Sunday, December 20, 2009

A Tale of Two Women with Breast Cancer

About a year ago, two women awoke to lumps in their breasts. One woman - a coworker of mine who is insured, will be alive to reflect on this a year from now. The other, my former nanny, may not ever see her children - who reside in Sri Lanka - again.

My coworker, Kim, had a history of breast cancer in her family. When she felt a lump, she fought for the absolute best treatment she could get. When the mammogram was unclear, she demanded a biopsy. She went through hell - and still faces reconstructive surgery - but she's alive. She's one of those million cases I hear about regularly - early detection (and treatment) saves lives.

My former nanny, Rani, did what I suspect nearly every uninsured person does. She didn't tell anyone. But eventually, that lump grew, and grew, and grew, until she was in a lot of pain. She had an immediate masectomy, several rounds of chemo, and now she's sitting in a hospital and needing every prayer you can muster to get her on a plane on Christmas night. You see, she didn't get treatment soon enough, and the cancer has spread to her brain and is terminal. Her current employer holds a plane ticket in her name to get back to Sri Lanka - he's even accompanying her on the 23 hour journey, but unless she can sit up and walk a little, the airline will not allow her on the flight (odds are 50 - 50 at this point). Her doctor has filled out two rounds of paperwork to get her on the plane, her employer has filled out paperwork, she has filled out paperwork. I suppose the airline wants some reasonable assurances that she won't die on the flight home.

Two of her children, whom she has been supporting from abroad, are in Sri Lanka and the third is in Dubai - a place where she has a planned layover to see him for probably the last time.

Both of these stories repeat themselves daily. Inadequate access to care results in death. People in jobs that don't typically have access to insurance - you know, the people who care for our children, the people who serve us food, the people who clean our offices - and many others. There are a lot of hard working people in this country who remain uninsured and have poor access to health care.

The argument I hear most against passing real health care reform - and I'm not talking about whatever pathetic handout to the insurance companies that we're going to end up with - but health care reform that guarantees true access to timely care - is that people don't want to pay for it. To those people, I say this.

You may not have paid for Rani's early detection, but you did pay for her surgery, her initial rounds of treatment (that came unfortunately too late), the radiation needed when the cancer spread to her brain, the additional rounds of chemo being delivered to her spine to try and enable her to walk again so she could get on the plane (and thank you, humane doctors who are choosing to deliver this care to a terminally ill patient who wishes only to say good-bye to her family), many hospital stays and I'm sure much more. It's care that the hospital will write off because she'll never be able to pay, and everyone else will pay higher rates to compensate for these write-offs. So you paid, you just did it in a horribly inefficient way.

So Congress and anyone else who stood in the way of getting real health care reform done, you get a grade of FAIL for Christmas this year. But doctors and nurses treating Rani, you get my thanks, for doing everything you could once the cancer was identified.



  1. What ended up happening to her?

  2. She didn't make it on the plane. Hospice care starts soon.