Worst Case Scenarist

If you are a pessimist, given to worry, and you have any kind of imagination, you have the tools to be a certain kind of novelist. As the disheartening plot turns, everything that can go wrong does go wrong, everything that could easily have been avoided is painfully collided with, every accident is for the worst, complications are always infinite. In the worst case scenario, luck turns inexorably against the doomed protagonist until the reader can read no more, or the reader simply dies, as we all eventually do.

And so it was with your recent medical diagnosis, shocking, suddenly skyrocketing numbers that often indicate cancer. Your own fault! Why was it a year and a half, maybe even two years, all crucial months in catching tumors early, since your last blood test?

Sure there had been a pandemic, but you attempted to get your annual physical on time only to learn, by a form letter from a corporation, that your doctor was no longer participating in your medical insurance plan. Not a problem losing your long time PC, you just pick a new doctor from a list, have an annual check-up, get a blood test, pandemic or no pandemic. Meantime, there were distractions, the pandemic was raging again and a crazed idiot was fomenting an armed insurrection that failed, in its first attempt, to impose a dictatorship in the country you live in.

Later, as people in your city get vaccinated in high numbers and society begins returning to normal, seeking medical records from your former doctor’s office, you learn your longtime doctor is back on the insurance plan, his earliest appointment a few weeks away. You get the blood test.

But, ominously in hindsight, it is now seven crucial months after you originally tried to get your annual physical.

Is the number really so terrifying? It is PSA, prostate specific antigen, a number that roughly correlates with a healthy prostate (yours has been bleeding on and off for months, the urologist told you not to worry about it, just flush the system — and piss out the soft blood clots — by drinking more water). If your PSA is under 4 it is generally considered normal and nothing to worry about. PSA level is roughly correlated with prostate cancer, what they look for is a sudden increase, which sometimes is an early (or late) indication of cancer. The rise in your PSA is what the doctors watch out for, a steady four that is suddenly a five can sometimes indicate the presence of cancer. Your PSA almost tripled in the last year and a half, a long stretch for a tumor to grow undisturbed, the 300% upward leap gets your attention.

Your doctor says “go see your urologist” because it is not his call to tell you “this is something to be very worried about, get to a specialist as fast as you can”. He may feel that way, but he’d rather have a specialist who knows how to treat it break the bad news.

The only problem with seeing the urologist right away is that you will have to provide current insurance information to make an appointment. The Patient Protection and Affordable Care Act ends, with two weeks’ notice, at the end of the month you turn 65. Should have expected that, shouldn’t you have? Your window to enroll in Medicare suddenly shrinks from three months after your 65th birthday to two weeks after. If you’re about to turn 65 you find yourself, suddenly, with days to navigate a complex and unwieldy bureaucracy to avoid a gap in health insurance.

Naturally, the best way to apply for Medicare is online. It turns out to be quite simple to do. You log into your Social Security account (ssa.gov, medicare.gov cannot help you apply) and within ten minutes your application is done and begins to be processed. The only problem you will encounter is if you have not been on ssa.gov since you last logged in five years ago when you created the account. Personal ID? No idea. assword-pay? Not the foggiest.

Eventually a receptionist at Social Security, after you answer a few questions, tells you your Personal ID, which turns out to be the full name of your girlfriend’s beloved cat — of course. Now they can email you a PIN to reset your password, which they do. Now just answer three simple questions and you’re in. Street you grew up on, favorite teacher, make of first car. Easy.

Except that the computer needs an EXACT match to verify your identity. Did you write Miss Richert, Mary Richert, Miss Mary Richert, Richert? Did you include make and model of the car or just the model? Did you write your street number with or without the “th” at the end of the number? You will never know. At least one of your guesses was wrong and you were locked out after the third try, unable to log in that day back in May, when you could have had Medicare in place before the Patient Protection Act stopped protecting you.

No worries, the kind receptionist tells you, they will send you a new PIN, by US Mail, within ten business days. They do, it arrives the second week in June. Only a few weeks after your previous thwarted attempt you are able to log in. Ten minutes later your application is submitted and being processed. Ten days later it is 2/3 complete, pending final assessments of some kind. There are millions of people applying, there is nothing that can be done to expedite any individual application. The pandemic means that anything that once worked a certain way no longer does, because, the pandemic.

There is also the matter of your kidneys, since you had a sometimes fatal (not in your case) kidney disease, you need to track certain things. Your last appointment with the nephrologist showed no sign of the disease, you breathed a sigh of relief and the doctor bid you goodbye. But you should still continue to track certain things.

One of those things is Vitamin D level, since excessively high Vitamin D levels can damage the kidneys, apparently. Sunshine and dairy products provide most people with enough Vitamin D, but if you’ve had five cancer cells removed from your nose, and avoid dairy, you may also avoid walking in the sunshine. Doctor gives you a prescription Vitamin D supplement, a mega-dose, once a week. The nephrologist, who had been tracking your Vitamin D, noted that it was a bit high when he tested it two or three years ago (the private, third-party lab, for whatever reason, didn’t follow his order and test it in the most recent, pandemic blood test…). He advised you to take it only twice a month. Latest blood test shows your Vitamin D level is excessively high, which is bad for the kidneys and other tissues and most commonly causes hypercalcemia [1] — none of which you are aware of.

Doctor tells you your recent blood work shows your blood calcium level is also high (hypercalcemia, which you learn about the next day). When you ask what could cause that he tells you it may sometimes indicate a benign pituitary tumor.

Five minutes on the internet tells you the six most common side effects of excessive levels of Vitamin D — elevated blood calcium levels checks in at the top of the list. Look, nobody is blaming you for not knowing any of this shit, it just is what it is.

Why was your Vitamin D level not tested during your last physical in November 2019, by the private third-party lab (ignoring the nephrologist’s request, which was always done at the hospital lab) in 2020? Anybody’s guess. The pandemic, it was probably at least partly because of the pandemic.

Best case scenario, Medicare is in place in time to make the appointments you need to make and you learn, to your great relief, that you have neither cancer nor the return of that sometimes deadly idiopathic (“cause unknown” from Greek ἴδιος idios “one’s own” and πάθος pathos “suffering”) kidney disease you underwent chemo for a few years back.

Of course, doctors go on vacation this time of year. Plus, the pandemic. Could be a few months before you can see the busy urologist, the busy nephrologist, a competent dermatologist, etc. Nobody’s fault that you didn’t get everything in order months ago, pandemic or no, just in case the worst case scenario was the one that was going to unfold, especially during a pandemic, which messed so many things up, was itself a worst case scenario.

And, seriously, why wouldn’t the worst case scenario be the one that is already unfolding? Hope is good, unless it’s dumb hope. Look at the signs and you will understand that you are most likely fucked. It’s been a good ride, bumpy but good. No complaints, no regrets. Try not to think of your prostate every time you urinate, ignore that slight stinging, it can be anything. Do NOT google warning signs of prostate cancer. Check your Medicare progress bar every other day, maybe it will move from 2/3 done to complete. Try to get some rest and forget those nightmares, things are never as bad as in your worst fears, until they are — which might not happen, except, of course, in the worst case scenario.



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