The Price of Fear

mind the gap

I first mentioned the lump to my boyfriend after it had been there for a month.  "I thought it was a pimple," I said.  "But it's not going away." "Go get it checked out," he said.  "We live in England, so why not?"  Why not, indeed?  In the four years since I graduated college, I'd spent more time than not uninsured.  I'd chosen the path of freelance work and enterprising startup jobs, which, while rewarding, came laden with different types of concerns then I'd ever been faced with before.  One Christmas, I stared at my pinky toe, which, after a run in with a table, had now grown to the size of an apricot.  Hospital visits were going to be several hundred dollars, at a minimum, I knew.  I decided that I could walk it off.   Another time, I fainted at a cafe, the back of my head absorbing the weight of my whole body on the concrete floor.  When my right pupil grew slightly but perceptibly larger than my left---a potential sign of a brain bleed, which can quickly turn fatal---I was told by my doctor friend that I needed an MRI, which would cost upwards of $1000.  I found myself playing the Russian roulette of What If games.  What if I spent over a grand that I didn't have and they found nothing?  What if I didn't spend that grand and it was something, and then I was nothing?  Eventually, fear won out and I got the MRI.  When they found nothing out of the ordinary on the scan, my relief was surpassed by anger, guilt, annoyance.

Now, though, I was in England, where the NHS ensures that all medical care is free.  Yes, you heard me---free doctors, free dentists, free prescription medications, free physical therapy, free surgeries, free outpatient care.  I scheduled an appointment with my primary care doctor, and I waited.  And I waited, and I waited and I waited some more.  Non-urgent cases are often given appointment weeks---if not months---out.  When I finally saw my doctor, he told me that his roll, essentially, was that of a gatekeeper.  "I think it's just a cyst," he said, "but that's just an opinion."  He couldn't diagnose my arm lump, but without him, I couldn't see a specialist.  "I've put into the system that you need an ultrasound," he said.

"Great." I nodded.  "When will I get that?"

"It's in the system," he repeated.  "You'll get a letter in the post once they book you an appointment."  Ah, the post.  The British are fond of the post, and use it almost exclusively for the scheduling of medical appointments.  Three to four weeks after you see your doctor, a letter arrives.  On it, is a single time on a single day.  Can't make it?  Only then can you call a hotline, where a slightly exasperated person (who are you, after all, to be too busy for their carefully arbitrarily scheduled appointments?) will offer you a different slot.  Maybe.  If there happens to be one open.

Six weeks after my initial doctor's appointment, I went to the hospital, where an ultrasound technician looked at my arm.  "This is definitely not a cyst," the man I'd never seen or met before said.

"What is it?"  My eyes were wide, fearful.  I would not cry in front of the businesslike ultrasound man.

He snapped his gloves off and shrugged.  "I don't know," he said.  "You've got to get it out.  I'll make an appointment for the surgery."  Seeing my wet cheeks---my attempts to hold back tears had clearly failed---he sighed.  "It's an in-office procedure," he said.  "It won't hurt."

He entered into the system and three weeks later, I got a slip of paper with my appointment time and not much else.  The appointment was still six weeks out, a month and a half I spent worrying over what the lump in my arm was and what the surgery entailed.  Did I have skin cancer?  Was I going to be under anesthesia?  Could I eat in the 24 hours before?  Would I have normal use of my arm immediately after?

The day of the procedure, I woke up early to make my way to the hospital across town.  I rode the elevator up to the sixth floor, and made my way to the dermatologist's office.  "Are we doing the procedure in here?" I asked, looking around.

"Procedure?"

"I didn't eat last night or this morning," I said.  "Just in case."

"Oh, honey.  This is just a consultation."

"But the ultrasound guy said---"

She shook her head.  "For this kind of thing, you don't even need an ultrasound.  Look: there are 350 dermatologists in the whole of the UK.  We're hard to get appointments with, so they like to put obstacles in the way."  She poked at my arm, and determined that it was, indeed, just a cyst.  "The ultrasound guys don't know what they're looking for," she said, and then: "Don't worry, we'll get this thing out of you."

The kind dermatologist walked me through what it will entail, finally filling in one of the many black holes that have surrounded this experience.  I haven't received my appointment yet for the final procedure, although I'm told it should be within the next four months, or approximately nine months from my initial appointment.

In the US, I likely could've had my cyst diagnosed and removed within a week, likely for a cost upwards of a thousand dollars.  In the UK, I'm receiving care free of financial worry but laden with every other kind: six months of not knowing what a strange lump in my arm was; months of back and forths to different doctors; a disconcerting lack of clarity from most parties; being at the beck and call of a scheduling system that likely hasn't seen any change in the last fifty years.

What is the value of fear?  What is the value of convenience?  I feel incredibly fortunate that I can even ask these questions; I realize the amount of people in the US who wouldn't have gotten the MRI ever, simply because the cost was completely prohibitive.  But as our health care system is changing in the US, I think these are questions worth considering.  While I remain in favor of free healthcare for all, I now know that free does, sometimes, come with it's own price.