From the category archives:

Radiation Oncology

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When do you buy a car without inquiring about cost? Probably never. Chances are you carefully research different brands of cars, repair records, gas mileage, safety records, dealer cost (so you know how low you can negotiate)  or you read used car ads for a good deal until your eyes bleed.

When it comes to your health, shopping for the best deal usually does not enter into your equation. If you are told that six weeks of radiation is mandatory following a lumpectomy, you just say: When do I start and where? You don’t say: how much would that be? Usually you pick the facility closest to you and one that is covered by insurance. You do not call around and ask how much others may charge. (They probably won’t even tell you.) Also, you’d like to think that  you chose a radiation oncologist on his skills and a facility based on its equipment, not on price. Most people go to the radiologist recommended by  their oncologist.

The reality is that even with good insurance, you will end up paying between 10-20 percent of the bills yourself. And here is the reality check: My bill for one month of radiation comes to $44,681.00.

This amount does not include the whole six weeks. It does not include the bill for radiation set up, initial consultation with the radiation oncologist nor does it include the cost of a CAT scan.

Of course the total amount of $44,681 is what people pay who don’t have insurance. I will pay a percentage of the adjusted rate negotiated by my insurance company.  If I did not have insurance, could I have asked for “an adjusted rate?’ Probably not. I would have been stuck paying the whole thing.

When your life is in the balance, the price becomes irrelevant. Yet when I write the checks, a few thousand dollars at a time, for my part of the bills, I cannot help but think of people who simply do not have it. I think of people who have to put it on a credit card and pile up high interest rates. I think of people who don’t even have the ability to put it on a credit card because they don’t have them or their available credit would  not cover their medical  bills. Combine this reality with the fact that a woman with breast cancer usually sees her income go down by an average 26 percent. In my case it already looks like my income for the year will be down by close to 40 percent. For one reason I work a lot fewer hours, and when I am at work I am distracted. And I have not even had to have chemo therapy, a major stumbling block in anyone’s work schedule.

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iStock_000007262008XSmall[1]“Dr. Weary, my oncologist, called me yesterday,” I tell Dr. Alpha, on my last day of radiation. “Please note that yesterday was Sunday.”

Dr. Alpha nods, waits to hear what I have to say.

I tell him how sad and disturbed Dr. Weary seemed when I nixed chemo. I admitted to Dr. Alpha that the idea of chemo scared me more than death itself. Dr. Alpha listens attentively. I suppose it is this precise trait that connects him with his patients. He does not seem annoyed. He does not seem distracted or bored. His face is alert, with an empathetic expression which makes you think he agrees with you and makes you talk more. But actually, as you reflect on it, you have no idea what he is thinking. Had his profession not been radiation oncology, I suspect he might have been perfectly suited for diplomacy. (Doctors of Osteopathy are trained to listen and to talk to patients from all walks of life, I found out.)

His listening skills, his neutrality, are such that I , at one point, feel emboldened. I blurt out that I think some oncologists have to give chemo just to have a viable practice. How could they make any money writing prescriptions for hormone pills?

Dr. Alpha does not look shocked. He nods.

“Yes,” he admits, that might be true for some oncologists, but not for Dr. Weary. He has a practice with all the patients he can possibly handle.”

I know Dr. Alpha is telling me the truth. Dr Weary is legendary in our city. Stories circulate about how personal and caring he is. He keeps people alive beyond everyone’s expectations. He often sits with his patients while they get their infusion. He called me on a Sunday. Maybe he should get a life I had thought. But learned that he has a young wife and four small children. He has plenty of life to live on a Sunday. Yet he called me because he is conscientious. I feel ashamed.

I inform Dr. Alpha that I missed an earlier appointment with him because I was out of town.

“Did you go somewhere nice?”

“I was be in San Francisco.”

“Business or pleasure?”

“Pleasure. Visiting my youngest daughter. When you get cancer,” I added, ”you start taking your pleasures seriously, “

Again, I immediately feel embarrassed. How incredibly superficial this must sound to a doctor who has a whole waiting room filled with seriously ill patients: The young woman with cancer in her collar bone, the lady with the meat loaf neck, the two young men with colon and prostate cancer. The teenage boy who has a shaved head and who comes in with a different adult every day. Hospital staff? Ward of the State? It does not seem like friends or family accompanying him. Dr. Alpha has patients rolled down to him on their hospital beds. They are kept in a hallway adjacent to the small waiting room. But I can hear groans and moans under heaps of sheets and blankets. Are these patients needing radiation for pain relief? Yet Dr. Alpha is poker faced. If he was tempted to slap me, he did not let on.

Uninterrupted I prattle on .

“And by the way, I hate AstraZeneca! They pat themselves on the back about their cancer drugs which nets them hundreds of millions in profits. At the same time they produce and sell numerous carcinogens. No wonder they don’t  explore pills for prevention or a cure.”

“I don’t like them much either,” Dr. Alpha says.

“During radiation I feel I am doing something about my cancer. Every day.  Now I just have to anxiously feel wait and see.”

He nods

“Yes, that is all normal,” he assures me. “This is how people feel.”

I wondered if this was normal for all radiation patients, or just his? Did life outside his aura of confidence and care seem cold and uncertain, scary? What about patients who had distracted, stress out radiation oncologists who were poor listeners? Was it Dr. Alpha that made radiation seem healing instead of destructive? Or was it, really, the idea that the machine killed cells in your body that you found comforting? Or both?

Aware of the ticking clock, his packed waiting room, of which he did not seem the least aware, I felt the need to get up and go. My six weeks of radiation therapy have come to an end. It has been remarkably easy. No pain. No nausea. No fatigue. But that is how it normally is with breast cancer. Radiation of other parts of your body is a totally different matter.

“Well, I guess I am ready to transfer my emotional dependence from you to Dr. Weary now,” I say.

I wanted to ask him to be my medical oncologist, the cushiest job he would ever have. How much effort would it be for him to call my local pharmacy to fill my hormone prescription and to do my blood work now and then? But I know it is time to bid Dr. Alpha adieu. Upstairs in the next building, I have my scheduled appointment with Dr. Weary and I am already running late.

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A Red, Hot Breast: Radiation Damage Already?

March 21, 2010

Every day now the same routine: leave work for the hospital. Park curbside by the entrance and walk through the sliding glass doors into the main lobby. Take the elevator one floor down into the basement, turn a corner and – voila – radiation oncology. Change into the insane asylum robe, wait a few minutes […]

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Preparation for Radiation: Foam Bag and CAT Scan.

March 6, 2010

Finally, I am scheduled for radiation therapy or rather: Preparation for radiation. I meet with a technician to get my measurements set in a foam contour.  Actually, it turns out to be  nothing fancier than a plastic bag that she fills with warm liquid. I  then lie  down and my contours are set as the […]

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Truth Between Dr. Guru And Me.

February 18, 2010

Dr. Guru calls me at work with the pathology report.  “I just got it,” he stresses. (So he did read my  blistering email after my first surgery. Then I complained about him not sharing the pathology results until two weeks after he himself received them.) “Everything completely clear, just as we knew it would be. […]

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Dr. Alpha Can’t Radiate Me – Yet!

January 6, 2010

Dr. Alpha, my new radiation oncologist, flips back and forth  in my pathology report. He seems annoyed. Not with me, but with the report. He pushes the reading glasses back on top of his head. “I don’t understand this,” he says. His tone bristles, but he looks kindly at me as he stabs his finger […]

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Visit with Radiation Oncologist

December 20, 2009

I leave Dr. Weary to meander through the bowels of the hospital until I end up in its basement.  “Radiation” reads one arrow pointing down yet another hallway.  Around that corner another door:  “Environmental Services.” Toxic waste? Then I realize it is only a euphemism for the janitor’s office. Around the next corner from the […]

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