You Do Not Meet the Qualifying Criteria

I know it has only been a month since I turned 75 but does being 75 years old put some mark on your forehead that says OLD in the United States.

We are in Houston for some medical stuff. It seems like ever since we got out of immigration we have been treated differently. When we boarded the bus to go the central car rental place the driver jumped out to help us with our luggage. That wasn't so different but when we arrived at the car terminal by the time we stood up the driver was at my elbow, past all the other people in the front of the bus, to help us. We were sitting right by our luggage and we could easily have gotten it and stepped off the bus. No, no. He took my elbow and help me and then Ned step down off the bus and then handed us our luggage. Okay....so that is his job but it just seemed a  little over the top. I've had the driver help me before but this just seemed different.

We did the paperwork for the car and headed out to the parking area to find it. In Houston there is a two level garage for all the car rental agencies. Just as we stepped out the door we looked at the signs to see which level our car rental agency was on. A man who came out right behind us stopped to ask if he could help us. If he had had a car rental logo on his shirt that would have been one thing but he was just another person going out to get his rental car. Okay.....so why did he stop to help us? Did we really look that lost?

There were several other instances of people jumping in to help. Enough so, that Ned and I were laughing about it. Then came the incident with Best Buy.

I bought my iPhone from Best Buy and the person helping me was very knowledgeable and very nice. So when they sent an email asking me to participate in a survey because I was a recent customer, I clicked okay even though I don't usually do surveys. The first question they asked was, How old are you? I clicked 75. The next thing that pops up on the screen is: Thank you for your willingness to take part. Unfortunately you do not meet the qualifying criteria on this occasion. Thank you for your time. Seventy-five years old is too damn old for Best Buy to be interested in my experience in their store. Man, that is cold, really cold.

Yesterday I had a colonoscopy. Yuck! After it was over, the doctor said everything looked okay and no polyps so unless I had a problem, I didn't need to schedule another colonoscopy since I was 75. So what gives? If you are over 75 you will probably die of something else before you would colon cancer? On the other hand I had already told Ned that I wasn't going to go through the prep for a colonoscopy ever again.

Maybe I just need to change my attitude. If having an OLD sign on my forehead means I don't have to have any more colonoscopies and makes the younger people run around and do things for me, I should just just sit back and enjoy old age.

A Short Houston Visit

Ned had another chemo treatment on Wednesday. This time it is with two new chemicals. If the first two didn't get all of the cancer, these two should. So far so good. He is feeling fine. The oncology nurses just can't believe that he has tolerated the treatments so well.

While Ned took it easy yesterday morning I met up with Eleanor Brown. We had lunch and lingered for quite sometime while we talked photography. Ellie brought something to share with me. She has been making some 8x10 folios that were exquisite. Of course her photographs are always wonderful but putting them into a carefully crafted folio is an elegant way of presenting work. She inspired me. Maybe my Mexican Squares should be a folio instead of a book.

Yesterday we went to Jack's football game....and our team won by a big margin. Yea, Raiders! Today we are getting ready to run some errands.

The photograph? It is from the feria in San Miguel. It just seemed appropriate since a lot of people refer to the chemo treatments as rat poison. And trust me, in a personal fight with cancer, you are on a roller coaster ride.

What Does It Cost?

The bills for Ned's treatments are starting to arrive. We are in shock at the price tags. I'm feeling guilty about the amount of money that is being paid by Medicare on our behalf. How can these prices be right? How can our nation afford to pay these prices. I'm not just talking about the government affording it, I'm talking about the total economic wealth of our country....government, business and individuals.

While I was in waiting rooms yesterday waiting for Ned, I read this article in the current issue of Atlantic Monthly. The author, David Goldhill, is a business man who lost his father due to hospital borne infections that resulted in a $700,000 medical bill. That prompted him to take a good look at our health-care system. The article is the lead article in the September issue and it is long so I'm not going to get into his business analysis of what is wrong. I hope you'll go read it for yourself. It reinforced my feeling that the proposals that are currently being worked on in Congress are not going to fix health-care because they are based on the same business model that we have now.

While I'm convinced that we need to do something, I haven't heard anything from Democrat or Republican that I think will make a radical change in the system for the better. Mr. Goldhill's ideas about what to do appeal to me but we would have to transition into a different business model. One where the patient is the direct consumer of health care. In our current system the providers of health-care are more accountable to insurance companies and government agencies than to us.

Have you ever walked into a car showroom, asked the salesman which car would be right for you and then said, "I'll take it" and you never asked any questions about the car or what the car cost? Well that is what we are doing and probably most everyone else who is covered by insurance isn't asking what does all of this cost either. In fact, I don't believe that the doctors could answer that question if we asked them. It just isn't the way that health care is provided. And we are at fault as well as the health-care providers. If something new comes out, even if the advantage over other treatments isn't significant, we tell our doctors we want to move on to the newest and greatest. Of course, a lot of that is encouraged by advertisements on television for drugs to treat everything from erectile dysfunction to growing thicker eyelashes. If instead of asking for the newest drug or treatment, we started asking questions about the cost/benefit ratio, I'm sure the doctor would send us off to the business office.

Maybe next week, I'll ask what does that little bag of Taxol cost.

The Treatment Plan

This has been an important week. Ned's treatment has started. Thursday was his first day of radiation. Here the technician is lining him up to slip him into the CT scan machine where the radiation is directed directly to the cancer.

Today he started chemo. We arrived at 8 AM and put Ned in this little room with a comfy chair, a TV and view of the tree tops around Rice University. They inserted an IV and started the drips. We received lots of information about the chemos and about controlling side effects. So far, so good. But the best part is that we are one week closer to going home.

Medical Observations

We are getting more than our share of time to observe the medical system here in Houston but I bet it is the same anywhere in the USA.

First of all you make an appointment but then the receptionist always says, "Be here 15 minutes or 30 minutes early to fill out papers." So why don't they just make the appointment for 2:15 instead of 2:30. And what is it with all the papers? I think that Ned has already filled out a small forest of papers. What do they do with them? Is there some giant storehouse out between San Antonio and El Paso that houses all of them? What if they actually needed one of the papers some day, could they find it? Why don't they have the "papers" on line and you could fill them out on line at your leisure rather than arriving 15 minutes early. Storage and retrieval would definitely take up less space and be easier.

We've also observed a lot of doctors' offices. What else are you going to do while you sit there in the waiting room with no magazines. The office that has been the most fascinating has been the surgeon's office. His office is in St. Luke's Texas Heart Institute. He is one of eight doctors on Dr. Cooley's team. I think every doctor has a secretary, a nurse or two, a physician's assistant or two and maybe another medical person or two attached to them. Then there is all of the administrative staff who move those papers around and check you in. Everyone of them is bright and cheery and efficient. The space for the examination rooms is fairly small and it is a beehive of activity. Everyone knows their job and it looks like the team is suppose to achieve every efficiency so that the doctor can move smoothly from the operating room, to the exam room to patient to patient. It all seems to work well because by the time Ned had his clothes back on the secretary was there with his prescription or directions for the next step. I have the feeling that by the time we were in the parking lot that all medical comments had been entered in his file and it was put back in the file cabinet. Very efficient operation.

Every medical office that you go in takes vital signs; weight, blood pressure and temperature. If you see three doctors in one day, your vital signs are taken three times. I mean for God's sake, who wants to be reminded of their weight three times in one day.

And the questions......Ned has repeated "his story" so many times as he has traveled through this medical maze. I can understand that the doctor needs to ask questions of the patient but sometimes I don't understand why so many people need to ask the same questions. When we saw the radiation oncologist the nurse put us in the examination room and sat down and asked questions like when did you notice this problem, what other surgeries or illnesses have you had, which medicines are you taking and what has are the results of the medical tests so far. Of course she is sitting there with Ned's new file with this doctor that is already 1 inch thick with all of the prior medical reports. She carefully makes notes on everything Ned says and adds them to the file. She leaves the room and we think that the doctor will be in. Wrong. Next a Physician's Assistant comes in and he asks basically all the same questions again very carefully recording them to the "file." On one hand we are hoping that either the nurse or the physician's assistant briefs the doctor so he doesn't have to ask all those questions again but on the other hand we are worried about whether they will get Ned's story right. We didn't need to worry, the doctor comes in and more or less verifies all of the information. Maybe someone in the medical profession can explain the reason for the repetitive questions as you move up the chain to actually seeing the doctor.

And one more observation.....Ned's brain has been observed with an MRI, and it was found to be "unremarkable." That sounds like his brain is well, unremarkable....just a common, everyday old brain. But those of you who know Ned know that his brain is quite remarkable. "Unremarkable" in medical-speak means that there is no sign of the spread of the cancer to his brain. In this instance, we were both glad that his brain was considered "unremarkable."

Moving In

Since we are going to be in Houston until Ned finishes his cancer treatment, we've moved into an apartment in a mid-rise condo near the Galleria. This gives us another chance to test condo living.

We took a one-bedroom apartment that is fully furnished right down to the wine glasses. All we had to do was bring our clothes and toothbrush. This is the first time in about 10 years that we have had wall-to-wall carpet. While I like hardwoods and tile, it is kind of nice to walk around barefooted on the carpet.

Then, we had to go grocery shopping. Grocery shopping here is such a shock. The fruits and vegetables are abundant in variety and quantity but they are so much more expensive than shopping in the mercados of Mexico. Meats are more expensive as well. I'll make my usual complaint.....chickens are too big. You can not fry a four to five pound chicken. Well, I guess you can if you can fry a turkey but it doesn't taste like the fried chicken of my youth. I did find a 3-1/2 pound chicken that was organic, free-range, etc., etc., but it cost about $8.50. Yes, that is right $8.50 for a 3-1/2 pound chicken. I hate to admit that I bought it. I WANT fried chicken. Other than that, I tried to be a careful shopper and looked for specials and store brands, still check-out was sticker shock.

The Medical Maze

It has been three weeks since we entered the maze of the great Houston Medical Center. And what a lot of twists and turns it has been.

The first thing I want to tell you is that if you are going to see a doctor or you will be in a hospital waiting room, be sure to bring your own reading material. I think that funds for magazine subscriptions have been cut. I didn't see a magazine in any waiting room newer than six months old if you could find a magazine at all.

Next, there are vast areas of the hospitals where cell phones do not work. There are no pay phones and the hospital phones that are for visitors to use are usually sitting on a corner table with people sitting on each side of it so that you have this very awkward situation of standing there over two people holding on to a phone receiver with a short cord trying to tell the details of what is happening to your loved one to the family on the other end of the connection. The people sitting can't help but hear. You have no privacy. Of course you could leave the waiting room and go find a place where the cell phone would work but then you risk missing the doctor if he comes out to give you an update.

I haven't had too much of it so far, but hospital food is still institutional food. They have spiffed up the cafeterias and made them more into food courts with more choices and St. Luke's Hospital even has McDonalds right there on the first floor of the hospital. The food isn't bad. It is adequate but it wouldn't take long to get tired of it.

Now for an update on Ned. We are still in testing mode. You would think that they would just schedule every test known to man and be done with it. That is not the way it is done. First you do this test and if it comes back with questions, then you do the next test and if it comes back with questions, then you do......well, you get the idea. This is all time consuming. It takes a few days to schedule the test, a few days to get the report back and what do you know, another week has gone by. We've spent most of the last three weeks waiting and eating...but the eating part is another blog entry. At any rate, one more test today and then we think that treatment will start sometime late next week. It is going to be six weeks of radiation and chemo. The oncologist said that Ned probably will not lose all his hair but it will thin out as will his mustache. I can't stand a splotchy mustache so he may have to shave the rest off. I haven't seen him without a mustache since the 1970's. Mm.....wonder what his kisses will be like without the mustache.

Another Doorway

Here is a door we didn't expect to enter on this trip but we have. The door into the Houston Medical Center and the whole medical system of things out of our control and of waiting for a call, a test or a report.

Here is what has happened. Ned went for his check-up and a couple of days later, his doctor called to say that the x-ray showed a mass in his lung. What a shock! No sign or symptoms. Nothing was there last year but now something is there. Next came a CT scan which indicated a 3 cm tumor consistent with a primary tumor. Then the wait to schedule a biopsy. The biopsy report indicated that Ned has an adenocarcinoma. Yesterday we saw the oncologist. He said that if you have to have cancer of the lung, Ned's situation is the best. He has never smoked, it is small and it appears to be a Stage I cancer. There will be another battery of tests and a meeting with the surgeon. Most likely he will have surgery to remove the lobe of the lung where this cancer is trying to make a home.

While the next few weeks may be difficult, we feel really good about finding the cancer early and about the doctors who are taking care of him. We feel fortunate that we have the great Houston Medical Center with all of its knowledge and technical expertise just literally a mile or two from our son's house where we are staying.

So while we have entered this door, we hope that it is a revolving door that whirls us around and sends us back out again healed and headed home to San Miguel de Allende as soon as possible.

What About Medical Care?

Just about everyone who visits us and especially those who think that maybe they might like to live part time or full time in Mexico asks us, "What about medical care?" It is a good question and it is one that we asked and continue to ask ourselves but our answer, at least for us, is changing.

At first we didn't think we would use any medical services in Mexico. For routine things we would continue to use our doctors when we went back to Texas. In an emergency we talked about getting insurance to be flown out if need be or maybe we would just jump in the car and head for the border. Heck, maybe we could even hire an ambulance staffed with a nurse and a doctor to get us to the border.

In the time we have lived here we have had friends who have had stents put in to clear arteries, knees replaced, emergency abdominal surgery, broken bones repaired (one of those was me), colonoscopies (one of them was me again), pacemakers calibrated, round-the-clock in-home nursing care......and the list goes on. Most of these were not covered in Mexico by USA medical insurance and while the cost for the procedures was not cheap it was about 1/3 the cost of what the procedures would have cost in the USA.

We have gradually gained some confidence with the doctors in Queretaro, which is about 40 miles away from San Miguel. That confidence isn't shared by all of our doctors in Texas. I have one that everytime I see him he tells me about when he and his brother had to hire an airplane to fly his uncle out of Puerto Vallarta only to find out that the test that had been reported to them wasn't correct. I've heard this story at least three times. He is quite sure that I will die of a perforated colon in Mexico. On the other hand, my Internist who is a female and younger than him and was in the Peace Corps just calls in a translator from her office and reads my Mexican medical reports and so far has thought that my Mexican care has been just fine.

This week Ned had two surgeries to remove a couple of squamous cell carcinomas. He had seen his dermatologist in the USA in May but here six months later he needed to have two places looked at again. We decided to try out a dermatologist here. She took some samples and sent them to the pathologist. When the report came back she went over them with Ned and gave him copies of the reports but she said that they did need to be removed. She told him what it would cost. We talked about it. He could wait until we went back to Texas, or he could take the reports and go back now and have the regular dermatologist take care of it or he could let her do it. Having the procedures done in Texas would mean that the cost would be covered by Medicare. But when you weigh the costs of getting back to Texas against the cost of having the procedures done here, having the cost covered by Medicare is sometimes a wash.

Here is where we are at this point in time. We are living in Mexico. We feel we can get good medical care here. Although just like in Houston, you have to search for a good doctor. On the other hand, we have Medicare and supplemental polices in Houston that cover most of our expenses for medical care so we will make the decision on where we get our medical care on a case by case basis and expect our Texas doctors to work with our Mexican doctors many of whom have studied some in the USA.

What about medical care in Mexico? I think your answer to that question changes over time and whether or not you are a full-timer. Today, we're straddling the fence......or maybe I should say the border.