Habit (22 page)

—Yes, Maxine.

—I just wanted you to know that ESD has terminated your mother's coverage for room and board and rehabilitation therapy starting tomorrow.

—Oh my gosh. Why?

—They say she should have reached full weight-bearing status by now.

—Wait a minute, Maxine. PT and OT say that any day the doctor will approve full weight-bearing activities, and she'll be fully independent again in about a month.

• Weight-bearing activities:
  Exercises while standing on both feet, holding onto something for support at first.
  
• PT and OT:
  Physical Therapy, which should need no explanation, and Occupational Therapy, which helps you figure out how to do all those ADLs when you've been messed up with cancer and broken bones and things.
  

—You can appeal, Ms. Morse. ESD will be calling you.

Nausea. A high-pitched alarm is shrilling between my ears. My brain instantly contracts to the size and condition of a spider monkey on crack, making this next conversation somewhat hallucinatory. I think I may have swallowed my pen, too, so lord knows how I'll ever remember what was
really
said.

Ring. Ring.

—Hello?

—Ms. Morse?

—Yes.

—This is Bertie Walker. I am a heartless creep from ESD.

—So I gather.

—I'm calling to explain why we want to abandon your mother to molder in a rat-infested state home when she still has every chance of recovering. We plan to do this based on the technicality that the therapy for your mother's hip is not progressing according to our guidelines. It does not matter to us that her broken shoulder delayed her, and uninterrupted therapy could mean recovery in a matter of weeks. We definitely understand she is not yet able to change her own colostomy bag, and that if she has to go home right now it will be impossible for her to cope at all since she can't walk yet or even get out of bed unassisted. It is legal for us to do this to her because of our rigid and cleverly constructed rule system, which is designed not by medical professionals, but by money-grabbing fat-cats who got George Bush elected and would also like to kill your children.

—Got it, Bertie. How does the appeal process work?

—Basically, Ms. Morse, you try a series of appeals providing detailed letters from the many medical professionals caring for your mother now (who are justifiably appalled at our behavior) specifying why this decision is not just inexcusable but also seriously stupid. Through all these appeals, we will keep repeating the same denials until hopefully you will give up in exhaustion.

—I wouldn't count on my giving up, Bertie.

—You're welcome to try, Ms. Morse, but it's a little irksome to us that your mother has an advocate like you. We wrap things up so much more efficiently if the patient is old, doped up on OxyIR, can't write, is barely able to hold a phone, and is stuck alone to advocate on her own behalf. We have every confidence that you will fail miserably anyway, and come to regret that decision you made after your father died to save a little money on premiums by leaving Medicare, which treats patients a little more like humans and not statistics. You will curse yourself for switching your mother to an evil, stingy HMO like ESD.

• OxyIR:
  Tylenol with codeine. Ma's still on it. I may have to snitch a couple for myself if this keeps up.
  

—So you're telling me you won't pay for my mother's care until she is better?

—That's right! We do realize we are being total monsters, so we'd like to offer you a tiny consolation. We'll pay for your mother's therapy for
three
days a week instead of the medically prescribed
five
. This is what I'll tell you right now just to get you off our back. Hopefully, you will think it's okay to stop paying attention. Then, when her therapists submit this inadequate program for authorization, it will go to a department that has no clue what is going on. They will say your mother is out of network, since she will still be two hours from home, in Carlisle. They'll say we only cover patients so far outside their networks when the care is urgently needed. They'll claim since she no longer qualifies for room and board at a Sniff, she must be fit enough to go back to Philadelphia for her continued treatment.

—That's ridiculous. She's—

—Yes, you and I know that this will not be true. But still your mother's Arnack will have to spend hours on the phone trying to explain the mess to a series of completely new people who have been thoroughly trained to lie to her and block her every way they can by putting her on hold, disconnecting her accidentally, and so forth. Our hope is that the Arnack will give up, too, and her facility will think long and hard before admitting the next poor old lady who has the misfortune of being covered by ESD. The best outcome to all of this is if sometime soon, when people with HMOs like ESD need rehab, there will be no facilities willing to admit them at all. It will be a great savings all around. Don't you think it's really in all our best interest, yours included, if you just let your mother die as soon as possible?

—I'm sorry. It's actually your
job
to get me to give up on my mother?

—Come on, Ms. Morse; don't act like you haven't thought of this already.

—My God.

—Everyone thinks about giving up, Ms. Morse, even if they're so repressed they can't admit it to themselves. Most people harbor tremendous resentment for their aging parents. Did you have a perfect childhood, Ms. Morse?

—No, but—

—And how has your relationship been over the last several years?

—Not great. But I think it's been sort of getting better—

—That's your problem. Guilt.

—What?

—You pushed your mother to get the cancer treatment. You're trying to keep her alive as long as possible, right?

—Of course, I am.

—Have you ever wondered why?

—Why what?

—Why you keep trying to help her if she was such a disappointment to you. What is it that makes you keep doing that?

—This is not about guilt!

—You can tell yourself that. But everyone's been there, even if their parents were nothing but delightful—the fantasy about Dad dropping dead in the checkout line at the grocery store right after a perfect physical. Mom going to bed a month or so later, feeling fine, and drifting off in her sleep. Or how about a real timesaving two-fer: Both of them could give up the ghost together arm in arm, hit by a truck crossing the street! You'll feel much better if you just admit to these thoughts, Ms. Morse.

—This is sick.

—Yes, and that's the problem. You're repressing what you really want for your mother and driving yourself crazy trying to prove you're a good daughter. This behavior is bad for you, and quite frankly, it's bad for us. We have the misfortune of living in an era of such extreme medical advances that older parents are being cosseted and spoiled and kept alive far, far longer than they should be, Ms. Morse. It's not exactly rational of you to help your mother out of guilt, and it's incredibly expensive for us. The bottom line is, all this therapy and care is only putting off the inevitable. So that's where we come in. ESD is here for you in your time of need, to provide some much-needed tough love. We make the practical decisions people like you can't bring yourselves to consider.

—Wait a second. I thought it was supposed to be the Democrats who want to pull the plug on Grandma. Health care reform hasn't even been initiated yet and
this
is what you plan to do?

—This is our best-kept secret, Ms. Morse. We've never needed a Democrat in the White House to put little old ladies out of their misery. Just get them to break their hips out of network and we'll take it from there.

—Wow. I had no idea ESD's health management was so comprehensive.

—So, Ms. Morse. Have I satisfied your needs at this time?

—Thanks, Bertie. I think I'll stay in denial and work on that appeal.

The lions have slipped the latch of their pen at the zoo. The whole group is out on the prowl. They have just located a sign. It reads:

I was already deep into the labyrinth of figuring out how to get Ma the heck out of ESD, but for other reasons. It had seemed like a good plan, back in the 1990s, to pay less every month, especially because Ma was macrobiotic and wouldn't even take Advil at the time. She had made a living will and literally thought all doctors were fools. ESD paid for her cancer treatment last year without much fuss, and I got the hang of requesting all the approvals on time. But at the end of the eight-month process, we got a notice that Ma's co-pays were about to skyrocket. This meant that if she were hospitalized again, savings on premiums would be completely nullified by the cost of treatment for any future illnesses.

So I'd begun exploring a switch from ESD back to Medicare. The thing making me increasingly anxious was the chance that, because she had not finished her treatment for the Orthodox Christmas broken bones, Ma could fall into some crack between the two policies. ESD did seem to be assuring me that we were allowed to disenroll up until March 31. My last phone call to ESD, though, was with an obliging man with a very thick Spanish accent. The battery was running out on the phone because of all my time on hold, and I felt mistrustful:

—(
on phone
)
Are you SURE I can disenroll my mother anytime before March 31?

—I theenk so.

—You THINK so.

—Well . . .

—Look, I need to know for sure.

—Lemme talk to my supervisore.

Click. Muzak Muzak fading dangerously in and out.

—Meesus Morse?

—Yes?

—You can.

—I CAN?

(I have to be sure. This is crucial. There's this Spanish tendency to drop the “t” sound after the “n” at the end of English words. . . .)

—I CAN or I CANNOT?

—No.

—No. I CAN'T disenroll my mother before March 31?

—You can.

—Got it. I can't.

—No . . . Meesus Morse, you . . . CAN.

(The phone is fading, please, phone, DON'T DIE NOW.)

—C-a-n, I CAN?

—Yes.

Once we disenrolled from ESD, they would no longer pay for anything. This was a little scary, and required checking back with Medicare to make sure they'd really take it all on when she changed over to them. Medicare said they would pay what they were responsible for, but they do have limits. This is why with Medicare it is important to get a Medigap.

• Arp Medigap:
  American Association of Retired People's Medicare supplemental policy. A common alternative to an HMO is Medicare with a Medigap: a supplemental to pick up what Medicare won't. Medicare premiums get taken out of your Social Security, but you have to pay for the Medigap yourself. It's not cheap, but it's worth it. You get your pick, and the one we're flirting with is from AARP, affectionately referred to by those in the know as Arp.
  

A couple of weeks ago, Ma and I had called Arp to start the ball rolling. Leaving ESD was not as easy as Arp made it sound. Having been jerked around enough by the system, I was deeply wary, and terrified to actually commit until I was sure I wouldn't inadvertently get Ma into a jam where
nobody
would pay for her care. What was freaky was that each time I called Arp, I got a new person with a different version of how things would go. One would say
yes, switch her any time and we will start paying for her rehab therapy from the day you switch
. Next day, I'd call just to double-check before disenrolling from ESD. A new, grumpier Arp doppelgänger would need to hear my story all over again before I could even get to any questions:

—Name.

—von Moschzisker.

—Spell it.

—Small-
v
-as-in-victor-
o-n
-as-in-Nancy. New word. Capitol-
m
-as-in-Mary-
o
-
s
-as-in-Sam-
c
-as-in-camera-
h-z
-as-in-zebra-
i-s
-as-in-Sam-
k-e-r
. It's pronounced von Mush-ISSker.

(Daddy had a brilliant spelling technique, but I was too grumpy myself to indulge in it:

v
as in wiener schnitzel

o
as in eau de cologne

n
as in encephalitis

M
as in empire

o
as in aubergine

s
as in estuary

c
as in seaside

h
as in agency

z
as in xenophobe

i
as in eyesore

s
as in escarole

k
as in que sera sera

e
as in eejit

r
as in aardvark.
Or Arnack or Arp, come to think of it.)

The Arp doppelgänger would go on to say that even after the switch, ESD would still be responsible for Ma's rehab. Then I'd call ESD and, of course, their position was pretty consistent: Once Ma disenrolled, they would not pay for a single thing. Meanwhile the express train was roaring though the stations on the way to the deadline for the switch, March 31.