Waiting with bated breath! The Medical Review Process.

So I spoke with my nurse at PC Headquarters today, and when she heard my name she said, "Oh! I'm reviewing your paperwork now!", which is so exciting.  Actually, it's beyond exciting, exciting doesn't even do it justice.  Astounding? Over the moon fantastic?  I am so so so so very READY for this part of the process to be over.  And hearing her say that I should have an update on my status on my toolkit this afternoon (which I be able to see in the morning) is a dream come true on the path to making my actual DREAM come true!

This medical process so far has been what feels like a comedy of errors and delays, both on my part, my body's part, my doctor's part and the medical office's part.  I have gone through it trying desperately to smile and stay positive and patient because half of me (the half that is actually represented by the voices of my parents and friends) thinks the process is so intense in order to test your determination, perseverance, patience, sense of humor and commitment to service. However, I have had some intensely non-patient moments in the face of everything that has happened during this process. Here has been my medical timeline, snafus and expenses so far (I am both healthy and uninsured, so I budgeted about a month and $800 for this entire process):

November 30: Receive update on my toolkit that a medical packet has been sent to me.

December 4: Receive packet.

December 11: (Unrelated, but effects my budget issues), my car breaks down.  Pay $372 to fix.

December 14: Go to dentist and find out that I have two "not quite cavities" that my dentist would like to fill. Otherwise get told my teeth and gums are in fantastic shape. Pay $240 for the exam and x-rays and schedule appointment for following day.

December 15: My dentist calls and must reschedule my appointment due to an emergency.

December 16: Happy birthday to me!

December 21: Go back to dentist, complete paperwork, get fillings. Pay $268 for the pleasure.

December 22: Realize that it is more difficult than I thought to get any kind of Doctor's appointment at the end of December right before the holidays. Schedule earliest possible appointment, 01/06/2011.

DECEMBER STATUS UPDATE: One month has passed, as has $508 of $800 of my budget and the doctor's visits haven't even started yet.

January 6: My FANTASTIC doctor, Dr. Mock, who has treated me since I was a kid (minus the 11 years I didn't live here), agrees to waive the office fees on my visit, which is an AMAZING help and relief (and a decision he may have come to regret by the end given all the staff time my file ends up taking (:  ).  Have first visit and physical exam.  Everything looks good, lose a lot of blood to needles, get injected with various things, get poked, prodded, tested, and generally pass this stage.  Pay $345 for all of the various lab tests to be run.  I thank the heavens, my mother and Dr. Mock that I am being spared the office visit fees and feel generally very grateful.  I have to wait to do the TB test because it is almost the weekend and would miss the window to analyze the test.

ALSO on January 6, because I am worried about how long this is taking, I email my medical contact and ask him about the timeline and whether I am still okay to make my program if I get the paperwork off in a week.  He responds that I am fine because the files will be prioritized by the program and answers some other questions.

January 12: Return to office for TB test ($73). Then have to go to a travel medicine clinic at another hospital on the other side of town to get my polio booster ($72).

January 13: Wake up with a hard throbbing red bump where my TB test is.  Ask my co-worker what she thinks, and we look it up online.  It doesn't look good.  WHAT?!?  Call my doctor's office, describe the bump, she says, don't worry, a small reaction is okay.

January 14: Return to the doctor to have the TB test signed off on and pick up my lab results and my completed paperwork.  Find out that my reaction is TOO LARGE and I must have a chest x-ray to confirm that I don't have TB.  My doctor is sympathetic, but firm.  So I get the chest x-ray.  Which shows that my lungs are clear of TB, but also shows that I have a STRANGE MASS on one of my lungs and a radiologist needs to look at the x-rays.  I call my medical contact to see what is needed as a result of the TB reaction, and he says a radiology report of the chest x-ray, but that I should check with a nurse.  He transfers me, I leave a message.  (NOTE: I never hear back as a result of this call, and because I left a message detailing what I was doing and sending related to the reaction, assumed I was okay).  Pay $79 for chest x-ray and lots of anxiety about the strange mass on my lung.

January 18: Got to enjoy three-day holiday weekend of anxiety, convinced I have lung cancer.  Return to doctor to pick up radiology report, learn that the mysterious mass on my lung is actually just a normal bronchus viewed in a way that my doctor wasn't used to seeing.  WHEW!

January 18: PAPERWORK IS COMPLETE!!! Place in mail to Peace Corps.

January 24: Follow up with my medical contact about my paperwork, which is still not there, and what date my file needed to be reviewed by for my program (I'm thinking that this would help me to know when to start looking for an invitation).  He informs me that in fact I will likely not make my program (NGO Advising in Sub-Saharan Africa), because the paperwork might not be reviewed in time.  This is a 180 degree shift from what I had been told about the timing.  I slightly FREAK out that now I don't even know where I am going and when.  I am afraid I will be invited to someplace very cold and won't get to leave for another 6 months.

January 24-31: WAIT for my paperwork to be acknowledged by the system.  Check toolkit everyday.  Convince myself that the snowstorms in DC are what is holding it up.  Then convince myself that they are lost in the mail and will never arrive.  Thank the heavens and technology that I scanned everything.  On the 31st they are finally shown in the system.  Breath huge sigh of relief!  I think to myself "OK, if they really want me in Africa, they will review this file very quickly.  If they start reviewing it quickly, that means I might be okay to go to Africa..."

JANUARY STATUS UPDATE: Two months have passed, as has $1077 of my $800 medical budget (not including my failing and expensive car).

February 1: Dental review status changes to CLEARED.  Freak out with happiness that things are actually moving and think I may be going to Africa after all.

February 2: Car breaks down again. Pay $269 to fix it.

February 2: Medical status shows that my file is being reviewed.  FREAK out with happiness again.  I think I might be going to Africa!

February 3-15: Wait for medical status to change. And wait.....and wait.....well, maybe I'm not going to Africa after all.

February 21: Receive letter from medical office stating that I am missing a Hepatitis B Surface Antigen lab report, and receive a detailed questionnaire about my TB reaction.  Feel thoroughly depressed about this state of affairs because I reviewed all the paperwork a million times and swear everything was done and I called about what they needed for the TB reaction, but find it kind of insanely funny at the same time.  I make the appointment.

February 22: Go back to doctor (I think they might be getting sick of me).  Get more blood drawn.  My doctor decides that they need to call an infectious disease person regarding the CDC recommended course of action in the case of a reaction to the test with a TB-free chest x-ray.  They can't get through.  So I say I'll come back for my paperwork and the information the following day. Pay $41.

February 23:  My doctor calls me with a scary tone of voice to tell me that my Hepatitis B results came back and....BUM BUM BUM.....I need an inoculation.  I breath a huge sigh of relief, because the inoculation is not required to be medically cleared, but I was convinced that she was going to tell me that I had hepatitis B or something because of her tone of voice.  I find out that the CDC recommended course of treatment for my TB response is EITHER a QuantiferonTBGold blood test (which must be done at a hospital) or to take 6 months of INH, a TB medication.  I sigh heavily and tell her I will call the Peace Corps and find out what I am supposed to do.

February 23: I learn that my medical contact is no longer working for the office of medical services and cannot seem to get a hold of anyone that can help me with my questions.

February 24: I learn from my step-father, an RN (who does some asking around for me since no one will return my calls at the local hospitals), that the blood test costs $270 for employees of the hospital (which means it is likely significantly more expensive for an actual patient).  I call my nurse at the Peace Corps (actually I try to call my nurse, but then get transferred to a variety of people first, one of whom calls me back to say she can't answer my question and I need to talk to a nurse).  I finally get a hold of her and she is very nice to me while I push and explain that three doctors have said I don't have TB, I don't have insurance, can't afford a $300-400 blood test and REALLY don't want to take 6 months of medication for a disease I don't have and REALLY don't want to have to wait 6 months to be medically cleared before I can even get a placement.  She says she'll talk to someone and get back to me.

February 25: She returns my call and informs me that I need to take the medication, but that once I start the treatment, I can still get cleared and placed without having to wait 6 months.  She is very nice and understanding about the fact that I really DO NOT want to take medication for 6 months for something I don't have. But apparently that is the policy. I call my doctor for the prescription.

February 28: I get the prescription ($12.99 for 3 months worth, much better than a $300 blood test).  Walk across the street and fax all of the paperwork to the number.  I get fax confirmation.

March 1: I call Karen (my RN at Peace corps), to see if she has received my paperwork.  She hasn't, but she tells me call back the next day.

March 2: I call Karen and get her voicemail which says if I am checking on my medical status or to see if a fax is received I should call this other number.  I call that number and leave a message.

March 3: I call Karen, can't reach her.  Haven't heard anything from the other person.

March 4: I receive an email from the person I left a message for confirming that my fax is received and telling me that I should wait a couple of weeks for it to be looked at and will receive something in the mail if it is incomplete or anything else is needed.  I absolutely refuse to wait two to three weeks to find out if my file is incomplete still.

March 7: I make it my sole job to call Karen every 10 minutes during the work day until she actually picks up the phone (no I don't leave messages, I just want to actually talk to a real person).  I don't get her today.
I also repeatedly try to get through to my new Medical Contact to ask some questions.  I manage to get her on the phone, and she tells me that she can't answer any of my questions.  She also gives me the email address for the business placement office so I can try to find out what they might be looking at me for.

March 8: I still can't get through to Karen, I keep trying.  The last time I leave her a message. I email business placement.

March 9 (TODAY!!!!): I get an email from Business Placement telling me that they won't look at my file until it's medically cleared, but that I should be geographically open and flexible to be assigned to a new program and that when my file is cleared they will review it.  Basically I learn nothing, but it feels like contact.  Also, I call Karen and she actually picks up the phone.  When I tell her my name, she knows immediately because she is LOOKING AT MY PAPERWORK right now.  And as you know from the beginning of this blog post, that is incredible.  She did say something about running it past a medical officer, but she didn't say anything about any incomplete or additionally needed information. Fingers crossed!