Cartoon by Hugh
Yesterday Laurie Ruettimann wrote an incredibly brave post on her blog, Punk Rock HR.
Some of you know that my mother is sick, but for the rest of you, here are the basic details. I stepped off a plane on Friday the 11th and heard the news that my mother was rushed to the hospital with a condition called acute pancreatitis.
Without telling too much of the story — my Mom is a diabetic who has heart disease and a lipid disorder. She has difficulty managing her diet, and her lifestyle puts stress on her pancreas and other organs. My Mom went into something called hypovolemic shock once the pancreatitis escalated. Her vitals were scary and organs failed. She was intubated and put into a medical coma to ‘rest’ her body.
Dudes, it’s a mess. I would give you an update but it changes frequently. The level of optimism changes, too, based on how the tests and bloodwork and xrays and scans are interpreted by doctors & nurses. Here’s what we know: everyone dies, your body can only take so much, and progress is measured in small steps. Recovery, if it happens, will be a long and winding road.
The good news? A weaker woman would be dead, already. My mom is tough as nails. This is her third bout of the illness and my siblings and I know what to expect (sorta). She might die. She might live for awhile and die from other complications. She might survive, recover, and get hit by a bus in twenty years. Who the hell knows? Everyone dies, and the smart people in our lives advise us to take each day as it comes.
You can read the rest of Laurie’s post here.
While I don’t comment on other people’s blogs as often as I’d like, Laurie inspired me enough to write. Following is my comment:
Laurie,
It certainly does not surprise me that you mother is such a strong woman…now I know where you get it. 
You are so brave to share this with us. You’re right; it’s something we all have had to/will have to deal with so we might as well talk about it and help each other through it.
It’s way too hard for me to even *think* about either of my parents getting sick. I lost my grandfather – my mom’s dad – almost three years ago and honestly I am still reeling from that. I was so close to him all my life and I remember after he died people would say, “Well, you should just be glad you got to have him him your life for 37 years.” What I wanted to say in response to that RIGHT AFTER I PUNCHED THEM IN THE FACE? “Yeah. Well. And that makes it even that much harder to lose him so SHUT UP.”
I had a relationship with him – and still have a relationship with my grandmother – that many people don’t get to experience with a grandparent. I got to know them as an adult; not just as a bright-eyed little girl who was always incredibly excited to see her grandparents on holidays and summer vacations.
My grandparents met when they were in first grade and grew up together in a small town in Illinois. They were high school sweethearts and eloped when my grandfather was drafted and sent overseas in WWII. They were married 65 years when he died. He would be 90 if he were still alive. She is 87 and couldn’t be healthier – although she gets lonely and she misses him. She was so busy taking care of him the last 7-8 years of his life as he developed heart and lung issues, diabetes, and was then diagnosed with a chronic form of leukemia six months before he passed away; it consumed her.
She struggles to keep herself busy and we talk nearly every day.
Laurie, hang in there. Of all the scenarios you laid out for your mom the one I like best is the one where she lives for another 20 years. 
We’re here for you.
Thank you for being brave.
Because my comment was already long enough and I didn’t want to hijack Laurie’s blog, I decided to finish my thoughts here.
Later in Laurie’s post she asked, “Have you worked and cared for a loved one? What has your experience been with FMLA or protected leave? Were you able to work and be an effective caretaker? How do you manage your time and your stress level?”
While this isn’t directly related to her questions she made me think of something our family went through a couple of years ago.
About six months after we lost my grandfather, my grandmother started experiencing excruciating pain in her right knee. It turns out that she needed a knee replacement and her [former] primary care physician – whom I affectionately refer to as Dr. Asshole – referred her to an orthopedic surgeon. We checked him out and found that his [former] patients referred to him as Dr. Death.
One woman we spoke to whom he’d done knee surgery on said, “Do not let that man touch you. Thanks to him I can no longer walk.”
We moved on.
Because her insurance dictated that she needed a referral to an orthopedic surgeon from her PCP, my grandmother went back to him and asked for a referral to an orthopedic doctor my grandfather had been to the year before whom they both had really liked and felt comfortable with.
Dr. Asshole declined.
By this time my grandmother’s pain was so bad that she could barely walk and was growing more depressed by the day. In fact, my mom had moved her in with her and my stepfather until we could get her through this. My grandmother is fiercely independent so this was no small feat but we convinced her.
My mom called and told me that Do (pronounced “Doe” – short for Dorothy – she can thank me for the nickname. What can I say? Grandma Dorothy is hard for a two-year-old to say. It just stuck.) was in such bad shape that she needed the surgery ASAP and she would just pay for it out of pocket; that she could not wait any longer.
The surgery plus rehab would be $45,000.
Yes.
$45,000
a
My reaction?
THE HELL SHE IS.
My mom: Well, she has the money and she can’t wait any longer.
Me: That’s not the point.
Me: Dr. Asshole is not going to prevent her from having her insurance cover that surgery just because he is not “in bed” with the doctor she wants to go to.
Me: She has a right to have it covered. It’s why she has insurance.
Mom: So what are we going to do?
Me: What’s the process to drop her insurance and go on Medicare?
My mom filled me in.
It was an incredibly stupid process involving only a fax number with no way of knowing whether they’d received the fax and no way to follow up. Also no way to know if and when they’d accept the request.
It was a Sunday night. I asked my mom to write up the documentation and request and fax it to them first thing Monday morning stating that it was an emergency and requesting a reply no later than 5:00 pm Tuesday. I said if we received no reply she’d send the second and final request Wednesday a.m. with a deadline of 5:00 pm on Thursday.
At that point I would go straight to the President and executives of the insurance company and yes I’d already done the research and had their names and direct contact information.
I also had direct quotes from the American Medical Association’s Code of Ethics supporting why Dr. Asshole was committing malpractice by refusing my grandmother’s right to a second opinion, among other things.
My background is in recruiting and sourcing. It’s what we do.
There was no reply to either request.
<SHOCK>
So, I sent the following email to the President and executive team at her insurance company.
Dear Sirs:
My name is [Stephanie's Grandmother]. I am 85 years old and I am a patient/member of [your insurance company]. I have made two urgent attempts to contact [your company] through the channel that I was directed to by your Customer Service regarding my request to disenroll from [your insurance company] immediately due to a medical emergency and possible malpractice situation (fax# 813-290-XXXX, Name, ID#, Reason, Signature).
Attached are the two communications I’ve sent to date, the first one sent on Monday, June 25, 2007, followed by the second request on June 27, 2007.
As outlined in both communications, the explanation and situation follows:
At the beginning of April, 2007, I began experiencing severe pain and swelling in my left knee. Following is the timeline of events that have
transpired:
April 2 received cortisone shot from PCP (no relief)
April 16 received second cortisone shot from PCP (no relief)
April 20 (am) sent to knee brace facility by PCP (the technician stated that he could not help because I had had no tests of any kind or medical information regarding what was causing the pain and inflammation in the
knee)
April 20th (pm) sent by PCP after call regarding knee brace visit to have x-rays
April 27 sent by PCP for ultra sound-facility called in pm requesting a return visit to redo ultra sound
April 30 second ultra sound
May 9 sent for MRI-A
May 14 appt. with PCP to discuss ultra sound and MRI-A
May 24 sent to vascular surgeon who stated knee problem was not vascular
(PCP insisted problem was vascular but did write referral to orthopedic Doctor based on vascular surgeon’s assessment)
June 4 sent to orthopedic doctor who requested MRI
June 11 MRI
June 18 met again with orthopedic doctor who diagnosed torn cartilage and recommended medical procedure (daughter investigated doctor and found several dissatisfied patients-one of whom called me and spoke at length about the pain and suffering she had and was still enduring due to his surgery)
June 21 daughter called PCP (I can not and will not deal with the office staff’s rudeness to me) to request another orthopedic doctor. This request was curtly and rudely denied.
June 25 called for an appointment with a highly recommended orthopedic doctor (who is a [your insurance company] doctor) as a Private Pay patient.
I am scheduled to see him Thursday, June 28th.
I called [your insurance company] again today to request the process for dis-enrolling from [your insurance company] and returning to Medicare. I spoke to a very nice young man.
I was informed of the dis-enrollment window November 15 through the end of December. When I explained my medical situation is in an emergency state, I was told exceptions can be made for medical emergencies or moving out of state where [your insurance company] is not available. I am now, after 3 months, barely able to walk, I am in constant pain, I have lost 15 pounds, I am very depressed, and I can no longer wait to have the recommended procedure performed.
Today, June 28, 2007, I did meet with the second orthopedic doctor, Dr. Awesome, (also a doctor for which we have been unable to obtain a referral from my PCP, Dr. Asshole) and paid $350 as a Private Pay patient (due to the fact that he flat out refused to give me a referral). Dr. Awesome reviewed all test results, examined my knee, and determined that I need a complete knee replacement. The doctor stated that my condition will continue to deteriorate until this surgery is done. The will require four days in the hospital followed by rehab. The estimated cost is $30,000, not including rehab. As you can see, this diagnosis is much more severe than the arthroscopic procedure (drill three holes and flush) recommended by the the first orthopedic doctor, Dr. Death.
According to the American Medical Association Medical Code of Ethics:
E8.041 Second Opinion: A Patient is entitled to a second opinion and the doctor is supposed to provide the necessary information for appropriate referral.
4.4 If a difference of opinion, the physician should consult with other healthcare providers to resolve the issue.
Obviously neither of these things have happened in my case, and therefore it is imperative that I be released from [your insurance company] and given access to my Medicare IMMEDIATELY so that I can have the necessary surgery performed.
Scheduling for my surgery is in process as it CANNOT WAIT. Therefore, I request a response from you by 5:00 pm EST Monday, July 2, 2007. I have an appointment with my attorney on Tuesday, July 3, 2007. If I have not had a response from you by that time, you will hear from him in order to get this resolved.
I can be reached at my daughter’s home: XXX-XXX-XXXX. If no one answers please leave a detailed voicemail message including your name and telephone number so that we may return the call.
Your assistance in this urgent matter is appreciated.
The result?
I received a response at 7:00 a.m. the very next morning from their President of Operations apologizing profusely for Dr. Asshole’s behavior and saying that they’d override him and fully cover the surgery and rehab and that he’d already assigned a nurse case manager to my grandmother’s case who would call her before 8:00 a.m. at my mom’s house.
And she did. And was just as kind and helpful as she could be.
And my grandmother had the surgery several days later.
And now she’s just fabulous. Again.
The moral of the story?
Don’t take this sh*t laying down people. It sucks that we have to escalate to the executive level just to get what we’re paying for…but if that’s what it takes then that’s what I’ll do.
And. Just FYI.
Nobody messes with my family.
Scridb filter
Tagged as:
Cartoon by Hugh,
Get a life,
It's personal,
Stephanie A. Lloyd,
Yes I am actually being serious
