Thursday, September 24, 2009
Six Months Ago Is Today
It's funny how subjective time can seem.
You know the feeling? Like when you go driving, trying to find a business or house you've never been to before; getting there seems to take forever, as you look all around for the address, but when you retrace your route, it seems to take no time at all getting back.
That's how these last six months have seemed to us. Six months ago today, March 24, 2009, at 5:12 p.m PST, my wife Julie's mom Chantelle slipped away from this world. Looking forward from that day, half a year seemed so far away; now, looking back, it seems as though it just happened, as fresh as yesterday.
Now, I look back at the blog posts (links below) where I recorded the events and our thoughts and feelings from those fateful four days, and I wonder to myself, "How did this all happen?" From the time her heart stopped, the 45 minutes of CPR and shocking, her "revival" into a deep coma, and our agony over what to do as the doctors gave us less and less hope for her recovery, we grew more and more puzzled. She had some medical issues, such as high blood pressure, borderline diabetes, and her ever-present weight problems. But What killed her is going to forever be a mystery, because the doctors were never able to figure out exactly what it was.
We've spent the last six months asking ourselves pretty deep questions, but the most troubling to us has been, "Why then?" Chantelle was ONE WEEK away from retiring from her job, had just gotten her first Social Security check, and was looking forward to our impending move to her beloved Denver, Colorado so she could get back into a church, find some social groups, and hopefully even find a husband to spend the rest of her sunset years dancing the night away, traveling the world, or at least having a serious cuddle with as often as possible. Instead of ending 65 years of always-struggling, often-painful, sometimes-depressing life by finally enjoying herself and once again finding love, her life ended just a few days before all that could happen.
A sudden death never seems "fair", but sometimes you have to wonder if some aren't more unfair than others. We still often get into conversations that of course go nowhere... asking "Why?!?"
But as we've spent these many months sifting through years of her accumulated "crap" (Julie's word!), from enough cake decorating equipment to open a bakery to enough fabric and patterns to outfit a craft store, and after what seems like hundreds of trips to Goodwill and other charities, we have finally boiled down her life's possessions into a manageable and precious collection of what we hold most dear. There are the pictures, of course. And we kept some of her hand-made clothing (even though much of it no longer fits) and many of her "crafty things" that don't really seem to have a purpose, but she loved them so much we can't seem to bear to part with them. We made new discoveries: pictures we never knew about, artwork she had done, diplomas and certificates for programs she never used, letters she had written, old birthday cards and drawings from her two girls she had stashed safely away. The debris of a life of love, of missed opportunities, of half-finished projects, of cherished memories and keepsakes.
But part of the "Why?" we have been able to answer, at least in part. And it's a story of two kinds of medical systems in this country.
Chantelle was very much interested in the current administration's plans to revamp healthcare, so I do not feel I am over-reaching to turn this from a discussion of her last days into a discussion of the healthcare situtation in this country. The reason is because both Julie and I have come to the conclusion that at least one aspect of Chantelle's death came from her years of stress over an enormous medical bill.
At the time of her death, Chantelle was working for Kaiser Permanente in Portland, Oregon. She was covered by Kaiser's cadillac insurance program, so when she collapsed and was rushed to the hospital, she received absolutely excellent care in every regard. Even though she was taken to Providence Medical Center rather than a Kaiser hospital, they covered everything; they just took a photocopy of Chantelle's insurance card and some information from Julie, and that was it. When it was all said and done, Julie and I had to pay only $50 out of Chantelle's estate to cover the cost of the ambulance. This, from a final bill of nearly $50,000. On top of it, as we were standing beside the bed saying our last goodbyes, Providence had a harpist come in, dim the lights, and sing and play as she was removed from life support and her body allowed to join her soul, which had obviously gone on four days before. It was all very beautiful and even joyous in a quiet, peaceful, and sad sort of way.
This is how end-of-life care should be for everyone, not just for those with "cadillac" insurance!
Now contrast this with an event seven years earlier: Chantelle collapsed in a faint, was rushed to the hospital, and was told she had to have a pacemaker installed immediately or she would most likely die: her heartbeat was hovering around 20 beats/minute. While her mom was in the ER getting checked out, Julie was ushered into the financial services office of the hospital. Since they had just arrived in Riverside County, California from the adjacent Orange County, and had not yet found jobs, they had no insurance. The financial advisor told Julie, "Don't worry, if you can't pay the county will cover it." Reassured, Julie completed the paperwork and went to be with her mom.
After the surgery and brief hospital stay, they went home and Chantelle began the recovery process. It didn't take long before a letter arrived, demanding nearly $50,000 in medical expenses. After calling the hospital, Riverside County, and even Orange County, they discovered that since they had not lived in Riverside County for at least 30 days, they were not considered "residents" and thus not eligible to have the county cover the bill; since they had moved out of Orange County, they were no longer their problem; and the hospital basically said "Nobody here would have told you the county would cover it without checking first." So, unemployed, fresh out of pacemaker surgery, in the middle of a recession, the collectors started their relentless hounding.
Over the years, Chantelle made some efforts to negotiate the bill, all rebuffed. She sought the advice of lawyers and medical legal experts, who essentially told her to either pay the bill or declare bankruptcy. The collectors became ever more insistent, sometimes calling her at work, at home, or on her cell two or three times per day. She put call blocks on the phone numbers, and they just kept changing numbers on her. She would get at least one written notice every week, sometimes more, and often in the most threatening of tones. Threats to take her to court, to confiscate her house (which she didn't own), or to take her car, or to seize other assets. Legislation in the middle of this decade helped a little to ease the abusive tone of the calls and letters, but they kept on coming relentlessly nonetheless.
Six years passed, the legal "statute of limitations" for taking an old debt to court. And the calls and letters still came. She sent them official notice to cease and desist. When they weren't outright ignored, the collectors pulled their loophole out and sold the debt to another collector, who would start everything all over again. For nearly seven years, collectors caused her enormous stress and literal heartache over a debt that SHOULD NEVER HAVE HAPPENED!
In those seven years, Chantelle had regular visits to have her pacemaker checked out. Every time, it dumped the collected data of her heart activity for the doctors to view. And every time... every SINGLE time... it came back clean. No sign her heart had any trouble keeping a beat all on its own. She had one just before her final collapse, and again it came back clean; in fact, the doctors were suggesting she have it removed completely. So why had she had to have one installed in the first place, if it seemed as though she never needed one in the first place?
Various legal folks have told us that we don't have a case, and we're not interested in suing anyway. What bothers us is how what may have been a simple misdiagnosis of irregular heartbeat when it could have merely been an early sign of diabetic shock turned into a $50,000 bill and seven years of sheer collector hell? That's the problem here; it's not the misdiagnosis, which may have simply been due to related symptoms and the rush of the ER. It's the fact that seven years later, after being hounded by a relentless and endless group of collectors, her life ended at least partly due to the stress of having to pay tens of thousands of dollars for an operation that she evidently didn't even need.
One final bit of irony, and overwhelming anger, happened on the day she died. As we were driving home from the hospital, quiet in our thoughts, her cell phone rang. I answered it, and it was "her" collector. I quietly explained that Chantelle had just passed away minutes earlier, and to please stop calling and sending her collection notices. After the most perfunctory of "I'm sorry to hear that" comments, this person then asked me, "So will you be paying her debt out of the estate?" After a moment of shock, I lost it. Here we were not even home from the hospital, and this vulture was already swooping in for scraps! I yelled back at her, "You're not getting a cent out of her, her estate, or anything else... she's dead! Do you not understand what I'm saying? SHE JUST DIED A FEW MINUTES AGO!!! And you helped kill her!"
I was angry and upset, and the person on the other end made some weak apology and hung up... and gloriously, we have never heard from them again. But those words have come back to me time and again, and I really do think now that the collectors had some part in killing Chantelle. Not quickly, but like slow poison... bit by bit, nibble by nibble, slice by slice... they ate away at her soul. For all her joy at retiring and starting a new life in Colorado, her one persistent concern was "those goddam Riverside people, they'll never leave me alone".
And nobody in this country, or any other country in the world, should have to spend the last years of their life giving serious consideration to declaring bankruptcy just to gain some peace from a medical collection agency. Chantelle was interested in the healthcare debate, but following her death it has come front and center for Julie and myself. At minimum a public option with open enrollment (as the Wyden amendment provides) is a necessity; I would prefer a universal system that covers every single human being in this country such as the Conyers bill, so that nobody ever has to go through what Chantelle, and those who loved her so much, has had to go through ever again.
For those who would like to know something more about the tragic events of those days, some recollections of Chantelle's life, hopes and dreams, and perhaps if you have not yourself lost anyone dear to you a glimpse of the chaotic mixture of joy and grief that losing a loved one entails, please read my blogposts from March 21st onwards:
Friday/Saturday - Chantelle collapses, "goes to sleep"
Saturday/Sunday - I've never been so proud of Julie
Sunday/Monday - Waiting for family to arrive, hope changes to acceptance
Monday/Tuesday - Saying goodbye
Wednesday - "Mumzy", a poem to the fallen
Friday - The perfect (and funny) tribute to a life lived face-on
Chantelle's Memorial Page and thank-you to the doctors, nurses, friends and family who were so supportive both during and after her passing