The Cost of Hope
Page 16
I must face my fear of dismantling these layers. Once this belonging-sculpture is leveled and I root out the contents of this dresser, the last visual clues to his mind will be gone.
I also must face another of my secret fears. It’s a faint one, but real nonetheless. He fiercely guards his private space. I have never opened these drawers. Once I enter them, what will I find? Will I find evidence after all these years that he really is a spy? More identities? Perhaps his three names—Laudeman, Rotunno, Foley—are not the whole story? Will I find a fourth name? A fifth? Will I find that, like his father, he has concealed another marriage that I don’t know about? Another family? Will I find baby pictures I don’t recognize? Long-preserved letters or legal documents?
I attack the layers slowly. As I work, I write down everything I find and sort things into piles. Keep. Throw away. Save for the children. Donate to Goodwill. I must be tough on myself. Nearly everything I find I want to keep.
Here is the catalog of the things that Terence filled his life with in his last six months:
San Francisco cable car conductor hat
Agfa box camera
Kazoo
Joke glasses with a nose
Two baby blue angel candle holders
6 rolls of film
Silver baby shoe bank
Calligraphy ink
Gold bow
Valve oil
Leica camera
Two “learn Italian” tapes
Zopkuu camera
Two alarm clocks
Gift-wrapped Chris Thomas King CD of Hurricane Katrina songs
Card from vintage furniture store
3 disposable cameras
Discman
Pocketknife
Arabic flash cards
Admission ticket to Pompeii
Violin bow
Teak box with:
11 gold pens
12 pairs of cufflinks
5 boxes of rosin
27 bow ties—some unopened
Unused urine sample cup
Book of checks
Book of check deposit slips
Clippings
Bush’s economics
Korean war
CD of Bob Dylan’s Highway 61
CD of Terry’s band, The Astronauts
Medication list from August 20, 2007
Boar-bristle clothes brush
Livestrong wristband
Book of souvenir postcards from 1876 Philadelphia
Investigative Reporters and Editors membership card
3 combs
Clothing patch from Oregon City Traditional Jazz Society
Philadelphia musician’s union card (Local 77) for 2006/2007
Metal model of a 1950s four-propeller passenger plane
4 watchbands
67 guitar picks
Beer bottle opener
Betty Grable pinup picture
Bagpipe practice pipes
Records and one CD of calliope music
Plastic model kit of the Titanic
Boston Globe, April 16, 1912, announcing Titanic sinking
Cinderella note cards
Calligraphy set
Plastic folder with 15 parking tickets
CD: Acting with a British Accent
CD of Christmas carols
CD of Chinese poetry by Terence Foley
CD set of Jo Stafford
Tape of Howard Zinn on U.S. imperialism and the war with Spain
NY note card (letter inside)
Center City Car Wash member card
Philadelphia Archery and Gun Club membership card from 2005
USAA membership card
Faculty DragonCard (Drexel)
Prescription drug plan card
Frequent photo rewards card from Ritz/Wolf camera stores
Community College of Philadelphia student ID from 2006
Luggage tags
Plane and train receipts
Post-it notes
Postcards (used and unused)
Cough drops
Batteries
Books:
Easy Japanese
Japanese-English dictionary
Pocket-size King Lear
Russian phrasebook
King James Version of the Bible
Pocket-size Macbeth
Mao’s Little Red Book
Basic Japanese Conversation
English-Chinese dictionary
Getting Along in French
1954 edition of Fenn’s Chinese dictionary
The Field Guide to Stains
The Hundred Best Movies
How to Play the Concertina
Instruction books for violin, sax, and trombone
Donald Keene book of Japanese literature
Book on the teaching of Islam
3 harmonicas
5 recorders
1.5-inch harmonica
Flash cards
French conversation
Spanish verbs
Spanish grammar
French grammar
Red silk flag of communist Vietnam
3 decks of playing cards
Pack of 2 decks of playing cards with dice
Straight razor
Clown head pencil sharpener
Model Norfolk and Western coal car
Model tuba
Pocket watch and chain
BB gun
Arab sheik Halloween costume
Volcanic rock from Mount Vesuvius
Bagpipe chanter
3 juggling balls and a teach yourself juggling book
Gun cleaning set
6 pairs of spectacles
4 money belts
American Dairy Association tie clip
Plants of the Bible playing cards
Booklet: On Khrushchev’s Phony Communism and Its Historical Lessons for the World
One corner of one drawer has a tiny stash of socks and underwear and handkerchiefs. The three shallow upper drawers have been turned into filing spaces for the index cards that he always carries with him in his left-hand breast pocket. I find them there organized and categorized by subject, each stack rubber-banded and labeled:
Movies to Watch
T2 Movies
Warfare
Boxing
TBF Poetry
Media Stupidity
Entomology
Latin
AP
Christmas Display
TBF Haiku
Story Ideas
Architecture
North Korea
Ph.D.
Jokes
UK Asia Center
China Civ
Interrog.
Medical
Music
Newspaper Clippings
Addresses and Directions
Japanese Flash Cards
Arabic Flash Cards
Notes to Self
Business Cards
To my relief—and disappointment?—there are no stray pay stubs from the CIA. No letters of commendation with Langley return addresses. No testimonials of service recognized by the grateful people of Cuba. Or the Soviet Union. Or China or North Korea for that matter. I find no unexplained photos. No baby pictures except of our own children. No letters from unknown lovers. No rent checks for condos in Florida. No evidence of requests from long-unacknowledged children for belated meetings.
Perhaps there is some evidence somewhere of some mysterious, unspoken, shadowy life that he once lived outside of my view. “No one ever knows one hundred percent of anyone,” he is fond of saying. If such an alternate existence existed—and for all his romantic mystery, I doubt there was one—he, like any clever spy, has erased all trace of it. All that is left is the shadow of an outsized personality for whom anything is, if not probable, at least possible.
I will never know.
What I do find, though, is plenty of evidence of the man I do know, a man who lives deeply inside his own family. There is Terry’s hair from his first cu
t. A crooked pottery mug made by Georgia. Photos and photos and photos. Our gap-toothed children. Our smiling children. Our sullen children turning from the camera. Our children in overalls. A white Easter hat. Birthday cards from Terry and Georgia from 1999. A sheet of crayoned coupons promising dozens of impossibly virtuous feats for Father’s Day.
One thing I find tickles me—something I have already seen a few years earlier. One evening over dinner, he gleefully told Georgia and Terry and me about finding a doodle that a young woman in his journalism class had accidentally left behind. He showed us the paper, and we all laughed. Now, here, in the bottom of his dresser, three years after his death, I find the doodle again—only now it is carefully trimmed and framed.
It reads: “Terence Foley is hot.”
Yet if anything really surprises me, it is the extent of his sentimental attachment to our mutual past. I open a drawer to find a stash of yellowing newspapers. I flip through them to find copies of every news project I have ever directed. Atlanta. Oregon. Lexington. Philly. There is a trade magazine with my picture on the cover. A nude photo of me from 1987 or 1988, discreetly tucked away in a small box. Safely stashed between two layers of cardboard I find our campy wedding photo from China and I remember, just for a second, standing there as the photographer snapped the shot. And there, as well, carefully preserved, I find the business card I handed him on that long-ago day in Beijing, tucked in side by side with one of his own.
As the summer heat spreads through 2006, Terence is getting better and my work is getting harder and harder. Tensions with the new owner are rising. Every night I come home to Terence with the tale of some new, usually unpleasant, twist. I begin to feel the odd, lurching vertigo of riding the waves of big uncontrollable shifts in power. Daily life begins to feel like some HBO special on the Borgias, or perhaps I, Claudius. Conversations start and stop depending on who is in the room. Cabals form, dissolve, and reform again. The neutral middle of satisfying work well done is crushed between the glaring counterpoles of—for some people—ambition unleashed, and for others, despair. Both appear in unexpected places, owned by unexpected people. Each feels equally unsettling. At night, when I can’t sleep, Terence walks me up and down the halls of our house. Up and down. Up and down. And for just that moment, everything is okay.
I am fired on Wednesday, November 8, 2006, one week after Terence begins his ninth cycle of Avastin.
That afternoon, I get a call from Matt Winkler, editor in chief of Bloomberg News.
“So do you know what you are doing next?” he asks me.
“No,” I say.
“Well, I do.”
Matt is an old friend from my Wall Street Journal days. Bloomberg is a once-upstart organization now flexing some big muscles. But how can I work there? It’s known for its 6:00 a.m. meetings, sixteen-hour days, and grueling pace. What’s more, it’s a two-hour commute from home. Each way.
Thrown off one bucking bronco, I’m being asked to jump onto another one and begin another wild ride, this time at a place just as ferociously determined to grow and thrive as the last one was to try not to vanish.
Terence once again steps into the breach.
“Don’t worry about a thing at home. I’ll handle everything,” he says. “Do it.”
And so I do.
We live in hope.
20
So what’s the cost of all this hope?
That’s the big mystery that my colleague Chuck Babcock and I work for six months to discover. Starting in the summer of 2008, and working well past the second anniversary of Terence’s death, I fax off requests to hospitals and doctors. Meanwhile, to help us understand what we are looking at, Chuck builds a series of spreadsheets, and I compare what we are seeing with my memories of our experience and my reporting.
You might think that I would have a pretty good idea of the costs of Terence’s illness. After all, throughout all of his treatments, the statements from the doctors’ offices, from the hospitals, and from the laboratories poured in regularly. Every month also brought a blizzard of envelopes from the insurance companies, the “explanations of benefits” that were supposed to tell me what we had been billed for a service, what the insurance company paid, and what we owed.
At first I think my own messy life is the reason I didn’t really have a clue about the costs. I am more than usually disorganized, more than usually perplexed by detail, more than usually panicked when confronted with numbers I don’t understand and can’t make sense of. And, as Terence got sicker, slowly and subtly I found myself increasingly overwhelmed. I kept the mortgage paid, the lights on, and the kids fed. I kept the car insurance current and the kids’ shots up to date. When doctors’ bills came with balances on them, I paid them. But tally them up? Figure out who was charging what for what? Untwist the maze of providers and services? Half the time the bills came with names I had never heard of for things I didn’t recognize. I had no trouble at first believing I was to blame for my own lack of knowledge.
Yet the more Chuck and I work, the easier it becomes to see why despite the blizzard of paper I received, I had no idea what anything cost. As we leaf through the stack of documents, it is also easy to see why 21 percent of the money spent on health care goes to paperwork and administration. The bills we review are voluminous and often incomprehensible. Some take days to decipher. What does “opdpatins t” or “balxfrded” mean? How can I tell if the dose charged was the same as the dose prescribed?
Chuck and I make nuisances of ourselves with the folks on the other end of the line. Who were these doctors whose names were on the bills? We unearthed bills with complicated corporate names, for health care providers Terence and I never met, for procedures I can’t remember happening. Sometimes one visit generated a flurry of bills from a half-dozen different providers. From the doctor. The person who took the scan. The person who read the scan. Sometimes the insurance payments lumped several different things together into one generic heading—like “radiology.”
As we work, a strange pattern begins to emerge: We begin to see that some things that should have cost about the same had wildly different price tags. What is going on? Why are our numbers varying so wildly? To try to figure out what was happening, we picked a common, standard procedure: computerized tomography, better known as the CT, or CAT scan. Computerized tomography is a procedure that links a rapid series of X-rays to make a 3-D image of a patient’s organs. Terence had been having CAT scans pretty steadily ever since that first day in the emergency room in Oregon when the cancer was discovered. During the Avastin/Nexavar trial, it was the results of the CAT scans that we waited so breathlessly for.
Surely it should be reasonably easy to find out how much we—through my employer’s insurance—paid for each one.
Unexpectedly, my messy life turns out to lead us to surprising insights. Because Terence and I moved a lot, Chuck and I can now see what most people never get to see. We can see not only what one hospital charged for the scans, but also what many different hospitals and other providers all across the country charged. And because each move came with a change of employer—and a change of health insurance—we can see something even more interesting: We can see what different insurance companies reimbursed for pretty much the same procedure. By the time he died, Terence had received benefits from four insurers and had undergone procedures in four different states. He was also eligible for Medicare for most of this time, although we never used it.
The first thing that surprises me from our research is simply the sheer number of the procedures that Terence had. If Chuck had asked me how many CAT scans I believed Terence had had, I would have guessed sixteen. One for each cycle of the clinical trial and, say, a half-dozen more throughout the years. Wild guess.
The answer is seventy-six. Seventy-six CAT scans during a seven-year illness. More than ten a year. I’m sure Terence’s guess would have been more accurate than mine, but I’m also sure he would have guessed low too. Way low. Some of the scans were ordered by Dr
. Pierce, some by Dr. Bukowski, and some by Dr. Flaherty. But many others were ordered in various hospitals across the country, some by doctors we never met for purposes I can’t now explain. Since none of us—Terence and me included—had to account for the cost of these procedures, all of us, doctors and patients alike, could casually afford to pop them like cherry Twizzlers.
Were all of them useful and ordered for a good reason? I’m positive of that. Were all of them necessary? I’m just as sure not.
And how much did they cost?
Some scans were done on the old enclosed-tunnel machines. Some on daintier machines that had more open space and made less noise. Some were done “with contrast”—that is, with a special dye used to help see the cancer. Some were done without. Some were done in hospitals, others in stand-alone imaging centers that do nothing else. Overall, though, each of the scans was pretty much the same.
Yet from Portland to Philadelphia, from 2000 to 2007, the price of the procedures ordered by Terence’s doctors ranged from $550 in April 2001 at EPIC Imaging in Portland to $3,232 in 2006 and 2007 at the Hospital of the University of Pennsylvania in Philadelphia. In between were charges like $1,252 at St. Joseph Hospital in Lexington, Kentucky, in 2002 and $1,750 at the Cleveland Clinic in 2003.
The most expensive charge was more than twelve times the amount reimbursed by Medicare in 2007, the government health program for the elderly and disabled that is the biggest U.S. payer of medical bills.
What’s more, we discovered that the amounts the hospitals and providers billed the insurance companies bore almost no resemblance to the amounts the insurance companies actually paid. And each insurance company made a totally different calculation of what they would pay for the same procedure.
The turmoil at the Inquirer provided a startling insight into this fact. Because the Inquirer’s new owner immediately changed our health insurance plan, Chuck and I are able to see something strange: what two different insurance companies paid for the same procedure.