11 August

Recovery Journal: Powerful Day, Lots Of Life. Report Cards and Pill Payments

by Jon Katz
Pills And Payments
Pills And Payments

A medical day, a health day, successes and challenges. I went to talk about my blood and heart tests with Karen Bruce, my friend and nurse-practitioner, she has saved my life at least twice.She is a gifted writer who is also taking my short story classes. She gives me stuff about my health, I can return the favor.

I am lucky to know her, although she can be frightening when aroused. I remember trying to tell her that my heart struggles were all about asthma, I ended up in an ambulance heading for the hospital.

Today, she had nothing but good news for me.  She was pleased. I remember the day we met, I told her rather smugly that I had been treating my diabetes  holistically, it was under control. I remember her shoving a blood test under my nose, and telling me it wasn’t.

That day, my A1C number, a seminal indicator of health,  was 9.4.

Today my A1C number was 6.5, absolutely normal  my blood sugar was also normal, my cholesterol levels terrific, my  blood pressure and heart beat excellent, all of my kidney and other functions great, my weight finally coming down after all of the post-surgery medications. “Excellent, excellent,” she said. “You are the only diabetes patient I have had in years who really listened to me, you are taking great care of yourself, your cardiology report is perfect.”

As someone who never got good report cards, that was a nice one, I was proud of me, and grateful to Karen for not listening to me, even if I listen to her.

There were absolutely no health issues for us to talk about, she said, so we had a good few minutes together. Then she had to rush off to other patients, she sometimes sees 25 or 26 in a day.

It was a bittersweet day, as it turns out, bad news follows good.

I confronted some life at the pharmacy, our wonderful small town pharmacy in the middle of town. If you really want to understand health care and it’s impact on human beings, go stand in line at a small-town pharmacy, people do not hide behind privacy lines there, they talk about themselves and their lives to one another.

I was hardly ever in a pharmacy before my heart surgery, now I am often there and it is common to see people so overwhelmed with medications and costs and rules that they have to forego their medications, or often pay for their medicines, for themselves and their parents, two or three pills at a time. Bridget, our pharmacist,  is very loving and caring in her work, she always finds a way to help people.

I am always struck by the openness of people there, the staff never talks about the customers, but the customers talk to each other.

“I don’t  have enough money for my medications this week,” a man told me in line, “I will have to buy it in one-thirds or fourths. I’m sure Bridget will let me.” I’ve heard this so many times in the pharmacy, seen so many people struggling to figure out how to get their medications and pay for them.

I called them the Bargaining Pill People. I felt badly for them.

I was never one of those people until today. I was never one of the bargaining pill people until this morning. One of the reasons I am doing well is that I took good care of myself but also have had good doctors and the best medications. Today, I went to pick up a refill of medication that is important to me, and the bill was way over $500, even with health insurance, which sometimes pays for medications, sometimes doesn’t. Nobody understands how health insurance works, not the pharmacists or the patients or the doctors. It is a runaway system, complex, expensive and bewildering.

I did not have an extra $500 to spend today, this is a tight money period for us, we are confronting a number of financial issues stemming from a complicated few years – a divorce, recession, revolution in publishing, and a 90 acre farm that took four hard years to sell. We will get there, we are not yet there. We are thinking about money very differently and spending it very carefully. We are, as they say, on a budget.

So I became one of the bargaining pill people. A major step for me into another dimension, one where so many people live. Bridget saw my face when I saw the bill – I will have to spend a lot more money in the coming weeks for  refills on insulin and other medications, insurance only pays for a fraction of their cost, and I have pretty good insurance. I must have gone pale. I mumbled something about this being a tough month.

She said “why don’t we do this in thirds?,” and she gave me one-third of the medication, I can pick it up in several different trips. She has done this many times, it was quick and seamless.

For many people, this is health care, this is normal. For me, it was the first time in my life I couldn’t pay for all of any medication I picked up for me or for my family. I was shocked by it, but my embarrassment didn’t last long. I went back to the line while they packed my one-third prescription, and I said to the elderly woman behind me, “well, this medicine costs more than $500.”  Then I told her I was getting it in thirds.

Lord, she said, that is rough, they are bandits and thieves. That, she said, is what she had been doing with her mother’s pills for several years. They lost their home paying for her father’s surgery and medications, and then he died. I pictured the next report card, without my medications, and I broke into a sweat.

Several people in line overheard this exchange, and they all commiserated with me, with us. One man patted me on the back.  He does it every week, he said. It’s okay, they said.

Honestly, this had never happened to me before, I suppose I always felt superior to everyone else, luckier.  it was a  transforming, humanizing, humbling experience. Something I had feared all of my life had happened, and it was okay, we worked it out, we will continue to work it out. I called Maria, and we had a plan in minutes. It was all right, we reassured each other. I liked the feeling of belonging, even to this curious community. We are, after all, all in it together. They all understood.

I took a deep breath when I left the pharmacy clutching my 30-day supply. Okay, I said, this is different. I thought of the many people who cannot afford to pay for health care at all, cannot buy the medicines that are good for them, cannot afford to take them regularly. Maybe I don’t really need the rest of this medication, I thought, perhaps I can take it every other day. Or skip a week or two, make it last until more money comes in.

This is what life is like, this is what unifies us. It does make my blood boil a bit when people say we shouldn’t have health care for everyone, I can’t imagine what they are thinking.

I sometimes recall the days when I never even thought about health insurance, when big companies paid for every penny of mine, when I never even knew what it cost. I am grateful not to be back there. I’d love to have a lot of money, but I would hate to ever be so disconnected from life.

I am learning about life, living my life, understanding what it means to be a human being. There is no virtue in being poor, and I do not romanticize that. But I am not poor. This is a difficult period, it is not my life.  I see that the less money I have the greater the empathy and compassion I feel, the greater my connection to other human beings, the more feeling I can bring to my writing and my photography, the more intuitive my emotions.

I wonder sometimes if it will ever be possible for human beings to feel that they are all one thing, each connected to the other, and in one way or the other, we all share the fate of each other. We love animals so much, but human beings too are creatures of this world, they also enjoy the right to health, happiness and a meaningful life. Isn’t this the foundation of faith, the highest calling of human beings?

I will certainly figure out a way to get all of my medications, there are all sorts of things I can do. Maria and I have become pretty sharp at handling money, and I like that. I was surprised today, but not stunned. This is the life I chose, this is the path I took. I will walk it with pride and dignity. I appreciated today, the good news and the struggle. There are all kinds of different ways to be healthy, I have never been healthier.

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