Yesterday was the big day when I was scheduled for a full day at Kirklin Clinic in Birmingham, for blood tests, a CT scan, a visit with Dr. Posey and Jill the Wonder Nurse, and a chemotherapy infusion. It has been nine weeks since we have seen Dr. Posey, and during treatment for pancreatic cancer a lot can happen in nine weeks. So we went. The 75 mile drive down highway 79 was uneventful, and we arrived with plenty of time. We started out at the blood test area to pick up the labels for the blood test vials, and then proceeded to the infusion area where Michael "accessed" the port, and drew blood for the blood tests. He left the plumbing hooked up to the port for later use, and sent us on our way to Radiology for the CT scan. This is where the day went funny on us. There was no CT scan appointment. Why? Well, because, in their infinite medical wisdom, Blue Cross Blue Shield of Alabama had not approved one, of course. Monica by now knows better than to get me involved in the negotiations for this and went off to play Mama Bear with the powers that be. She got absolutely nowhere, and BCBS decreed that if we would come back tomorrow, they might have a decision. Maybe. You see, they have outsourced their decisions on such things to an outfit in New York, which something tells me just fronts for a set of doctors in India or Bangladesh. In any case, there would most certainly not be a CT scan today, because BCBS is practicing medicine and deciding that such a thing is not medically necessary today. Oh yeah! So, when we saw Dr. Posey, we had an exercise in futility in diagnosing what was going on. The good news was that the CA19-9 marker went down for the first time ever since the first of the year, from 76 nine weeks ago to 30 yesterday. The bad news is that without the scan, there was not a way in the world that they would be able to definitely tell me whether the swollen right leg is cancer related (the main tumor, the last time we looked, was wrapped around some major abdominal blood vessels, and involved some of the lymphatic system) or whether I might have a blood clot which should promptly be treated some other way. So, quite in the blind, the decision was made to continue on the current regimen of gemcitabine treatments. After that, we went back to the infusion lab for this week's infusion of gemcitabine, which took another two hours. So we got out at about 4:30 p.m., and barely made it back to Guntersville in time to get to Bunch Pharmacy to pick up the latest prescriptions. What a day!

It would appear to me that we in the USA are rapidly closing on having all of the drawbacks of socialized medicine, with none of the purported benefits. It is partly privately financed, but the controls are given over to remote bureaucrats who determine who shall live and who just isn't worth it. BCBS is our local health insurance near-monopoly (in Alabama, it is the vast majority carrier) and controls just about anything. My coverage is the best there is here (Thanks to my employer, Aegis Technologies, and the insistence of the owners) and for that I am very thankful. Nevertheless, it would seem that for cancer patients, there is a very real problem. Even when I arrange my life to fit their schedule (we did wait nine weeks for the next scan, as BCBS demands) they still are capricious in their behavior. What am I supposed to do? I know it would cost less if I would just promptly die (cancer is notoriously expensive to treat) but it would seem that they could probably not put that statement in any of their sales literature. The medical facility which I am using is state-financed (all run by the University of Alabama, Birmingham) and they appear very well run. It is the insurance company which is playing god in this little drama, and all in the name of proper cost controls. I am so very unimpressed.