Well This Is Interesting

I received a letter today from Group Health. Mind you, it's been eighteen months, give or take, since I've been a Group Health member, but they wanted to let me know of a drug recall. Teva Pharmaceuticals has recalled a specific lot of capecitabine that was sent to pharmacies sometime between June 6 and June 9, 2014. Group Health can't tell who got drugs out of that lot, or even if they actually did, but since I was prescribed capecitabine they wanted me to know.

Great. I know. Not that there's much that can be done about it now. It's not like aspirin or something, where you buy it just to have it on hand. If you've got capecitabine, at $100+/pill, you're taking it. Well, unless, like me, you opt out of chemo. But that was later. Any pill I was given in 2014 I took. 

So what was wrong with the pills? The particular lot in question was apparently found to be "unstable." The letter doesn't say what's wrong with unstable capecitabine, but it does assure that serious health problems are "unlikely."

Which is good. I can't afford anymore serious health problems. 

But I actually could've done without knowing the extent to which drugs tend to get recalled. Scary. Some things you just don't want to Google...

Question of the Day

Say you have stage IV cancer so you get scanned every quarter, and, in addition to the cancer tumors in your liver, your scans also show some spots on your lung, which the radiologists and oncologists all agree are "no cause for concern."

Now say you go off your cancer treatment and roughly three weeks later develop a cough. Do you a) assume that's just a summer cold (despite the lack of any other symptoms) and not worry about it, or do you b) worry that it might be time to start worrying about those spots?

Personally, as much as I'd like to go with "a," I have to admit that it's awfully hard to let go of "b." I guess we'll find out for sure which it is next week when I'm once again scanned.

Science!

Ok, I lied. I said I was done with videos, but I just found some more. Only instead of amusing songs about poo, this time I found...science. Or perhaps more accurately, talking heads talking really fast about the things scientists have learned about cancer. Now, not being a scientist, I can't really say whether any of the things said in these videos are, in fact, true, but they seemed pretty convincing to me.

Appropriately science-y. And, actually, reasonably entertaining. 

So here you go: the SciShow, talking about cancer (and, for the record, I don't care what it does to me, I'm not giving up bacon)...

Need More Proof That Everything's Relative?

The copyrights to thirty albums (give or take), untold songs released both by him and by others, and three movies (give or take); the rights to a variety of trademarks; a record label; a recording studio; and a reported "vault" full of unreleased material. All in addition to the typical rich people stuff (e.g, cars, houses, etc.). 

No (known) children, no living parents, a sister and seven half-siblings (give or take), two ex-wives, and heaven only knows how many significant others.

A society prone to the proliferation of vultures. 

And, so far at least, no identified will or other estate planning documents, though a decedent who was known to be generally on top of relevant legal matters. 

Yeah, I would not want to be the person (or, more likely, people) who winds up managing the distribution of Prince's estate. 

But reading about it all sure makes my car, retirement fund and condo full of crap seem a lot less relevant. 

Since Everything Has to Come in Threes...

...here's one last video about cancer. Moreover, it's kind of a counterargument against some of the others pointing out that, despite all the scary headlines and instructions like "test your poo," most of us don't really need to worry. 

Well, I need to worry, but most people reading this probably don't. 

But before I get to the video, having spent a fair amount of time searching YouTube for cancer videos, I'd like to first post a quick open letter...

Dear Songwriters,

While I appreciate all of your efforts -- truly, I do -- I have a few small constructive criticisms that you may want to bear in mind for your future efforts in cancer-related songwriting: 

1. Please, no more songs about angels, butterflies, phoenixes, or really anything that flies. If the patient is flying, it's fair to say the treatment didn't work -- unless, of course, they're on a jet headed for Barbados to celebrate their successful treatment, but that's a different sort of song.

2. Please also, no more plodding introductions played in a minor key, especially on piano backed by strings. Depressing the patient so much they kill themselves is not, actually, a preferable alternative to whatever they might be dealing with as a cancer patient.

3. Not to be the bearer of bad news, but as nice as hope and love may be, they're not really substitutes for treatment. Emoting is good, but let's not go overboard.

4. While songwriting is a fairly rare, and potentially valuable skill, I feel the need to remind you that ownership of a rhyming dictionary and knowledge of a few chord progressions doesn't really give you a direct line to the heavens. So let's perhaps try to avoid trying to explain why this is happening or what God wants or similar claims to knowledge you can't possibly have.

5. Finally, please don't go overboard on the remembrance. I agree that it is sad when people die. And most of us do want to be remembered. But not forever, and not obsessively. Death is the unavoidable consequence of life; you don't get the one without the other. And given that fact, it's a pretty happy coincidence that humans are pretty much programmed to move on. Embrace that programming, 'cause the inability to do so isn't romantic or caring; it's dysfunctional. Just sayin'. 

For what it's worth...

And now for my last cancer video -- at least for the time being:

It's Too Bad I'm Not Scottish

If this PSA is any indication, the Scots take their colon cancer -- or rather, bowel cancer -- screening very seriously. It makes you wonder if, had I been Scottish, might my cancer have been diagnosed earlier than it was as American. 

Perhaps.

Of course, on the flip side of that equation a) it seems that the screening was mostly focused on older people (which might have made sense at one point, but increasingly doesn't) so might not have been directed at me, and b) the steps the test required -- click the link at the end of the video below for another video showing testing procedure -- is probably the sort of thing I would've avoided if at all possible. Anything that involves "catching your poo before it hits the water" is probably not something I'm going to be rushing to the front of the line to participate in, so even if I could've been tested I very probably wouldn't have been. So maybe I wouldn't have been diagnosed any earlier.

Who knows? And really, who cares? It is what it is, and so we roll along. 

But in any case, the Scottish bowel cancer screening effort gives me an excuse to post their PSA (which I found amusing) and, once again, gives me the chance to identify yet another advantage of "socialized medicine": in a single payer system, this kind of broad uniform screening is way easier to do than in a system that requires hundreds of entities to first agree as to who's going to pay for it. (Everybody's answer: "Somebody else," and therefore it never happens.)

So now, without further ado, I give you "The Poo Song":

I Got Nothin'

There is a downside to going off chemo: it doesn't really give you much to write about on your cancer blog. Add to that the fact that I've got no trips planned and Kevin is being boring, and there's really not much to write about. 

So instead I'll post a video (well, more like an audio, with transcription):

How Did It Get To Be Friday?

Time flies when you're not paying attention. Actually, it flies regardless, but it seems particularly airborne when you're occupied elsewhere. So what's happened in the last few days? Let's see...

The queen turned ninety. Apparently a big deal, but I can't imagine why. I mean, ninety is impressive and all; and everyone should have a happy birthday; but let's not go overboard.

Prince passed away. As a sophomore in high school when Purple Rain came out, I'll admit to feeling the loss. But most of what I'm feeling at the moment is curiosity. It's been striking just how much press space has been devoted to his career, and I'm trying to figure out why. It can't be just that he was talented; lots of talented people have passed away without this kind of attention. It can't just be that he was young; plenty of younger people have died. It might be that he was transformative -- as one article I read argued, pretty much everything we hear on the radio now owes some sort of debt to Prince -- but, again, other transformative artists have passed away without this much attention. It could be the combination of the three, but I almost wonder if this doesn't have as much to do with the journalists writing as it does to Prince himself. In any case, may he rest in peace.

Former wrestler Chyna passed away. Again, can't say this impacts me much, but it was kind of an object lesson on the power of the news cycle. A word to the wise: if you're famous and want to be broadly mourned when you die, don't do it on the same day as Prince. And one more time, rest in peace.

I'm sure the clown show that is the US presidential primary season continued marching forward (in its big red shoes), but I'm trying to limit my exposure to such things -- you wouldn't think insanity is communicative, but the evidence of this election season so far suggests otherwise -- so I can't address any specifics. 

Finally, some friends threw a painting party, so I have a few more squares. I left them behind to dry, so I can't post more detailed pictures now, but I'll update the periodic table once I get them back. 


And with that, I think we're more or less caught up. 

We're #11

Nope, not one. 

Eleven. 

As in, colon cancer is the eleventh most deadly cancer when deadly is defined by the percentage of patients who will die within five years of diagnosis. 

Pancreatic is still number one (don't feel obligated to cheer). Intuitively, wouldn't you expect brain cancer to be the number one? I mean, my pancreas hasn't worked for thirty years so it's not like the organ itself is so crucial, but a brain, well, that's hard to live without. So why should cancer of the pancreas be number one and brain cancer number six? 

Go figure. 

Anyway, here's the rundown I found:

#1     Pancreatic cancer, 93%
#2     Liver cancer, 83.9%
#3     Lung cancer, 83.4%
#4     Esophageal cancer, 82.7%
#5     Stomach cancer, 72.3%
#6     Brain cancer, 66.5%
#7     Ovarian cancer, 55.8%
#8     Leukemia, 44.3%
#9     Laryngeal cancer, 39.4%
#10   Oral cancer, 37.8%
#11   Colon cancer, 35.1%
#12   Bone cancer, 33.6%
#13   Colorectal cancer, 33.5%
#14   Cervical cancer, 32.1%
#15   Non-Hodgkin lymphoma, 30.7%
#16   Kidney cancer, 28.2%
#17   Bladder cancer, 22.1%
#18   Uterine cancer, 18.5%
#19   Breast cancer, 10.8%
#20   Skin cancer, 8.7%
#21   Thyroid cancer, 2.3%
#22   Prostate cancer, 0.8%

Happy Tax Day!

By my count there are fifty-three minutes left for those on the west coast to click the submit button on their federal tax returns. I assume most people have already filed, so I thought I'd pass along this little graph I found from the CBPP that explains where the money goes. It seemed timely. And as someone who works in the field of science and medical research, may I just say, thank you for your two percent.  

Forty-seven minutes now...

Life's a Lot Easier When You Don't Give a Crap

In other words, taxes filed. 

I think it took me about fifteen minutes, and that's mostly because my computer is a virus-infected mess, so the TurboTax pages were slow to load.

I will admit, though, the question about was I someone else filing on behalf of a dead John did sort of throw me. Weird to think that answer will soon be, yes, (though at that point it will no longer be my problem). 

This Doesn't Actually Help to Get the Laundry Done

Two Thoughts for Thursday

One: I thought I would feel better, faster, after giving up on chemo. It's been a week since the last Avastin/Irinotecan infusion, and a week since I last took my pills, and I still feel like crap. Ah well...

Two: How is it possible that tomorrow is April 15? Memorial Day -- and summer -- are right around the corner. Unbelievable. All I can say is that it's a good thing that in addition to being April 15 tomorrow is also some strange holiday observed in Washington DC (Emancipation Day?) which punted the tax deadline to Monday. I suppose I really ought to get started on mine now...

A Post for Future Colon Cancer Patients: Learn from My Mistake

I've always been fascinated by the social science research that looks at choice and decision-making, particularly within our extremely commercial environment. I wish I could remember where I saw it, but I have the distinct recollection of a theory/argument/hypothesis/whatever that took the position that in some ways habits were a defense mechanism.

The idea was that a person who goes into a typical American grocery store is now in an environment where they're being overwhelmed by choices. Which one of the scores of different toothpastes do you want? Which one of the scores of cereals do you want? Chips, veggies, yogurt, pasta, soup -- you name it, and there's a zillion options to choose from.

And if you actually considered the full range of options for each one of those choices, you'd basically go crazy. Your brain isn't capable of making that many choices. So we develop habits. We go in the store and pick-up the Crest, the Cheerios, the Lays bar-b-que chips, the broccoli and the Campbell's chicken soup, and then we stand and contemplate our options in the yogurt and pasta aisles. 

I wish I could remember the number of choices it was theorized we could manage. But in any case...

Dear fellow colon cancer patient, 

The next time you are in the paper products aisle as the grocery store and you pick up a package of bathroom tissue, STOP! Now look at the package. Is it your habit to buy the cheapo, store brand stuff, or the really expensive name brand stuff that if you found a piece on the floor you might think it was a bath towel if it wasn't for the fact that it's only four inches square? If it's the latter, you're fine. Stick with your habit. But if it's the former, PUT IT BACK. You now need to redirect one of your limited number of choices from the wine aisle -- just ask the clerk to recommend something -- to the toilet paper aisle. Examine each and every one of the options, and then buy the most expensive, heaviest, absolute best toilet paper you can possibly afford. (Give up the wine if you must.) And when you come back to buy more, keep buying that expensive stuff until it becomes a habit. Then you can go back to mulling over the wine options.

Oh, and if you're the sort of person that travels with a bag or a very large pocket, may I suggest carrying a roll of your new brand of upscale bathroom tissue? That way, if you're out and about and you've got to use a public restroom (pretty much an inevitability for the colon cancer patient), you can avoid the cheap sandpaper most of those places stock.  
Trust me on this. 

The Universe Repeats Itself

So have you ever had this experience? 

You go out to buy, say, a car and you look around and you find this neat new thing you've never noticed before. The Toyota Rollerskate or the Honda Hamster. So you test drive the Rollerskate and decide it's the car for you -- plus it's got the added benefit of being unique -- and so you buy it. 

And then on the drive home you notice that every third car on the highway is also a Rollerskate. The car's not unique at all; you've just never noticed it before.

Giving up on treatment is kinda the same. Yeah, I got a few texts and emails of the "Are you sure this what you want to do?" variety -- and, for the record, no, not entirely, but of the available options this seems the best course right now -- but I actually started noticing a lot of reaffirming messages. For example...

This was a chemo weekend, and this cycle hit me pretty hard. As a result, I spent most of the weekend (at least the part where I wasn't in the bathroom) moving from bed to couch and back again. At one point I turned on the TV and caught most of a documentary about Tower Records. If you were a teenager in the '70s, '80s or '90s and were raised on one of the two coasts, you've probably been in a Tower Records. And if you were like a lot of us, you spent a lot of time in Tower Records.

It was a really interesting film. I learned that Tower started in Sacramento as part of the Tower Drug Store, and was first spun off as the Tower Record Mart. It became Tower Records as it started to expand, with kids essentially lining up to get in every time they opened a new store. Eventually they spread internationally and at one point sales exceeded a billion dollars a year; just a few years after that, they were bankrupt and gone.*

What killed 'em? In some ways this is the best part of the documentary, in that you get both the talking heads that, years later, are still upset and angry about what happened, but you also get the talking heads who seem a bit sheepish, sort of mumbling about how they did it to themselves. In one case, it's the founder that's mumbling, and then they show an interview he did where he was talking about how streaming (though that's not the term he used) might be possible, it was still many years away and Tower would have lots of time to react. The film then states that the interview was conducted like the year before Napster. And, of course, there's the finance guy who acknowledges that eliminating the single, swapping vinyl for CDs, and then setting the retail price for CDs at twice the cost of vinyl (despite the fact that CDs were actually cheaper to produce) might not have been the most prudent of strategic choices. 

A really interesting tale about the death of a really significant company and cultural icon. The name of the film turned out to be All Things Must Pass. 

And then there was my weekend reading. I've mentioned before that I'm fond of Terry Pratchett's work, and over the weekend I finally got my hands on his last, posthumously published novel. The book was part of the discworld series. Although the series started as if J.R.R. Tolkien was trying, above all else, to be funny, as the universe expanded and the target audience bounced from adults to kids and back again, the series sort of evolved into this filter through which Pratchett would funnel current events. You'd read the novels, with their collection of wizards and elves and werewolves and Igors, and start to think, oh, I read the news story about this. 

Pratchett was diagnosed with Alzheimer's in 2007 (give or take) and, at least per the afterword, clearly knew he was close to dying. Not surprisingly, then, even though Death makes only the briefest of appearances, the book is really all about death -- or rather, how the world responds to death. One of the series' significant characters dies, and then the rest of the book is largely about the ways the universe around them responds to the hole they've left behind. I don't think I'm giving away too much to say the characters eventually come to grips with the character's passing, and move on with their lives, comforted by their memories. 

Not a bad book to be reading the weekend you opt out of chemo. 

Last, but not least, I finally told my health care team at the SCCA that I was giving up on chemo for awhile. The nurse wrote back wanting to better understand why, but also said that my oncologist was okay with my choice and would see me after my scan the first week of May. 

So, yay. I feel okay about the choice and am looking forward to not feeling like crap, just as soon as the effects of the last infusion finally wear off. 

But as the small print says, I reserve the right to change my mind at any point in the future for any reason, or even no reason, at all. 


* Mostly. As they started to sink, the Japanese stores were spun off as a separate company, At least at the time the documentary was made, Tower Records (Japan) was still going strong. 

The Universe Has Spoken

No one reading this will be surprised to learn that my drugs didn't arrive on Thursday as promised.

They didn't arrive today, either.

This afternoon, mostly out of curiosity, I called Pharmacy B to find out what happened. I got no answers, but the woman on the phone was suitably apologetic and promised she'd get them out to arrive tomorrow. We'll see. Maybe they'll surprise me -- third time's the charm -- but if I was laying odds I'd say it'll be Tuesday at best. Hard to see either the Idiot Insurance Company or Pharmacy B paying the freight for weekend delivery. 

Anyway, the good news is it doesn't matter. I was already close to stepping off the chemotherapy train, and between my recent hassles with the Idiot Insurance Company and Pharmacy B, the hell that this most recent infusion has been (trust me on this), and the fact that, movie trailers notwithstanding, I couldn't come up with a single reason to continue, I've decided I'm done. So the pills may eventually come, but I'm not taking 'em.

I'm tired of feeling like shit all the time.

I'm tired of looking like one of those caterpillars Indiana Jones had to eat in Temple of Doom -- fat, white and hairless. It may be stupid and shallow, but I want my facial hair back. I want to look like me when I die.

I'm tired of taking handfuls of pills everyday. Hell, I'm tired of having to keep track of literally dozens of prescriptions. 

I want to get a tattoo.

Mostly, I just want to feel normal again -- even if it's for far less time than I could continue feeling abnormal.

Granted, I'll probably give my oncologist the chance to object. Last time I was going to opt out he gave me the pill option, so maybe he'll have some alternatives up his sleeve. Or maybe after a few months off I'll forget how bad all this was, or the Wonder Woman movie will seem close enough to warrant an effort to extend my life, and I'll climb back aboard. 

But in truth, I sort of doubt it. 

At my check in this past Thursday, I mentioned to my PA that I was getting close to needing a break. She was surprisingly supportive, and made some mention of my treatment being "a marathon, not a sprint." 

It occurred to me later that, as I proved at the 5K, I have never been a runner. 

Round 2

You'll never believe who called me today. I lie. You will. 

Yes, today at 11:30 am I picked up a voice message from Pharmacy B. They were calling to let me know they had to reschedule delivery of my prescription so could I please call them back. 

Sure. Why not? Let's call them back. 

So I found a quiet corner and called them back. I got a very sunny somebody who explained that the Idiot Insurance Company had told them that they couldn't file a claim on the prescription until April 8, and we needed to reschedule delivery for sometime next week. 

Wait, says I. And I told Sunny the story, from the beginning, of yesterday's calls. I explained that I had talked to multiple people at Pharmacy B, and multiple people at the Idiot Insurance Company, and we'd gone from no drugs, to yes drugs, to no drugs to, finally, at 5:00 pm, yes, absolutely, drugs. So what the fuck happened, I ask.

There's no need for swearing, says Sunny, primly. I disagree, says I. I'm dying of cancer. The only thing slowing that process are the drugs you keep refusing to send me. I spent all day on the phone yesterday getting to the point where we all agreed that I would get the drugs. I was assured by one of your colleagues those drugs would be shipped today. And now you're telling me that all that's changed. I think swearing is entirely appropriate. In any case, can you please explain what happened?

Your insurance company won't pay the claim unless it's submitted after April 8. Fine, says I, I'll call my insurance company, and I hung up on Sunny.

(A brief aside: while I feel a tiny bit bad for hanging up on Sunny, the customer service at Pharmacy B is so cosmically atrocious that I figure I can't possibly have been the first to do so. In fact, the ability to tolerate being hung up has to be the core skill stated in the job description. I'm sure she'll live.)

So now I call the Idiot Insurance Company. Actually, I first have to find their phone number which, for some odd reasons, requires me to try three different browsers before I find one that will render their webpage such that you could actually read it. But I find the number and give them a call. 

Hello, this is Sunny #2 and this call is being recorded, how can I help you? Deep breath. First, says I, you need to know that I am extremely angry. I apologize in advance if I'm testy. But... and, once I again, I give the entire story. So I need to know what happened, and, more important, I need you to fix. Sunny #2 is now very Cloudy. Cloudy, in a slow and calming voice, starts asking for my identifiers: birth date, name, clickity clickity click, the name of the prescription I'm trying to fill, clickity clickity click, is it okay if I put you on hold? Sure, says I, no problem.

So the classical music kicks in and since I'm trapped in this little room with nothing but the classical music, my burning rage, and the computer to keep me company, I start surfing the news sites. (Apparently, Donald Trump had a bad day in Wisconsin.) Eventually, Cloudy comes back. She's talked to the pharmacy supervisor who "solved" my problem yesterday and thinks she can tell what's going on: Pharmacy B is submitting its claim against the wrong prescription which is why it's being denied. Would I mind holding while she gives them a call to sort this out? No problem, says I, so the music and the surfing continue.

After a few minutes, Cloudy comes back to apologize for the delay and to inform me she's being transferred to a manager. Am I willing to continue holding? Sure. Why not?

Music and surfing... another apology from Cloudy... music and surfing... apology... music and surfing... apology... music and surfing...

Finally, Cloudy comes back for the last time. She assures me that it's now all worked out and my drugs will arrive in the morning. Thank you, says I, and I hang up and stretch my arm for the first time in twenty-some minutes which causes my elbow to go all tingly. 

At this point, I have spent forty-five minutes on the phone, the last twenty-five of which were mostly spent on hold. In my heart of hearts I know I should probably call Pharmacy B back, yet again, to confirm that my order is in fact being processed and will ship this afternoon, but I just can't do it. The thought of having to go through the story one more time.... Just no. Not gonna happen.

So we'll see. In truth, a part of me sort of hopes they don't. 'Cause if they don't, I'm going to take it as confirmation from the universe that it's time to end my treatment. 

If this is what it takes to get the drugs I need, I don't want 'em. 

Remind Me: Why Are We Supposed to Prefer Private Health Insurance?

Dante was wrong. There are not nine circles of hell. There are ten. The tenth is occupied by private health insurance companies and specialty pharmacies. 

I'll spare you the detailed dialogue generated by the fifty-five minutes I spent on the phone with a pharmacy clerk #1, pharmacy supervisor #1, insurance claim processor #1, insurance claim processor #2, insurance supervisor #1, and pharmacy clerk #2, and just give you the rundown on the key statements and events. Modern health care at it's finest. 

Oh, first a bit of background on my treatment relevant to this conversation.

Every third Thursday I get my chemo infusion. On that same Thursday I'm supposed to start taking the capecitabine pills. I take the pills for fourteen days. For the next seven days I'm cancer-drug free, and then the cycle starts again. And in the interest of providing excellent customer service saving money, my insurance provider requires that I use their selected "specialty pharmacy" -- i.e., mail-order pharmacy -- to obtain the pills. In order to have the pills available for consumption on Thursday, I need to order them at least three days before.

And so we begin...

In February, I received an email from my insurer letting me know that in the interest of providing excellent customer service saving money, effective March 1 they were changing their selected mail-order pharmacy from Pharmacy A to Pharmacy B. I was instructed to contact Pharmacy B to get my prescriptions set up for processing.

I, however, could not call in February as I needed Pharmacy A to send me the drugs associated with my February 24 infusion (moved to Wednesday due to my New Zealand trip) and on February 25 I climbed on a plane and left the country for two weeks. 

On March 14 I was back in the country, and called Pharmacy B to transfer my prescriptions and order the capecitabine for my March 17 infusion. The pills didn't show, and trashed by the infusion, I didn't have the energy to call. Worse, on Monday I left for a three day conference, and since I wouldn't be there to claim the pills it wasn't worth calling until the day before my return.

Eventually, though, I'm able to call and I get... Dance Interlude #1. The person I talk to gives me the song and dance about how there's a new federal regulation that requires them to review all prescriptions and blah, blah, blah. But oh look, the release has finally come so give us your address again and we'll get this processed for delivery by Friday. 

So I start my pills eight days late. 

Jump forward a week and a half, and that brings us to today. I call Pharmacy B to reorder my pills, so I'll have them for this Thursday's infusion. Enter pharmacy clerk #1. Nope, can't do it. We can't refill the prescription because it's "too soon." Nothing that can be done. Call back in a week. 

Yeah, no. Can you please connect me to pharmacy supervisor #1? Enter pharmacy supervisor #1. Yup. Nope. Nothing we can do. But wait, I ask, you guys sent the last round to me a week late. I submitted the request on time. Now four weeks ago. Plenty of time should've passed to allow enable you to fill the prescription that I need on Thursday. Nope. Can't renew until next week. Unless you convince your insurance company to approve the "early" renewal, you'll have to wait until next week. But wait, says I, it was your fault I didn't get the last round of pills on time. Shouldn't you have to call my insurance company to explain and convince them to pay? Long, testy back and forth follows, but pharmacy supervisor #1 eventually agrees to call the insurance company.

Perhaps understandably, I decide that I'm less than confident that this will actually happen, so I call the insurance company myself. 

Enter insurance claim processor #1. Very friendly, cheery guy who asks what he can do for me. I got two issues, says I. First, I want to complain about, and after venting, try to understand, the decision to move from Pharmacy A to Pharmacy B. Begin Dance Interlude #2. "Better customer service" says insurance claim processor #1. Yeah, I'm not sure you've really accomplished that, says I, and we go back and forth for a bit, and it soon becomes pretty clear that Pharmacy B is cheaper than Pharmacy A (duh), but eventually we move on to issue #2. I want to make sure you're going to approve my refill when Pharmacy B submits it, says I. Clickity clickity click. Ok, says insurance claim processor #1, I'm going to need to transfer you to insurance claim processor #2, who can handle that for you. 

And so insurance claim processor #2 comes on the line. What do I need? Refill of my capecitabine so I can start up the next round with Thursday's infusion. Clickity clickity click. Nope. No can do. It's too early. You can't refill it until next week. I again provide the long narrative, in all its gruesome details, explaining that I need to get back in sync with my infusions. Understand, but no can do. Now we wander down various rabbit holes as I try to come to understand the reasoning behind this decision. I get put on hold a couple of times, and each time insurance claim processor #2 comes back to reaffirm, in no uncertain terms, that there is absolutely no way the pills can be sent this week. 

Could I perhaps talk to a supervisor, says I. I've already talked to my supervisor, says insurance claim processor #2. You don't understand, says I. I don't want you to talk to your supervisor, I want to talk to your supervisor. Clearly thinking I'm asking for the impossible, insurance claim processor #2 sighs and agrees to see if she can locate a supervisor who will talk to me. 

Enter insurance supervisor #1. I start at the beginning, yet again, going through the whole story. And now begins Dance Interlude #3. Now it seems the problem is that sometime between Pharmacy A's last shipment and Pharmacy B's first shipment, Pharmacy A submitted a claim for the round that Pharmacy B eventually shipped. (Don't worry, it gets better.) And while the insurance company had established March 1 as the conversion date from A to B, they nevertheless paid Pharmacy A's claim. But eventually Pharmacy A and/or the Idiot Insurance Company got their act together and Pharmacy A's claim was refunded. And that, explains insurance supervisor #1, is why I can't get a renewal until next week. Hold everything, says I. A claim that was paid and refunded, and thus in a very real way never really happened, somehow prevents a subsequent claim from being paid? Yes, says insurance supervisor #1. Are you freakin' kidding me, says I. 

Apparently she was, because now the story changes. Recognizing that I was clearly unimpressed with the Pharmacy A story, now we move to an analysis of the wording on my prescription. Apparently, the fact that my prescription contains fourteen days worth of pills but is described as part of a three week cycle seems to be confusing both Pharmacy B and the Idiot Insurance Company. But, says  insurance supervisor #1, if I can call my providers at the SCCA and get them to submit a new prescription, then I can get the pills this week. 

At last, a chink in the armor!

To confirm, says I, if my provider rewrites the scrip to say it's a fourteen day dosage, then I can get my pills. Yes. Great, says I, I am totally down with this plan -- except for the part where I have to call my provider. Since I didn't create this problem, I don't think I should be the one to have to chase down the solution. I think you should call my provider to sort this out. Amazingly, after much hemming and hawing, insurance supervisor #1 agrees to make the call.

The light at the end of the tunnel appears. 

A few hours later insurance supervisor #1 calls me back to let me know that it's all worked out, and Pharmacy B will be sending my drugs. But, says she (revealing the dark lie at the heart of the whole "to bring you better customer service" bullshit), you may want to give them a call to confirm that they've got your order queued up.

Sigh. Fine. I'll call them. 

And so I do. And so enters pharmacy clerk #2 -- who has clearly never heard of me before and can find no sign that an order for my drugs has been submitted for processing. But as we talk and she clickity clickity clicks in the background, she eventually finds evidence that the Idiot Insurance Company has approved the refill which no one has ordered.

And so the order for my drugs is finally approved and processed. 

Best health care in the world, baby!

Six Myths about Estate Planning

Myth #1: It’s just stuff.

It’s just stuff right up to the moment that either Person A gets some stuff that Person B wanted and/or Person A gets some stuff that Person B believes to have more value than the stuff that Person B got. At that point, it’s no longer “just” stuff. Now it’s “essential” stuff, or “crucial” stuff, or stuff “worth sacrificing everything else for.”

Myth #2: Value is an objective measure.

When you go to the store and buy a box, yes, there’s an objective measure of its value: whatever you paid for the box, that’s what it’s worth (or, perhaps more accurately, whatever the store was willing to accept for the box is what it’s worth). But once you’ve owned that box for a few years the objective measure of its value disappears. It’s now “the box Dad used to store the pictures of the grandkids,” or it’s “Mom’s favorite tool box,” or it’s “the box that Aunt Mabel added the false bottom to and hid all her diamonds in.”  You can take the box to the Antiques Roadshow, or put it out for bid on eBay, but no matter what you do there will be a dispute to its value.

Myth #3: It’s the big stuff that matters.

                                                   

Who gets the house? Who gets the car? Who gets the money left in the retirement accounts? Important questions, for sure, but not the only important question. Who gets Dad’s cheap-ass Timex? Who gets Mom’s “favorite” worn out purse? Those questions can cause everything to seize up just as easily as “why did Cousin Fred get the Lamborghini?”

Myth #4: Your beneficiaries will understand your decisions.

No. They won’t. We all have our own sense of justice, we all have our own sense of who the involved individuals are, and we all have our own sense of the “value” of things. Those are the filters all the decisions will be run through, and since the filters are different the understanding will be different.

Myth #5: There’s a distribution that will satisfy everyone.

No. There isn’t.

Myth #6: It’ll work itself out.

Less a myth, I suppose, than a question of definition. An estate works itself out the way Superbowl XLIX worked itself out. This is to say: some percentage of the people will walk away ecstatic, others will walk away upset, and some won’t care in the least; some will argue that the outcome was the result of talent, skill, planning and intent, while others will argue that it was all just dumb luck; some will find the outcome just, others will wonder how the universe can be so unfair; some will say the decisions were the dumbest ever made, and others will find them extraordinarily well-considered; and eventually it will all just recede into the background and folks will accept the outcome -- they don’t really have much choice -- until something happens or someone says something or just because, and it all comes boiling to the surface again.

No, I Don't Have Time to Talk about My Account

It could just be my region, but here in Seattle "customer service" seems to have become the holy grail of the health care industry these days. Radio ads, billboards, and buses all seem to be pasted with smiling (fake) doctors and patients extolling the virtues of the "customer-focused" attitude of this clinic or that. 

Of course, "customer service" is one of those terms that can be defined in lots of different ways. Take UW Medicine. Seemingly good doctors, nice facilities, and generally good care. But I think I've noted here previously that what the organization has really mastered is collections. 

I see the doctor, UW Medicine throws a bill, and two weeks later I start getting friendly calls from the billing department wondering if I have time to "talk about my account." This, of course, is just code for "can we take your Visa number and collect our fee?" 

Oh yeah, the fee in question is typically twenty bucks. 

So UW Medicine is deploying a phalanx of phone operators to chase down twenty bucks on a Saturday morning. And in so doing, are undermining all the good will and warm customer service-y feelings their doctors, nurses, and other providers have generated by providing really good care. 

Kinda stupid, if you ask me. 

But happily, it's also no longer my problem. After this morning's call, I got so fed up I blocked the number. 

I'm Probably Not Extra Material, But Maybe I Could Be a Prop

Still morbid. Sorry...


So a friend forwarded me a news article stating that Star Wars, Episode VIII is going to be shooting near Seattle at some point in the future. There weren't a lot of details, but the Seattle location will apparently be used to represent a planet not previously seen in the Star Wars movies.

Planet Misty? Planet Bikelane? Planet Microbrew? One can only guess. 

Anyway...

No doubt they'll need extras. But since I'm too tall to play a stormtrooper -- clearly, the go-to role for Star Wars extras -- at first I was thinking I should hope the planet will be populated by wookies. Wookies are tall, and the actors are completely covered by the costume, so the fact that I'm tall and look terrible wouldn't necessarily preclude me from being selected as an extra. 

But then I realized the fact that I'm generally non-engaging, and sometimes nearly inanimate, probably would get in the way. And then I had a stoke of genius. If I were to die before filming started, I could have my siblings hold off on taking my ashes to the naked beach in Maui and stick me in an urn just long enough for the executor of my will to take me to where they're shooting and ask if I couldn't put me in the background somewhere. 

The one cancer dude got an early screening of Force Awakens. And while I'd agree that asking for a role, even as an extra, might be a little much, the request to be a prop doesn't seem like a huge ask. To be "the vase in the background at the twenty-three minute mark" of  a Star Wars movie would be pretty awesome. 

Or even better, "the vase in the background at the twenty-three minute mark that gets exploded by the light saber." Now that would be a way to be remembered. 

Ah well. It's good in theory, but probably unlikely that the timing will work out. So I probably won't be in the next Star Wars movie, not even as a prop.