It isn’t a good sign when your surgeon is taking your suggestions on how to do his work. But I’m getting ahead of myself.
Rotating tines, each sharp as a boning knife, are lacerating the flesh inside my lower left back. With the only medical insurance I can afford being a catastrophic policy paying only after I spend tens of thousands on a specific illness, I endure a whole day of this clock-stopping pain before considering seeing a doctor. Living in Montauk at the tip of Long Island, which is kind of like the McMurdo Ice Station in Antarctica when it comes to medical treatment, I drive to a walk-in emergency clinic in East Hampton where I’m diagnosed with an intestinal infection and dispatched with a $160 bill and an antibiotic prescription.
It’s 10 p.m. and two rounds of antibiotics since the walk-in clinic and a day and a half since the pain began. With the Knicks losing in the background, I’m on my knees grinding my nose into the living room coffee table trying to make it seem like I have some control over this unrelenting torture. Alone, no family nearby, barely able to sit up, unable to climb any of the six flights of stairs in my house, I’ve got to do something before I’m totally disabled. I get myself into the car and head towards Southampton Hospital, hoping to follow giant blue “H” signs to this place I’ve never been to. Hunched over the wheel, I work to keep my head tilted up enough to keep the car on the asphalt.
I pour out the nature and arc of my symptoms to the well-groomed ER doctor.
“I’ll get you started on some intravenous pain killers. We’ll do a CAT scan.”
2 a.m. and my CAT scan’s being read by an “affiliated radiologist” which, after some follow-up questions to the technician, turns out to be someone in Australia where, conveniently, it’s lunchtime.
“You’ve got a kidney stone,” the ER doctor says.
“And the pain’s from . . .”
“It exits your kidney, which probably was a few days ago. Then moves down the ureter, which is very painful, and which is where it’s now, actually lodged at the entrance to the bladder. Once it passes there, you’ll pass it out in your urine.”
With a sieve to piss through to catch the offending stone, one percocet, a prescription for more, and the phone number of a Southampton urologist, I make it home and fall asleep for a few hours, the pulsing pain roaring back around 10 a.m.
The percocets are barely tamping down the pain and, though I’m religiously panning my piss, I haven’t seen any fucking nuggets yet. The pain, though, isn’t to be denied; my abdomen feels like it’s filled with sulfuric acid.
I decide to make a run for the city where I can see doctors with offices near specialists ready to deal with things that walk, talk and quack like kidney stones but maybe aren’t. To steel myself for the drive, I take two percosets so that, if I crash on the way, at least I’ll be somewhat numb.
Exit by exit, the drive feels like I’m hauling myself hand-over-hand up a barbed wire rope. En route, I get the number of (no kidding) Dr. Weiner, a urologist I once saw for another problem. He gives me his cell number and a squeezed-in appointment for 8:30 the next morning.
I’m lying frozen on a day bed in my NYC pied-a-terre, stiff as a cadaver, unwilling to trade the pain I know for what moving may bring. I’m thinking about calling someone. No one — friends, kids, old girlfriends — knows this is going on. If I don’t inform people, they’ll be angry, right? They’ll say it was a safety issue. That I could have passed out from the pain, maybe even died from being internally suffused in urine when the backed up kidney burst. Or maybe they’ll think not calling is a sign we’re not close, that I don’t love them. I’m really worrying about this?
I think maybe they’ll just commiserate. Who am I kidding? I’ll have to listen to their stories about everyone they’ve ever heard go through this agony, females telling me that now I know what they go through giving birth. Or I’ll be read to from the fucking internet, from bloggers and former surgeons general naming all the distended anatomical structures inflamed inside me. Or they’ll come over so I can writhe and moan self-consciously under their watchful gazes, answering ridiculous questions designed to make them feel like they’re helping (“Would you like a cold compress?”; “Maybe some air would do you good?” A pizza?).
The next day, Dr. Weiner says the stone is blocking the entrance to my bladder, the area grossly inflamed, the kidney all backed up with urine. He schedules lithotripsy, which is bombarding the stone with waves that somehow break the stones while not destroying the rest of me.
On the table at the lithotripsy, all IV’d up and ready for relief, Dr. Weiner and the assistant can’t get an x-ray of the stone. They need one so they know where to target their special rays. Painfully, they have me flipping in all sorts of poses but, owing they say to massive inflammation, they can’t get a good bead. Desperate for relief, I suggest a doggie pose. When Dr. Weiner says “yeah, let’s try that,” my faith falls to the level of someone participating in his own surgery.
After being un-IV’d and ferried over to St. Lukes Hospital, Dr. Weiner gets rid of the stone the old fashion way: putting me under and using the access provided by my penis like it’s the Holland Tunnel. Two days later, in his office and without anesthesia, he uses the same access point to remove a stent.
I’d be remiss if, in telling this story, I omitted the most important part, the one referenced in the title of this blog, namely the billing. For months afterwards, bills roll in. Emergency room, emergency room doctor, radiologists, lithotripsy center, Dr. Weiner, anesthesiologist, bacteriologist, hematologist, St. Lukes Hospital surgical unit. 21 different billing entities billing a total of $25,975.57. Now it gets interesting.
My insurance company, with which I have a $10,000 deductible per illness per year to meet before they even want to hear from me, starts processing these bills, bills which, I realize, because I have only catastrophic insurance, are at the usual, three to four times what any insurer pays, bloated, fuck-you, “cash-payer” rate. The insurance company attributes the earliest of these grossly swollen bills to my $10,000 deductible, and then starts sending me checks for the rest. Since I’m going to be out-of-pocket at least $10,000, I start calling these entities to say that I have limited cash which I’m going to use first to pay those offering the most substantial reductions, the remainder going on payment plans. Every one immediately offers to reduce their bills by as much as two-thirds. You’ll have to trust me (though I have a complicated spreadsheet that proves it), that the net effect of all these reductions is that I made a profit of a little over $10 on my kidney stone, or approximately $2/day for five days of agony.