An All-American Healthcare Story

It started with the spoiled meat. My healthcare journey, I mean. As I was cooking dinner one night, my spouse hollered from the other room, “What literally smells like feces?” Come to find out, the sausage I was browning had gone bad, and I could not smell it.

I’d always known I had a poor sense of smell. Whenever people would say something smelled bad, I would nod along as if I, too, could tell (but I usually couldn’t). On the flip side, I also couldn’t enjoy good smells, either.

When I had a cold the previous fall, my left nostril became completely useless, and didn’t really improve even once the rest of the symptoms had passed. “I should probably go see an ENT,” I thought. But it took the incident with the meat to convince me.

One uncomfortable nasal endoscopy later, my self-diagnosis of a nasal polyp was confirmed. In fact, the ENT’s response when she looked into my nose was, “Wow, that’s a HUGE polyp!” (Very reassuring to hear…not.) That was the beginning of one relatively healthy woman’s trek through the hellscape that is the American healthcare system.

I’ll pause here to say that everything ended well. In fact, everything proceeded well, too. There were no roadbumps along the way, no operating table disasters, no bills sent to collections. And yet, the whole thing felt like an ordeal, and gave me unbounded empathy for the people who have to deal with this shit when they are truly unwell, or alone, or living on the edge financially. I am in the unutterably privileged position of having good health insurance, a fiscal safety net, a job that is flexible with my hours and work location, no children or other dependents who need my time and need me to be well, and a supportive partner with a similarly flexible job and the ability to drive me around and take care of me.

Here’s a probably incomplete catalog of the appointments it took to get my situation sorted out:

  • An initial office visit to the ENT, including nasal endoscopy
  • A follow-up visit to see how the prescription steroids had affected my polyp
  • A CT scan (at a different doctor’s office) to map the inflammation in my sinuses
  • Another ENT visit to look at the CT scan and discuss next steps
  • An appointment to discuss details of the surgery
  • The surgery itself–an early-morning, half-day process, with the following day reserved for recovery
  • A one-week surgery follow-up including nasal endoscopy
  • A three-week surgery follow-up including nasal endoscopy
  • A two-month surgery follow-up, to discuss allergy testing
  • An appointment for allergy testing
  • A follow-up appointment to “read” the allergy test results
  • An appointment to test the allergen mixture
  • An appointment for my first allergy shots
  • An appointment for my second allergy shots
  • An appointment for my third allergy shots
  • An appointment for my fourth allergy shots, and to teach me how to give them at home

I’m now giving myself allergy shots once a week at home, and I had a six-month surgery follow-up scheduled at the beginning of the year. There were also multiple trips to various pharmacies for both prescriptions and over-the-counter supplies that I needed at points along the way.

Y’all, that’s a lot of dang appointments. And consider that each one is, say 45 minutes, at the very least, with an hour or so of travel time to get to the doctor’s office, and another 30 minutes or so to get to my work office or back home afterward. That’s hours and hours worth of time that someone working a part-time, hourly job likely wouldn’t have the flexibility to commit to for what was ultimately an elective surgery.

And not to mention the cost. As I said before, I have good health insurance, provided by my employer. I’ve chosen to carry the high-deductible plan, with an HSA that my employer deposits money into. My spouse and I keep the equivalent of our deductibles earmarked in savings. Last year, for maybe the first time in my life, I hit that deductible, about halfway through the year.

Because the ENT is considered a specialist, I didn’t pay a co-pay each time I visited. Instead, they would bill my insurance provider, and then send me a (paper) bill for what I actually owed. With the frequency I was visiting the office there for awhile, the bills would cross in the mail sometimes. I would go to pay my balance when I was there in person, but then receive a bill for what I was pretty sure I had just paid. Being the conscientious person that I am, I made several phone calls to figure out if I actually owed what was billed. This also took time, which I had the flexibility to do from my desk at work.

In addition to those charges for the office visits, each nasal endoscopy cost something, too. The CT scan cost money as well, that I paid to a different provider. And let’s talk about the bill for the surgery. My ENT’s office has a staff person whose entire job is to meet with patients before the surgery and go over what their financial responsibility will (probably) look like. She calls their insurance provider to talk it over, and then has a meeting with you in her office to go over the numbers. I paid a portion of what it was expected I would owe as a deposit. All of this was okay for me because we had that deductible’s worth of money saved, but it was a lot out of pocket!

So I paid the deposit, I had the surgery, and I knew I would owe some money, but it was unclear exactly how much that would be, when the bills would come, and to whom I would pay it!

Several months after the surgery, the bills finally started arriving. I owed money to the ENT for her services. I owed money to the surgery center. I owed money to the anesthesiologist. There may be others that I’m forgetting. And of course, there were multiple different third-party systems that I had to access to pay all of these.

Asynchronously from the paper bills, I would receive email notifications from my insurance provider that an explanation of benefits was available. This had numbers that corresponded in some way to the bills, but were not directly mappable.

The bills themselves were mind-boggling. There would be a column for the total cost (around $44,000 for the surgery alone), a column for the adjusted cost once my insurance was billed (something like $7,000), a column for what the insurance paid (something on the order of a few thousand dollars), and then a column for what I owed (around $700). The amount paid by insurance combined with the amount I owed did not actually match the amount of the adjusted cost, which itself was obviously a lot less than the initially quoted total cost.

There are entire associate’s degrees dedicated to learning how medical billing works in this country.

Once I hit my deductible of $1500, I had an additional $1500 to spend to hit my out of pocket maximum. I got there pretty quickly, too. At that point, I would occasionally still get a bill in the mail, but for $0–effectively just more paper to shred; existentially, a confusion to ponder over.

There are so many what ifs that I take away from this story.

  • What if…I had not been well enough to drive myself to the initial appointments, and had no one in my life to drive me, so had to either pay for a ride or spend the extra time it takes to navigate public transportation?
  • What if…my job didn’t allow for the hours I needed away from the office to go to all these appointments?
  • What if….I was living paycheck to paycheck and couldn’t afford the out of pocket maximum insurance required of me?
  • What if…I didn’t have a live-in partner to drive me to my surgery and then keep an eye on me as I recovered from the anesthesia? (He hollered up the stairs periodically, “Have you gotten up lately?” to make sure I was moving around like I was supposed to, to avoid blood clots.
  • What if…I had moved in the middle of all of this, and some of the paper bills got lost in the mail?
  • What if…I could only access the Internet from a public computer, making it that much harder to pay all of the bills online or do research about what was wrong with me?
  • What if…I couldn’t immediately pay the bills out of pocket, so they got sent to a payment plan or, worse, to collections, adding yet another layer of complexity and paperwork to getting them paid?

I am a relatively organized, highly educated, financially comfortable, married American citizen, with stable housing and a vehicle that I own. Given all of that privilege, navigating an elective surgery was eminently doable–more of an annoyance than an actual hardship. Given the same advantages, I can imagine that navigating all of this for an emergency surgery, or for a long-term illness, would be significantly more difficult because of the emotional strain and physical side effects, though still doable. But lacking that firm footing, I can barely fathom what it would be like trying to handle all of this.

I think the healthcare system in America is broken. My story shows it. I’m not a politician, and I’m not the one who can bring about systemic changes in any of these systems, but I can vote for the the people who will. And I can be understanding when I hear stories about healthcare related bankruptcies. I can have so much more sympathy when co-workers take time to deal with health issues, or to support family members with health issues. It’s easy to feel helpless, but I think my list of what ifs can give us some ideas.

  • What if…we make ourselves available to give rides to people in our lives dealing with health scares?
  • What if…we use our influence at our companies to protect the jobs of people needing time for appointments, phone calls, etc?
  • What if…we educate people about financial literacy and help them save to have a cushion for healthcare spending?
  • What if…we volunteer at hospitals or surgery centers to look out for people who are alone?
  • What if…we support places like our local libraries that are invaluable resources for people who need access to computers and the internet?
  • What if…we make noise about making Internet access a public good?

My story, which was hardly traumatic in the first place, has a happy ending. The bills are paid. I have a lot fewer doctor’s appointments on my calendar. I can smell now, and I can count on one hand the number of sinus headaches I’ve had since my polyps were removed and my deviated septum was repaired.

My spouse bought me a candle for Christmas last year, that I chose not to light until I knew I’d be able to smell it. We joke that it’s the most expensive gift he’s ever bought me: a $44,000 candle. And it sure smells awfully sweet.

Maybe Easter is Coming?

I have fond memories of Easter. Even secular households in the Bible Belt South learn to embrace the evangelical rhythms of spring, and my family was no exception. We would die the eggs and hide them in backyard, for just me, the only child, to find. I’d get a basket of goodies (I remember I never liked the giant chocolate bunnies, though they seem like a delightful extravagance.) Easter lunch meant egg salad, the occasional bite tinged purple or pink, having been made from the colored eggs.

Other years we ventured to church, if only for the family-style lunch that followed at Uncle Ray’s house. Then I learned about Easter ham, and Sister Schubert rolls, plates piled high and tables crowded with family and friends. I squirmed through the service, not knowing the words or the tunes and not believing.

At fourteen, I was born again, and Easter meant something more. My dad, a notorious late sleeper, drove me to a sunrise service. I remember it was always chillier than the floral sundresses we donned would have indicated. A tableau on the church lawn under a grey sky, and then we piled onto the buses bound for Cracker Barrel. Big breakfast, a nap on the youth room couch, and then the sanctuary service. I loved the swelling verses of Christ the Lord is risen today, Alleluia Amen. We only sang it that one day of the year, even though its truth carried us through the rest of the days.

We were married on the Saturday following an Easter, which also coincided with my dad’s birthday that year. Our guests kept asking whether our wedding date was on Easter weekend–no ma’am, we’re in the South, the church wouldn’t let us do that! The flowers outside the church had exploded into bloom, as if resurrecting themselves in celebration of our union–Allelulia, Amen.

The first Easter we were in Atlanta, I felt drawn to open my home as others had before to me, and we invited in some transplants like us. I made Easter baskets for everyone and cooked way too much food. It felt over-the-top but also just right.

And then I broke with the church, and Easter was a somber day. I awoke with Christ the Lord is risen today in my heart, and I couldn’t stop myself reading the onslaught of social media posts from my friends who still blithely believed. I didn’t buy the resurrection story anymore, and it broke my heart.

So I began making attempts to mask the sadness, reverting back to the secular version of celebrating–food and friends and conversation. I cooked the ham and bought the jelly beans. It felt better than wallowing in my sadness and unbelief. I believe in the trappings of religion, and I miss them, those markings of the passage of time.

Easter is coming again. It was early last year, and I imagined the scurry of women pulling out cardigans and scarves to layer over their celebratory garb, little girls wailing their feet are cold in their brand-new white sandals, family photos with a steely sky in the background. This year it is later, and we’ll have people over for brunch in the sunshine, and drink mimosas, and I will make too much food again, because that’s what I do.

I could write a trite tale of Easter coming again in my heart, but that wouldn’t be true. Chris the Lord is risen today ends with a question mark these days. But I do feel the resurrection of spring coming, the sun returning to bronze my winter-paled arms, the grass sprouting up greenly, flowering trees dropping petals like rain over parked cars. I have new rhythms these days. I open the windows with an Allelulia, Amen on my lips. Easter is coming.

New Year, Old Me

The year started off for me with more of a whimper than a bang. I was laid out sick on New Year’s Eve and binged an entire season of The Marvelous Mrs. Maisel. I didn’t see midnight; at 11:26pm I was conked out. But I slept like a rock until 8:52 the next morning and woke up feeling fine. I watched the Bulldogs lose their bowl game and powered through putting the Christmas decorations away in preparation for heading back to work the next day. By the evening of the 2nd, my fever was back! So I worked from home in my sweats for the next two days. So much for getting back to the grind.

It’s difficult to make resolutions when you are fundamentally happy with your life. I’ve mostly caught up on laundry, I’ve cut back the dead plants in the backyard and under the mailbox, and I cleaned out the fridge, freezer, and pantry. Andy and I have planned out some vacations for the year. I could expend a lot of mental energy and a fair amount of effort on minor tweaks and optimizations, say, setting an SLA on folding the laundry…but honestly I don’t think the ROI would be worth it. I’m mostly pretty efficient, and I’m mostly organized enough. I’m content.

I’ve stuck with Pilates for a year now. I remembered in my first Sunday morning class of the year that I had started going as a semi-resolution last year. And I’ve finally decided I somewhat like to run. I’m already signed up for a 15K in February and will find another fun half marathon to run in 2019.

This will be the year I commit to volunteering with the cats at Lifeline Animal Project more regularly and finally find a way to read to kids. I’d also like to make new candles out of the bits of wax left from old candles. And, I’m going to plan to read one book every month that I already own.

That’s it! Those are my big plans for the new year. And maybe you’ll see me back here periodically.

Here’s to books, cats, traveling, and eating relatively well in 2019!

Just Blow Your Nose Already

This may border on TMI, but what is a blog for if not ocassionally indulging myself in a little oversharing?

I really hate to blow my nose.

I don’t know why. It’s a perfectly natural thing to need to do. But I will sit there all congested, sniffling and snurfling and putting off the inevitable. And yet when I finally give in and just blow my nose already, life is amazing! I can breathe! And I wonder why I didn’t do it sooner.

You may wonder what the heck that anecdote has to do with anything. Well, I’ll tell you: it’s about noticing the extraordinary in the ordinary. Celebrating the small things. And that’s what my goals for 2017 encompass. Nothing earth-shattering on this list, but rather digging into where I’m already planted.

I love my life. I may sometimes gripe about work or any number of things, but more often than not I’ll find myself driving down the road thinking how astounding it is that I get to live these days. I read a quote by Neil Barringham that says, “The grass is greener where you water it,” and ain’t that the darn truth?

Heading into the new year.

Here’s how I’m going to water my grass in 2017:

  • More writing and projects, less TV watching.

After dinner I usually let myself turn into a pumpkin. It’s as if because it’s dark outside I become incapable of productive action. Here’s me claiming it won’t be so! The plan is to post here once a week, plus my monthly reading recap.

Plus I haven’t done a cross-stitch or any other type of project in too long. I’m planning to take a hand lettering class and would like to get more into that.

  • More rowing while dinner’s in the often, less mindless scrolling through social media.

We got ourselves a fancy rowing machine for Christmas because I wanted it, and yet I’ve only really used it once so far! 20 minutes or so while something bakes is the perfect amount of time to get in a quick workout.

I would also like to run a half marathon in 2017. (Look, I know I say all the time how much I hate running, but I like having a physical goal to achieve, and it seems like completing that would make me feel good. I’d like to prove to myself that I’m capable of it even if I never do it again.)

  • More calling my friends, less feeling disconnected.

I hate talking on the phone (except to my parents, true story), but there are people in this world who I like, so I should make time for them. Related to this is planning another girls’ beach trip with my disparate pals and entertaining at our home once a quarter (and getting our back patio area spiffed up).

I’ve gotten all organized for book club this year, because I was determined not to let that die, so it should run more smoothly and fill me up more this year than it did last year.

A few other miscellaneous resolutions:

  • Take more pictures with Andy.

When I went to look for one for 2016’s Christmas card, my Amazon Cloud Drive informed me there were only NINETEEN pictures of the two of us from the entire year. And many of those were multiple attempts at the same sub-par selfie. We do fun things together and that should be more evident in our photographic vault.

  • Read one non-fiction book per month.

I’m copying this onto my work goals as well, so it will happen.

  • Clean regularly.

We have a house cleaner who comes, but only once every six weeks because that ish is expensive. So I set a recurring event on my calendar to do a cleaning blitz every three weeks in between. The carpet won’t know what hit it.

  • Keep up with transactions in YNAB (our budgeting software).

Andy is so on top of things financially and I often take that for granted and slack off. But I should be more aware of what’s going on, even if it’s just to log into the software and categorize my transactions once a week. My wallet will appreciate not having to hold receipts for months at a time.

My word for the year? Consistency. Because, as Gretchen Rubin writes, “What you do every day matters more than what you do once in awhile.”

If you’re doing some daydreaming about the year (it’s not too late!), I found this free printable from Love & Renovations very helpful!

2016 Reading Recap

I read 73 books in 2016, out of my arbitrarily set goal of 76. (I read 75 last year, so I upped it by one.) Looking back over the list on Goodreads, I don’t think that my rating system really works for me. Some of the ones I marked as 4 stars haven’t stuck with me, while some of the 3 star reads seem, in further removed hindsight, like they deserve better. My average rating of all my books for the year was 2.9, which strikes me as a bit sad, but I don’t feel sad thinking back on my 2016 reading life on the whole.

Rankings

I had two five star reads:

This book, like one of last year’s favorites Wonder, deftly handled a very sensitive topic. If there is anyone in your life, child or adult, who has questions about what it means to be transgender, I would highly recommend sending George their way!

I don’t do a lot of re-reading (so many books, so little time!), but in order to call a book a favorite I’ve decided I need to read it more than once. I started with Fangirl and it was as wonderful as a remembered.

Half of a Yellow Sun, Ready Player One, and What Alice Forgot were other favorites from the year.

Musings

I read very little non-fiction in 2016, which is perhaps why I was able to read so many books. I would so much rather curl up with a good novel, or even a bad one, than most non-fiction. However, I did read a few good ones, like Modern Romance, Big Magic, and The Year of Living Danishly.

2016 is the year I discovered Liane Moriarty and the joy of reading a new-to-me author’s backlist. I also read a number of books that either have or will soon have a sequel, which is delightful. Outlander and the Chief Inspector Armand Gamache novels were my favorite series discoveries that would keep me in books for quite some time, even if I read nothing else.

I distilled and embraced some types of books and authors I like: sweeping, epic novels with some romance; British chick lit writers; smart and sexy romances. No shame in any of that.

My Year in Books on Goodreads has fun statistics like total page count, shortest and longest books, and also the full list, so click through if that strikes your fancy.

Book Club

2016 was a disappointing year for book club, with really inconsistent meetings and a dwindling number of members. I need to re-group for 2017, as I don’t want to let it fall apart, but I can’t keep doing it the way I have been.

I only tagged 7 books onto my Book Club Reads shelf on Goodreads:

  • January: Brain on Fire: My Month of Madness by Susannah Cahalan
  • February: Lizzy and Jane by Kathering Reay
  • March: Big Magic: Creative Living Beyond Fear by Elizabeth Gilbert
  • April: State of Wonder by Ann Patchett
  • August: The Gifts of Imperfection: Let Go of Who You Think You’re Supposed to Be and Embrace Who You Are by Brene Brown
  • September: 13 Ways of Looking at a Fat Girl by Mona Awad
  • October: Quen Sugar by Natalie Baszile

We also went to see Me Before You at the movie theatre. Of the books were read, 13 Ways and Lizzy and Jane were the least-liked.

This Year

I haven’t decided yet whether I want to tackle a reading challenge this year, like the one from Modern Mrs. Darcy or Book Riot. I did neither in 2016 but was still relatively pleased with the breadth and diversity of what I read, which seems to me to be the point of those challenges. I am trying to consciously pick books written by non-white authors or featuring non-white protagonists.

I’m hoping to read one book per month for work, so that will up my non-fiction count. I have a list of books for professional development on Amazon and add to it frequently.

I’d like to be more consistent with my rankings on Goodreads so that I can remember things better. And I may do a few more re-reads so I can better answer when someone asks me what my favorite book is.

Happy reading, bookish friends!