Sam scoffed. “So now I have to be the poster boy for everybody else?”
“Not at all,” Michelle said. “But I am asking you to give it more time. See if your perspective about quality of life changes. If you won’t do it for yourself, then do it for Julie.”
Julie set her hand on Sam’s shoulder. She had not thought she had a single tear left inside her, but that familiar lump came back to her throat as her eyes watered.
“Give it time,” Julie said. “Please, Sam, for us. Let’s give it more time. Let’s put our energy on living, not dying.”
Sam motioned for Julie to cap his tube. Once he could speak more easily, he stayed silent long enough for the mood in the room to turn even more uncomfortable.
“What’s your deal with this, Michelle?” Sam eventually asked. “Why do you care so much?” His voice had turned soft, and his eyes were heavy.
It was obvious to Julie that this conversation had taken an enormous physical and emotional toll on him. It had on her, as well.
“You ask a fair question of me,” Michelle said. “And it’s a story I think you may be able to relate to. Do you want to hear it?”
“Last I checked, I’m not going anywhere.”
Michelle strained to smile. “We have to go back in time a bit, to my first husband. I was thirty-nine. I’m fifty now. Happily remarried to a doctor who works at this hospital, in fact. But back then I was happily married to a man I met in college-a man I thought I’d be with forever.”
“I thought I’d be getting married to Julie and buying a new condo in Cambridge. Now I can’t wipe my own ass. Funny how life throws us curveballs like that.”
Michelle shrugged off Sam’s aggression. Her eyes misted with memories. “Our curveball was a brain tumor. A grade IV astrocytoma, to be specific. He tried all the treatments-chemo, radiation, even surgery. Nothing helped alleviate his symptoms or his suffering. He was dying in the most horrible way. Seizures, nausea, blinding headaches, memory loss like an Alzheimer’s patient. I didn’t know what it was like to watch someone I love suffer so much, but I can relate to Julie’s pain because the experience was utterly excruciating.”
“Then you should be able to understand why I want to die.”
“I did and I do,” Michelle said. “I understood so well, in fact, that I moved my husband and teenage son across the country to Oregon, where he could legally get the prescription you’re wanting. And he got it, and he died. This was completely against my upbringing, my religion, but he needed my help and support.”
Sam returned a grim smile, but Julie was glad to see any smile from him.
“You’re making my case just fine,” he said.
“But it wasn’t fine, Sam. We’re all going to die, no debating that. What I learned from my experience is that death can bring more problems if you do something to speed it up. My husband didn’t die of a brain tumor. He died from the pills he ingested, the pills I helped him obtain. I thought the burden was mine and mine alone, but it turned out my son, Andrew, felt like he had a hand in killing his father. He didn’t share his feeling with me until after his dad was gone, but later he expressed his guilt for not doing more to stop it from happening.
“Andrew wasn’t sleeping. Started drinking, smoking, his grades went from As to Ds. He sank into a depression. I tried everything. Pills. Doctors. We eventually moved out of Oregon and settled in Massachusetts to get as far from the place where his father died as possible. It didn’t help. He carried the guilt with him all the way across the country, and it followed him like a shadow.”
Michelle’s sadness was pronounced. “I knew when I got home and the house was quiet that something horrible had happened. I knew when I called Andrew’s name and he didn’t answer. I just knew.”
Michelle closed her reddened eyes and put a hand to her mouth, head lowered. She stayed that way until her composure returned.
“I found him hanging in his closet. He was gone. He took his own life. He took his life because I took his father’s. And that’s when I knew that it wasn’t just about my husband and his freedom of choice. It was about all the lives connected to him, including my son’s. So I changed my tune about death with dignity and I turned my focus, my full passion, to preserving life at all cost. Death is coming for us all, Sam. And if you push Julie hard enough, she may just crack. She may move you to Oregon, or Vermont, or some state where you can legally order your own death. And you’ll be gone, and Julie will live with that decision for the rest of her days.”
Sam eventually broke the lengthy silence that followed. “I’m sorry for your loss, Michelle. You have my deepest sympathy. You’ve given me a lot to think about.”
Michelle smiled. “Then I’ve done my job,” she said.
In the protracted silence that followed, Julie sensed that anything she chose to say would be wrong. Except for the words, “I’m sorry,” which Julie spoke in a soft voice, directed at Michelle.
Julie bent down and gave Sam a light peck on his forehead. As she lowered her head, Julie could see a few red dots marking the lower portion of Sam’s neck. She stood, kissed Sam’s lips, and said she loved him. Then she hugged him and hugged Michelle. For a moment the mood lightened.
Then, being the doctor she was, Julie shined her penlight on those skin abrasions. “Well, in addition to that prescription for Prozac, I’m going to get you another for an antihistamine,” she said.
Sam returned a puzzled look. “Why is that?”
“From the looks of it, you’re about to break out in hives.”
“Hives? Oh, crap. Well, I guess when it rains it pours,” he said.
Julie laughed because she could not stand to cry anymore.
CHAPTER 18
ONE WEEK LATER…
Julie finished a busy morning in the ICU, plus extra time on the phone with an obstinate agent from an insurance company. Goodness, weren’t they all? This one refused to pay for Xolair because the patient had “asthma-like symptoms,” not pure asthma. It did not seem to matter to her one bit that Julie’s patient had failed standard therapy with prednisone. What mattered was that prednisone cost three dollars a month, and Xolair could run anywhere from five hundred to two grand, depending on the dose prescribed. It irked Julie to no end that someone in a cubicle without an M.D. was reviewing checkboxes to see if all the criteria had been met.
“Has the patient been on a moderate dose of inhaled corticosteroids plus long-acting beta-agonists for three months?”
Come on now, Julie wanted to scream into the phone. The patient is here, right now, and he’s having a hell of a time taking in a good breath, not to mention he’s had four emergency room visits in the last month. Julie knew that Xolair would make a difference. The patient had an immunoglobulin E level through the roof, the exact area Xolair worked on.
“Is the patient’s diurnal variation in peak expiratory flow greater than thirty percent?”
Do you even understand what that means? Julie wanted to say. She controlled herself. This was a game, and she was adept at playing. Her goal was to get the best treatment possible for her patients, while the insurance companies she battled wanted the least expensive/best treatment possible.
Therein lay the conflict: two little words with such an enormous impact. Least expensive. Julie knew she would win the Xolair battle eventually. After all, she had the MD. The game being played was one of attrition. If the insurance companies set up enough roadblocks, enough doctors would give up and settle for second best. It was a profitable strategy for the companies, but Julie was not about to be one who gave up the fight. She was compulsive about getting everything in order before even picking up the phone. The price Julie paid for her effort was a lot of extra time during nights and weekends, gathering her swords and shields for battle.