Three-tiered Triumph

I had my first real appointment with my new oncologist today, and I couldn't be more delighted. She is that great combination I always want but can't always find in a doctor: excellent clinician, wonderful person.

I'll only be seeing her three times a year (less often as those years pass), but I'll look forward to the visits. Everyone in her office is kind and friendly and good at what they do. The cozy waiting room looks like it belongs in a boutique hotel. And (drumroll, please) . . . she takes insurance.

I think this is a geographical aberration, but lots of very good doctors in New York City—including several of mine—don't accept insurance. They get paid up front, and they don't have to deal with the hassle and high overhead costs that come with trying to get reimbursed by a third party. The catch, of course, is that you have to be able to shell out their fees—which are typically above the "reasonable and customary" limits that most carriers impose—and wait weeks or months to get reimbursed, often for a percentage that is significantly less than what you paid.

The system isn't fair, but it's hard to fault doctors who want to focus on their patients instead of on accounts receivable. Still, it's a huge relief to know that in this case, I only need to cough up a co-pay.

The second piece of happy news is that my new doctor had received the results from my mammogram and breast sonogram, and they were—and I quote—"perfect." I'm going to have another breast MRI, just to be thorough, but not until January. That way I'll have some kind of breast imaging done every six months, instead of doing all three tests together once a year.

The final piece of good news was waiting in the mail when I got home this evening: an insurance reimbursement check for one thousand two hundred thirteen dollars and sixty-two cents!! I still have more claims pending, but hallelujah!!! (And it looks like my prediction was dead-on: tomorrow I will get the first paycheck for a temp gig I began last week, and it is not even going to come close to matching the payday I had today.)

By my count, that's three more Post-its® on the wall!

Kindred Spirit

Last night, I went to a reading by Kris Carr of her new book, Crazy Sexy Cancer Tips.  

At 31, Carr was diagnosed with an exceedingly rare vascular cancer, with tumors in her liver and lungs. With no conventional treatment options available, she struck out on her own, investigating every possible avenue of healing. The book is both a chronicle of her "cancer adventure" and a how-to guide for women newly diagnosed with any form of cancer.

You may have seen Carr on "The Today Show" earlier this week or in a segment introduced by Katie Couric on "The CBS Evening News" tonight, featuring both the book and an accompanying documentary that had its television premiere on TLC this evening.

I heard about Carr through a friend of a friend and was intrigued by her story and, even more, by her attitude. This woman takes orange panties to a whole new level.

I'm looking forward to reading the book and to checking out the film (thank you, TiVo!). Meanwhile, I wanted to pass along a link to Carr's blog and to share something she said at the reading that echoed my feelings about this disease:

Cancer is not a gift, because I wouldn't give it to you.

Well said indeed.

RTFC!

I had my annual mammogram and breast sonogram today, at the same place where I recently had a follow-up PET/CT scan.

Again, I had to fill out form after form about my medical history. (How is it that I can pay bills, buy gifts, or rent DVDs by spending about 60 seconds on a website but no one can provide me with medical care unless I write the same information in longhand over and over again?)

So when I was called in for the mammogram, I assumed that the young technician had actually reviewed the form in front of her.

You know, scanned it.

Glanced at it.

That assumption didn't last long.

"Have you ever had a mammogram before?" she asked (I was going to say "brightly," which accurately describes her tone and expression but grossly misrepresents her intelligence).

"Yes," I said wearily. "I've had several." (By my count, this was number seven.)

She looked at me expectantly, her eyebrows raised enthusiastically. I could not fathom her reaction.

"Are you excited?!?!?" she chirped, as if this were sophomore English and I'd just told her I'd been invited to the senior prom.

I stared at her, paused, and finally spoke.

"I've had breast cancer twice," I said, as matter-of-factly as I could.

Her eyebrows fell and took the rest of her face with them.

I don't know what happened with the patients who came after me, but I like to think that she read their charts at least.

* * * * *

I wish I could say that this was an isolated incident, but it wasn't.

Before one of the two surgeries I had right after my re-diagnosis, the anesthesiologist came over to prep me. I had filled out lots of forms then, too, including the one that listed my drug allergies. My most serious allergy is to Reglan, an anti-emetic drug that is often used with anesthesia.

Reglan does keep me from puking, but it also keeps me from moving, sleeping, speaking, or tolerating almost any kind of stimulus. In other words, it renders me catatonic. For days. When it was given to me in 2001, I lost seven pounds over a weekend during which I left my bed only to pee. I could not lift the telephone receiver, could not bear to have the lights or the TV on, could not do anything but endure the minutes that passed in slow motion.

The anesthesiologist asked if I had any questions.

"You're not going to give me Reglan, are you?" I said, half-joking.

He pulled a vial of it out of his jacket pocket. He had been about to inject me with it.

* * * * *

Then, earlier this year, I met with the doctor who took over for MOSWO (my oh-so-wonderful oncologist) when he left practice.

I've seen my chart, which is more than an inch thick. And I know how thorough MOSWO is. I'm sure he left some kind of summary of my case—the Cliffs Notes® version of my breast-cancer saga.

I figured the new doctor would at least read the summary and skim the chart before seeing me. I knew MOSWO had consulted with her when he designed my treatment plan the year before, so I imagined that she'd just need to refresh her recollection about my case.

Turns out she had no recollection at all.

We were at least 10 minutes into the visit when something I said brought her up short. She had been in the midst of asking me about the medications I was taking, and I named one that gave her pause. She asked why I wasn't taking a different drug instead.

I told her that I had been on the other drug for about four years but that MOSWO had taken me off of it after the second diagnosis.

"Wait a minute," she said, looking momentarily baffled. "You mean this is your second breast cancer?"

If that wasn't bad enough, the exact same thing happened the next time I saw her.

I didn't go back a third time.

Équipe Knowèr

On our recent trip to Greece and Paris, Zach and I had the exceedingly rare opportunity to spend two and a half weeks of uninterrupted quality time together. That luxury gave me the chance to really reflect on, and really appreciate, our relationship.

Two and a half weeks of bliss can't make up for two and a half years of hell, but it can give you a little insight.

And here's the flash I had:

One reason—maybe the reason—that we've come through these trials is that we have always taken a team approach to our marriage. In any given situation, we do whatever is best for the team—our team.

Teamwork is not a novel concept, of course—just visit any locker room at halftime for an entire pep talk on the subject—but thinking about it in such explicit terms helped me to articulate, to myself at least, something that I haven't always been able to explain.

Zach and I have sometimes made choices that seem to mystify other people. Often these choices involve spending stretches of time apart, in different cities or even on different coasts. And those stretches are typically tough for both of us—we'd much rather be in the same place, and certainly in the same time zone—but they always have a purpose.

Looking back, I don't think either of us would undo any of the long-distance interludes in our relationship. They have caused each of us to grow as individuals and have strengthened our bond as a team. They have forced us to adapt, to find ways of being together when we're not together. And they have given us reason to appreciate every day we do get to share the same meal and sleep in the same bed.

I had this insight about our relationship at the end of our trip, when we were in Paris. So when we coined the term that neatly encapsulates our philosophy, of course we did it in French: Équipe Knowèr. (Before you ask, we have no idea how to say "Team Knower" in Greek.)

Now, whenever we have some kind of triumph, we cheer "Équipe Knowèr!" in our best French accents. (We haven't done this in public yet, but I imagine the time will come soon enough.)

The tricky part is that unless we're careful, "Knowèr" can sound a bit like "Nowhere"—which is sometimes more accurate but certainly not what we had in mind.

Our latest Équipe Knowèr undertaking began yesterday, when Zach headed out to L.A. for what Southern folks would call "a spell." We've had this in the works for a while but only made the final decision a few days ago, when we were able to sort out the last of the many details.

We spent so long in pre-launch mode that it feels a little strange to finally have moved on to the next phase, but here we are.

And the first thing I'm going to do is put another Post-it® on the wall.

Mo' Mentum

The other day, when I felt once again like I had a particularly fine view of the underside of life's boot, I realized that things had, in fact, begun to look up.

Just the tiniest little bit, maybe, but up nonetheless.

I decided to literally count my blessings—the recent ones, at least—so I could try to keep things a bit more in perspective.

I got out a pad of Post-it® Notes and wrote one blessing (or, in some cases, accomplishment) per sheet. I came up with eight, from the really important—"Dad out of hospital" and "PET/CT negative"—to the mundane yet effortful ("basement cleaned").

Then I arrayed them on the glass coffee table so I could see them easily, lest I get sucked back into the mental quicksand again.

When Zach came home, I told him about my little art project and invited him to join in.  And on Sunday, right after finding a good home for our ragtop, he did:  "Sold our dear Cabriolet!"

He also moved the Post-its® to the wall, so now they're probably more like an art installation.

Now, of course, I'm eager to keep it up, so I'm looking for things to accomplish.  In fact, I'm poised to add one more bright yellow square first thing tomorrow morning, when I send off an application for an internship I hope to get this fall.  (More on that—and plenty of "40-Year-Old Intern" jokes—if it comes through.)

As Zach, or my mother, or anyone who's ever worked with me can tell you, I'm a list freak.  So perhaps it's not surprising that I came up with this particular coping strategy.  But I bet it would work even if you don't gravitate toward enumeration.

Give it a shot.  Or just do it virtually, and post a comment here instead of a note on your wall!

The W List: Women Who Blog

I was tickled the other day to learn of a movement afoot to recognize and promote great blogs authored by women. Valeria Maltoni started it with this post at her blog, Conversation Agent.  Then Krishna De of Krishna De's BizGrowth News picked up the baton, expanding and alphabetizing the list and encouraging others to keep up the momentum.

Author/columnist/teacher/coach Marci Alboher was kind enough to add me to the list in a post on her terrific blog, Hey Marci.  Now it's my turn to trumpet the work of a few women whose words I have been admiring, admittedly from afar (i.e., without commenting—known in the blogosphere as "lurking").  They are:

Emdashes by Emily Gordon
Greek Tragedy by Stephanie Klein
Separated by a Common Language by M. Lynne Murphy, aka "Lynneguist"
She Just Walks Around With It by Kristy Sammis

If you, too, are a woman who blogs, you can help the cause by reproducing the whole list, including your additions, in a post of your own (with links back to the original posts to help readers follow the trail). There are undoubtedly many versions out there by now, but here's the most comprehensive one I can assemble:

45 Things by Anita Bruzzese
A Look at Art & Design by Lisa Mikulski
angiemckaig.com: still a great pair of legs by Angie McKaig
The Anti 9-to-5 Guide by Michelle Goodman
Ask-Dr-Kirk by Dr. Delaney Kirk
The Artsy Asylum by Susan Reynolds
Back in Skinny Jeans by Stephanie Quilao
Beltway Confidential by Julie Mason
BlogWrite for CEOs> by Debbie Weil
Biz Growth News by Krishna De
Brain Based Biz by Dr. Robyn McMaster
Brain Based Business by Dr. Ellen Weber
by Anne Simons
Branding & Marketing by Chris Brown
Brazen Careerist by Penelope Trunk
Build a Solo Practice by Susan Cartier Liebel
Christine Kane by Christine Kane
CK’s Blog by CK (Christina Kerley)
Communication Overtones by Kami Huyse
Confident Writing by Joanna Young
Conscious Business by Anne Libby
Conversation Agentby Valeria Maltoni
Corporate PR by Elizabeth Albrycht
Crazy Aunt Purl by Laurie Perry
Creative Curio by Lauren Marie
Customers Are Always by Maria Palma
Customers Rock by Becky Carroll
CustServ by Meikah David
Debbie Millman by Debbie Millman
Deborah Schultz by Deborah Schultz
Designers Who Blog by Cat Morley
Design Your Life by Ellen and Julia Lupton, identical twins
Design Your Writing Life by Lisa Gates
Diary of Claudine Hellmuth by Claudine Hellmuth
Diva Marketing Blog by Toby Bloomberg
Do It Myself Blog by Glenda Watson Hyatt
Dooce by Heather B. Armstrong
Email Marketing Best Practices by Tamara Gielen
Emdashes by Emily Gordon
Emily Chang - Strategic Designer by Emily Chang
Enter the Laughter by Marti Lawrence
Escape Blog by Melissa Petri
Escape from Cubicle Nation by Pamela Slim
eSoup by Sharon Sarmiento
Essential Keystrokes by Charlene
Every Dot Connects by Connie Reece
Fish Creek House by G. P.
Flooring The Consumer by C. B. Whittemore
Forrester’s Marketing Blog by Shar, Charlene, Chloe, Christine, Elana, Laura, and Lisa
Forward Steps Life Coaching by Thea Westra
Franke James by Franke James
Get Fresh Minds by Katie Konrath
Great Presentations Mean Business by Laura Athavale Fitton
Greek Tragedy by Stephanie Klein
Half of Me by Jennette Fulda
The Happiness Project by Gretchen Rubin
Hey Marci by Marci Alboher
Get Shouty by Katie Chatfield
ifelse by Phu Ly
Illustration Friday by Penelope Dullaghan
Inspired Business Growth by Wendy Piersall
Is today a zoo day? by Mary Schwalm
Jen McClure’s Ruminations & New Communications Review by Jen McClure
J.T. O’Donnell Career Insights by J.T. O’Donnell
Joyful, Jubilant Learning by Rosa Say
Kinetic Ideas by Wendy Maynard
Learned on Women by Andrea Learned
Lindsay Pollak by Lindsay Pollak
Live The Power by Karen Lynch
Successful Blog by Liz Strauss
Lobo's Movie Reviews by Judy Wolfe
Lorelle on WordPress by Lorelle VanFossen
Making Life Work for You by April Groves
Manage to Change by Ann Michael
Management Craft by Lisa Haneberg
Mandarin Design Daily:The MEG Blog by Michelle Goodrich
Marketing Roadmaps by Susan Getgood
Moda di Magno by Lori Magno
Modite by Rebecca Thorman
molly.com by Molly E. Holzschlag
My Shingle by Carolyn Elefant
Narrative Assets by Karen Hegman
Netdiver by Carole Guevin
Nichelle Newsletter by Nichelle Stephens
On My Desk by Linzie Hunter
Once More Unto the Breach by Jody Rosen Knower
Ordinary Life, Extraordinary Living by Carol Ross
Peace, Love, and Harmony by Kristen Harrell
Presto Vivace Blog by Alice Marshall
Priscilla Palmer: Personal Development Demands Success by Priscilla Palmer
Productivity Goal by Carolyn Manning
Proxyland by Wendy Fried
Purse Lip Square Jaw by Anne Galloway
Separated by a Common Language by M. Lynne Murphy, aka "Lynneguist"
She Just Walks Around With It by Kristy Sammis
Small Biz Survival by Becky McCray
Small Failures: Sustainability for the Rest of Us by Jess Sand
swissmiss by Tina Roth Eisenberg
The Brand Dame by Lyn Chamberlin
this is rachelandrew.co.uk by Rachel Andrew
Sheriar Designs by Mani Sheriar
Spacey Gracey Review & TrueGritz by Grayson Daughters
Spare Change by Nedra Kline Weinreich
StealthMode by Francine Hardaway
Talk It Up by Heidi Miller
Tech Kitten by Trisha Miller
The Copy Writing Maven by Roberta Rosenberg
The Blog Angel by Claire Raikes
The Engaging Brand by Anna Farmery
The Floozy Blog by Kate Coote
The Kiss Business Too by Karin H.
The Origin of Brands by Laura Ries
The Parody by Sasha Manuel
The Podcast Sisters by Krishna De, Anna Farmery and Heather Gorringe
Veerle’s blog 2.0 by Veerle
Water Cooler Wisdom by Alexandra Levit
Wealth Strategy Secrets by Nicola Cairncross
What’s Next Blog by B L Ochman
Work in Progress by Lisa Takeuchi Cullin
That’s What She Said by Julie Elgar
Versa Creations by Vivienne Quek
Your Career and Your Biz by Eve Tahmincioglu
Ypulse by Anastasia Goodstein

Click away!

Happiness Is Not a Bowl of Cancer Cells

I came down with some bizarre, transitory illness last night—fever, headache, and chills, cured with a single Extra Strength Tylenol—and therefore didn't have a chance to read most of yesterday's newspaper, so I missed Jane Brody's "Personal Health" column in The New York Times.

It's called "Thriving After Life's Bum Rap," and it opens with a very provocative question:

Can getting cancer make you happy?

Brody goes on to cite many cancer veterans who answer with a resounding "Yes!"—people who found perspective or peace or purpose after their diagnoses.

I am not one of those people.

Cancer did not make me happy.

Cancer did not make Zach or my family or any of my friends happy.

Cancer sucked the first time and sucked even more the second time.

Has cancer been a character-building experience?

Maybe.  But I think my character was pretty solid before, and I wasn't exactly in the market for a renovation.

I get that people find silver linings where they can and that sometimes a life-threatening (or at least -altering) experience can reshuffle priorities that might have been out of whack.  I realize that there are life lessons to be learned from the trials we endure.

But it has always rankled me to hear someone say, "Cancer is the best thing that ever happened to me."

I do not mean to be unkind, but really?  The best thing?

Do people just not get out enough?

To me, that line sounds like something a screenwriter inserted into a third-rate melodrama, to be shot in extreme close-up through a Vaseline-coated lens.  I have to wonder how it escaped the screen and made its way—unchallenged—into popular culture.

Think about the words people dream of hearing:

"I love you!"

"You're hired!

"You've won!"

"It's a girl!" or "It's a boy!"

But not "You have cancer!"

Not for one second.

So while I salute anyone who has found a way to salvage something positive from a visit to Cancerland, I cannot accept the proposition that a rational person would actually choose to make the trip.

Take it from me:  the terrain is rocky, the food is lousy, and the souvenirs suck.

And in Health

On my father's 38th birthday, long after he'd been relegated to "confirmed bachelor" status by his family and friends, he went out on the last blind date of his life.

After two decades of dating, he knew exactly what he wanted in a potential mate: someone with a good heart who wouldn't bother him too much.

I'm not kidding about the second part.

I find it hard to believe that no one else met those exacting criteria before my mother came along, but there it is.

Lucky for us all that none of her predecessors met the mark.

My father was smart enough to move quickly—he married my mother exactly four months after their first date. (I didn't come along for another two and half years, so don't get any ideas.)

Today is their forty-third wedding anniversary.

In all those years, I don't think a day has passed that my father hasn't marveled at his good fortune.

If you know my mother, you know that she has the world's largest heart.

Well, one of the largest.

My dad's got the other one.

Happy anniversary, Mom and Dad.

A Tornado Grows in Brooklyn

My apologies for not posting sooner to say that although Wednesday's freak tornado touched down—and wrought enormous havoc—in our home borough, it was miles away from us. So far, in fact, that I only learned about it through the news.

Zach and I managed to sleep through a storm that had folks in other neighborhoods up all night—including one co-worker of his who said she was whimpering in bed.

Perhaps Mother Nature decided to give us a tiny break, knowing that we have been living through tornadoes of various other sorts for two-plus years now.

Thanks to all who were concerned for us—and sorry to have caused you any worry.

In Which I Divulge the Source of My Sense of Humor

My dad, and my mom and I, spent the day in the ER yesterday.  He is doing pretty well, all things considered, but it was a typically grueling day for all of us.  

ERs just suck, no matter what the circumstances.  My dad was poked and prodded all day long—a catheter here, an IV line there, a rectal thermometer, a chest X-ray for good measure, a bunch of overdue suctioning for his ventilator tube, and who knows what else when we weren't there to see it.

My mom and I stood, sat, stood, ate unhealthy food, watched inane television (Wife Swap!!!) in the waiting room, and stood some more.  At one point, the ER was so overwhelmed that they diverted all incoming ambulances and kicked all visitors out.  We had spent the night in that particular ER before, so we half expected to do it again.

I recognized one nurse and a physician's assistant from one of our other visits, and another nurse recognized me from the ER at a completely different hospital where she used to work.  It's no wonder everything has started to blur together.

In any event, my dad finally got up to a regular room sometime after 9PM.  His very personable nurse came in to get him settled, then returned a few minutes later.

"I'm gonna take your temperature and blood pressure," she said sunnily.

"Why don't you give me an enema while you're at it?" my dad chirped.  (Well, more "mouthed" than "chirped," but she understood him right away.)

At first she thought he was actually submitting a request but then realized he was being wry.  She laughed and tried a comeback of her own, but my dad stopped her cold:

"I do the comedy around here," he shot back.

His eyes may have been narrowed for effect, but they were twinkling just the same.

Monogamy at Last

It might sound counter-intuitive to celebrate the lapse of my primary insurance policy, which happened at midnight last night. You'd think that having coverage through not one but two providers would give me extra assurance, financial security, and peace of mind.

You'd be wrong.

I never once dated more than one person at a time, but I imagine that juggling romantic attachments would present the same challenges and frustrations as managing the referrals, pre-certifications, claims, and reimbursements of two different insurance companies.  It's very hard to keep things straight and make everyone happy.

Having two insurance policies means two sets of cards in my wallet, two prescription-drug plans to keep track of, two sets of files at home, and endless conversations with providers, especially when I'm trying to avail myself of the oxymoronically named "coordination of benefits" provisions of the two plans.

The usual sequence of events goes something like this:

1. I need to see a doctor.
   
2. I make an appointment with the doctor.
   
3. Someone from the doctor's office calls and tells me I need a referral.
   
4. I try to explain that no, actually, I don't need a referral because my primary insurance plan has a nifty practice whereby I need just one referral that says, "This chick has breast cancer."  Anything related to evaluation or treatment falls under that single referral.  And, well, I got that über-referral more than a year and a half ago, when I was first re-diagnosed.  
   
5. The person at the doctor's office stands firm and tells me that the doctor cannot see me without a referral that my own insurance company says I don't need.
   
6. I call a really, really nice nurse I know at Columbia's Health Services, and she faxes me the referral within the hour.  (I'd hate to think what the rest of this list would look like without her.)
   
7. I go to the doctor with the referral in hand.
   
8. If I'm lucky, the doctor just collects a co-pay and bills my insurance company for the balance.  I'm not usually lucky, so I typically have to pay the bill up front.  This can range from about $150 to $500, depending on the doctor.
   
9. I come home and submit a claim for the bill I have just paid.  (There is usually a lag between coming home and submitting the claim.  Sometimes it is a matter of days, but more often it is weeks or months.  If I don't get the claim filed within 15 months, we have to eat the cost.  I try hard not to let this happen, but occasionally I fail.)
   
10. I wait for the claim to be processed.  If all the planets align, this still takes a minimum of two to three weeks.  (The planets never align.)
    
11. If the doctor bills my insurance company, I get a bill from the doctor anyway.  I call the doctor's office and am told to ignore the bill.  For now.
    
12. I get the often inexplicable Explanation of Benefits (EOB) in the mail.  A good percentage of the time a mistake has been made in processing the claim:  it's denied because I didn't have a referral (even though I did, even though I didn't need it); it's denied because I have other coverage (even though the other coverage is secondary); it's denied because the diagnosis codes are a) wrong or b) missing or c) for a test or service that is excluded from coverage (but shouldn't be); it's denied because the planets didn't align.
    
13. I call the insurance company.  They promise to "reprocess" the claim.  This takes another 10-15 business days at best.
    
14. I call the doctor's office to explain why I am not paying the second bill I've received.  They make a note in my file.  I make notes in my own file.
    
15. I get a third bill from the doctor's office.
    
16. I get a revised EOB from my primary insurance.  More often than not, the EOB shows that the insurance company has paid less than 100% of the claim.
    
17. I make a copy of the corrected EOB, plus a copy of the doctor's bill, plus a copy of the receipt showing whatever amount I've paid, and send them all to my secondary insurance.  I make a note in my file.
    
18. I get a fourth bill from the doctor's office.  (Or maybe a tenth, depending upon how long it takes to get the initial EOB, or to get it corrected.)  By now, the bill is printed on pink paper with words like "delinquent" or "overdue" or "your responsibility" or "to avoid referral to a collection agency" in BOLD TEXT AND CAPITAL LETTERS.
    
19. I call the doctor's office and explain that I am not a deadbeat, that my secondary insurance company is on the case, that they will get paid (eventually).
    
20. I get an EOB from my secondary insurer.  It shows the amount they paid, either to me or to the doctor, and tells me how much (if any) of the balance (if any) I actually owe (let's call that "X").  I make a note in my file.
21. I get a fifth (or eleventh) bill from the doctor showing the amounts that the two insurance companies paid and asking me to pay the remainder (let's call that "Y"), which is often more than the secondary insurer's EOB says I owe.  (Doctors who have contracts with the insurance companies agree in advance to discount their rates but often then try to recoup the discount directly from the patient.)
22. I fax the secondary insurer's EOB to the doctor's office, circling the part that says "[Provider's Name] may bill you $X."  If only I had BOLD CAPS at my disposal.
23. Someone from the doctor's office calls and concedes that I owe only X and not Y.
24. I pump my fist several times in the air, resplendent in my success, triumphant in my victory over the minions of Satan's health-care bureaucracy.  
25. I make a final, self-congratulatory note in my file. 
26. I pay Y.