Thanks A Lot Obamacare - Off Goes My Arm

Thanks a lot, Obamacare - Off Goes My Arm

Gottleib

Thirty-five years ago, I was cleaning a bathtub in my apartment in New York when I slipped and tore the bejeebus out of my right shoulder. Over the next couple of years, it dislocated more and more. Anything would do it. Applauding mildly at a Yankee game. Getting punched in the mouth. Moving a pot the two feet to the sink in the kitchenette. Pop!

A surgery was called for. It was drastic, the kind of thing more appropriate as a punishment in Game of Thrones than as a modern medical procedure. A muscle transplant was performed though a big incision. For the six months following surgery, my arm had to be taped to my chest. Then, as I describe in this blog post, another six months of horrific physical therapy that involved the loud ripping of scar tissue. Ouch.

After that, the shoulder kept dislocating. It got to be like a party trick you'd do in a carnival sideshow.

And so was born a pre-existing condition. There came a time in the 90s when my health insurance was interrupted by lengthy periods of travel in Asia, and when re-applying later, anything to do with that shoulder or my back - that whole thing was excluded, top to bottom, for life because I had had been paralyzed by a spinal cord tumor that dinged things up a little when scooped out - was written out of the policy.

A few years ago, another shoulder injury rendered the arm nearly unusable. I spent a couple of months negotiating prices with surgeons, operative facilities, anesthesiologists. It was absurd, trying to get everyone to knock a few bucks off here and there. The fifty bucks here and the thirty bucks there added up to real money for me. For the doctors and their billing offices, of course, this was the act of a subhuman unworthy of their attention.

And in surgery, when it came (cash up front, no checks, please) the doctor seems to have wanted to teach me a lesson. He did something that every doctor I've talked to since has been shocked at. He removed 100 percent of the cartilage in the glenohumeral joint.

Now, that's the ball-and-socket that needs to move smoothly for your shoulder to work. Without cartilage separating the ball from the socket, there's nothing but bone rubbing on bone. Bone on bone is a good way to get a prisoner to tell you anything you want to hear. It's not so good if you want to use your shoulder.

By now, I am unable to use the right arm because every movement feels like someone has snuck up behind me with an axe and planted it in my upper arm. Then their accomplice twangs the tendons in there like a washtub bass. The shoulder has withered away and become misshapen. The upper arm is restricted to a bizarre position flat against the side of my torso. I am crippled, and sick of it.

The only solution, and I've known it for years, is a total shoulder replacement. This is a pricey deal. It's big surgery. And, of course, as a precondition, not covered.

Actually, I was covered for almost nothing. In California, where I was living at the time, I had been declined by all insurance companies and could only qualify for the state's high-risk pool. That was $18,000 per year in premiums, another $18,000 out of pocket and a $70,000 cap. In other words, it was a fuck-you policy, designed by Republicans to assist in the killing-off of a large swath of voters while transferring their assets to one of their favorite constituencies, the insurance companies. All it was good for was to save you whatever came between $36K and $70K. I went with the more straightforward Republican health plan. Don't get sick.

Along came Obamacare. The online application process in the beginning was tantalizing. Because of the initial web site difficulties, it was hard to get to the point where I could believe that it wasn't going to flash the word DENIED at me. When it worked, I couldn't believe it. I had insurance.

Fast forward to today. Literally today. In four hours, one surgeon will hold my humerus in place while another uses a hammer and chisel to whack the humeral head (the top of the arm bone that goes into the shoulder socket) off. Oh, yes, this reminds me: you might like to stay away from YouTube videos of any upcoming surgeries you might be considering, so you don't see how they're going to hollow out the bone and press-fit a spike into it, a procedure requiring great athleticism on the part of the surgeons. The spike has a titanium ball at the top. This will nestle against a plastic cup that will be pinned into three holes drilled through a jig into the glenoid - the part of the shoulder blade that extends to the side, like a little elephant's ear and serves as the socket of the joint. If all goes well, a few weeks of not using it at all, a few months of rehab, and presto-chango! A new shoulder.

In order not to think about the fact that my arm will be being severed and reattached - all but a little skin at the back, some tendons and nerves (I can hope, can't I), I'm here, writing this quick diary.

Me and my arm are off. My apologies to any Republicans who preferred the sight of someone crippled out there on the hiking trails. Sorry not to be able to accommodate you any more.

[Sorry for any typos or bad edits - can't be late to get up to date.]