No Object

Her latest scan shows no change in the tumor.*  Not bigger.  Not smaller.  For her oncologist, this means the chemo she is currently taking is not working.  She asked him what could be done.  He started off by saying: "Well, if money were no object . . ."

<insert record screeching noise here>

A client told me this story.  When she got to the part about "if money were no object," I felt my jaw tense a little.  Because here's the thing about medical care in general, and cancer in particular: money is an object.  For many people, money is more than an object.  It is a freaking pink elephant.  Cancer is expensive, even with the best insurance.  Check out this chart from the NIH for some 2010 numbers.

I had no idea how to react to this story as my client was telling it.  Especially because I knew very specifically that money was quite the object for her and for her family.  She never talked about it directly, but from things she said, I knew they had used all of their reserves to even seek treatment at this place, far away from her home town.  I also knew that she wanted to live.  She wanted it so much she hardly even fought for it. It was something so fiercely desired that it could be nothing other than true.  Of course the treatment would work.  Of course she could go back to her active, outdoorsy lifestyle with her family.  There was simply no other option.

And yet.  The chemo was not working in the way it should.  Curing was not happening.  And the next option, the experimental option, was even more expensive.  The doctor, I think, was trying to prepare her for that decision so many people before her had to make:  your money or your life.

That is much too simple, of course.  It was the much more subtle decision about how much hope she had left, and how much of it she was willing to mortgage against the money she would have to raise, who knows how.  It was the decision about a future where financial struggle for her family was inevitable, but her presence with them was not.  It was the decision about how much room she had left in her body, mind and spirit for more physical suffering with this new treatment.

Her oncologist wanted to acknowledge her financial reality along with her medical reality.  It sounded uncaring to me when she told me the story, but I think she understood.  She told me this story with not a hint of indignity or frustration.  She told it to me as a practical assessment of the Way Things Stood.  My indignity at it all simply was not a part of her world.  So I let it go.  Mostly.

I will forever be indignant that money is an object when it comes to taking care of another human being.  Cancer is a natural process -- one gone haywire, but natural nonetheless.  It does not discriminate.  We do, in the care we make possible based on income, insurance and geography.  I don't have the answer.  I just want to hear us talk more openly to each other about the questions.

And my client?  For her, she made the only possible choice.  She took the experimental treatment.  As of this writing, there has been a small reduction in the size of her tumor.  Not what they hoped for, but a reduction nonetheless.  Prognosis still to be determined.


*--names and identifying details have been changed