Necrotic

 A sad day today. Someone whom I met in Nashville in 2022, and who has since become a regular audience member in the live chat of my Wednesday podcast, hardly ever missing a week, and often giving me generous donations, has received a prognosis from his physician that he has at most a year to live. He goes by Sammie.

It was devastating to hear it. I can't imagine what he is going through. 

He is a retired sound engineer. He said worked with the famous band Lynyrd Skynyrd in the 1970s. He once offered to help me with the audio of my podcast as I struggled to get the microphone settings correct.

He lives by himself, somewhat estranged from his family nearby. He has become, via our private direct messages to each other, someone I would consider a friend. He had, in a roundabout fashion, extended an invitation for me to visit him at his home in southwest Virginia.

A month ago he went into the hospital because of abdominal pain. His gall bladder was in bad shape, so they removed it.

Jessica had the same thing happen to her two years ago, exactly over her birthday.  She woke me up in the middle of the night and asked me take her to the emergency room at a hospital. She was in severe pain. She already knew it was her gallbladder. 

In the ER they took an ultrasound and confirmed it. They offered her fentanyl and she gladly took it. The first round didn't work so she a second before getting relief.

Of course we wondered about the cost. She had no insurance.  The ER nurses didn't bat an eye hearing that she didn't have insurance. They said that because she was uninsured and technically had no income anymore (having wound down her practice) that the State of Arizona would pick up the entire cost through a fund they had established for this.  The nurses went into an almost scripted procedure that would get her into the state fund as quickly as possible, like they had probably done many times before.

She was admitted into the hospital in a private room. The nurses took great care of her. She was scheduled for surgery with one of the best specialists for this operation in the whole Phoenix Valley. 

"This is the guy you'd want doing your gallbladder," the nurses told her. "He's the guy they send people to, if the first surgeon botches the removal and they have to fix it."

Jessica had known for several years that she would probably have to have her gallbladder removed. Her mother had required a similar procedure. But surgery is always a bit harrowing. 

She came through fine. No complications were expected. The nurses kept her in that room that night and would have let her stay several more days but she was eager to get home. A couple weeks later she saw the surgeon again for a follow-up. She never got a bill for any of it. 

I'd already learned from her one of the dirty secrets of the American medical system, namely that in a great many cases, it is better to be uninsured than to be insured. The self-pay cash rate is far cheaper at most clinics, but if you tell them you have insurance, they have to charge the much higher rate, and you stuck with whatever settlement shakes out of it. She herself had run cash-only practice in Scottsdale. Technically that was because of Arizona state board regulations that prevented naturopaths from accepting insurance. That sounds bad, but that is a great benefit to them, to have to run a cash practice. They hate insurance. It's like you're working the Mafia. In Oregon, that's what it's like. At her old clinic in Portland, she had to take insurance. The patients are often much less invested in their treatment, because they think of it as "free" for them. People who pay cash are far more invested. But in this case, not even cash was necessary.

No complications were expected from her surgery. It turned out that it had gotten caught early, such that only a small part of the organ was inflamed. 

The nurses told her that among gall bladder patients, the ones most likely to have trouble are older men, often because they try to tough it too long until the organ becomes truly necrotic. Women tend to come in earlier, and thus they tend to be fixable.

I don't know if that applies to my friend and listener Sammie. According to him, the hospital delayed surgery several days. Only then was it discovered that severely necrotic state of the organ. Bile had been pouring into his abdominal cavity. Two days ago he learned that this had caused irreparable mortal damage to his internal organs. Probably his pancreas.

This sucks. I'm praying for him.