by RIP RENSE
Nov. 21, 2008
Let me tell you about Dr. Death.
He is a Southern
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.
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.
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,
Of course, there was
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
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
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
“Oh my God!” she shouted.
“And all this time I thought it was a second huge
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.
© 2008 Rip Rense. All rights reserved.