a very lucky patient

About eight months ago I was thrilled to be able to go to the dentist by purchasing a Groupon. The idea of having a regular family doctor seemed foreign. For me, medical care aside from dentistry coupons and Planned Parenthood seemed a distant dream until Jason got a new job that promised the most stunning set of benefits I'd ever imagined. We went to dinner the day the insurance came through and excitedly pored over the glimmering packet of benefits and lists of doctors we would be able to see with moderate co-pays. Jason got glasses and a physical, checked out a mysterious chest pain, and our concerns about his well-being were quickly allayed. Up until that point it seemed that if either of us had a health issue, it was him.

A few days after my initial meeting with our brand new family doctor - a serious and charming man who wears a lot of linen and has a bright smile - I was laying in bed poking around at my breast doing a perfunctory self-exam when I found a lump. I have done these self-exams since I first got my period. I think I used to do it because I was curious about the budding breast tissue and liked to pretend that I had breasts to examine. At some point it became a still-unnecessary, but good, health habit, so I kept it up. I pointed it out to Jason and we came to a general consensus, "Huh. Ask the doctor at the annual." I was a little uneasy about it, but mostly because it threatened to be a cyst or some other grossness. At the annual, the PA who did my exam ordered an ultrasound, said not to worry, and gave me a clean bill of reproductive health.

A week later at the ultrasound appointment, I lay on my back with my right breast covered in warm gel as a radiology nurse passed the probe (it's not really a probe, but that's what it is called - I looked it up) back and forth until she got a clear picture that made her face freeze. "I'm going to have the doctor look at this. I'll be right back."
"Why? What's wrong" I asked, as the emotional center in my brain screamed, MAYDAY! The only thing she said was that the lump wasn't fluid-filled and we would need a mammogram. "What does that mean?" maydaymaydaymayday. It turns out it meant that the lump was a tumor. 

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An aside on mammograms:  It hurts. It hurts in a way that it doesn't seem like your breasts ever could hurt. The nurse tugs and lifts and pushes and smashes your breast onto the film plate, slips her hand out at the last moment while the upper plate comes down, then clamps it even tighter. As though it would be possible to do anything else, she tells you to hold still, then hold your breath. Each picture is taken fairly quickly, but they take multiple pictures.


Once the mammogram was done, a nurse walked me to a long, narrow room where a doctor sat in front of six monitors, each one showing a different view of the inside of my breast. She pointed to the lump- a dark, oblong mass in the middle of a network of fine white lines and cloud-like puffs of breast tissue. "I'd like to get a biopsy of the tumor." No one had said the word "tumor" yet, and the force of it hit me hard. "The nurse will take you back in the other room and get you scheduled." I don't think I said anything, or maybe that is just a fitting dramatization of the moment in my memory.

I scheduled an appointment for the biopsy a week from the date of the ultrasound against the urging of the scheduling nurse. It was the last week of school and I had students' projects and papers to grade, instruction and review to complete. They had final exams coming up and it seemed unfair to trust that precious instruction time to someone else. The biopsy waited. I cried as I walked to the car, texted Jason because I wasn't much for talking right then but the message didn't go through.

...

We went in for the biopsy on the afternoon of the second-to-last day of the school year. They called with the results Monday just half an hour after I got home from entering final grades, submitting book tallies and attendance reports.

"Sara, this is Joy from Dr. Dallas' office. We need to set up an appointment to go over the pathology report from your biopsy. Can you come in tomorrow at 10:40?" My heart has never raced so fast or fought so hard to leap out of my chest.

"Yes. What are the results?"

 "Positive. We'll see you in the morning." And that was it. That was all she said.

 ...

In the span of a month I have gone from being thrilled to have one doctor to having at least seven, (radiologist, medical oncologist, fertility specialist, genetic counselor, surgeon, chemotherapy doctor, general practitioner) and at least five more than that have reviewed "my case," because I also have a case now. I am incredibly lucky to have insurance. I feel guilty for the privilege that it is and outraged because it shouldn't be. I am three times more likely to survive than a woman without insurance. I cannot even begin to wrap my head around that extreme injustice, or how very very close I am to being on the other side of that shitty dividing line. If Jason hadn't taken this crummy job, or if Joy hadn't taken the lump very seriously, or if I didn't do the exams women my age don't really need to do, or if, or if... We'd be looking a very different future. I wouldn't have gone to the doctor to have the lump looked at if we didn't have insurance; it's too expensive and the likelihood of me getting breast cancer at my age are less than 2% even if I am genetically predisposed. I've always believed in universal healthcare but had little personal experience from which to speak. 

A friend of mine recently said she wouldn't be interested in marriage until everyone could do it and her righteousness struck me and I felt a little like a traitor for being married. And now I am again on the privileged side of the road, and it doesn't feel good. Which is not to say I am not glad and grateful for the insurance that will not only save my life but mine and Jason's likely financial future among the middle class - indeed I am immensely grateful - it's just that it doesn't feel right, knowing that owing to little more than good fortune, I will come out of this on top and someone else will not. After all, it is the right to marriage that got me the insurance in the first place.