$3 Million for 7 Weeks

deckThree weeks after my partner Randy died of metastatic cancer, I called the oncology resident who had been his on-call doctor. I remember exactly how long it took me to make that call because I was in a place of noticing how long things took, with mild interest, like: when will I feel hungry? When will the best part of every day stop being when I’m asleep?

It took me three weeks to work up to hearing Randy’s doctor’s voice on the phone and simultaneously make words in English.There was something I wanted to ask her or, more accurately, something I wanted to make her say.

“If you’d known how much time he had left,” I said, standing on our tiny back deck, looking over the early-spring woods, “would you still have given him chemo?”

What I remember is that she paused very briefly, and then she sounded choked up. That satisfied me, as if she were my enemy showing overdue weakness. “No.” she said, “Not if I’d known how long he had, no.”

“Thank you.” I said. We exchanged some version of “Nice working with you” and then hung up. I had wanted exactly what I got: an admission, maybe of having fucked up, maybe of the possibility that she’d act differently in the future. That next time she would acknowledge what she couldn’t fix. Show some respect, next time, for the monster: a rare and unbeatable cancer, the oncoming death of a still-young man.

Not long after that, the hospital called me. They were inquiring after the outstanding 10% of his bill not covered by his insurance, the first job benefits he’d ever had. That 10% of the bill for seven weeks of cancer treatment came to $300,000 and change. Randy had had a very rare cancer, a carcinoma of unknown primary origin: the original tumor had been shrunk to nothing by his immune system, but not before the cancer cells mutated and slipped into his bloodstream. So “poorly defined” cancer cells were spread throughout his body, with no point of origin, no tumor to be cut out or site to be irradiated.

In Randy’s case, by the time he was diagnosed he had cancer in his blood and in his bone marrow.

I don’t know why Randy agreed to the chemotherapy. I wasn’t in the room for that discussion. Randy never asked me what I thought he should do with his diagnosis, which had a five-year survival rate of zero. My turn at decision-making came later, when he was admitted for the second time, to Palliative Care. That day I only heard the word “palliative” by eavesdropping at a nurse’s station. By then Randy weighed 128 pounds at 6’2. He needed oxygen because the cancer had blocked some of his bronchial tubes, trapping an infection. They could have removed those particular tumors, but the lead oncologist explained, “You’ll be back here in a month. And you could die on the table.” I don’t remember Randy speaking, just leaning back into the pillows and shaking his head.

Randy had given me medical power of attorney, luckily. He was drifting in and out of lucidity. One of his oldest friends, a general contractor and a robust guy, threatened to fireman’s-carry him out of the hospital so he could die at home, but my father’s connections at another hospital allowed us to get Randy into hospice.

He spent one more night in the hospital, with the agreement that we would be leaving in the morning. I remember sleeping next to him and waking up and looking at the clock at 5:30. It was softly gray and he was sleeping peacefully and I lay there soaking up the closeness and the quiet, knowing that the hospital would be coming to life around us soon and there would be a lot to do.

Then it was the morning, and there were pieces of paper to be signed and the terrible waiting around for the paperwork to be done and the ambulance to be available and someone important from hospice was there to help expedite for some reason, because she was a friend of my father’s maybe. She was wearing a suit and pearls and was very nice but when she said, “I don’t know how you’re being so strong” I snapped at her, I don’t know why, and said, “I think that when people say that they mean ‘so glad it’s not me.’” I’m sure she was used to people needing to be angry; I hope she took it in stride.

The hurry went on as Randy’s breathing got more ragged and he closed his eyes more often, and the adjustable bed and the morphine pump were located and assembled and then we brought him home. He rode in an ambulance with a DNR order I’d signed, and I think maybe someone else drove my car home and I rode with him, but my memory here is patchy. I remember that my brother, bless him, and another old friend of Randy’s went to Kmart to get sheets that would fit, which seemed strange to me.

“This will not take that long,” I thought, watching them make the bed. “It won’t matter if the sheets don’t fit.”

I was right; Randy died around 8:00 that night. The only worthwhile treatment of the $3,000,000 of medicine administered by the hospital was a high dose of morphine, invented in 1804 and with a co-pay of $10 for, as it turned out, more than we needed (the fancy patented patches hadn’t been strong enough). From the beginning, from his diagnosis, when they said that his best-case scenario was an extra year, he lived for seven weeks.

Still a year would have been nice with nothing but $10 morphine and chicken soup. Five or six months even, without the nausea and the starving and the poisoning. It was Randy’s decision, and the doctors’ decision, and it’s hard for doctors to say, “We can’t help you.” That’s not their job: it’s not what they pictured themselves doing in medical school.

But chemotherapy made Randy’s remaining life shorter and worse. With his diagnosis, it’s hard to see how a doctor could have thought it was the right course of action. UNC is a teaching hospital; maybe he was a useful study. Maybe it always seems better to spend $3,000,000 than $10.

Randy and I had reached the place so many twenty-something couples find themselves at thirty-something: trying to figure out if we should stay together. We’d started couples therapy a few months before he got sick, and stopped when his therapist said he should address his depression first. (Depression is sometimes a symptom of a malignancy, it turns out.) A lot of our similarly late-blooming friends decided to have kids. Others split up. Our story ended differently.

When I think about that story, its arc and its particulars, I usually picture us lifted up and carried by our friends, who crowded the hospital hallway like a subway car and filled the house on the night he died. And I see his doctor sitting next to his bed and extending her hand, saying solemnly “Thank you for fighting with us.”

And I wonder if she meant it the way I interpret it now: that he had been indulging them, their scientific curiosity, their lack of humility. It’s hard for me to think that no harm was done.

 

 

Amanda Yaggy is pretty thankful to be back in New York. When she’s not at her day job she reads, writes and plays with cats. Procrastinate with her at @amandayaggy.

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