Our Journey Through the U.S. Health Care System
Health insurance assigns a cardiologist for office visits, but not hospital procedures, and the barbaric thoracentesis
Just before Thanksgiving, a treadmill stress test was done in the cardiologist’s office. They asked me to wait in the waiting area because the room where he was going to take the test was too small. About 20 minutes later, they said they were finished and I could come back. I walked in and Craig was in distress, breathing hard, and red-faced. They said he had failed the stress test (that was obvious!). They had to give him Nitroglycerin. The cardiologist said he needed to be admitted immediately for an angiogram due to a heart blockage.
The nurse went to call his insurance to get approval. She came back several minutes later saying we were out of luck because his health insurance was contracted with his cardiologist for appointments only, not for hospital procedures. Michael’s health insurance company was not contracted with the hospital where his cardiologist did procedures. It was the most absurd thing I had ever heard. How can you approve a patient to see a cardiologist for appointments, but not for procedures?! Well, it’s because the health insurance companies have separate contracts with hospitals and separate contracts with doctors. Sometimes, they don’t coincide and there’s a gap and real people fall through the cracks, all because of contract negotiations over money. The insurance company said we needed to find another cardiologist to do the angiogram, but that meant waiting weeks or even months to see a new cardiologist and set up the procedure in another hospital! His doctor and nurse could only say, “We’re sorry.” and “Good luck.” I felt like screaming at the top of my lungs.
It was just after 5pm as we left the cardiologist’s office, stunned and afraid. The usually busy office with patients waiting and staff people running around was now silent. Only the nighttime lighting was guiding us to the exit door. Craig was so weak, he could hardly stand. I didn’t even know if I could get him to the car. I wanted to cry, but there was no time for that. I was shaking from fear and anger. No one should have to go through this. What the fuck!
As we slowly walked out of the reception area, suddenly a door opened to my right and the office manager appeared providing us with a miraculous answer. She whispered, “Please don’t tell anyone I said this, but if you show up at the emergency room tomorrow morning at 6am and tell them you have chest pain and shortness of breath, you will be admitted. The doctor will take it from there. He is doing surgeries tomorrow. If you go through the ER, insurance has to cover it.”
The next morning at 6am, we arrived at the ER and Craig was immediately given a bed in the ER and not too long later, they started admittance procedures. As we were waiting, a stretcher pulled up and the orderly said they were taking him to Radiology for a thoracentesis. We said hold on, what is that? We had been told he was there for an angiogram. We learned a thoracentesis is one of the oldest procedures known to medicine. The oldest known historical reference dates back to the fifth century B.C.E. It is a barbaric procedure where you insert a long needle into the back and drain the fluid buildup from under the lung. Nowadays, the radiologist uses ultrasound to make sure the needle goes in the right place and doesn’t puncture the lung. Craig didn’t want to do that until he spoke to his doctor, but we were told the doctor was in surgery. After a 6 1/2 hour wait in the ER, his doctor appeared. He explained that he couldn’t do the surgery until the fluid was drained because it is too much of a strain on the heart. Couldn’t someone have explained that to us earlier? If they had explained to us that his doctor had ordered it and why, Craig would have agreed to it. Finally a room opened upstairs and he was admitted, but it was too late for the surgery that day. He did have the thoracentesis and although painful, he had immediate relief from his shortness of breath.
The following day, the angiogram was successful. An arthroscopic incision at his wrist sent a tube into his heart and opened up the collapsed vein. For Craig, it was painless. For me, the wait in the waiting room was difficult. I started thinking what if I never see him again? It was entirely possible that he could die. I sat silently staring at the red phone, trying to think positive thoughts and pray that everything would be alright. Afterwards, the surgeon ushered me into a what looked like a recording studio and showed me the video of the procedure. I saw where he put the stent and how he inserted it into the blood vessel. Craig was feeling immediate relief after the thoracentesis and the angiogram.
After the surgery, tests continued. They discovered a very large kidney stone in his ureter, the tube that goes from the kidney to his bladder. They were very surprised that he had never had pain. The kidney specialist said it looked like it could have been there for years. Usually removing it is no big deal—they use a laser to dissolve it, and suck it out. But, because of the location and the size, they explained that a three-stage procedure was required and it would take over two months to complete. First, they would put in a ‘JJ’ stent in the ureter and let it sit for three weeks to widen the ureter, then they would dissolve the stone and suck it out. Finally, a week later, the stent would be pulled out in the doctor’s office.
Another test discovered a mass about the size of a large lemon in his pelvic area. As Craig always said, “These doctors will find something wrong if they do enough tests.” They planned a biopsy of the mass for the following day. But at 6pm, the renal surgeon came into the room and said he wasn’t sure how to go about the biopsy. We’re thinking if he doesn’t know, who does? He explained that the mass was not easily accessible, lodged between the bladder and his sacrum. If they did a biopsy and it was cancerous, the cancer cells might spread throughout his body cavity. The doctor was known to be a great surgeon, but he spoke English with a very thick Indian accent. Honestly, Craig and I understood very little of what he said.
Craig was so upset, he decided he wanted to go home immediately. The angiogram, the reason he had been admitted, had been achieved so he was done. He started pulling out the cords and heart monitor. One of the nurses pleaded with him to stop, but he was dead set on going home. I was dead set against it because I knew I wouldn’t be able to take care of him at home. Then we started fighting. We had never fought in our many years together. The nurse was trying to negotiate the situation, but she was tired and got defensive. They called the charge nurse in to mediate but she seemed like she didn’t care (she probably wanted to open up the bed for someone else). She said, “Ok, if he wants to go, that’s fine. I’ll go get the paperwork.” and left.
I was livid. I wanted him home more than anything but I didn’t feel capable of taking care of him in his state. I ran to look for the charge nurse and accosted her in the hallway. Meanwhile, a wonderful nurse named Josefina came in during the shift change. She was sweet and kind and loving and she persuaded Craig to stay. Thank you, Josefina!