The Day My Doctor Didn’t Inject Me

amy   June 30, 2016   Comments Off on The Day My Doctor Didn’t Inject Me

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The first time I met my oncologist, a few things caught my attention immediately:

  • His tall, lanky frame
  • His English accent
  • His bowtie
  • His wit
  • His title of “Doctor.”

My geek was in danger of showing, thanks to my husband Jason’s years of influence. In those first few moments with the oncologist, I was desperate to work a Doctor Who joke into the consultation somewhere.

The 11th doctor

The 11th Doctor Who, played by Matt Smith, a younger-looking version of my oncologist.

Even though I’ve morphed into a Whovian over the past few years, my oncologist became my favorite British Doc. His patience with my questions, his sensitivity to the seriousness of my condition, and his well-timed laughter at my lamentable jokes endeared him to my heart. Of course, he also guided me through cancer treatments, and monitored the side effects to long-term prescribed medications while acknowledging those attempts at humor. I was cared for, respected, and, thankfully, recovering. I was also impressed with how he managed the cancer center and its many patients, knowing all of our names, the particulars of our families, and the burdens we carried along with our diagnoses.

At a checkup this past December, he and I discussed how my body had reacted months earlier to Prolia, an injectable medication used to strengthen bones with Osteopenia or Osteoporosis. Given that I was 36 years old when the bilateral mastectomy took place (and 37 when I had a hysterectomy), the doctor made a strong case for prescribing Prolia. My first dose was administered at the cancer center, and I had experienced some difficult side effects. Mainly, bone pain that had kept me bedridden for two days.

As unpleasant as that experience was, I trusted this doctor’s expert opinion. The purpose of the bone scan he had ordered had been to set a baseline, since my body’s lack of estrogen would impact my skeleton. It had been surprising to discover damage already present. As I have been reminded repeatedly by the nature of life as a patient, I was not in control of the breast cancer diagnosis, but am tasked with learning to manage its aftermath. My oncologist had a vital role in that achievement. Never once did I feel patronized or pitied; rather, I felt informed and empowered. He and I agreed that the benefits of Prolia outweighed the possible repeat side effects. While writing in my file, he sighed.

“Let’s schedule it for after the New Year. There will be some finagling to be done with your insurance company before it’s approved.”

Ah, my insurance company. I notice that, whenever it comes up in conversations with medical professionals, it’s referred to like the acquaintance no one really wants invited to the party but who has some necessary reason to be there. We will all simply have to grit our teeth and hope it doesn’t create a whirlwind of drama, as its past history predicts it will.

That was December 14, 2015. On the day of my January appointment to receive Prolia, I received a phone call. The insurance company had denied coverage of the injection, which costs thousands of dollars. Thousands of dollars that I didn’t have to spend.  The reason given seemed like a minor technicality: the cancer center’s pharmacy is part of the hospital it is affiliated with, and that pharmacy cannot fill the prescription unless I require a hospital stay after receiving it.

That set off the next six months of phone calls, mailed correspondence, furious note-taking, frustrated tears, obscenity-laced rants, and a broken toe.  It made no sense to me: the medication was prescribed, my medical history proved its necessity, and insurance had already paid for it once. What was I missing?

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It turns out, not much and a whole lot at the same time.  The first dose I had received almost a year before was covered because it was the first one, and my reaction to the medication was not yet documented. There were also slight nuances in language and paperwork that were unknown to the cancer center staff but that were required by the insurance company. The bigger, most important–and missing–piece of the puzzle was my beloved doctor.

He had left the cancer center two weeks after my December visit (and had not informed me that he would be vacating his position.) It was apparent that he had been the energy behind resolving issues such as these, and I was struck by how much I had relied on him. I don’t fault him for not saying a proper goodbye; I don’t know what the circumstances around his leaving were. His absence from my treatment team, however, left a large void that has yet to be filled.

How much had I taken his care and detail for granted? Starting over again with someone new is exhausting, no matter how well-intentioned she is. My memory issues don’t lend well to rehashing particulars about the past 2.5 years of treatment, and she can’t possibly laugh at my jokes with the same speed or sincerity. My whole arsenal of Doctor Who humor has been retired.

Furthermore, she wasn’t there when the positive BRCA2 results came back, or when my veins blew out at the first chemo session, or when my ringlets of curls began to thin. She didn’t reassure my husband over months of discussion about our children, or by complimenting his steadiness and devotion. She didn’t talk to me about the devastation that is sexual dysfunction after a course of treatment like mine, broaching it not like a father tasked with an awkward conversation with a daughter, but like a knowledgeable physician that can see how long-term effects will greatly impact his patient.

The Prolia injection resolved with the medication mailed from a specialty pharmacy to the cancer center. I was required to pick it up and have someone other than the center’s staff administer it for me. Luckily, I have friends who are phenomenal nurses and doctors, and who are more than willing (for reasons I can clearly imagine) to stick me.  I should have had one of them accompany me when I picked it up, and had them administer it right there in the waiting room out of spite. Supposedly, I’m pre-approved for the next injection in six months. I’m going to wait a few weeks from now and then begin making calls to confirm and/or secure that approval.

My next checkup at the cancer center is two weeks away. I don’t know if the doctor and I will have a conversation about the two excellent novels I read while bedridden after the Prolia injection. I’m not sure if she will remember my children’s names, or laugh at my oh-so-witty responses to her questions about my health since the last visit. I appreciate her time and efforts and will continue to develop a working relationship with her, but how I will miss that Englishman’s chuckle and bowtie. As in all things, life goes on, but I hope I do not take anyone’s skill or expertise for granted.