did as told, quickly losing hope that I’d see a qualified doctor who could examine the mole on my skin in time to avoid the monster.

“If you already have coverage with the VA, there’s nothing we can do,” she said after reading my info sheet. “You’ll have to go through the VA.”

“Yeah, but I can’t get in,” I explained as patients in the waiting room paused to listen. “I’m supposed to see a doctor every six months.”

“I’m sorry,” she said.

“Early detection is the best and least expensive way to manage this,” I urged.

“I’m sorry. We can try to put this through but I doubt it will help.”

“Please do,” I said. As I turned to leave, the faces in the room showed sympathy and I was certain they were glad not to be in my shoes.

I walked out into the bright sunlight in a panic, conjuring possibilities: Maybe a car wash, get a second and third job, turn tricks to raise funds so I can be screened by a dermatologist.

“Hey!” shouted a voice behind me. “Hey! Are you a vet?”

I turned to see the man who was wearing a military baseball cap in the waiting room. He'd followed me outside. “Yeah,” I said. “I was in the army.”

He wore a Vietnam-era Screaming Eagles cap from the 101st Airborne Division that fought in the 1968-69 Tet offensive, during which the Viet Cong launched a massive attack against American troops. He took my hand in greeting and held it in both of his. He gazed at me in earnest.

“Listen,” he said, “you make sure the VA takes good care of you. They’re supposed to do that. They’re there for you. I get great care through the VA.”

“Then, why are you here?”

“For a friend,” he answered. “The VA will take care of you,” he continued, “you make sure of it. OK?” He kept my hand in his.

“All right,” I said. “I’ll make sure of it.”

“That’s it!” He patted my shoulder, let me go, and went back to the waiting room.

I saw a dermatologist two months later. He removed the mole for biopsy and it turned out benign. Safe, for now.

In time, the unhappy PA moved on and now I see a real doctor at the VA clinic. I have more peace of mind knowing he’s monitoring my vitals and checking the spots on my skin. I see a dermatologist almost every six months. In a pinch, at least, I won’t have to wait a year.

My worries, finally, had more to do with the PA’s unhappiness than with how the VA cares for vets. But how was I supposed to know? I thought that’s how the system worked. Had it not been for that vet, I would have thought the worst about government healthcare.

There have been horror stories of vets who failed to receive adequate care but overall it appears to be a system that works pretty well. As I say, it’s better than having no care at all.

Those who argue against a government-sponsored healthcare plan could probably point to any number of flaws in the system, but a plan not unlike the one we provide our veterans seems a perfectly sensible one to me.

When panic attacks come, I can assure myself of prompt access to the doctor when I need him. I have access to a qualified physician who monitors my health, can tell me what’s going on, and who, I hope, will send me to a specialist whenever it becomes necessary.

If we could make the same commitment to the millions of American citizens without insurance as we do our veterans, we might begin to find a way to a solution for our national healthcare problems.

After some thought, I was able to laugh at the monster again. I decided not to call the doctor today. I'm not worried about getting 86'd from life. The sore in my mouth, I realized, is a cut from a cracker I ate. If it doesn't go away, though, I'll call the VA. §

1 comment:

  1. You've made some interesting points on the necessity of preventive care in the U.S. health care system. Our government would be wise to treat all of its citizens as it does its veterans, with compassionate care and dignity. That automaton PA aside, I think the VA is a fairly good model of so-called 'socialized medicine' that works for American vets, and could easily be applied to all U.S. citizens with minimal costs and abundantly healthful results.