A Young Woman’s Story of Fighting Breast Cancer and the So-Called Healthcare System

Courtney comes in to see me eight weeks after having a double mastectomy. She was diagnosed with breast cancer in August of 2017. Courtney is thirty-two years old and is in graduate school for a specialized degree in education. Her intention was to teach by bringing high-needs children into connection with nature and the outdoors. Courtney, like most adults her age and younger, came to Tahoe because of it’s beauty and opportunities for outdoor adventures. And like many people her age, finding affordable housing in this area is almost impossible, and one has to have at least two jobs in order to live here. So Courtney has been a nanny, a retail worker; a teacher in some capacity when she can find opportunities, and has scrimped by.

Courtney sat down in the chair, still wearing her little apron that holds the drains from the surgery, with the embroidered words, “Fuck Cancer,” in pink letters. Courtney carries her binder everywhere with tabs marking sections with all of her medical providers, her diagnosis and treatment information, lists of drugs she needs to take, and a huge section devoted entirely to her ongoing arguments with Medi-Cal.

“I sometimes spend several hours on hold waiting to talk to someone about why they’re denying coverage for my anti-nausea medication,” she says.

Today, after Courtney sinks into her chair across from me, she takes a deep breath and sighs, “It’s in my bones,” she says, her eyes welling. “I just came from my oncologist’s office and she said it is in my ribs and sternum, which explains why there was so much pain after a simple needle biopsy before my surgery. The needle broke my rib.”

Every time Courtney vomits, it further damages the rib, and the pain is beyond excruciating. But Medi-Cal is denying the dissolvable anti-nausea medication that prevents vomiting and the medication is too expensive for Courtney.

Courtney is thirty-two years old. She has been my client for a little over two years. When she first came in to see me, her main struggles were around choosing horrible men who fulfilled a story she had about herself…one most women are familiar with….”I’m not good enough for a decent boyfriend, so I may as well take whatever I can get.” Courtney is intelligent, with a great sense of humor, and a college degree. Courtney’s smile was huge, her eyes bright and fringed with dark eyelashes, and her heart seemed that it could hold infinite amounts of compassion for everyone but herself. She was the kind of girlfriend who would wait for hours for horrible men to call back; she would bring her horrible choices in men food if they were sick; she would hang on to every little crumb that suggested they might be interested in her, and make it into a banquet, as women whose orphan complexes speak loudly do with crumbs. We orphans know hunger; we know how to starve, and we know that crumbs may be all we get. We have histories of being easily discarded, replaced, and being told we do not have the right to take. We are told from early on in our lives that we should be silent, that we do not deserve to take up any space, that we are “selfish,” when we ask for any need to be met, whether it is for food, clothing, or attention and affection. We know we must not disappoint in any way. The thread between those who hold the power of approval and our hearts is very strong and we are afraid to sever it.

There was a lot of work to be done in therapy. Courtney had coverage through California Health and Wellness for behavioral health services with me until she re-applied for services. She was denied because she had moved a few hundred feet over the Nevada County line into Placer County, which happens to be one of the counties in California where insurance plans provided through the Affordable Care Act had been cut as of the present administration’s plan to repeal and replace. The repeal seemed to be occurring, but no replacement had been offered as of Courtney’s application for coverage in April of 2017. She stopped coming to therapy, partly because her life was headed in a very positive direction. She had applied to graduate school to obtain her master’s degree in special education. She had a focus to provide outdoor and experiential education for children at risk or with special needs. For the first time maybe in her life, she owned her life and felt more empowered to make healthier choices. No more horrible men. And, she couldn’t afford therapy even if she did want it now that her coverage had been terminated.

But when she was diagnosed with breast cancer in both breasts, she contacted me for an appointment, and I was glad to see her even if she couldn’t pay. The treatment plan included a double mastectomy with follow up chemotherapy. The tests revealed that the cancer had spread and that the best option was a double mastectomy. “But I’m going to have breast reconstruction,” she said with her adorable smile lighting up her face. “I’m going to have perky titties!”

She told me that once she was diagnosed with breast cancer, her medical treatment was being coordinated through the Gene Upshaw Cancer Center here in Truckee, CA. Thus far, she has received excellent care by her medical providers, however, many of the prescribed medications and treatments recommended and approved by her doctors have been denied by Medi-Cal.

CA Health and Wellness terminated her coverage for my services because her physical address is in Placer County, where, because of the uncertainty around changes in the ACA, California Health and Wellness, Anthem Blue Cross, and other providers who participated in Covered California’s marketplace plans have opted to terminate coverage in most California counties, Placer County being among them. Her mailing address is in Nevada County, where for the time being, her insurance coverage would have been maintained had she continued to live in that county. Her choice of where to live is the result of the lack of access to affordable housing in this area. She searched for months and finally managed to get a room she could afford in someone’s house, which unfortunately, was in Placer County within a few hundred yards of the Nevada County line as I’d mentioned.

Therefore, Courtney, whose cancer treatment required a double mastectomy in September of 2017, with follow up chemotherapy, radiation, and hormone therapy, has no access to mental health services with me when she needs them most. The argument from CA Health and Wellness may be that she has the option to seek mental health services through Nevada County, however, Nevada County only accepts clients with chronic and severe mental health problems or psychiatric emergencies. She may also obtain therapy through the Cancer Center, however, those services are limited because the need is so great. She has developed a trusting and safe relationship with me, and she should have the right to continue with the therapist of her choice.

Courtney came to see me a week ago after a visit with her oncologist, who informed her that the cancer has spread to her sternum and ribs, and that she is now considered a Stage IV cancer patient. She will undergo chemotherapy beginning next week, with the hope of a positive outcome, which may prolong her life.

In addition, Courtney informed me that Med-Cal has denied coverage for breast reconstruction (which at this point she has chosen not to do); pain medication, a dissolvable form of Zofran for nausea, and numerous other medications. Medi-Cal is denying coverage for Percocet because they tell her, “you have had three prescriptions, and you are now considered a potential addict who is likely to abuse the medication.” This client had a diagnostic needle biopsy in August, which broke her rib, and which was not diagnosed until just recently when she underwent a bone scan. In late September, she underwent a double mastectomy, and has suffered from excruciating pain as a result of the broken rib and the surgery. Vomiting has further aggravated the fracture to her rib and sternum. She tells me she has been on hold with Medi-Cal for several hours at a time trying to get information as to why they are denying coverage for necessary treatments and medications, only to be told there is nothing they can or will do to reverse their decision. I realize that Cenpatico (California Health and Wellness’ parent company) may not be involved with her medical care, and that her Nurse Navigator at the Gene Upshaw Cancer Center may be the person to advocate for her, however, I am really astonished, angry, and disappointed that this young woman who has virtually no financial resources right now, is being denied medical care that what every American (and every human) should have access to without question. It is not difficult to become incensed over the reality that some of the wealthiest people in this country who also have the most power and privilege, e.g., the policymakers and politicians, refuse to back down on their positions that deny access to basic human services for those who most need it. They seem not to care how dehumanizing their decisions are, nor do they have any insight or concern as into how painful it is to be among those who are unable to meet even their most basic needs.

Courtney has been personally affected and hugely impacted by the decisions made by the current administration around repealing the ACA and the proposed tax bill. With the proposed changes in the ACA, she will not be eligible for ongoing therapy with me, or, quite possibly, other expenses related to her treatment for cancer because she lives in Placer County. Additionally, if the new tax bill is approved, she will no longer be able to claim her medical expenses on her taxes.

And yet, Courtney smiles. She plans to go wedding dress shopping with her friend in a couple of weeks, she finds the humor in her situation, but also honors her anger over the de-humanizing problem of getting her basic healthcare needs met. I will write letters to anyone and everyone in some effort to advocate for her; I will invite the risk of speaking my truth about how cruel this nation’s people with political and economic power are in in making the care and well-being of humans into a profit-oriented business. I will gladly subvert a system I believe is archaic and just plain silly in its self-important and cumbersome way of what is euphemistically called, “Health CARE.”