Closer and closer

 I'm now less than 18 hours from surgery. It's been a day - a good day, in that some important things got done; a difficult day, as both of us are anxious, anxious enough that the dog has noticed.

One of the things I learned from my father was not to worry about things over which I don't have control. Note that I'm not perfect in that: sometimes there were things I should have been responsible for, and then failed. Indeed, it was one of those circumstances when Dad said that to me: I had lost control because I hadn't done something for school, and now it was too late. Still, that night I was able to sleep.

This surgery isn't really the same thing, either. In one sense, I had control. I suppose I still do, in that I could cancel; but, really, I made the decision and set things in motion. Once I had done that, I had given up control, and the cost of retaking it would be great. I will sleep tonight, and probably tomorrow night, because, well, what else is there to do?

I would that this was already over. I mentioned in the last post that imaging was delayed, and so deciding about and scheduling surgery was delayed. We experienced something that both Karen and I knew was possible, but that we hadn't personally experienced before. One of the two studies my doctor ordered was questioned by the insurance company. That would have been a nuisance at the best of times, but we found out about 24 hours before I was supposed to be in Knoxville for the studies. This was Thursday, with me originally scheduled for Friday, just before the weekend. Worse, we learned this when the imaging center called me. It wasn't like we'd had a heads up from the insurance company. I just got a call that there was a problem, and so the studies would have to be postponed.

That scheduling was important. First, of course we wanted to have the information to define whether my cancer had spread, so that we could then make a plan. But also, if the tests were to happen on the same day they would have to happen in a certain order. The radioisotope that I would need for the bone scan needed several hours to circulate before the scan; but it had to be gone when I had the MRI. Since it's an hour and a half drive to the imaging center in the first place, we'd tried to have both the same day: the MRI first, then receive the radioisotope, and then have the scan. Worse, this was already tight due to the healthcare staffing issues that we're still wrestling with. Suddenly a carefully crafted plan was awry, and a new plan meant a further delay.

There is something, first of all, to be said for all those years in healthcare administration and management. I actually knew something of how to approach an insurance company. Beyond that, there is much to be said for the care of the Episcopal Church Medical Trust that negotiated my Medicare Advantage plan. While it doesn't work quite that way anymore, I remembered when there was an ombudsperson in the Medical Trust office. I called CMT Customer Service and got, first and foremost, a sympathetic ear. Second, she had a "back line" number to a manager with the Advantage plan provider. That person was also sympathetic - not really able to do anything, but at least not cold or unhelpful.

That left us stewing over the weekend. First thing Monday, though, I tried calling the insurer, trying to find out what was hung up, and just who needed to speak to whom to un-hang it. Part of the problem was that none of us - not me reading my plan, not the CMT person, nor either of the folks with the insurance company - could find an automatic reason either study should have been hung up. Neither one should have required pre-approval; and when someone down in the structures of the insurance company thought different, it was hard to understand why. And, since neither of the folks with the insurance company could see why there was an issue, neither knew quite how to make things happen faster, much less actually intercede. 

So, there we were. There were a couple of nice notes. Both the CMT person and the first person with the insurance company called the following week to check on me. They still couldn't do anything, but at least I felt attended to. And at least I had some idea of steps I could take. Karen and I wondered repeatedly what folks did who didn't know how the health care system or health insurance worked.

I called the imaging center back and asked about scheduling the studies on different days, to get in as soon as I could. Better to make the drive twice than to lose twice as much time. We worked that out. The MRI came mid-September, and the Scan in the last week of the month.

Ironically, just before the MRI I received a call that it had been approved - the study that most assuredly should not have required pre-approval had been approved. More, within a day or two of receiving that call I received a letter that the scan had been approved. It was a relief, but also a surprise. I had been told only one study had had issues, and here I had evidence of consideration of both.

I was glad to get them done. Indeed, I enjoyed them. Sure, things were a little tight, but I just relaxed, closed my eyes, and sang Taizé chants to myself (and the scan was actually closer than the MRI). I told the MRI tech that I found it restful, noise and all (light classical music in the headphones was a good choice). She said she'd never had a patient say that. But, then, we've already agreed I'm a little odd.

And so now here I am waiting. Tomorrow we'll collect ourselves, touch base with our pet care, and head down the mountain to be ready for the surgery. And, I'll sleep tonight, trying not to worry about things I can't do anything about.

Thanks for listening. You know my profession, and most of you know me well enough to know that talking helps. I appreciate it.