Start the Presses: Preventative health care is not sexy, but it could save your life

Dan Evans

Dan Evans

Groggy from the propofol, I blinked awake in the recovery area of Shadelands Advanced Endoscopy in Walnut Creek. The procedure was done, and all that was left was to find out how it all turned out.

And, of course, to exchange my blue patterned hospital gown - plenty of room for breeze in the back of that one - for the less revealing clothing in the plastic "patient's belongings" bag on the side of the room.

First, though, I needed a moment.

"How you feeling?" asked a nurse, peering down at me.

I didn't answer immediately, my mind inexplicably deciding to focus on the fact that the fluorescent fixtures matched, exactly, the ones in the Register's old offices on Soscol Avenue.

"Hmm?" I responded, brought back by the look of concern that flashed across the nurse's face.

"Oh, I'm fine. Fine," I said.

"Good. The doctor will be here in a moment. You just rest a bit."

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A bit more than a decade ago, billboards started popping up around the country with stark-white lettering on a blood-red background: "This year thousands of men will die from stubbornness."

The campaign was a markedly unsubtle plea for the male of the species to be more proactive about preventive medical care.

More recently, that nearly forgotten advertisement from a semi-obscure federal agency became internet-famous after an enterprising graffiti artist embellished one with a spray-painted "NO WE WON'T."

First-rate anarchy, that.

Last week, I went through that rite of passage for those passing the half-century mark: the colonoscopy. What you have heard, if you have heard, is true: the prep is the worst part. It involves eating no solid food for about 36 hours before the procedure and taking, the day before, a course of medicines designed to, ahem, clear you out.

On the plus side, consuming the medical equivalent of Drano does tamp down on those hunger feelings.

The minus side is most of the rest of it.

Far worse, though, is not knowing if a time bomb is lurking in your GI tract.

My cousin, Andrew Evans, lives just outside of St. Louis. He is seven years younger than me and, in February, was diagnosed with Stage 4 colon cancer. Like so many people in similar situations, he had no idea anything was wrong until it was really, really wrong.

The afternoon after my procedure, I gave him a call. He was at home, receiving his eighth round of chemo via a pump attached to his body. (Full disclosure: I made sure he knew I planned to write all this, and he explicitly gave me his permission to share his experiences.)

It started, Andrew said, with a pain in his side, one that just wouldn't go away. By the fourth day, two days after his wife Amanda told him he should get it checked out, he made his way to urgent care.

"I thought I might be having appendicitis," said Andrew. "They did a CT scan, and when the doctor came back, he told me that I definitely didn't have appendicitis."

"But," the doctor told him, "I'm 80% sure you have cancer in your liver, and based on its location and appearance it looks like a secondary location."

Shocked, Andrew asked if that meant it was likely Stage 4. The urgent care doctor said yes, adding that he needed to get to an ER immediately.

And so the treadmill of hospitals, doctor's appointments and chemotherapy began. Andrew estimates he's been in the hospital for about a month since this all began, so often that the floor nurses all know his name and minute details about his condition.

Though I might complain - and, well, I just did - about my own prep for my colonoscopy, it ranks as decidedly minor compared to the ordeal Andrew went through. The medication they gave him in the hospital for his ever-expanding list of ailments already made him decidedly nauseated, and apparently - for reasons he still doesn't completely understand - a blood transfusion had to occur at the same time.

Amid all of that - IV fluids, medications, platelets, nausea - Andrew still had to go through the same colon cleanse I did.

Awful.

And for his reward?

"And then I got the colonoscopy, and they found a tumor in my upper colon," he said. "That was the diagnosis, and there is cancer in the liver. My liver is f***ing overrun."

About five years ago, my doctor at the time recommended that I get a colonoscopy, saying the age for screening had recently been lowered to 45 from 50. Though not excited about it, I made the arrangements, but stopped when I found out my insurance wouldn't pay for it, and I would be stuck with a bill for around $8,000. I did it this year because I'm now 51 and insurance will cover it.

I told Andrew this, and he said that sounded about right.

"No insurance company will pay for it unless it fits into their exact criteria, but it's not reasonable to pay for it yourself," he said. "I've had bowel issues all my life, and I probably should have gotten one at 35, but there was no way that would happen. I couldn't pay $8,000. That's ridiculous."

And in a sadly familiar tale, Andrew said he's constantly been having to fight with his insurance company to pay for procedures, to bill things correctly and to simply get the care he needs. Whether the denial comes from a person, a spreadsheet or some AI-powered claims system, the result is the same: Another barrier between a patient and care.

That burden, Andrew said, has fallen largely to Amanda. She is the one dealing with the insurance company, chasing down billing problems, and fighting through the administrative nonsense that no family should have to navigate in the middle of a cancer diagnosis.

"My wife has been my rock," he said.

That nonsense, this distraction, is all the worse because he knows his time is limited. His form of cancer is aggressive, unusual for colon cancers. The chemo, for all of its awful and intense side effects, has not reduced the growth; it has only stopped it from growing.

"It is treatable, not curable," he said. "I'm not fighting for it to go away, I'm fighting to have more time."

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Dr. Ali Vaziri, who had chatted amiably in his Napa medical office about my large intestine a few weeks prior, pulled back the curtain to the recovery room. As I returned to my usual level of consciousness, he told me I was cancer-free, though there was a bit of diverticulosis I needed to be mindful of. We'd discuss it more when we had our follow-up in a week or so.

He cheerfully wished me a good day, and we both went about our usual lives.

I feel enormously grateful that nothing serious was discovered, and grateful to live in a world where such procedures are common, mostly convenient and largely covered.

But gratitude is not quite the same thing as acceptance.

Preventive care should not depend on whether you know the right age cutoff, have the right insurance plan, can afford the wrong bill, or have the stamina to fight through whatever bureaucratic obstacle gets placed in your way. These sorts of preventive treatments save lives. They give people choices. They give families time.

I was lucky. I got the test, got the good news, got dressed and went home.

Andrew did not get that version of the story.

So get the appointment. Push through the embarrassment, the inconvenience, the bad prep drink, the insurance nonsense, and whatever stubborn voice tells you to wait.

Your family, your friends and your community need you here.

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