So, you've got cancer

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Apart from the expected mental turmoil that results from a cancer diagnosis—even a “good” one—practical concerns quickly march to the fore. Naturally, medical questions take priority in the beginning:

  • What kind of treatment will I have?

  • Who should provide it?

  • When will it start and end?

  • How long will it take to recover?

In my case, “Who should provide it?” drove everything else. 

The initial ultrasound was ordered by my primary care physician and carried out locally. With the results in, that PCP referred me to a just-as-local ear, nose, and throat specialist, who peered down my throat, made the diagnosis, and performed the biopsy to confirm that diagnosis. As he believed I was a candidate for surgery, he referred me to someone at Stanford University’s cancer center who specializes in this stuff. That took a couple of weeks and was pretty straightforward.

But I was now in two different medical systems—the local provider, which I see for my everyday health issues, and Stanford, which was tasked to deal specifically with the surgery. In the case of other kinds of surgery, this could be worked out pretty easily—go to Stanford for the surgery, then return to the local outfit for any follow-up.

But this kind of thing requires a team. You’ve got the surgeon, but also a couple of oncologists—one for chemotherapy and another for radiation (one or both you may not later need). Then there’s the speech and swallowing therapist who evaluates each of those things before and after surgery. There’s a nutritionist who helps ensure that you’re eating enough of the right things. And finally, there’s a dental surgeon, who tours your mouth prior to treatment to see if you might have issues that could complicate the surgery or cause unwanted complications if you receive radiation. (Radiation of the neck area weakens the jawbone. After receiving such treatment, trauma to the jaw is absolutely forbidden—boxing and tooth extractions are off the menu forever.)

Therefore, early on you need to decide who’s going to do what. While we have a really good radiation oncology group in my county, and getting radiation locally rather than 90 minutes each way from my home would be far more convenient, I chose to go All Stanford All The Time because of how intimately linked the various doctors and therapists are. As a group they meet and create a single treatment plan that covers everything. This made more sense to me than splitting care and plans between two groups. 

Another person in my position might choose to do it differently. For example, the radiation treatment I might need runs for six weeks, five days a week. If I didn’t live as close as I do to Stanford, I might very well have chosen to take my medicine locally so that I didn’t have to rent a place in the very expensive Bay Area for the duration of the treatment.

Once you settle on the provider, you can pretty much take the rest of the planning off your plate. You’re now a passenger on the treatment train. To the extent that there’s any upside to having cancer, one is that your case is taken very seriously, even with Covid in the air—you and the doctors want to take care of it as soon as possible. I spent the better part of the two weeks after my diagnosis answering the phone and writing down appointments. Your job after that is simply to show up and have stuff done to you.

And then there are the financial considerations:

  • Can I get the time off work?

  • Will my insurance cover it?

  • If my insurance won’t cover all of it, can I afford the remainder?

I’m very fortunate to work for a company that offers solid health insurance and provides the kind of time-off you need to get through treatment and recovery, but god forbid if I didn’t. This stuff is expensive. I’m writing this after having treatment, and while I haven’t received every invoice related to it, what has been billed stands at around half a million dollars. 

The insurance company didn’t pay that much and I expect that if I didn’t have insurance I would have been charged less, but still, the price you pay to save your life can be obscene and, for many, well beyond their means. Without health insurance this could easily have bankrupted me. I’m trying to leave the judgmental stuff out of these pieces, but honestly, if you’re the kind of jackass who dismisses universal health care as some kind of socialist plot that benefits no one, please fuck right off.