An old friend of mine died on Christmas Eve last year. The family didn't want anyone to make any calls until the day after Christmas. They said she wouldn't want to "spoil" anyone's holiday. That's her. That's they way she lived. Thinking of others.
Maybe she thought it was a part of getting older. Maybe she thought the odds of this being serious weren't likely. Maybe it was the expense . Maybe it was fear. Maybe it was the million things that made her delay seeking health care in favor of taking care of everyone else in her life.
A lot of people knew she wasn't feeling well. No one insisted she get an answer for her malaise and discomfort. The bottom line is that my friend hasn't been feeling well for a long time and she didn't get adequate health care. That's the new normal in the U.S. Be sick and don't know why we're sick. She finally got to where she had to have an answer for her health problems.
She got the diagnosis.
The Big C.
Stage IV breast cancer.
That was the beginning of December.
She died Christmas Eve.
The cancer may have killed her, but it was really socialized neglect.
The United States health care system pushes people to self ration their care. It's not an efficacious decision. It's not made on sound medical decision making principles. It's made based upon the patient's purse. My friend, in her late 50's died from self rationing her health care. Why we respect and encourage people to neglect their health is crazy. Any one will concede it was her right to avoid using health care, but would she have made that choice if she thought it wouldn't bring financial destruction to her family?
Why does our nation neglect to adopt sensible approach toward accessing our health care system?
We live in a country that promotes health care rationing in the cruelest and most inefficient ways imaginable. Self-rationing is particularly troubling. Why did she do it? A woman in her 50's with breast cancer is very treatable. She wins 80-88% of the time with early detection. Waiting until she couldn't ignore the symptoms any longer gave her a losing hand. She had only a 14% chance of living 5 more years at Stage IV. Did she deny herself Mammograms? They are fairly inexpensive as imaging goes. Did she decide to not even try aggressive breast cancer treatments since the diagnosis came at Stage IV? Was she afraid of the expense or that treatment would increase her premiums for a small group policy? Why ever she didn't find out sooner or recognize the symptoms is academic now. She's gone.
This year, 2011, is the first year when mammograms will be offered for no cost sharing to people with insurance. The uninsured still have to try and get them on their own, but at least we've taken one small step. The Republican controlled House wants us to step back from this small token of good health care policy. They don't see laissez-faire health care as socialized neglect that encourages women to opt out of preventive care. They don't see their position on health care and any other social program for what it is, neglect. They want people to pay their way and if they can't or won't then "that's the free market at work". If someone dies from that system, then it's too bad, so sad and off to the next distraction. There's nothing to see here. Eventually the American public must wake up and see that the U.S. health system benefits too few of us and that it's predatory finance system efficiently excludes at least 30% of our population from adequate health care. Then, America, the land of the free, needs to take one more step and see that our health care system binds us. Our failed health care system controls us with job lock and fear of entrepreneurship. It's sucking the life out of our economy.
I couldn't write about my friend immediately after she died. We'd grown apart, but I knew her well. She was at my wedding. I know her husband and children. Over the years we saw less of each other, but I always knew the places we'd cross paths and she would be there, as expected, every time. We used to belong to the same church. We'd serve on the same committees. Her husband sang with me in the choir. I know she was devastated when her daughter died of lymphoma less than a year after she watched her daughter marry the love of her life. I knew some of her pet peeves, but not her favorite color. We could make each other laugh. I know she was a practical, no fuss kind of woman who thought of cut flowers as a guilty pleasure. She was the kind of friend you see when you go to certain places or events and could expect have a long chat to catch up. We'd pick up where we left off as if hardly any time passed at all. Earthy, but not crass. Quirky, but not silly. Sensible, but not cold. Compassionate, but not a push over. She was solid, balanced and a lot of people (including me) are going to miss her terribly.
She's gone. Her impish laugh is no longer something to look forward to. And it didn't have to happen.
It turns out she rationed herself out of health care. She had the membership card, a valid health insurance card; but was afraid to use it. Both she and her husband work for small businesses and were part of small group plans. Maybe she didn't want to deal with higher premiums. Maybe she didn't want to cause a huge hike for the rest of the group. She certainly was another casualty of a country that can't tell the difference between health insurance and health care.
My friend was no simpering woman who kept to the background. She was fast forward, clear about where she stood on any issue. A "can do" person who didn't appreciate nonsense, but for some reason she non-sensibly put off finding out why she was feeling so poorly over the last 2 years. Maybe she thought she could handle it. Maybe she didn't know who she could talk to about it. Maybe, if it was a finance problem that she didn't know how to get around. She didn't reach out. She didn't get care. She suffered in silence. That isn't wasn't like her.
She wasn't depressed. She was active, energetic, but not manic. She enjoyed a good time like anyone else. She was slender, but not skinny. Her only bad habit was smoking. She apologized for it and tried to quit, but she was afraid she'd gain too much weight. Although I'm not entirely sure if she ever gave up tobacco for good, she wouldn't punish herself for smoking by denying herself health care out of some perverse, self inflicted penance. She would deny herself health care over money. She'd also procrastinate. She'd also think she'd beat the odds. She would think it wouldn't happen to her.
She has had a key to opening the portal to health care, but she didn't use it. She could have had the tests. She wasn't afraid of doctors, she had an appendectomy a while back. She wasn't terrified of needles. She always made sure her kids got care. So, why didn't she get herself to the doctor and .... I don't know why she didn't get care. Maybe she could have. Maybe she had a barrier that she was too embarrassed to talk about. It doesn't matter now. She didn't get care. She's gone.
The world is a little dimmer without her.
RIP Bebe.
We'll miss you.