Public Libraries & Me

Date: 16/04/10
REMINDER: LIBRARY ITEMS DUE BACK SOON
According to our records the following items are nearing their return date.
Please return or renew them as soon as possible as fines may be charged on overdue items. Please be aware you may not be able to renew your items if the item has been reserved or your account has expired.
Please contact us if you have any query regarding this notice.


Recently, I received this noticed for three days prior to my books reaching the deadline for their return. I have loved public libraries for almost as long as I have loved books, but I must confess, I have not always been diligent about returning my borrowed books in a timely fashion. The first thing I got when I began my transition from America to England was a library card for the Cornwall public library. I began checking out books right away and I must admit I have been late getting them back a couple of times, but nothing too horrible or so I thought until recently.

This time as it drew close to the return date, I began receiving email updates each day letting me know it was almost time to return my books. When I got the first one I thought what a great idea, but with another coming each day, I began to wonder if I was on some sort of list. You know, the kind where someone out there feels like you might need a little instruction or guidance to put you on the proper path.

I decided I was being a bit silly thinking that this might be some sort of behavior modification program designed for people like me until I returned my books yesterday on the last and final day before they would be overdue. And while I can’t say for sure, I think I might have seen a look pass between the two librarians along with a subtle head nod if you know what I mean. Now I am wondering if there’s a repeat offender list for book borrowers … and if so, am I on it?

Bought or borrowed, I hope you are getting your nose in a few good books and I promise if you ever loan me one, I won’t keep it so long that you have to ask for it back.

Life After Cancer – Now

When I was 31, I went to a dermatologist for a reason I can’t remember now and during the course of my visit, she took a close look at the moles that dotted my physical landscape. There was one in particular that looked a bit iffy to her and she said that it might be problematic in the future. Her suggestion to remove it to avoid an issue later was re-adjusted after discovering the limitations of my insurance coverage.

With a husband in a Ph.D program, we were lucky to have any coverage, even the bare bones policy he was able to get through the University. It did not cover mole removal that ” might ” be a problem in the future and as I was working a job that provided no health insurance and frankly not enough money to spare for the out of pocket costs involved in the procedure, I walked out of her office thinking I would just keep an eye on it.

Even though I was concerned, the pressures of a husband in graduate school, the needs of a young child, and the struggle involved in trying to pay for what was a very lean living, I looked at the mole a time or two and then forgot about the spot I had been warned to watch. Had it been in a more obvious place like my face it would have been easier to see the future before it happened.

By 33, I was divorced and struggling to build a career in pharmaceutical sales while juggling parenting roles and the early beginnings of a social life as a single woman again. I was also unknowingly on the edge of something bigger than I had ever faced. On the morning of Christmas Eve, I felt a strange compulsion to check the mole I had not thought about for months. I was rushing around trying to get ready for the evening ahead and the next day with all of the places my daughter and I would need on be Christmas Day when I suddenly felt compelled to stop and look at the spot on my back.

After twisting myself into a position I where could see the shaded place on my shoulder in the bedroom mirror, I found that I needed more light to see it properly and went into the only bathroom in the house to try to get a clearer look. Standing on the toilet, I twisted myself once again so that I might see my reflection in the mirror of the old medicine chest on the wall.

I knew in the moment I saw it that I was looking at cancer. That’s a melanoma, I said to myself and wondered who I might call. No one was taking new patients that day and I could not be seen by a physician until a week into the new year. The doctor who saw me would not commit to a cancer diagnosis and seemed to take it off just to give me some peace of mind almost going so far as to suggest it was probably nothing.

I was standing in a phone booth in south Georgia a few days later when I got news. Having called the office to find out the results of the biopsy, the receptionist unknowingly gave me the results when she said, ” We don’t know yet, they’re checking it for levels.” I knew enough even then to know that if they were checking it for levels then it was not going to be good  In 1994, I had no cell phone or internet access and I even though I had known intuitively what I was seeing on the day I found it, her words scared me so I could not think clearly beyond asking the woman on the phone to please have the doctor call me as soon as possible. I was barely in my car before my pager went off and when I called the office, my doctor said, ” I don’t usually do this over the phone, but it is malignant and we should know what level we are looking at within about 24 hours.” I kept it together while we scheduled a office visit to discuss the results and she finished by saying we would talk when I came in about what our next steps would be.

All work for me stopped at that point even though I tried to go on with my next sales call. I left the office before seeing the doctor unable to stay focused on whatever drug I was there to discuss. During the two hour drive back to Marietta where I lived with my daughter, I worried the whole way about questions with no answers and stopped at the first library I came across on my way home. For the next hour or so I skimmed over the pages in the stack of books I had pulled  from the shelves trying to absorb as much information about melanoma as my distracted brain could take in. It wasn’t long before I began to consider that my  future might now be defined by terms like, ” five-year survival rates.”

My daughter was barely six and I was painfully aware while reading that there was a chance that I might not live long enough for her to remember me or to know how much I loved her. I carried those thoughts along the information from my visit to the library with me for the next day or so, stressed as you might expect until I met with my doctor who said something I remember now as, ” It is the best it can be, a Clark’s Level I.”

I had read enough to have a decent idea of what that meant, but even after she took more tissue from my back and the margins came back clear, I still lived in the shadow of a diagnosis that could have killed me if I had I not felt compelled to check the mole that day.

Additionally, there were occasions during my work history that I had to provide my own health coverage as my employer didn’t offer it or I was between positions. My premiums would start out high, but manageable and I would pay everything out of pocket while maintaining a painfully high deductible. Like many in the same position, I thought if I avoided making claims, my premiums might stay reasonable, but they still increased by obscene amounts every year.

Even while I was working for a major pharmaceutical company that had over 100,000 employees all with one particular insurance company, there was still no way that I could intimidate them into behaving with integrity. On one occasion, I tried to do battle the health insurance company to pay for an office visit that clearly fell with the parameters of coverage. They kept denying they had received the claims even though the office had filed it three times and I had filed the same information twice. Multiple phone calls later, including a conference call between the insurance company representative and someone from the doctor’s staff and myself, we both confronted the insurance employe, but got no results. In the end, the office then threatened to send my account to collections which forced me to have to pay the whole bill myself. I was never reimbursed for the office visit and their reason for not paying was that they maintained they had never received a claim. After wasting hours of my time, I gave up, which I ‘m sure is just what the insurance company hoped I would do.

Health insurance companies have held the American people hostage for far too long. Canceling the coverage of people who have struggled to pay crippling premiums for catastrophic coverage only to be told when they receive something like a cancer diagnosis, that they are not covered based on whatever obtuse bit of fabricated nonsense the insurer can cite. By the time the policy holder fights for what they paid for all those years, they’ve either lost everything they own or have died.

I myself was always afraid to admit to my doctor during visits that I’d had cancer. My oncology visits were paid for out of pocket so the paper trail for me was limited. After 10 years of being cancer free, some physicians assured me that I would not lose coverage and encouraged me to be open about it. There were times when I had to tell my doctors, but begged them not to include it in my medical records because I was afraid of being denied future coverage or having my premiums be raised so high that I could not afford healthcare insurance at all. Even without knowing my cancer history, during one of the last times I provided my own coverage, my rates increased so quickly after the first year that I was forced to raise my deductible to $5,000 in order to pay the premiums.

I don’t know what the future will hold with passage of health care reform, but I do know that is an embarrassment to me that so many Americans have responded in such vitriolic ways in the days leading up to the vote. I can only imagine what people will be saying later today as America wakes up. While it may not be a perfect solution, it will make it possible for hard working people to have access to health care coverage with stricter controls on the corrupt power that has been wielded too long by health insurance companies.

Taking the paragraph below from the British Times Online which is not noted for its liberal attitude, you can see how their observations confirm what many have experienced in the US.

” It will also outlaw the worst abuses for which the US health insurance industry has become notorious, including dropping coverage when patients become ill and discriminating against those with pre-existing medical conditions.”

Currently, I live in the UK with my British husband and have coverage under the NHS. So for the first time in my adult life since leaving the Army, I don’t have to worry about my own healthcare coverage. I do still have family in the US and I worry about them a great deal.

I have heard the comments of Americans who have been saying that they don’t want a medical system like the one in place in the UK. They cite negative conditions and situations that I have not experienced here. Quite the contrary, my every experience with the NHS, both personally and by observation involving the care given to family and neighbors has remarkable.

A few months ago during a visit home to America, I tried to share these truths with someone I had been friends with for 31 years. I told him in detail about my own experience with the NHS and what I had witnessed with others here. He argued with me each step of the way, going so far as to say, ” I know that’s what you believe happened, ” while refusing to acknowledge that there might be some benefit to having a similar healthcare model.

He couldn’t tell me what was in the healthcare reform proposal having not read it. All of his energy came from listening to the interpretations of talk radio hosts intent on keeping their listeners passions stirred up over a topic that most seemed disinterested in reading about themselves. His comment this morning on his Facebook page was just as I expected,

” Welcome to the new U.S.S.R.-United States Socialist Republic. “

I am actually surprised to see something so mild after the things he has said in the past.

I understand that many in America will not be happy this morning, but for me this is what life after cancer looks like now that one fear has been removed. Access to healthcare should be for all Americans and thanks to efforts of people who do more than shout about freedom, it now will be.