DR. DEATH
Nov. 21, 2008

        Let me tell you about Dr. Death.
          He is a Southern California neurological surgeon, a specialist in brain tumors. I will not name him here, because I do not wish to cause problems for a friend who is, or was, being treated by him. I will make up for this omission one day.
          Dr. Death adheres to the hypocritic, as opposed to Hippocratic, oath. People are vessels that happen to house the stuff that makes Dr. Death rich. Patients are necessary inconveniences to be endured on the way to mansions, cars, kids, season box seats. Cancer is gold.
          Dr. Death works not to save lives, but to save insurance companies money. Got brain cancer? That’s a no-brainer. Go home and die. More cost-effective. Humbug. I was a hit-man for the HMO.
          Two months ago, my friend---call her Maude---was taken ill. Well, that doesn’t really cover a situation where you are suddenly unable to understand spoken or written language, retain information, and are hit with a headache that feels likeYosemite Sam clobbered you with a skillet.
          Stroke? Not likely for a person in strapping good health, mid-40’s. This left a proverbial "team of doctors" with the more ominous suspicion of brain tumor, something that was confirmed after a couple of days and a few MRI’s at a fine local hospital. And not just any brain tumor, but most likely a glioma---the fastest growing malignant tumor there is. Same thing Teddy Kennedy has.
           It was the "size of a grape," doctors said in one of those absurdly mild similes, and it was growing in Maude’s speech center (left side), near the surface. As if that wasn’t horrible enough, the thing also had “tentacles.” Then there was a larger, mysterious, darkened area covering much of her left hemisphere that was not identifiable. The verdict: do a needle biopsy and start appropriate treatment ASAP. Kill the monster-grape-with-tentacles.
          “I’m so glad I can just get this thing biopsied and treated right away," Maude said at the time, between bouts of crying. "I just want to get this thing out of my head, whatever it is.”
          Her friends came to visit, her room filled with the inevitable flowers, and her spirits shifted from despondent to philosophical to resolute. From "my life is over" to "I want to fight it" and "I want to outlive my kitties." There was, thankfully, a little good news: her confusion gradually lessened during the hospitalization, and she recovered a fair amount of verbal ability and improved short-term memory function. The doctors had no idea why. Might have had to do with reduced inflammation.
            I should here note that Maude is an accomplished person and tough cookie. Single, she came to the U.S. as an immigrant 20 years ago and built a very successful career as a graphic designer. She is heroically devoted to helping and saving animals. She has boundless mercy for those in need.
          How ironic.
          Enter Dr. Death. HMO Boy. Fully three days into Maude’s hospitalization. (So many tumors, so little time.) The first thing he did was to crudely order all her friends from the hospital room. Reported comment: “What are you doing here? Leave!” He spoke fast, he was “blunt.” He told Maude that the likely diagnosis would be brain cancer, but that a biopsy was too dangerous and could cause uncontrolled bleeding in the brain. So---ready for this?---
          Dr. Death tested her reflexes, her ability to comprehend speech, and. . .
          Sent her home.
          There is no urgency, he told her.
          No urgency.
          Just a probable brain malignancy, that’s all.
          Folks, I wish I was writing fiction. I wish this was just a tragic little tale being made up for your entertainment. I wish the next part would involve Dr. Death waking up to find the Ghost of Christmas Past at his side, conjured up to teach him love, forgiveness, care. Or that he was promptly run over by a truck, and Maude was readmitted to the hospital for the treatment she needed.
          But no. Maude went home, as instructed, compulsively and frighteningly rubbing her left temple and forehead, declaring how much she liked Dr. Death because he spoke so plainly. Besides, as she said too often, she couldn’t afford to pay for a biopsy if the insurance wouldn’t cover it.
          And so began eight weeks---eight weeks---of MRI’s, CT scans, a lot of paperwork, and a whole lot of no progress. Dr. Death proved very hard to reach, did not return calls promptly, if at all, and his secretary was disorganized, persnickety, unresponsive.
          Of course, there was no urgency.
          Or was there?
          At some point in the testing, Dr. Death reversed himself and admitted that a needle biopsy was certainly in order. (What happened to the danger of bleeding was not clear.) Said biopsy would happen in a week or so, he announced, after Maude finished more tests. When that week or so passed, she was told it would happen in another week or so, after still more tests. And so week-or-so on.
          In a decision to rival any of the greatest by George W. Bush, Dr. Death next cleared Maude to drive, and to go back to work. Really. Soon he would have her take flying lessons. You know, I can’t speak from experience here, but I’ll just bet that people with brain tumors who are experiencing sudden cognitive shutdown are not generally cleared to navigate the 405. (Although, given the driving habits of people in L.A., I could be wrong.)
          And I’ll also bet that it is not easy to be a graphic designer when the term, “thingy-or-whatever-you-call-it” has replaced a great many ordinary nouns. Maude managed, though. She got through her days, clinging to hopes that her situation had stabilized, and might turn out to have been a stroke, or something less dire than a glioma.
          One night, I observed her lying on her living room floor, exhausted, clutching her skull in pain, complaining of “pressure” in her brain.
          It was at this point that I tried to help, and got in touch with a friend who has successfully battled brain cancer for about five years. I described Maude’s symptoms, and his answer was prompt and unambiguous: it sounded exactly like a glioma, and she needed to get biopsied and treated immediately before the goddamn thing grew more. He referred me to doctors at UCLA, and within days, Maude was being evaluated all over again, insurance or not.
          Yet this promptly evolved---devolved?---into back-and-forth between Dr. Death and UCLA, and more tests, and more delays, and more tests. More week-or-so’s. One day, to Maude’s great joy, a “tumor board” reviewed her case and said that it could not rule out stroke as possible cause. (Funny that no one ever put her on blood-thinners after she left the first hospital!) But this hope was short-lived. At last came something called a PET scan, and another UCLA doctor who glanced at it, saying, “It’s a tumor, and you have to get biopsied. Right away.”
          Round and round the mulberry bush. . .
          Yet again came the flutter of insurance paperwork, and the chess game of coordinating different doctors---something not easily accomplished by a patient who couldn't remember their names, or even the probable name of the tumor in her head. Maude found that she had to arrange a pre-op with her regular physician, for some reason, then get the biopsy scheduled at UCLA, see, but then there was a ten-day window before the paperwork would have to be redone, y’know, and Thanksgiving was approaching, and Dr. Death was not returning her calls, and doctors at UCLA said they would “try” to get the biopsy before the holidays, but, well. . .
          Anxiety? Try blind panic:
          “Why is this all taking so long? I don’t understand. I don’t understand," she would say over and over again. "Why doesn’t (Dr. Death) answer my questions? He's just stopped responding. I don’t think he cares about this at all. What’s wrong with people? They have to get this thing done before Thanksgiving, or I’ll have to redo the paperwork, and get another ten-day window. I’m scared. I’m scared this thing is going to get worse. I don’t know how much time I have. I don’t even know what this thing is yet!”
          Ten days ago, Maude's fears came true. In the middle of her work day, she found herself unable to explain anything clearly, or understand what people were saying. Sentences were bird chirps, printed English turned into hieroglyphics, the headache was a dam trying to burst. Her statements were staccato, broken, repetitive, her thinking garbled. Words were missing, terms interchanged. A “friend” became a “doctor.” She couldn’t pronounce names, or the names of the tests she’d had. “MRI” became “m-something.” Time was a jigsaw puzzle, with pieces lost. Context was all but extinct.
          The tumor was on the move.
          Somehow, Maude managed to fire off a short e-mail to one of the UCLA doctors, who responded by phone, but she never got the message. Operating a cell phone was something to be relearned each time she picked it up. A friend began e-mailing the doctor on her behalf, but the message she received in return---“Get to the emergency room immediately”---didn’t reach Maude for three or four days---not until last Sunday night, when she phoned me with a tirade of near-babbling. My wife and I rushed over.
          The three of us put together an e-mail to the UCLA doctor, appealing for immediate help, and he called back at 11 p.m., urging that Maude check into emergency immediately.
          By early Monday morning, that’s right where she was, amid the puking, dying, crying, wide-eyed, and those freakishly cool-headed ER pros. Doctors administered repeated cognitive function tests, during which Maude was unable to identify a watch, and pronounced the color blue as green. She spoke compulsively, it seemed, repeating the same statements over and over. I thought she would rub her forehead raw.
           Now let me ask you something, dear reader. If a friend, or a daughter, or a cousin, or even a stranger, approaches you and says that he or she is in extreme pain, what do you do? Walk away? Ignore it? Say, “Feel better soon?” “Good luck with that?” And what it you are a doctor? Take two aspirin for that brain tumor and call me in the morning?
          Two months after Maude’s initial symptoms---two months---someone prescribed medication to relieve her headache and brain swelling. In an equally astonishing turn of events, one of the emergency room doctors looked at her latest MRI and said that the larger darker, mysterious mass was “inflammation." This was the first time, Maude said, that any doctor had said this.
          “Oh my God!” she shouted. “And all this time I thought it was a second huge
tumor!"
          Two hours after taking steroids, she was almost pain-free. I’d forgotten what the woman looked like with a relaxed face.
          As of now, a team of UCLA doctors has decided to bypass the biopsy, and just remove as much of the tumor as possible. As one told me, the situation is extreme, and they are all but certain this is a glioma. Maude has had four or five MRI’s in the past few days as physicians plot to remove tumor tissue without removing her ability to speak and comprehend language. This will be dicey. Gliomas die off in the middle, and grow by spreading outward. Like bombs.
          There is no urgency. . .
           It is beyond dispute that had the original hospital proceeded with the planned biopsy and treatment, the tumor would have had two less months to metastacize. It is also beyond dispute that a country where Teddy Kennedy gets diagnosed and treated for a glioma within days, while the likes of Maude contend with obstructionist HMO-appointed gatekeepers, is obscene. If not criminal. . .
          The other day, I e-mailed the friend who has been battling a glioma for years, the one who kindly referred Maude to UCLA in the first place. I told him about Maude’s initial diagnosis at the first hospital, the planned biopsy, and how Dr. Death stepped in and derailed the whole process.
          Here is my friend's statement:
          “This would be unbelievable if I hadn't already heard this tale dozens of times. Really sorry for (Maude.) An HMO 'doctor' killed a very good friend (also with glioma) by misreading his MRI, and then refusing the advice of those much more informed than he about treatment. Gross negligence if not criminal, manslaughter if not murder.”
          But not surprising, considering the unspoken credo of the likes of Dr. Death, hit-men for the American health care corporatocracy:
          Save money, not lives.  

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