“Cancer?” Now he had the young man’s attention. All the blood seemed to run out of his face. “You think I got cancer?”
“If it’s testicular cancer and your girlfriend is correct in saying she noticed the change in your testicle a few weeks ago, we caught it early,” Donald quickly said. “Even at a later stage, testicular cancer is highly curable.”
“But… it’s still cancer,” Michael said, his voice tinged with worry. “What will—”
Donald held up a hand to stop the patient. “Don’t worry about this yet. Get those tests done today and I’ll have the results back by tomorrow. If it is testicular cancer, I can put the order in to have you ready for surgery in three days at the latest.”
“Surgery?” The patient now looked terrified.
“It’s okay,” Donald said. He helped the young man off the examination table, putting his arm around his shoulders. “It might not even be testicular cancer. It might be something else. You’re sure you haven’t had any injury to that region recently?”
“No! But—”
“There could be a number of other factors,” Donald said. “It could be a cyst. That can be treated with medication. It can be a number of other things but we won’t know precisely until you get those tests done.”
“Testicular cancer?” The patient was clearly having a hard time dealing with this.
“Is highly curable.” Donald gave the young man a smile, hoping to put him at ease. “Trust me, Michael. If it is testicular cancer, it’s highly curable. In fact, out of every form of cancer out there, Testicular cancer is the most curable.”
“If it’s… if that’s what it is, how did I get it?” Michael asked. He appeared to be handling this better but his eyes still had a look that radiated pure fright.
“We still don’t know what causes testicular cancer, but it usually occurs due to a buildup of various proteins that are produced by the testes themselves. Of course other factors can be weighed in as welclass="underline" smoking, excessive drinking, an exposure to radioactive material, a family history of cancer. Another cause is the overproduction of testosterone, which help produce sperm cells. Stimulate that production through fertility drugs and that can be a factor as well.”
Michael was listening now. Donald liked it when he had the undivided attention of his patients, especially those that were usually not prone to listening to their doctor’s advice. “So what do we do?”
“Get those tests done today. I’ll have the results tomorrow and I’ll call you and we’ll take it from there.”
“And if it is testicular cancer?”
“Then I’ll put in a request for you to undergo surgery at Lancaster General as soon as possible. Who’s your insurance carrier?”
“Red Rose Medical,” Michael said, his tone of voice suggesting his displeasure at his insurance company. “They’re not… well, they’re not very good, but it’s the only insurance I can get through my job. My deductible with them is pretty high.”
“I’ll take care of it,” Donald said, clapping Michael’s shoulder, trying not to let his own displeasure show through. Red Rose Medical was one of the worst insurance carriers he’d ever dealt with. Most claims sent their way were questioned, and a third of them were denied before they went through a Byzantine process before finally being paid grudgingly six months later. Donald had one patient who suffered from chronic asthma that had become so bad she was forced to breathe through a ventilator. Red Rose denied his claim for surgery to remove nodes from the lungs causing the asthma, claiming such surgery was not medically necessary. Donald had gone to bat for the patient, a thirty-eight year old single mother of three who lived in Marietta, and recruited a colleague of his, Dr. Edward Staley, a Pulmonologist, who refuted Red Rose’s absurd claim that the surgical procedure wasn’t medically necessary. Red Rose’s definition of medically necessary usually meant,’If the patient is on life-support and is going to die, then any medical procedure necessary to save the patient’s life is necessary. Anything else, forget it.’
Donald remembered that incident well. He and Dr. Staley had shown up at the lofty offices of Red Rose’s corporate office in King of Prussia ready to do battle. Present at the meeting had been the panel that listened to appeals, all of them corporate types with no background in medicine save for a quick trip through some Health Care Administration courses in college, and one physician, a substitute for Henry Wagner, MD, who was their only physician on the appeals board and usually sided with the corporate types despite the medical evidence; Donald was sure Wagner was paid handsomely for ignoring the Hippocratic oath. Wagner’s substitute turned out to be a last minute replacement and — surprise, surprise! —had once worked in Pulmonology as an Intern and now practiced Internal Medicine.
After Donald and Edward presented their case, along with their recommendations for immediate surgery for Mary Hess, they waited for the verdict. Several of the executives were conferring with each other in whispered tones and Donald had tried to pick up bits of the conversation. The executive sitting next to the substitute MD, Dr. Cantrell, was talking quietly with him and shaking his head. It was clear from the look on the executive’s faces that they didn’t like what Dr. Cantrell was telling them. Finally, the executive in charge turned to Donald and Edward. “What are the underlying causes of the patient’s asthma?”
“She was born with it,” Donald had said. “The diagnosis was originally made when she was nine months old and the patient has been on various antibiotics and medications since then. According to her medical records, her original pediatrician diagnosed acute asthma that would worsen when she entered her early teens. Mary went through her early teens fine, but the condition did worsen when she reached her twenties. Surgery was recommended at that time, but her insurance company instead opted for a high-level antibiotic therapy which she underwent with minimal success.” Donald had paused, taking a quick survey of the room, making sure his point was well made. “The nodes in her bronchial tubes have only gotten worse, forming bronchitis and heavy scarring in her lungs. Ms. Hess is highly susceptible to pneumonia. The slightest cold can lead to the condition and, left untreated, could kill her. She is now at the point where the condition will steadily worsen, filling her lungs with fluids and effectively drowning her. The antibiotics have had no effect on her now for the past three weeks and a ventilator is only prolonging the condition. Without surgery to excise the nodes and extract the fluid from her lungs, she will eventually require the assistance of a breathing machine, which will require permanent in-house care. This could lead to a number of conditions that could hasten her demise or prolong it; complete respiratory failure, being the chief one. That in turn will lead to a coma and my God, consider how much money that will cost if that were to happen?”
Eddie later told him that despite his obvious sarcasm at that last remark, his little speech had worked. It had helped that Bernie was filling in for the droid Red Rose had on their payroll who posed as a physician. Bernie had said a few words to the executive on his left and, judging by the man’s face, it was serious enough to merit his attention. The executive relayed Bernie’s message down to his colleagues and the verdict was rendered immediately. Mary Hess’s surgery would be paid in full, including all post-op care. Prolonging the life of their “member” wasn’t their primary focus; preserving their financial bottom line by paying the fifteen thousand dollars necessary for her surgery, as well as the five thousand dollars that would be required for the post-op work, was more attractive than millions of dollars paid out over the possibility of her lifespan, should she live that long after succumbing to complete failure of her respiratory system. That didn’t include the lawsuits that would no doubt be filed against Red Rose on her behalf by her family.