womens health – Marilyn R. Gardner

Dedicated to Tami, Betsy & Chien-Chi – you are amazing!

It’s October and across the United States a sea of pink is in place. Pink ribbons, t-shirts, turbans, and signs all urge people to be aware of breast cancer. Susan G. Komen For the Cure sponsored walks and community health center high teas, featuring survivors and sweets, are all on board with the need to know about the disease and fight for funds to inform, as well as the continued need for research funding.

Daily I speak with women who have been diagnosed with breast cancer. They contact me because they have lost health insurance and are desperate for a way to pay for treatment. Our program is their last resort. Some come who have stopped treatment. They can no longer pay and so cancel their appointments. Their oncologists plead with them to continue, but without insurance they see no other way. It’s their voices that I hear when I see the pink ribbons. When women contact me, they are rightfully angry. They have usually lost their jobs, with the loss of their jobs they lose their insurance, with the loss of insurance they lose their treatment, with the loss of treatment, they ultimately lose their chance at survival. I’m not being dramatic. This is fact. It’s a domino effect. Their anger is not at me, it’s at a broken system, but I’m the one who is best situated to receive it. It’s a sea of angry pink.

While to those who have never been affected by breast cancer, all the pink may seem like a cute, little campaign, to those affected the pink ribbons are symbolic of their lives. There is a quiet desperation and determination to make sure women in the future have the best possible options for treatment and survival.

I have learned much from working with these women and I receive far more credit than I deserve from them. It is some of the reflections that I have heard that have affected me the most. My friend Chien-chi said this:

I wasn’t afraid of losing my breast. I wasn’t afraid of losing my hair. I was afraid of losing my mind!

Chien-Chi is Chinese and has used her experience to be a passionate advocate for women in her community to learn about breast cancer and take advantage of early screening. She has moved her passion from heart to paper, from paper to funder, and from funder to program. I am privileged to be a small part of her program to educate the Asian American community in the Boston area about breast cancer.

So I rarely use my role as a nurse in this blog but if you are a woman and you read this you can do a couple of things. As you see the pink ribbons, don’t think of them as pink ribbons, but think of them as women, each of whom are going through a long journey and process. Read up and talk to your doctor about breast cancer and your individual risk factors. And lastly, if you don’t have insurance and need to be screened, be aware of this program: The National Breast and Cervical Cancer Early Detection Program. It is present in all 50 states, Washington DC, and 5 US Territories and 12 tribes. I know there are varying opinions of government-funded programs but I have worked in this program off and on for over 11 years and can say, without hesitation, that the amount of money spent on the program is nothing compared to the number of lives saved – lives of moms, sisters, grandmas and friends. So – that’s my shout out to the sea of pink that may surround you during October.

I like my job – it has its moments of discontent, but for the most part I am able to use my nursing background in a creative way, developing and promoting programs for those who are most likely to miss out on access to good healthcare. At times because of immigration status and at other times economic status, all are on the fringes of society and third culture kids do well on the fringes. Sometimes daily and sometimes weekly I speak with women who have been diagnosed with breast or cervical cancer. Everyone of them has a couple of things in common: All are in various stages of trauma and all are desperate for one reason – none of the women I speak with have health insurance. Our program walks them through a process connecting them to health care, and in connecting to healthcare they are linked to life.

It’s in some of those moments that I have a fantasy of a courtroom. The jury would be The People and the trial “Health Care Executives vs. The People”. This trial would tell each womans story – how they came to find out they had breast cancer, the moment of silence that enveloped them as all other words became meaningless other than the big C, the state of shock and disbelief as they walked through the initial days where words like surgery, chemotherapy, and radiation suddenly became routine in their vocabulary and “cut, poison, and burn” became ok to be used on their bodies. Each women would have no mercy on the listeners, telling their stories complete with graphic exhibits. Exhibit A would show a picture of the breast that used to be and Exhibit B would show the head of hair they used to have before they lost both. Exhibit C would give the empirical data on cost of treatment, salaries, cost of insurance, and financial impact on their families.

Each woman would include in their narrative how they came to have no money to pay for treatment and stopped the chemotherapy or radiation recommended knowing that it could well be their death sentence. These details of the cost of insurance and treatment would be juxtaposed with tax returns of the health care executives of the major insurance companies in their state.

18 million includes base salary of $1,095,785 plus benefits (Aetna CEO – Ron Williams)
17 million includes base salary of $584,243 plus benefits including over 2 million dollars in a sign-on bonus (Coventry Healthcare CEO – Allen Wise)
13 million includes base salary of $1,144,000 plus benefits (Wellpoint CEO – Angela Braly)
8 million includes base salary of $1,300,000 plus benefits (United Health Group CEO – Stephen Hemsley)

The list would go on and each of the people listed would have a court order to be present, and answer to these women. They would have to face the shock of the women as they processed, with growing astonishment and rage, the information that the salary plus benefits of one CEO could pay the treatment costs of almost all of them. They would need to answer to the righteous anger that would undoubtedly be voiced at the greed and insensitivity of those removed from need and financial burden.

In my fantasy the trial is short but dramatic and of course The People win. It’s front page news and there is both rejoicing for the women and derision and disgust for the healthcare executives. But I am jolted out of my fantasy through the ringing of a phone and one more woman, newly diagnosed and in shock, to be a witness and tell her story in my make-believe trial.

Bloggers note: All data is taken from FierceHealthpayer.com in their second annual review of health plan CEO compensation. Published in May of 2010.