Reflections on Possums, Friendship, and What's Wrong With the American Healthcare System

Yeah, all of that. This post is to summarize Operation Possum Chomp, its aftermath, some advice, and how it fits into the bigger scheme of things.

I'm a damn possum, okay?
My number one piece of advice is to never insert your hand into the mouth of a possum (Yes, I know "Virginia Oppossum - Didelphis Virginiana." It's a damn possum).

She has a bite strength of about 50 psi, delivered quite efficiently through this set of hardware. Delivered in the right place and with sufficient enthusiasm, it can break bones in the hand or foot. 

The good news is possums don't latch. They snap. I equate it to having your hand slammed in a door. With needles. 

If you have a garage or shed, possums like cardboard boxes. Okay, there's your PSA.

One more PSA. If you are ever bitten or scratched by a wild animal, worry less about catching it than first aid. Scrub it good with hot soap and water and follow up with a thick layer of topical antibiotic cream. Nasties are carried by saliva and any you can wash away or neutralize is a good thing. 

You should also seek medical attention. Possums are not a known reservoir of rabies. The last confirmed rabid possum was during a rabies epidemic in New York in the 1990s. However, all mammals, including us, are susceptible to rabies (we'll talk more about that in a bit.) Possums can also carry a variety of zoonotic beasties that just got very efficiently injected into my hand.

I ended up with a tetanus booster, a course of strong antibiotics, and a lecture about the rabies vaccine. The doc can't order you to take it but she can make it VERY clear that she wants you to. Rabies has been treatable for well over a century. If you're over 40, you've probably heard horror stories of injections into the belly with large bore needles. The good news is that things have improved. It's not fun, but it is doable and hurts a lot less than the large bore needles you just got hit with. 

So, what was my first thought on getting this information?

This is the United States. My first thought was "What's this going to cost?" I have very good insurance from Blue Cross via the ACA federal exchange. But I couldn't make the decision until I knew the cost. 

Let that sink in. I couldn't make a decision about a 100% effective vaccine that would completely negate the small, but not non-existent, chance I had of contracting a disease that is 100% fatal after the treatment window has passed. And it's not just fatal . . . it's bad fatal. Think if HIV and MS are dogs and you're the bone. 

My first thought was the cost. There was also a fear of pain, but mostly it was getting a multi-thousand-dollar hospital bill. It's real. Stories abound of those who end up in the ER with snake, spider, or scorpion bites and stings and post their $50,000 bills online. 

And, of course, it was too late to call Blue Cross. 

In bed, cradling my aching hand, I got thinking about it:

The bite is probably not rabies. 
The spot is probably not cancer.
The tick bite is probably not Lyme Disease.
 And so on and so on. Most of our fears don't come to fruition.  

But I thought about those I know who are battling horrific conditions and those no longer with me. If they'd been offered a vaccine that would negate even that microscopic risk, even if painful and inconvenient, they would have been first in line. 

It's like the HPV vaccine. What parent wouldn't want to protect their child from a known cancer link? The biggest argument I've seen against it is standard murikan puritanism, "How DARE they suggest that MY CHILD would be susceptible to a SEXUALLY-TRANSMITTED disease?" 

Uh . . . that child is a mammal. They are susceptible to sexually-transmitted diseases. 

And, I'm a mammal that was bitten by another mammal. That makes me susceptible to rabies. 

The final decision came to me when my injured hand spasmed. That's an early symptom. Now, I know, rationally, that I have inflammation in the tendons and nerves and a small spasm is perfectly normal. But there was a catch in my throat. One thing rabies does have in common with HIV is that is can be latent for years and then unfurl its deadly flower. I didn't want to have that dry spot in my throat every time I had a muscle spasm or weird pain or a headache for the next decade. 

My call with Blue Cross went well. After reviewing my policy and the byzantine labyrinth of deductibles and co-insurance and co-pays and out-of-pocket maximums, I was looking at around $500. The initial shot to arrest the virus is $1,000 per dose. I needed six doses. That is before office visits and the actual vaccine. 

I cannot imagine facing the decision for myself or a loved one without insurance. The loss of the once robust county health systems has left a real void. I wasn't being reckless. I wasn't petting a wild animal. I wasn't taunting or trying to tame it. I was raised by a true mountain man. One of the first lessons is that "If you can touch it, that means it's too sick to run away. DO NOT TOUCH WILD ANIMALS." My "crime" was reaching into a box in my own garage without looking first. 

However, I was in a tenuous situation where even $500 was disastrous. Business is slow, I'm behind on my bills, and I don't have family to reach out to. 

Oh, wait, yes I do.

The family I chose. 

I made the decision to crowdfund the vaccine course and had it done in about two hours. Not just the money, but the warmth and support. What could have been stressful and terrifying became something to schedule and work out. I was given confidence and a reminder that I have people who care. That matters all the time but it never matters more than when you're sick or hurt. 

But what's a warm and hopeful story points out the farce that is the current healthcare system. 

1) A common life-saving vaccine that is administered about 30,000 times per year should not cost a-fucking-grand per syringe. It's not some exotic biological or experimental drug. The wheel has been invented. It's a blood plasma derivative followed up with a standard killed-virus vaccine. In particular, vaccines and anti-venoms should be strictly price-controlled. When you are bleeding on a gurney with poison being pumped through you by your own heart, you can't ask for quotes or make the kind of informed decisions that make competition work. You are the epitome of the captive market. 

2) Reformatting the American health care system must include revitalizing the county health system. I should have gone to my doctor and received an immediate referral to the county health department. There, while they were mixing up the initial drug cocktail, I should have been interviewed about the incident for statistical purposes and then given the vaccine with a modest co-pay based on my income. County health clinics would be a perfect use for current Medicaid funding after we merge Medicaid, Medicare, Tricare, and CHIP. Some places do still have great programs, but it is a frayed patchwork quilt that can vary by county. 

3) And even though I want to hug every single person, near and far, that helped me, it's insane that anyone should have to crowdfund mission-critical time-sensitive medical care. 

But, politically, I'm not interested in tweets and slogans. "FREE HEALTHCARE" is meaningless. I want to talk about the details. I don't want to hear that "Oh, I'm sure [candidate] has thought all that through and just doesn't want to bore us." No. I want to see the details about how we reformat such an enormous segment of our economy. I know most other countries do it. We're different. It's a complex situation that dates back to the formation of Medicare that was exacerbated by chaining health insurance to employment. That dates to post-WWII as a way to circumvent wage-hour laws. We have a hell of a knot to untie. 

I was lucky. I had a low-risk bite, health insurance, time to think it through, the ability to have an analytical phone call with my insurers, responsive insurers (not an off-shore call center) willing to go through it step by step with me, and amazing friends who had my back. 

Repeating the statistics. THIRTY THOUSAND people in the US receive the combined rabies series every year. It has reduced the death toll to nearly zero. In under-developed countries, the annual death toll is up to 70,000. In the US, rabies has been controlled in humans. It has not been eradicated. The number we don't have is how many people who don't have the resources just bandage their wounds and decide to roll the dice. 

As of today, I have a big bottle of horse pills, 4 neatly closed puncture wounds (three in a perfect triangle), and the memory of the seven injections I got yesterday. Each puncture got its own special shot of Rabies Immunoglobulin (RIG). Then two more syringes of RIG in the get-along and then a shot of the rabies vaccine in the arm. I have three more doses of vaccine, but they are one and done in the arm.

Rabies Immunoglobulin is critical to keep the virus from infiltrating the nervous system. Once infiltrated, the disease is fatal. The only question left is when. The window varies from 5 to 10 days, but in general, it's ASAP. It's not a railroad spike in the gut anymore but it hurts like a motherfucker depending on the location of the bite. You know what hurts worse? Rabies hurts worse.

RIG is on the World Health Organization's List of Essential Medicines. And it is very very hard to get and is around $1,000 per syringe. 

That's wrong.

EDITED TO ADD:

I'm having some minor side effects from the vax, mostly deep muscle and joint aches. It's a known effect and will disappear. But this was in my inbox this morning. This is the bill for the visit where the main RIG infusion was done. It's the biggie, but there were five more procedures outside of this one. My insurance covered it and the generosity of my tribe covered my co-pay. But this is wrong:


Comments

J.D. Allen said…
I feel all of this. I have Rheumatoid Arthritis. I take two injections of Humira a month to be able to do things like walk and type. I pay $1500 out of pocket every month until we hit a yearly max out of pocket of 8K. And that with a subsidy from the manufacturer. I think those injections are over $6000 each. Like you, we have good insurance that is connected to the Hubs employment. It's crazy. No way anyone could afford this medication without it. Commercials for the drug clearly say it's the most prescribed biologic for man autoimmune diseases. Costs should be lower. And I imagine in other countries, it is.