Not Having Insurance Was Scarier Than Finding The Mass

I had one of those periods so many of us have had. My breasts ached, and I did the physical manifestation of a grimace so many of us have done, I hunched my shoulders and cupped my breasts. It was the last week of January 2019, and I had just turned 41.

The lump I found

What I felt made my gut wrench; I later described it as finding half a tennis ball under my areola. The doctors would measure it as a greater than 7 cm tumor in my right breast, directly under my areola and encased in breast tissue, mammary glands, and fat. I had never felt anything there before, my person had never felt anything there before. You don’t find a 7cm mass in your breast and not KNOW it’s cancer, but the scariest moment was thinking about the health insurance I didn't have. Like so many Americans, I had hedged my bets that I wouldn’t get sick while trying to pay student loan debt I had accumulated putting myself through university and law school, and other debt. I was chronically underemployed since graduating law school in 2007 and had struggled for years to keep my head above the proverbial water.

No insurance to cover a mammogram

I didn’t have insurance, I didn’t have a primary care physician, and I didn’t know how to get a mammogram without those.

I turned to the organization that I have relied on for gynecological services while a teenager and young adult, Planned Parenthood (“PP”). I made an appointment, Scott came with me. This became particularly funny for others who share their location from their phones with other people. He thought to mask his location, I didn’t know to do so, and we laughed later about who thought I was there for an abortion if they had seen me. The staff at PP is always easy to engage with and professional; however, when I explained my concern to the nurse practitioner (“NP”), and she felt my right breast, she became vocally and visually distressed. I had NO physical symptoms other than the large mass in my right breast. I had none of the traditional physical symptoms that often manifest with late-stage breast cancer like a rash, or breast skin rippling, or nipple inverting.

The tests that detected my cancer

I had a mammogram and ultrasound scheduled, 1 April 2019. The expressions on the staffs’ faces were grim and concerning. Both diagnostic tests indicated a large mass in my right breast. I wasn’t asked to schedule a follow-up or to await a call from a doctor after my scans had been reviewed; I saw the breast cancer doctor on call within thirty minutes of my ultrasound. He ordered a “fine-needle aspiration biopsy”, during the procedure a resident kept two-finger tapping the top of my arm in a gesture that felt a little too much like “there, there” but was supposed to distract me from the needle repeatedly going into my breast. The results were immediate and definitive, breast cancer. It wasn’t a surprise, but I still cried. I was alone, by choice. My person had left the day before for a week of judging a moot court competition in DC, his favorite time of year, I was supposed to join him on Thursday. He had asked if I wanted him to stay or return. I declined. The result wasn’t going to change whether he was here or not.

A practicing lawyer with no insurance

Mostly, I cried because I didn’t have health insurance and no idea how I was going to pay for treatment. I was also ashamed because the doctor asked me what I do for a living and then was taken aback when I told him I don’t have health insurance. A practicing lawyer shouldn’t have these problems. It did become almost farcical when the doctor left and his assistant entered the examination room while I was still crying and handed me a book with a title like “So you have breast cancer”, my dark sense of humor got the best of me and I went from crying to laughing a bit hysterically.

Utilizing public healthcare program

On April 3, I met with the financial assistance office. I had been working consistently for several months at that point, which was always an issue with insurance, I often made too much to qualify for my states' expanded Medicaid option and not enough to cover my debt and afford private insurance. My institution couldn’t have been more helpful. They wanted me to have coverage. They wanted me to have the best quality treatment that the world-class institution provides. I am incredibly fortunate to live in a state with a generous public healthcare program. The best healthcare in the world is here and the public policy measures to give me access to it. My state has an expanded Medicaid program for people with breast cancer. The financial assistance office amortized my income over time and got me accepted into that program. With one printed form I no longer had to worry about paying for treatment

Later that month, an MRI would show lesions on my liver. A biopsy would confirm my breast cancer had metastasized. I have de novo stage IV ER/PR+ HER2+ metastatic breast cancer.

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