“It’s probably not a sign of cancer,” Dr. Jacobs informed me, “but since I can’t be completely sure, I’m going to refer you for a CT scan.”
Possibly because he knew that when it comes to pain, I have a breaking point of mild discomfort, Dr. Jacobs did not seem surprised that my only question was, “Does it hurt?”
“No, but some people find it unpleasant,” he answered, describing the injection-free, knifeless procedure. I have my share of mental health issues, but claustrophobia isn’t one of them, so I was okay with the test.
I was not, however, okay with paying for it, because my career as a freelance musician offered no benefits and, after my divorce, I was uninsured. Dr. Jacobs had been cutting me a break on his fee, but his one-man socialized medicine practice wasn’t Columbia Presbyterian’s billing policy.
He said, “If you’re sick, you get the treatment you need and you worry about how to pay for it later. What do other people in your position do?”
What do we do? One pianist slipped on the ice, got up, went upstairs and tried to play a dance class with three broken fingers. The instructor noticed her crying and found someone in the office who pulled her out of the class and promised to pay her, even though she was not going to play the class, and then that kind soul escorted her to the emergency room, which happened to be a block away. Another accompanist waited until his chronic pain was so intolerable he walked into Bellevue Hospital, where he was finally treated for whatever disease he had at whatever stage it was in. I had grown up thinking of Bellevue as a snake pit, but this accompanist claimed he received excellent care.
Dr. Jacobs said some clinics probably differ from private hospitals more in waiting-room time than in level of care. He suggested I see the social worker for recommendations.
The social worker told me that Montefiore Medical Center, affectionately known as “Monty,” was well-thought-of. I called, but the wait was six weeks—the Full Monty. I asked about a nearby city hospital, and she warned, “Don’t go there.” She recommended Jacobi, another city hospital, near where I grew up in the Bronx.
Jacobi’s urgent care secretary, Lorraine, echoed Dr. Jacobs: “When we’re sick, we can’t worry about money.” She made the appointment for the next day, and added, “Bring your tax returns.” I was going to billing on my way to the scan so I could be fee-scaled to the correct rung of the safety net. Having grown up in a housing project, I knew exactly what this meant: The middle-class ground that I, and my two kids, had been standing on for the previous 10 years was underwritten entirely by my ex-husband and, on some sickening level, I was right back where I started.
I hadn’t set foot in a hospital since giving birth. That involved pain, fear and risk, but after a delivery they hand you the baby. This time, the best I could hope for was to walk out as well as I had walked in.
I’d never thought about cancer. I didn’t even know anyone with cancer, except for my casual acquaintance with the elderly neighborhood dry cleaner. He closed his store for a couple of months while he underwent treatment. When he reopened, he summarized his state of health as “still ticking,” which sounded so unnatural in his pronounced Armenian accent that I wondered whether he was repeating how a particularly perky hospital employee had relayed the bottom line, or if Timex ads had resonated metaphorically in his psyche.
When I was called into the examination room, the resident read Dr. Jacobs’ notes, and as she nodded her head, it registered that there were now two doctors who thought I may have had cancer far enough along to require urgent care. She conducted her own exam. I hoped she’d say, I don’t feel anything, whatever was there is gone, but she palpated the lump and said I was to return the next morning for a CT scan.
On my way out of the building, I saw reporters and a throng of police. Two officers had been shot. Suddenly my health issues, my money issues, my parenting issues all seemed blessedly manageable. I arranged for a friend to take my children overnight.
When I got to the CT scan suite, the technician handed me and another patient two bottles each. “You have to drink these before the test,” he said. We both took a sip and made the same revolted face. I read the label. Barium, it said, in a “pleasant-tasting” solution. I looked at the other patient and held up two fingers. He said, “Sí, dos, ay.” He continued to drink. I didn’t.
“That man is much heavier than me,” I told the technician. “If he has to drink two bottles, I probably only need one.”
“It doesn’t work that way,” the technician said, handing me a straw. “Try drinking it with a straw. It’ll pass over your taste buds.” A straw? What is it with medical personnel? Count to ten and you won’t notice that I’m injecting anesthesia into the roof of your mouth. Take deep breaths to take your mind off the fact that a six-pound baby is forcing her way out of your body — and taking some of your insides out with her.
The Spanish-speaking patient held up his empty bottle as if to say, “Don’t worry, I did it and so can you,” and started on his second. I tried again and couldn’t get it down. I told the tech it was impossible.
“You have to drink it. Take as long as you need. I’ll just keep taking other patients ahead of you,” he said, cleverly.
The tech was telling me, in essence, what I would tell my own children: Everyone else is drinking this and so can you. How easy it is to tell other people what they have to do. I felt a rush of empathy for my children when, fifteen gagging minutes later, I went to the bathroom and poured the “pleasant-tasting” solution down the sink. When the tech returned, I handed him the empty bottles. He raised an eyebrow, but I merely tried to look dignified, and he brought me into the CT room.
The resident, wearing a nametag that read PGY2, greeted me by announcing that he would inject me with contrast dye, and that some people have a fatal reaction to it. I stared at him. PGY2 reassured me, “I have to tell you that.” As I remained rooted to the spot, he added, “The odds are very low, you know, maybe one in 50,000. We’ve never had a problem. We’ve done a lot.”
A lot? Perhaps 49,999 of them? I told PGY2 I needed to call my doctor. PGY2 was accommodating. He had plenty of patients to put ahead of me.
Fortunately, Dr. Jacobs was able to come to the phone. I asked his opinion on betting my life with one in 50,000 odds. “Take the dye,” he said. “Allergic reactions are very rare, and they’ll get a much better picture.”
“But I might be the one in 50,000, right?”
“I think you should take the dye.”
As I walked back to the exam room I tried to think logically. I like everyone else who ever bought a lottery ticket believed that one in 50,000 is a real number, and if it were me, then I would be 1one hundred percent dead. But so would I be if I had cancer and delayed treatment. Bottom line, I trusted Dr. Jacobs. He knows his stuff. He cares about his patients.
I went back and told PGY2, “I’ll take the dye.” In a surprise twist, he responded, “No, we’re not going to give you the dye. I talked to my attending, and she said since you’re so nervous, you’re more likely to have an allergic reaction, and not to give you the dye.” Now I was arguing for the dye. He went back to conference with his attending and returned with her approval to administer the dye. He and the tech prepared for this by looking at a screen, but something was wrong. I gathered that the screen was supposed to be lighting up so they could see something and that it wasn’t lighting up at all. The tech looked daggers at me.
Ohhhh. So that’s what that drink was for. “Maybe barium just doesn’t work on me,” I posit.
“It works on everybody,” the tech retorted. He added that “what little barium” I’d drunk “two-and-a-half hours ago,” was just about out of my system. I had to drink some more. To my own amazement, I found myself looking around the room for a sink. He added, “No waiting room, no phone calls; drink it right here, right now, or come back tomorrow.” I managed to get down just enough for the screen to emit a feeble light, and PGY2 put in the intravenous line.
I felt sweaty. I felt a burning sensation. Gasping, I told PGY2 I was having a fatal allergic reaction. He replied that he hadn’t injected the dye yet. The IV had compressed and had to be taken out. He tried the vein on my hand. He got the IV in, but it fell out. He tried the other arm, but the vein was too small. Three times he tried to inject me with contrast dye, and three times he failed. In my superstitious haze, I thought of Dr. Jacobs’ scientific logic in ordering the test, and came up with, it’s probably not a sign from God that the contrast dye would kill me, but since I can’t be completely sure, let’s leave it out.
I told him not to try a fourth time, and we did the scan without the dye. The tech directed me, “Breathe. Don’t breathe. Breathe. Don’t breathe.” I embellished this chant with, Heads, you . . . tails, you . . .
The next day, the phone rang. The CT scan was negative. The woman said something about disclaimer notes regarding the picture not being clear, but I felt like crying with total relief. Everything seemed different now in a way I hoped would last. So what if I have no insurance, no savings, no close family and no romance on the horizon?
I have two healthy children.
I have time to fix things.
And I’m still ticking.
