Stanford--Incredible People Service

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medical       *
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Wed JAN 4

I haven't been doing so hot. I was taken off the clinical trial last week...the extent of pain making it unlikely that I was responding. I did receive chemo last Friday with 1 of the 3 drugs changed. I spent 7 hours driving on Friday--I drove up, Jerry Hurley drove back. I felt good when I got home but then I had a severe increase in the amount of pain. It turns out that my opiate requirement has increased more than 2 fold in less than a week and I still wasn't getting relief. I have gone to a Fentanyl patch...it is long lasting and takes a few days to stabilize and titrate. I'm feeling much better than yesterday....so this is going to be trial and error for the pain meds.

Before my next visit to Stanford I need to get two imaging studies...one of the brain and one of the chest. The Stanford guys really want me to get the Chest image on the same machine and with the same radiologist as last time...in Palo Alto. That is really easy to arrange because it is in the Stanford system.

I requested that I be able to get the image of the brain locally to save me the 450 total miles on the road. That's when I began having problems. The local imaging place didn't have enough information to schedule and didn't have an authorization from my insurance company. I called the insurance company and they sent me back to where I had come from...you know all of these delays and booby traps trying to navigate this crazy medical system....and it's not Medicare....it's not the bureaucrats at medicare when it comes to authorizations....medicare is very weak at guiding folks, many of whom are elderly, sick, deaf, and otherwise handicapped to the right person...it is very weak at guiding providers as well...take my word for it as a provider who wanted to be the only psychiatrist in the county who would do fee for service medicare as my retirement project...But it's the private insurers that are the real experts in prior authorizations used as a method for denying a service.

I am still impressed with the provision of services at Stanford. When I first got sick, I called the chest center at UC Davis. The person who took my call  told me that I had to get a referral from my doctor and that if I self-referred, I would have to make sure that UC Davis had all of my records and then it would be a wait of about 5 business days to schedule an appointment.

The second call I made was to Stanford. Within 5 minutes I was talking to the nurse coordinator for the Thoracic Oncology and I hung up the phone 30 minutes later on Friday morning at about 11:45 AM with an appointment for the next Tuesday morning. BANG! that was it.

Yesterday, I was so discouraged and sick in trying to arrange this local scan, that I finally called Stanford and got the nurse coordinator. She said...don't worry about this. I'll take care of the authorizations and I'll call you back.  BANG! it was done.

God, I wish everyone were getting this kind of medical service. It's the same insurance that I've had for years, but Stanford has worked out the pathways through that system pretty effectively.

My interactions with Stanford providers, receptionists, claims clerks has been unbelievably professional and upbeat. They are supportive, they provide hope, they seem to care, they go the extra mile...there is no doubt that you have to have good people skills in order to have a job there. I hope the University is treating their employees as well as their employees are treating me.

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odds and ends   *
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It has become harder and harder to maintain my hygiene. Because of these tumors in the spine, I can no longer torque my back to wipe my butt very well. To feel clean, I would have to shower after every bowel movement. My alternative was to get a Bidet toilet seat. They are not cheap. But mine has been a god-send (curious word for me, huh?...well I wouldn't call myself a strict aetheist...my God is uncertainty--that it is unknowable from my position in the universe).

This part is a little indelicate. Opiates are constipating. It had been more than 48 hours since a bowel movement yesterday and it felt like I was passing a volleyball. Apparently my bathroom pipes thought it was a volleyball and I managed to plug my toilet to the extent that the wimpy plungers wouldn't work. Of course, it was the toilet with the bidet seat, so I spent some of my morning with a toilet snake (has protection for the ceramic bowl). Just one of the things that I'm running into. But success!