even if i am. (16 page)

“I just want to see you happy again,” I told your voicemail. “We all just want to see you happy again — your family, your friends, your girlfriend, Gladys… That’s all I was trying to do. I’ll call you later tonight when I get home. I miss you.”

chapter thirty-one

song for a sleeping girl

You spent a great deal of time drafting an appeal letter to Blue Cross. I didn’t understand why it was so time consuming. It wasn’t until you asked your parents and me to proofread it that I understood the burden.

From:
[email protected]
To:
mother
To:
stepfather
To:
[email protected]
Sent:
Friday, December 2, 3:03 p.m.
Subject:
appeal letter

Dear Blue Cross Person:

My name is Anthony Glass. I am 30 years old, and in August I was diagnosed with advanced stage 3 rectal cancer.

It was finally the answer to questions I had been asking, complaints I had been giving to a variety of physicians, for over five years. My symptoms had been disregarded by my doctors, and consequently, disregarded by me. It was a hard lesson to learn, but one that taught me that my health is my responsibility. When I was referred to a general surgeon to perform my coloanal anastamosis, a surgeon who was not board-certified in colorectal surgery, I felt it was my responsibility to find a specialist.

Dr. Beart, the chief of colo-rectal surgery at the USC Norris Cancer Hospital is one of the leading specialists in the country. He is a board-certified colorectal surgeon, and treats cases like mine on a regular basis. However, my referral to him was denied by my medical group.

Unfortunately, this was no surprise. When I was first diagnosed, I asked to be referred to a nutritionist so that I could modify my diet to suit my condition, and help prepare me for the rigors of chemo/radiation therapy, as well as surgery. The referral was denied. Although I don’t understand the logic behind denying a cancer patient a meeting with a nutritionist, I accepted the decision. However, a surgeon is another matter.

I am writing to appeal the decision to deny Dr. Beart as my surgeon, and ask for Blue Cross to assume the responsibility it owes to me in providing me with the kind of care my health requires.

Thank you for your consideration,

Anthony Glass

— Forwarded Message to [email protected]
From:
stepfather
To:
mother
To:
[email protected]
To:
[email protected]
Sent:
Saturday, December 3, 5:21 a.m.
Subject:
Re: appeal letter

Hi, Anth. I have a few editorial comments on your Blue Cross appeal, below. It was easier to rewrite it than to change your version, which was a good take-off point. It will seem to the medical director that you may have had help in writing this. That is not a bad thing, as he will see that you are backed up and well advised, and he may even worry a little about adverse publicity or malpractice action. He is well enough paid that a little worry is part of his job description.

I hope your recovery continues, and each day is better than the last. It is encouraging that you are eating real food and doing a little work from home. Whatever is going well can of course be attributed to the excellent nursing care given to you by Chas.

We think of you often and you are always in our prayers.

Love,

Dad

To:
Medical Director

Subject:
Appeal of disallowed out-of-plan services

I, Anthony Glass (age 30) have been diagnosed with Colorectal adenocarcinoma, stage 3.

I believe that I have not been well served by my health plan and have been forced into getting out-of-plan care for which I have personally paid $36,550, which I can ill afford.
My previous request for coverage was denied, and I could not wait, in the face of advancing cancer, for prolonged wrangling with Blue Cross.

Failure to diagnose
:
I have had bowel dysfunction for over five years and have made repeated visits to my plan physicians, only to be reassured that it was nothing to worry about:
this, despite diarrhea and blood in the stools for many months.
Finally, at my insistence, a colonoscopy revealed cancer and imaging studies showed multiple lymph node involvement.
A program of local irradiation with chemotherapy adjunct, then surgery, and then chemotherapy, was recommended and commenced.

Disallowed services
:
I had significant problems with diarrhea and was facing radiation, surgery, and chemotherapy.
Therefore I requested consultation with a nutritionist to avoid making my condition worse by wrong food selection and to build myself up for this ordeal. It was disallowed.

More significant, I was referred to a general surgeon for this major colorectal cancer surgery.
In getting a second opinion, I became aware that colorectal cancer surgery is a boarded surgical subspecialty, and that USC has a center designed for this purpose which handles a large number of such cases.
I requested authorization to have my surgery there and it was disallowed.

The surgery has been performed, and involved dissection about the rectum at the pelvic brim, removal of a segment of colon and regional lymph nodes, primary re-anastomosis, and extensive dissection in removing a large, tumor-containing node which lay just under the left kidney and rested on the aorta and renal vein. My surgeon was Dr. Beart, chief of colorectal surgery at the USC Norris Cancer Hospital. I feel I had the benefit of state-of-the-art surgical care.
However, I was required to personally pay $36,550 up front, out of pocket, to avoid having my surgery cancelled.
It seems that Blue Cross was toying with my life and my future by only allowing a general surgeon in a non-cancer center for this specialized procedure.

Request
:
Accordingly, I request that my out-of-pocket expenses for the surgery be allowed and reimbursed by my Blue Cross plan, and that I be covered for surgical follow-up with Dr. Beart and his group.

Thank you for your sympathetic consideration.

Anthony Glass

“I read your stepfather’s letter. It’s concise, I’ll give it that.”

“Yeah. It’s rather formal sounding, but if he thinks it’s what we should send to my health insurance…” Your voice was hoarse over the phone. “Oh, I got a call from the hospital, checking in. I couldn’t think of anything bad to report, so I told the doctor I was doing fine.”

“Did you mention your tingling leg?” This was the only symptom I could think of, even though there were a dozen more.

“No, it hasn’t been bothering me.”

“Well, that’s good…” My tone deflated.

“Sooo?”

“Yeah?”

“I bought a Baja guidebook at the promenade today and am geeking out thinking about all the different ways we can spend Christmas together? What do think? Christmas in Mexico?” I could feel your excitement through the phone. You were eager to share a spark of something good.

“I thought you’d never ask.” I said through a smile.

“I’m waiting for Zach to call me back, I get the feeling he wants to hang out tonight. Maybe you should come over anyway, and I can show you the book while we all watch the football game? Yes? Maybe? One big happy family? Football and Baja?”

“As long as you cuddle with me and not Zach.”

…

Monday, December 5

this is what it’s like to be at home sick

1. the days go by infinitely faster.
   it’s frickin’ monday again? really?
   
2. puritanical work ethic = guilt
   whenever someone calls, i feel compelled to give them detailed accounts of what i’ve done with my time, and the things i have accomplished, even if its utterly asinine “…and then i changed from my walking shoes, to my house shoes… mmm, comfy they are!”
   
3. what have i done?
   secretly, i thought this recovery period could be recalled in later years by scholars as “anthony’s most prolific creative period, a time from which his genius was truly unleashed…” rather than a time in which he watched movies and took walks and short naps.
   
4. man becomes dog.
   i feel myself coming to understand the relationship dogs have with the mailman: when you’re least expecting it, all of a sudden, there’s someone AT YOUR DOOR! i can see his shadow, the lid on my mailbox slams, and then he’s gone! such an invasion of privacy, i almost barked this morning. just take my netflix and go!
   
5. i have become one of them.
   there was always a mystery to the masses of people i would see mulling about when everyone else was working (and no, i’m not just talking about the homeless). i mean the cult of people who hang out at the coffee bean on an idle tuesday afternoon, the small mass of hipsters shuffling along abbott kinney boulevard, seeming to have no destination or time frame. they can’t all be actors, can they? walking on the promenade early this afternoon, i looked into a storefront window, and in the reflection (gasp!) saw that i had become one of them.
   

do you think they all have cancer too?

posted by Anthony Glass at 6:18 p.m.

…

I was half awake for a good chunk of the night, enduring that in-between state of confusion and wakefulness and fatigue. So, I just lay in bed trying to sleep, thinking of us in Mexico. I played it out like a daydream, making it up as it went along: lying on a deserted beach, salt water shedding our winter skin.

You slept fitfully next to me. Seriously, you’re the worst sleeper. EVER. I imagined you sleeping soundly and quietly next to me on a beach in Mexico, fully surrendering to the lullaby of the receding tide. Then, the dream took a turn, to us on a rocky boat at sea, drowning as waves crashed over me.

It was just your arm twitching on top of my shoulders.

“Babe, try to get some sleep.”

From:
[email protected]
To:
[email protected]
Sent:
Tuesday, December 6, 6:21 p.m.
Subject:
the kind of thing

just got back from riding down to the beach,

ate some lunch and sat on the grass looking out at the ocean.

the kind of thing one thinks one would do

if one had a day off from work.

it doesn’t sound like a lot,

but i ate the whole sandwich and bag of chips.

felt a little like i’m getting my appetite back.

made some basic grammatical changes to the letter,

and filled in some missing info, but other than that,

i just don’t feel connected to it.

read my old letter, and started to feel like

perhaps i’m sending the wrong letter.

i guess if everyone prefers my stepfather’s letter,

then it’s the one i should be sending to Blue Cross,

but i just don’t feel like it’s my words.

despite it all, i am feeling much better.

i miss you.

“Song for a Sleeping Girl”
Devics

…

I’m not even sure I was a good caregiver — not that you didn’t compliment me, but I struggled to keep up with everyday life. It was hard work, caregiving. Overwhelming work. Yet, I was determined I could handle this myself; full-time job, bills, laundry, grocery shopping, dishes, yard work, not to mention keeping up with Gladys. Anyway, it was temporary. Things would get back to the way they were. They’d be even better.

Everyone wanted to know how I was doing, as if it were the only question that mattered. When I ran into Zach at the office, whom I hadn’t seen hardly at all, he asked, “How are you?” I smiled like a politician and stated, “I am good. Things are very good.” It was the only answer I ever gave, because I knew it was the one people wanted to hear.

“Hey, you guys wanna go to an art show tomorrow night? It’s on Abbott Kinney. I’ll come pick you up…”

From:
[email protected]
To:
[email protected]
Sent:
Thursday, December 8, 1:02 p.m.
Subject:
rough night

rough night last night,

took a couple of aleves, and then rolled around