The nonmobile, hard lump had been on my sternum (the bone in the center of the chest) for many months. As a physician, I had figured it was costochondritis -- an inflammation -- from years ago that had hardened with age.
A CT scan, however, stated otherwise: "Consistent with metastatic carcinoma or lymphoma. . . . " That meant the lump was likely due either to a cancer that had spread throughout my body or to a cancer of the lymphatic system, which manifests in different locations.
Because the medical group with which I am associated has HMO coverage, I followed the organization's rules as I began to explore my options. At first, I considered this process to be simply an inconvenience. After all, I take care of patients in this system, and I've never compromised the care I administer. Once in a while, I've had to fight on a patient's behalf to offer a medicine or procedure, but I never put those fights in perspective -- nor had my professional treatments refused.
But the delays began almost immediately, when my internist referred me to a surgeon for a biopsy. He demurred. "I won't touch that. You need a thoracic surgeon." Fortunately, a thoracic surgeon immediately squeezed me into his schedule. The pathology disclosed lymphoma. My brain shook into reality. I was now a patient. And I needed to take this patient seriously.
The next step: treatment. I called professional friends to discuss treatment options, then anxiously waited -- for more than a month -- for my oncology appointment.
My mind raced: Was it OK to wait this long to start treatment? Would the tumor progress? Would this delay make recovery impossible?
Because I was so impatient, the thoracic surgeon referred me to an oncologist friend simply so I could ask questions and gather information while waiting. My wife and I paid for this consultation.
At last, the appointment with the HMO's thoracic surgeon arrived. But the doctor's office was in a less-than-desirable part of town. During chemotherapy sessions, which last six to eight hours, how would my wife function here, I wondered? Then, after the oncologist botched and repeated my bone marrow biopsy (which is very painful), my wife looked up his qualifications. He had graduated from, and trained at, a foreign medical school. For a condition so serious, I would have preferred that my physician be the graduate of an American medical school. Other problems followed. Before chemotherapy was to begin, I called the oncologist repeatedly in an attempt to have specific questions answered. Finally, he responded.
