Going with the flow

I hadn’t been out of my element to this degree since my college days, when I drunkenly debated the lyrical merits of the song “99 Red Balloons” with a philosophy major. Yet, there I was. Floating downstream in a kayak on the Klickitat River in Washington state, ready to take on some rapids and holding my paddle upside down.

Thanks to the good folks at First Descents, a nonprofit that provides free adventure trips to young cancer survivors, I was able to give this whole kayaking business a go. It was the next phase of a much larger, multi-step plan that forced me to abandon my comfort zone, to get out there and live.

Since my whole cancer ordeal began in 2013, I’ve slowly made my way out onto that limb. I’ve posted pictures of my breast reconstruction on my blog (for the benefit of fellow breast cancer patients, and perhaps some random pervs), joined an annual 200-mile charity bike ride (despite the fact my last bike-riding experience had been 30 years prior, on a pink Huffy with a banana seat), momentarily forgot my intense fear of public speaking with a speech to about 200 people (with the assistance of about $100 worth of hotel booze) and now, clumsily attempted whitewater kayaking.

Photos courtesy of First Descents and Wet Planet

The kayaking trip had a slightly “Breakfast Club” feel to it, minus the teen-angst-fueled drama and animosity. We were strangers when we arrived, all from different backgrounds, seemingly little in common.  Artists, college students, writers, firefighters, athletes and parents—these were our labels out in the wider world. In some cases, we were separated by an age difference of 20 years or more, as evidenced by the belief that the Spice Girls was “oldies” music and the quizzical stare at the mention of “Hammer pants.” But there was one label we all shared: cancer patient. And though we were all at different stages of our respective cancer journeys, it was a powerful common ground. We were part of a club that none of us really wanted to belong to, but which had afforded us this amazing opportunity: the Cancer Club.

When the 15 of us descended upon a remote lodge tucked in the forests of Oregon, none of us really knew what to expect from the week ahead, but we had our reasons for being there. In need of physical challenge or new adventure. To replace something cancer had taken. To regain a sense of normalcy that so frequently eludes you following a cancer diagnosis and treatment.  I think I can safely speak for all of us when I say we were looking for a safe space, a place where it was OK to not be an inspiration or a fighter, but rather just be.

The teens in “The Breakfast Club” knew what it meant to be pigeonholed. And so do cancer patients. How many times have you heard a cancer patient being described as a brave warrior? It’s not a bad metaphor, per se, but it’s a metaphor that’s never quite sit right with me. Warriors sometimes lose battles, and I don’t like to think of people with cancer “losing,” as if they didn’t fight hard enough. As with many things in life, the cancer journey is primarily made up of just putting one foot in front of the other. I’ve been told, “I could have never handled it like you did.” To these people I say, “You’d be surprised what you can do when you’re just trying to stay alive.”  

Having cancer is kind of like wandering through Wonderland. It’s a place where negative results are positive—“My PET scan came back clean!” It’s a place where you will time to move both slowly and rapidly, so you can simultaneously savor moments and speed towards those that are in the distant future, because not being alive for your child’s high school graduation is a heartbreaking prospect. And sometimes, you have to face your own mortality to learn to live again. The latter was my reason for awkwardly planting myself in a kayak and heading down river.

As I approach my five-year NED (no evidence of disease) anniversary, my anxiety level has been ratcheting up. No woman in my family has gone five years cancer-free. I’m the only one alive. For years now the “I’m the only survivor” spin has had a negative connotation. But not anymore. Heather, you’re not dead. And if hurtling down a river doesn’t prove it, I don’t know what does.

I suppose one of the biggest lessons I took away from this week was to, literally and figuratively, “just go with the flow.” It wasn’t an easy lesson. For the better part of the past five years, I’ve been fighting against the current, trying to beat back cancer and do everything to prevent it from returning. But out there on the river, such defensive efforts just left you upside down in your kayak, in said river. It’s a tough lesson for someone who needs to feel in complete control at all times. You can’t control everything in life. You can’t control the river.

Was the trip amazing? Yes. The people, the food—thanks to Bumblebee and Gem for helping me “get regular” again for the first time in years—the kayaking, the instructors. Everything. Amazing. Did I relish smelling like basement mildew thanks to a wet suit that never quite dried? Nope. But it wasn’t anything a shower couldn’t take care of. Was I awkward as all hell? You betcha. Kayaking put into sharp focus the range of motion and core strength I had lost thanks to cancer and surgery (plus my overall lack of athletic prowess). 

But I gave it my all. My grit, as it turns out, was not a casualty of cancer. Nor was my opinion of “99 Red Balloons.” I still think that song is total bullshit.

HOTDP: Survivor-Rider Rachel Kelley

This is part of a continuing series chronicling "Humans of Tour de Pink"--the amazing survivors, co-survivors, supporters, volunteers and others who make up this rolling family.

 
Rachel Kelley would often receive compliments on her road bike from strangers. It was sleek and black and adorned with fierce pink flames. “I would tell them it was an expensive bike—I had to be diagnosed with breast cancer to get it,” says Kelley, who’s a 12-year survivor. 

Kelley’s bike is part of a Liv Cycling program that each year donates limited-edition road bikes to breast cancer survivors participating in the Young Survival Coalition’s  three-day, 200-mile Tour de Pink charity rides. She received her survivor bike in 2014 and is riding in her sixth Tour de Pink West Coast this year as captain of her team, Zen Pedalers. Last year, the team raised more than $51,000 for the Young Survival Coalition, a nonprofit dedicated to providing support and resources to young women diagnosed with breast cancer.

It’s a cause near and dear to her heart, and Kelley recalls the road leading up to her diagnosis:  On March 29, 2006—her 9^th wedding anniversary—she showed up for her first day of work and immediately went to her new boss to ask for time off. Diagnosed with breast cancer in her right breast just the night before, Kelley had a whirlwind of medical appointments ahead of her. “I met with my breast surgeon on March 31 and on April 6, I had my surgery,” she says. Seven weeks of radiation, five days a week, followed.

The Cypress, Calif., resident quickly discovered that breast cancer was a disease assumed to strike only older women. “The local support group I was referred to was made up of women who were in their 50s, 60s and 70s,” says Kelley, who was 42 when she was diagnosed. “And it met at 10 a.m. on Thursdays, so not exactly the most convenient time for those who are working. But at the time I didn’t think to look for other resources.”

Cycling for a cause

Breast cancer wouldn’t be the only health issue to beset Kelley. A back injury in 2010 left her using a walker. During this time, she began accompanying her husband, Christopher, on his cycling trips.

Reclaiming life, on a bicycle built for two. Photo: Rachel Kelley                   

In 2012, he rode in his first Tour de Pink West Coast. The benefit bike ride is actually part of a cycling trifecta that includes not only the West Coast, but South and East Coast rides, as well. The Tour de Pink rides are the major fundraisers for Young Survival Coalition, raising more than $1M for the organization. This money helps fund endeavors that include support groups, research advocacy and conferences such as the Young Survival Coalition’s National Summit.

Still recovering from her injury and on the sidelines for 2012, Kelley met for the first time Tour de Pink co-founder Lisa Frank, who is also a survivor. “I remember her standing in front of me and asking, ‘Who are you?’” she says, laughing at the memory of the interrogation. When Frank discovered Kelley was a survivor, she got excited. “She told me I had to be out there at the beginning of each day’s ride to have my picture taken with the survivor-riders. The survivor-rider photo was a tradition. I told her, ‘But I’m not riding.’ She didn’t care. She made sure I was out there every morning for the picture. We got such a welcome from her, and I thought, ‘Now this is an awesome organization.’”

With the proper rehabilitation, Kelley was able to ride with her husband the following year on a Co-Motion tandem bicycle. In 2014, she rode all 200 miles on her Liv survivor bike. It was quite the feat for the previously casual bike rider.

This year, as Kelley marks 12 years of survivorship, it’s a particularly poignant time for her: 12 years was how long her mother went before she had a recurrence of breast cancer. As Kelley and any other survivor can attest to, the fear of recurrence never quite goes away. But she doesn’t dwell on it long before she moves on to what challenges she looks to tackle next. 

“I want to do the Tour de Pink East Coast and South rides one day,” she says. “I don’t have a bucket list. I have a bike-it list.”

For more information about the Zen Pedalers or to help support Young Survival Coalition by donating to Rachel Kelley’s ride, please visit: https://west.ysctourdepink.org/Rachel .

When Laser Met Vagina: the MonaLisa Touch, Part 1

Full disclosure: I received the MonaLisa Touch treatments for free so long as I blogged about it - the good and the bad. Anyone who knows me knows I don't sugarcoat anything; if something sucks, I'll tell you it sucks. That's the brutal honesty of my journalism upbringing. This procedure didn't suck, which is good because it involved a laser and my girly parts. Read on for installment No. 1 and stay tuned for updates about the other two MonaLisa Touch sessions.

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Vaginas and lasers—I used to think those two things went together like "live wires" and "standing in a bucket of water." Do lasers belong in those delicate nether regions? Believe it or not, I'd argue they do.  

Over the course of the past year or so, there’s been some chatter in my online breast cancer Facebook support groups about this very topic. I, along with many other survivors and those called “previvors” (the brave gals who’ve gotten surgery to prevent hereditary cancer) would eagerly grill a group member about her experience with some fantastical device called the MonaLisa Touch. How many treatments does it entail? (3, about six weeks apart) How long did the treatments take? (About five minutes each) Was it painful? (No).

For most of us, the MonaLisa Touch procedure, which isn’t covered by insurance, was cost prohibitive at $500 or more per treatment (based on your physician and where you live), so we wanted every detail, every possible success or drawback before we even considered undergoing it—and we wanted multiple recommendations. Many agreed that even a modest amount of relief from our symptoms would make this worth it.

That’s certainly how I felt.

Menopause magnified

More than three years out from my breast cancer diagnosis at age 36, and more than two years after my hysterectomy/oophorectomy, I was painfully aware of the effects this cancer business and a lack of estrogen had had on my body. All the glorious things that come with menopause, things that take a good 10 years or more to hit most women, I had managed to squeeze into less than two years. At the age of 39, my libido was shot and my lady parts were like the Sahara Desert.  (I swear, I would wipe after peeing and there would be tumbleweed on the toilet paper.) And sex? That was about as pleasant as planting a bare bum on a Bunsen burner.

There are some studies focused on MonaLisaTouch and how it may relieve the painful symptoms of menopause, and many of the women in the Facebook groups had anecdotal tales of success. At the bare minimum, it seemed this laser treatment gave a small measure of relief. On the other end of the spectrum, there were women raving about how they could finally enjoy sex again for the first time in ages. I wanted to know where I’d fall on the spectrum, so I decided to saddle up.

Photo Credit: Rob Young

An approximation of how menopause made me feel, minus the camel

As luck would have it, someone from the breast cancer nonprofit I volunteer with knew someone who could hook me up with a doctor. Treatment would be complementary so long as I’d write about my experience.

To the laser!

Forever the health reporter and cynic, I didn’t have much in the way of high expectations as I jostled my way through the holiday crowds around New York City’s Rockefeller Center on my lunch break for my first of three 5-minute treatments. Couldn’t these people see I was on my way to get my vagina “lasered?” MOVE, people!

When I got to the office building of urogynecologist and author, Dr. Elizabeth Kavaler, I contemplated forgetting the whole thing and opting instead for lunch at New York Yankees Steak next door. But I’m a Mets fan, and I had been through way worse. Time to buck up, buttercup.

Dr. Kavaler went through my rather depressing personal health history—bilateral breast cancer, BRCA2-positive, strong family history of breast cancer, double mastectomy, chemo, tamoxifen, painful intercourse—the whole nine yards. She debriefed me on the finer points of the laser, how the fractional CO₂ power it harnessed was based on the same premise as the laser resurfacing plastic surgeons perform on the face to stimulate collagen production and give skin a more youthful appearance. My vagina was getting a facelift, so to speak.  But this wasn’t about making things look prettier down there.  Rather, I really wanted the treatment to make things function like they did before my cancer diagnosis.

“OK, are you ready?” Dr. Kavaler asked.

“Oh sure,” I said, as if I did this sort of thing every day.

And away I went, whisked off to an unassuming treatment room that housed no terrifying equipment, nothing resembling a blowtorch, which is good because scary equipment probably would have sent me screaming from the office.

A topical numbing agent was applied to the delicate areas and when everything was good and numb, the laser inserted. Slowly, Dr. Kavaler pulled it through the vaginal canal. At one point, I felt a slight pinching sensation that lasted for a split second. That was it. I was done a few minutes later.

Now, I’ve had some women ask me how it felt after treatment. The best way to describe it is, for about two hours after I completed that first treatment I felt like I had ridden many miles on a road bike—you know, those bikes with the really uncomfortable seats. But by that night, my vagina had recovered. I had no discharge or bleeding.

Now for the good stuff …

Of course, by this point you’re thinking, “Yes, Heather, but what about the sexy time?” Those who know me best will tell you, I don’t promote or rave about much.

I waited more than a week after my treatment to have sex with my husband, who, by the way, is pretty much the most patient and understanding man on the planet. I think he was curious about how things would feel post-treatment, maybe wondered if my vagina had some cool new super powers or something.

The first thing I noticed about the first time was that I had lubrication. Not a tremendous amount, but more than before. Prior to my treatment, it didn’t matter how turned on I was. There would be the need for lube. This time around, I still needed some help, but only a little. Which brings me to the next point…

Hallelujah! I had absolutely no pain! And sex actually felt, dare I say, very good. Is it like before I had my treatments and surgery? No. But I think with the second and third treatments, things will only get better, though I don't think things will ever be "the same as before."

Before treatment, I cringed at penetration and in my head I would be working out ways to avoid it. “You sure you want to do this? Whoa, was that an earthquake I just felt? Did someone just ring the doorbell? Hold up! I’m pretty sure I left a roast in the oven. I’d better go check.” Now, I look forward to sex and actually initiate it.

I certainly never thought I’d say this (or would have reason to, for that matter), but my vagina and I can’t wait for our next date with the laser. Stay tuned!

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Blame It on the Chemo --- or How I Came to Sign Up for a 200-Mile Bike Ride

Chemo damaged my brain.

Those who have known me long enough would say, “You mean, ‘Damaged it more?’” Yeah, well, screw you if you’re thinking that! Anyway, it’s true: Chemo has affected the part of my brain responsible for rational decision-making. Exhibit A: I signed up for a 200-mile charity bike ride, despite the fact I haven’t been on a bike in more than 30 years (it was Pepto-Bismol pink and had a green frog on the banana seat), despite the fact I was pretty sure I'd be a slacker when it came to training, and despite the fact that when I registered, I didn’t own a bike. 

Those who have known me long enough would say, “Charity bike ride? What is the charity? You?” Yeah, well, screw you if you’re thinking that!  Anyway, Tour de Pink East Coast benefits a wonderful organization called Young Survival Coalition, which provides education and resources to young women diagnosed with breast cancer, like me. I would never consider doing a ride of this nature unless it benefited a cause very near and dear to my heart, and unless I could ride with a whole bunch of awesome people. I suppose I also did it because I could; 2016 marks the first year since my diagnosis that I haven't had any part of my body removed or worked on. I suppose it also helped that the chemo damaged the part of my brain responsible for recognizing my athletic limitations. 

I was so worried about raising the minimum $2,500 for this ride that I sort of forgot to concentrate on training. Then I focused on securing my team some super awesome custom jerseys and kinda let that consume me. Then I was like, what about accessories? We must have the proper accessories! ...Shhhh! Did you hear that? It's the sound of training falling to the wayside.

I'll get this bike-riding thing down eventually.

Now I find myself 17 days before the ride and probably only having racked up about 40 miles over the course of a few infrequent excursions. Those who have known me long enough would say, “40 miles—really? Didn’t think you had even that in you. Did you accidentally get stuck to the back of someone’s bumper and get dragged?” Yeah, well, screw you if you’re thinking that!  Anyway, my goals for the ride changed: I’ve gone from “I want to complete as many miles as possible” to “Please don’t let me die.” Believe me, the irony of dying during a cancer bike ride isn’t lost on me. But hey, if I face-plant or get hit by a truck full of hot garbage, I’m going to look good when it happens, thanks to a stellar custom jersey and killer accessories.

Luckily, I’m also teamed up with some pretty great gals (and fellow slackers): childhood pal Tara and fellow survivor and “BRCA sister” Mollie. We’re the ride’s equivalent of the kids who sit in the back of the class, passing inappropriate notes back and forth and competing to see whose farts are the loudest. Not coincidentally, at the back of the pack is where we plan to ride (due to lack of training and, more importantly, out of concern for the safety of our fellow riders).

We won’t be the fastest, won’t be the most stable on our bikes and won’t have road rash on anything less than 90 percent of our bodies by the time this is done, but we will be surrounded by amazing (and inspirational) Tour de Pink riders and we'll be having fun. Those who have known me long enough would say, “I never doubted that.”

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Make a tax-deductible, totally secure donation here

I have a thing for nice, round numbers and I’d love for my team to hit the $10,000 mark. If you’re reading this and can identify with slacker underdogs like me and my teammates, please consider making a donation to the cause. Seriously, it can be, like, $5. No amount is too small. And you can keep your donation amount hidden, then go around and brag to everyone about how you donated a king’s ransom. We won’t tell.

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Breaking Up is Hard to Do

Tuesday was my last “date” with my oncologist. 

Ever since I had heard he was leaving to practice in Florida, I had been trying to compile a list of reasons he shouldn’t go. All I had so far was 1. It’s too humid down there and he’ll have to live with frizzy hair and 2. The most insane news stories come out of Florida. Did he really want to be a part of that? (No offense, Florida.)

Dr. Asim Aijaz’s practice has always been insanely busy, something I chalked up to him being an awesome oncologist. Every time I left his office, I felt like my concerns had been heard, and I knew exactly why treatment was proceeding the way it was. I never doubted the path I was taking. Yes, the wait to see him could be interminable, but that’s because he took his time with you. Funny thing, I never heard other patients complain; they knew that they, too, would get his undivided attention when their names were called.

But the typically buzzing office is quiet today. In preparation for his departure, Dr. Aijaz has stopped adding patients to his calendar. My butt never touches a waiting room chair as I’m sent straight into the back office for my blood work. As the nurse is trying to find a functioning vein in my battered circulatory system, I spot the good doctor walking quietly down the hall.

“You! I’m going to have words with you,” I say sternly, pointing a bony finger at him. He pretends to duck into an exam room. “You’re lucky I’m getting my veins prodded right now!” I yell.

Something tells me my oncologist will have no shortage
 of interesting patients in Florida.

After I’m patched up from three attempts to get blood, and I've lied my way out of getting weighed ("I weighed myself not that long ago and here is the weight I wish I was"), I make my way down to the exam room to wait for the doctor. Finally he appears. “You,” I say again and trail off. I had been prepared to chastise him for breaking up with me. How could he do this? I’m young and need many more years of follow-up. I hate change.

He perches himself on the end of the exam table, and I’m reminded of the first time I met him in December 2013. “I know a lot about you,” he had said then, leaning against the exam table. He had studied my chart, my lab results and everything else in my folder, which at that point was the thickness of “The Grapes of Wrath” and about as equally depressing. He knew me, and he knew what course of action we needed to take. He was very methodical in describing why my tumors were ugly, and why chemo would be needed to reduce my risk of recurrence.  

He uses this same methodical manner now, to break up with me. It wasn’t me. It was him.

He carefully explains that he received a great opportunity in an Orlando health system. It's a step up in many ways. As the only oncologist in this New York office, his current workload is insane. He has kids almost the same age as mine. He’d like to spend more time with his young family, and Florida presented the best opportunity for this.

How the hell was I supposed to argue with that reasoning? Me, who wanted nothing more than to spend more time with my family? It was at this moment that I really began to think about the personal lives of those who work tirelessly to fight cancer and extend lives—the missed family dinners and the children's bedtime stories that go unread because patient appointments ran long that day.

Everyone always focuses on how much doctors make, but you know what? You couldn’t pay me enough to be a doctor. Not that I’d have that opportunity anyway. No way could my attention span see me through med school, fellowship training and whatever other hoops they make you jump through before you're allowed to look after humans. But I’m thankful for those people who do make this sacrifice, for putting in years of training to help people like me. (This includes those unsung heroes of cancer care, the oncology nurses, as well.) And kudos to the all the healthcare practitioners who are able to finally achieve a work-home balance.

I ask about what I do now. Do I stick with the practice, and his replacement, or go elsewhere? In his usual honest manner, which always gave me the sense he was looking out for me and not the business side of medicine, he advises me to go elsewhere. Did I mention I hate change? He hands me the contact information for recommended oncologists—my confirmation that I have to start all over again with another doctor.

With that, we exchange “good lucks,” and shake hands.  He’s sad, I can tell. After all, how could he possibly get lucky again and find another patient as endearingly crazy as me? Then I remember where he’s headed and I smile. Where he’s going, he won’t need luck. 

How to Screw Cancer Patients Over Like a BOSS: Tips Gleaned from the Folks at MVP Healthcare

     

How many times have you said this: “Man, I wish there was a quick and easy way to screw over a cancer patient and not pay for services that should be covered!” Well, if you’re an insurance company, you’ve likely uttered this at least 5 million times a day, and you probably have a very precise method for addressing this. But MVP Healthcare may have a better solution!
            MVP is for the first time (unintentionally) revealing its secrets for dicking over cancer patients and aggravating them to the point of insanity, and we think you’ll find it’s very efficient. 

Let’s take a look at how the process works, with one patient we’ll just call Heather, and let’s say she had aggressive breast cancer and is looking for reimbursement for out-of-pocket expenses related to nipple tattooing, a widely recognized final stage of breast reconstruction:

No, not a fan of MVP at this point.

Step 1: Make your company policy known upfront while feigning faux compassion. Example: “Oh Sweetie, I don’t know the specifics of your case, and you haven’t even submitted any paperwork yet, but go ahead and file that claim. They’re not going to pay it.” Cancer patients enjoy being called things like “honey” and “sweetie.” These verbal pats-on-the-head are a sure crowd-pleaser!

Step 2: Don’t bother to say things like, “You needed pre-approval,” because your company’s policy is to deny these claims no matter what the fuck Heather does. This is also the point you ignore all supporting documentation Heather has sent, including a letter of explanation and support from her plastic surgeon and photos of her titties. Holy fuck! Why did this crazy bitch send pictures of her carved-up boobs? Ain’t nobody want to see that shit! Lunch is RUINED!

Step 3: Point out that nipple tattooing by prominent tattoo artists who are known nationally for doing these sorts of things are not covered because they’re not recognized providers. Ignore the fact that hair salon owners are also not recognized providers but insurance companies, including MVP, often cover the cost of the chemo wigs they provide. Roll your eyes if Heather mentions her plastic surgeon doesn’t do tattoos, so she had no other options for completing her reconstruction.

MVP apparently thinks this looks completely normal.
Nope, no tattoos needed here.

Step 4: Speaking of chemo wigs, ignore Heather when she tries to use the example of the time you attempted to deny her coverage for a chemo wig, though her benefits book said you covered 50 percent of the cost, and you tried to deny payment for fat grafting as part of her reconstruction because you viewed it as “cosmetic.” Fuck, don’t these cancer patients ever let ANY shit go?

Step 5: Never give a straight answer. Let’s say Heather calls to check on her claim because she never received anything in the mail acknowledging it but she sees online that it was just denied, with accompanying vague codes mentioning a random code is missing or that she should have only had one nipple done per day. Inform her that, why, you just CAN’T figure out what’s going on and you’re sending her claim back for reprocessing, which should clear things up. Have a good laugh about it when you get off the phone.

Step 6: Play loose with deadlines. Have the first representative tell her that reprocessing her claim should take a couple of weeks, then when that deadline passes, have the next representative tell her that, no, you have 30 days before you have to make a decision. When THAT deadline passes, have a supervisor (let’s call her Sue) tell Heather when she calls back that, “Hey, you were told initially that we weren’t going to pay.” When the patient puts up a fight and mentions what she’s calling a “runaround” (PFFFT! WHATEVER!) tell her you’re on the case and you’ll get back to her with more information on how to proceed. Give her your direct phone line, but –AND THIS IS IMPERATIVE—make sure it’s the wrong number.

I finally feel complete with the tattoos.
But "feeling complete" is not something MVP covers.

Step 7: When Heather calls the next day and points out that the number you gave her directed her to a pre-recorded message, telling her that to go further, she will have to answer some questions and she’ll be entered to win a free cruise, let out a little laugh and make your voice sound apologetic about giving her the wrong number.  Also, make a mental note to bring up with your company’s top brass that you have a great idea for a cancer cruise, which will round up all of the cancer patients and set them adrift on the ocean.

Step 8: Make up more excuses. Something like, “Well, it appears in order to get this claim settled, we have to formally deny it. It was never properly denied.” Heather will mention that there were denial codes attached to her claim and she will ask, “Doesn’t that constitute a formal denial?” This is where you say something super confusing, like, “I would tend to agree with you.” Heather will ask what the fuck that means, but you don’t have to answer. Make it known you’re just the messenger! You should also at this point pretend you still care about Heather’s well-being, and that you want to help her get this claim settled, even though that would mean working against your own company. Maybe she won’t figure it out. 

Step 9: Record a denial of appeal in record time. This will let Heather know how wrong she is—and yeah, go ahead and try to file a level 2 appeal, you dumb shit, Heather. You’ll want to assign a senior medical reviewer for her appeal who is in a totally unrelated field of medicine, say, family practice, and have that person be so fucking dated that he/she could have theoretically been the attending physician at the Battle of Gettysburg. Such a top-notch doctor overrides a practicing plastic surgeon with extensive experience in breast reconstruction and microvascular surgery EVERY TIME.

           

Step 10: If the patient mentions that all stages of reconstruction are covered by the Women’s Health and Cancer Rights Act, stick your fingers in your ears and go, “La la la la – I CAN’T HEAR YOU!”