Category: Cancer

Well, it turned out the estimate I posted before was radically wrong. Curt’s report to me, sometime back, that the running total was 40,000,000 won ($40,000) was based on a misunderstanding on his part.

The bill, yesterday, was so affordable as to be mind-blowing. Like any medical bill, it’s hard to understand – further complicated by the fact of it being in Korean. I have placed the important figures in colored ovals in the scan below, in the upper right quadrant.

The pre-insurance total (red oval) was 10,807,626 원 ($9700 at current exchange). That’s what I was expecting to pay after insurance. And the after insurance total (green oval) was 2,806,960 원 ($2500).

This is just mind-numbing. Why does healthcare cost so much in the US? It’s not like they were using substandard equipment, here, with me. It’s not like Korean doctors are underpaid – they all drive BMWs. It’s not like Korean taxes are impossibly high – they’re lower than in the US. I guess I’ll go on a more detailed rant about this, another time. But for now, just consider: 23 days of hospitalization, over 10 hours of Operating Room time, 46 hours of ICU time, uncountable doctor visits, 2 PET scans, CT scans, an initial radiation treatment, MRI. All in that bill.

I love Korea.

The yellow oval for 90원 (8 cents) deserves its own blog entry – it’s a very funny story. I’ll write it up later.

Just like in the hospital, I woke up at 4:30 am, wide awake, too hungry to go back to sleep.

I lay in bed for a few minutes, and then said, well my body's hungry. That's a good thing.

So I got up, got some yogurt. Just like in the hospital. But now I'm having some tea, too, and I have the freedom to turn on my computer and gaze out at the world.

I will nap later – I promise. Meanwhile, hello world.

i went to my “practice” radiation session today. they tested their gadgets on me but also prepared my restraint system. a set of customized plastic molds were prepared shaped to my head and torso.

when strapped down inside them, i have zero freedom of movement. ZERO. i can only breathe. i cant twitch. i cant open my eyes. i cant turn my neck even a millimeter. i cant swallow or flex my tongue.

just breathe.

machines hum. the automated table moves me in and out of the ring-o-xray-zappers. doctors and technicians talk.

breathe in. breathe out. my training in meditation is the most useful skill ive ever acquired.

when they unstrapped me the doctor grinned. “you passed. you got your license.” he said i did perfect.

hospital life has many small rituals. every morning i weigh myself and record the result in the log by the scale.

since check in until now i have lost slightly over 7 kilos – thats 15 pounds in just over 3 weeks. although its a bit expensive, i can highly recommend cancer as a great, reliable way to drop those pesky extra pounds. try it today!

i was just sitting here, after dinner, dozing, and a sudden, strange, poking sensation just above my right thumbnail manifested. like two ants doing a pair of coordinated pirouettes in that spot. *dink* *dink*

and with that, as if a switch had been flipped, feeling (touch) sensation was restored to a broad swathe of skin stretching up the inside of my thumb and along the soft part of the outside of my thumb. its not painful at all, just a bit tingly then as if completely normal.

is that how nerves work?

as an outcome of my major surgery, the extraction of flesh from my right forearm had removed or damaged some nerves leading to my thumb, so since then my entire thumb has been numb and with some limits on full movement too. this sudden development doesnt restore everything. . . a little more than half is still missing. but its interesting and weird and hopeful how a large area of sensation "pops" back like that.

andrew and i were talking about some financial aspects of my upcoming discharge. at some point, i will be presented with a bill. i really am not certain what it will look like. curt told me that he saw a running total sometime during the first week in the neighborhood of 40 million won ($40000), which could mean a current total of double that or more – but, caveat: that number is meaningless, because its pre-insurance. insuance will be paying different aspects of the bill at different rates, ranging from 95 percent for surgery to zero percent for hospital food and bed space. so the final bill remains a mystery.

but andrew had a good point, too: theres only so much they can do to collect. jokingly, he imitated a supercilious hospital administrator: "pay your bill right now. . . or we will put the cancer back!"

this made me laugh.

this is a low quality picture – you can barely make out at least 4 sleeping figures in the darkness. the 10th floor lobby at 5 am is full of caregivers (family or paid, but not patients and not part of hospital staff) catching some sleep in classic korean style: wherever and whenever they can.

i was trying to explain to my evening shift nurse just now that im not experiencing pain so much as anxiety or nervousness. this was hard. . . i lack the vocabulary. i managed to get it across with some pantomime and a dictionary.

at one point i noticed i was shaking my leg in that nearly universal body language of nervousness, so i gestured to it, "there, see? nervous."

she understood but then she wanted to explain some saying to me. its pretty rare for a nurse to stick around to make conversation, especially with such insurmountable linguistic barriers. . . so i was surprised. i was even more surprised when over the next 5 minutes she successfully explained the saying to me: when we shake our legs nervously like that our happiness will run away on them.

hmm.

i had a long consult downstairs during midmorning. dr ryu was pretty firm about discharge thursday afternoon, after my "practice run" radiation that is planned for thursday morning (low radiation, calibrating their gadgets to the shape of my head, etc.). im excited by the prospect of discharge.

they removed the last of the stitches in my forearm. that was a rather painful and drawn out process – there were originally hundreds of stitches that have been removed in stages. andrew said it looked like a sharkbite scar. i could see that. the only stitches left, of the five surgical sites on my body, are a couple stitches that are helping to close my tracheal opening that was made for the oxygen tube.

the happiest news, for me, in the present moment, is that after recounting to dr ryu my tale of hol(e)y woe and the multiperforations from yesterday, he asked some questions about my eating situation and imperiously ordered the nursing staff to remove my iv. well. . . the externals were removed – but thats the worst part – ill still have a spigot in my arm for medicine delivery. but thats ok. im free of the trundly five-wheeled too-skinny demon!

at one point, talking about the radiation, dr ryu said something to the effect of, "its important for patients to have recovered their strength."

i said soneting like, "well ill work hard on getting stronger," having interpreted his statement as a kind of indirect advice or caution.

a strange expression crossed his face, more serious and reflective than before. "oh. . . youre strong enough. . . . strong enough." perhaps it was in part a reference to my notable strong-willed attitude, which has been sufficient to create some small conflict between us on a few occasions. i have very much come to like dr ryus subtle humor.

three more failed iv perforations this afternoon. were on number eight. my arm has many holes. . . i am become hol(e)y.

depressing difficult day because of that.

i did thirty half orbits today – thats 3 km. goodnight.

this morning they decided it was time to relocate my iv to a different vein. this is just something thats done periodically. so preliminary to that they yanked out the old one, and for about 15 minutes i had freedom from that terrible bondage. i literally jogged two orbits with the sort of shuffle-foot move necessitated by wearing flipflop sandals – 200 meters. i was grinning stupidly at people, and saying "freedom!" with a simpsonsesque irony familiar to younger koreans. i walked another 7 orbits (thus totalling almost a kilometer) before i was called to heel and sat for the new iv.

as sometimes occurs, they had trouble placing the new iv – recalcitrant veins and all that. so it took four attempts before a new one "took." the new placemenent is particularly uncomfortable, being right at the inside left elbow, which limits movement on my left arm. as a consequence, i have graduated from one good hand and one useless hand to having two half-useful hands instead.

i have begun to feel that this system of iv-stands has evolved as a weird kind of unintentional social control for healthcare environments. it prevents the patients from moving around too much or too fast by having them hooked up to these cumbersome carts.

after lunch i was rushed downstairs for a consult with dr ryu. he said there are imperfections in the "flap" (as he refers to the reconstruction, i think from the surgical technique involved), but my otherwise notable resiliancy seems to be compensating more than adequately. reading between the lines: the procedures outcome has been disappointing but the patients stubbornness is making that fact utterly moot and as a result the patient will be just fine.

dr ryu also told me to talk as much as i want – "i know you like to do that." and he said stop tilting my head to the left or i might get stuck that way. he remarked too, "i think you would like to go home." i said, "definitely." so he said that if things stay on track with the infection clearing, i might get discharge before next weekend.

this morning i kind of got a little bit angry with the nurse, not at her but over all the frustration with the hospitals failed attmpts to understand my dietary situation. their latest boneheaded idea appeared yesterday, when all my meals began showing up finely chopped into dangerously ironic rice-sized pieces.

i know theyre just trying to help. so after finishing that bowl of rice as a sheer self-torture execise, i told the nurse “just give me the regular food. take away all the special flags.”

lunch was regular and fine. i ate the good parts, skipped the bad, supplemented with some fruit and yogurt, and called it easy. and now at 3pm, for the first time since here, they offered me an afternoon snack. ive seen other patients receiving these. im not sure if its a sunday special or part of the “regular” menu i demanded this morning.

what was my snack?

a baked potato. koreans eat these plain as finger food. so, per my friend dougs request, i had a baked potato party. unfortunately, he wasnt here. maybe next time.

i ate all my rice for breakfast. milestone. took freaking forever, though.

when i walk around the ward pushing my little IV-stand, i refer to it as orbiting. its part boredom relief, part exercise, but in itself its pretty monotonous, too.

ive realized the hospital has posted little signs that calibrate on the elevator lobby, showing distances. a single triangle-shaped "orbit" of the tenth floor is 155 meters. but before noticing this id already worked out my own calibration. i prefer to do a "half-orbit" which cuts off most of the west ward where all the most depressing chemo patients seem to be, and by counting paces id concluded that a half-orbit was almost exactly 100 meters (so on the floor plan its more like a two-thirds-orbit).

thats a very convenient number, because i can know that ten half-orbits make a kilometer, etc. so i just walked a kilometer. im going to shoot for two or three each day (20~30 half-orbits), thus equaling my daily walking commute to work.