Soooo, it has been awhile since I last posted, and I don't know if anyone still checks back here regularly. I'm guessing no, but on the off chance that someone does, hey, surprise!
What's been up with Victoria's Adventures in America recently? Well, as politeness dictates, I have to smile and wave it off casually, like "oh, not much," but tbh a lot (or so it feels like). I'm only updating now because I have been so, so swamped under the stresses of life and work, and my lifestyle has finally caught up to me and I am at home, sick in bed, and finally have time to dust the cobwebs off this ailing baby.
Life in America is tough as nails. The sophomore slump is real. Basically, for the past year, I have been depressed, and at times suicidal, and came very close to just pulling the plug on life here for a bit and taking a leave of absence to fly home and nurse my injured feathers. The only thing that stopped me was finals, and the fact that I would have to forfeit 9 weeks' worth of studying if I just upped and left at that moment. I called home, and begged my parents to come over, but their passports had expired and were in the midst of being renewed, so that was a non-starter too. But somehow, I hauled ass and got through it, got my 4.0s for the quarter, hunkered down to a crazy 3 days of packing, and moved over to a nice room in East Palo Alto to start my internship.
For those who aren't familiar with the Bay Area, Palo Alto is where the health-conscious, preppy tech start-up millionaires live. Menlo Park (or more precisely, Sand Hill Road), where I work, is where the venture capital and private equity billionaires live. East Palo Alto, where I live, is the ghetto cousin of Palo Alto that no one talks about at polite dinner parties. I live on the border - near enough to Palo Alto to be safe, but technically "in" East Palo Alto, so I get a ton of street cred and also cheap rent for the area (I pay $980 a month for a well-furnished room in a condominium-like development; my fellow intern pays $1900 for a shitty ass room in SF with no window screens in a neighborhood where people try to sell him weed every morning).
It's been nice - living outside a dorm environment with clean, private bathrooms and access to a good kitchen is amazing. I cook a lot now, and bring my own lunches to work - working in an office that is dominated by guys makes for rather unhealthy meal options (think quesadillas 3 times a week, pizza 1 time a week, and the token salad to make themselves feel better) - and that's been fun. I have also been converted into an organic-eating health nut. After long conversations with S about the nutrients in food, we have both come to the conclusion that cheap NTUC food is about the same quality as Whole Foods (preppy, expensive, all-organic free range etc supermarket) here. After observing my eating habits for awhile during term time, he concluded that I was suicidal and eating things that would drive myself to a slow but painful death, and was about to stage a full-blown intervention had we not discovered one day that food standards are extremely different in America than in Singapore.
For example, I was eating soft boiled eggs a lot here to build up my strength, but in America no one does that unless you're already AT FULL HEALTH, because it's expected that eggs contain salmonella. Also, egg quality: my family buys Seng Choon corn eggs, which are slightly more expensive but by no means the best eggs on the market (consider carrot eggs, XL eggs, etc), but in America, that translates to free-range, cage free, Omega-3 enhanced, vegetarian hens' eggs, which retail at slightly more than $1 per egg.
Also, we were discussing our friend's pregnancy, and the types of food she was eating: steak, lobster, vitamin-enriched bread, and I burst out laughing: "Isn't vitamin-enriched bread such an oxymoron? All bread is vitamin enriched," referring, of course, to the Gardenia loaves that line the shelves of NTUC. Pretty much all bread in NTUC is vitamin-enriched, and I'd always thought it was ridiculous that they'd put it on the packaging because... everyone else is too, so where's the value-add? S looked at me for like 5 minutes like I'd grown an extra head or something, and said, "In America, most bread is salmonella-enriched."
So there you have it. I have converted into a full-blown organic food snob because that is the only way I am going to have a fighting chance at staying alive in America. I eat salads now. I feel like younger me would have recoiled in horror if she saw the preppy mess that I have turned into, but seriously, kid, America is very likely to kill you.
But despite my best efforts (and plenty of organic fruits and vegetables), I have been taken ill with my long-time nemesis: ulcers. And to soothe the worries of S and my parents, I finally caved and agreed to see a doctor despite my longstanding feud with western medicine. (Now that her passport has finally been renewed, my mum was threatening to take a plane over and drag me back home and make me take a gap year to recuperate.) It was also my first *real* experience with the American healthcare system, which certain members of the opposition in Singapore laud in comparison to Singapore due to the high reliance on insurance, which should theoretically translate to low out-of-pocket costs. After a whirlwind of a day... I'm not entirely sure where I stand on the relative benefits of upper class US healthcare vs Singaporean healthcare. I know for sure though, that if anyone laments the high costs of Singaporean healthcare in front of me ever again, I will cut them. (Not even kidding)
So, to make up for my lack of posts in a long time, here is an overly detailed timeline of my Healthcare Adventure Day.
8am: I roll into the office. I want to die. S says he will help me make an appointment with a $5m dermatologist whom he used to see, who is basically a skin genius. He charges $300 per visit if you don't have insurance. I still have insurance for 4 more days, so I say let's go for it.
8:15am: S calls me and says they won't let him register for me. I call the doctor's office and spend 15 minutes on hold to get registered. The doctor's assistant tells me he is booked out for the next 2 months. I am expecting this (forewarned by S) and so I ask if they have any cancellations. They do not. They try to get me registered anyway so if there's a sudden cancellation I can take it. I agree.
8:30am: I spend another 10 minutes on hold as they transfer me to registration. This is normal for American healthcare. According to S, I am still having a very good day in terms of waiting time. The registration lady asks me for my important details: insurance and name. She says she will have to call the insurance companies to see if they will cover visits to a particular doctor (insurance companies in America each cover selected doctors in what they call their "network". You only get reimbursed if you visit these doctors. Otherwise, you pay extra.) and she sounds extremely sour about it. I don't blame her. It doesn't sound fun. At this point I am sick and tired of waiting and just want to see a fucking doctor, so I ask if I can just pay in cash. Her whole manner changes and she's like "Oh, yes, of course, sweetheart, let me just call your insurance to see if they'll be willing to cover you anyway, okay, sweetie?"
9:30am: No word.
10:30am: No word.
11:30am: No word. S says this is normal. He researches my insurance network to see which doctors are covered. It turns out I actually have pretty good insurance - $10m doctors at the Stanford Hospital are covered! He tells me to call them. Nope. Not happening. Not going through that registration crap again.
12:30pm: No word. S says to call Stanford Hospital.
1:30pm: No word. S says to call Stanford Hospital.
1:45pm: I am so frustrated. I search the list of healthcare providers, see a doctor at Stanford Hospital with promising credentials (Asian dude, went to Harvard Medical School) and decide to call the Stanford Hospital. I go through the whole registration bullshit again. Luckily they recognize my insurance and don't have to make calls to find out if I'm covered. We progress to the next stage: making an appointment.
1:50pm: All doctors are fully booked out till September. At this point I have resigned myself to dying a slow and painful death. I don't even care which doctor I see. It doesn't even have to be the Harvard dude. He could have gotten his degree from Cal for all I care (loljk). I just want to see a medical professional who will prescribe me painkillers so that I can wallow in my misery.
1:55pm: The receptionist asks if I can make an appointment at 2:30pm that day. They had a sudden cancellation and this is the only slot they have available for the next 2 months. It's at the Stanford Hospital, not the Redwood City branch where they usually keep all the dermatologists. By some cosmic miracle, the opening is for the Harvard Medical School dude who I wanted to see in the first place!!! I'm like hell yeah and take off from work. I speed down the road and cut off like 3 elderly people. Thou shalt not get in between me and this rare appointment. I call S. He agrees to come down for moral support because I have a debilitating fear of doctors.
2:25pm: I barely make it into the doctor's office in time. I smell a whiff of the clinical, lab-like smell of the hospital and I want to cry. But in hindsight, Stanford Hospital is actually pretty nice. More like a high-class hotel than a clinical place where hopes and dreams come to die. I am seen by a doctor's assistant who asks me some preliminary questions about why I'm here today and my medical history. S comes and is comforting.
2:35pm: The doctor arrives with a nurse assistant, who takes notes as he examines me. I am immediately struck by the difference. For once, this doctor doesn't look horrified at my ulcers. He doesn't try to force a simple diagnosis down my throat (doctors: "eat more fruits and vegetables!" me: "...why would I be here in so much pain if that worked") and he actually sits and THINKS. He says he is thinking about all the uncommon diseases that might have these symptoms because he knows I've heard all the common ones before. This is refreshing. A doctor that treats me as an intelligent human being. This is new.
2:40pm: He says he wants to take a swab of the ulcers because S tells him I hate blood tests and invasive procedures. He apologizes and says he knows it will hurt, but having some cells will be helpful to look at. I agree and clutch the examination bed, preparing myself to die in pain. The pain doesn't come. He is gentle, and even though the ulcers bleed a little upon contact it's nothing like the kind of pain I'd been put through before (one swab to take some cells, 10 minutes spent later to stop the ensuing bleeding). I am amazed at the gentle doctor.
2:45pm: We go through my entire family medical history. He is looking for indicators for diseases that are incredibly rare. I am impressed that he knows them all off the top of his head. He is thorough. I am totally sold on this guy right now. In 10 minutes he has reached the eventual conclusion that doctors I'd seen in Singapore took 10 years to get to: that it is probably autoimmune, but unlike doctors at home, he's unwilling to pump my body full of steroids because he actually wants to figure out what it is before bringing in the big guns. In contrast, doctors recommended steroids when I was like 13, causing my mum - the largest proponent for western medicine in my healthcare experience then - to demand a cessation of treatment. You don't make people take steroids as a matter of eliminating potential diseases. You don't make kids take steroids. This doctor is curious. He says he will talk to his autoimmune specialist colleagues to see what they can come up with. He suggests a blood test, and potentially a biopsy, but is willing to proceed with my case any way even if I don't get the tests done, because he knows how much I fear them.
3:15pm: I end up getting the tests done. I trust this guy: he's not making me take these tests just to shrug and be like "all the tests are negative, so... we don't know what's wrong with you lol". I end up waiting in the hospital's lab area and am sitting next to a nice lady who is entertaining her baby in French. They are waiting for a blood test too. The receptionist calls her up, and says that since she doesn't have insurance, she needs to pay for the test upfront. The French lady is like, yeah that's no problem. The receptionist says: "that will be $664."
The French lady blanches and goes "Six HUNDRED?" (In France, healthcare is cheeeaaaaap. Socialism!) She needs to sit down and call someone. The receptionist says she is sorry. There isn't a mistake with the pricing - she just genuinely feels bad. I go in for my blood test.
4pm: I am done with my blood test. I go to the pharmacy to pick up my prescription. They ask for my insurance card.
4:15pm: The pharmacist tells me that one of the creams the doctor prescribed isn't covered by my insurance. They cover the ointment version (slightly cheaper) but not the cream. S asks how much the cream is if I pay in cash. The pharmacist says she will go check. She comes back with the biggest shit-eating grin on her face, and says "five twenty seven". I say, "oh, five dollars? That's not a big deal, I'll take it," at the same time that S goes "Five hundred and twenty seven dollars??" We both look at each other like the other person is crazy.
4:16pm: S is right. I am wrong. Fuck. I have to sit down. Unlike the lab receptionist, the pharmacist is not sorry. Watching first timers getting screwed over by big pharma is probably hilarious.
4:20pm: I end up getting the ointment. I text my parents about it. My mum is appropriately indignant. My dad probably had a minor heart attack. My pharmacy bill for a bottle of pills and a 60ml tube of ointment comes to $58. My heart weeps. Insurance doesn't actually cover all your medical bills - just a portion of it. You still pay some part of it yourself. You just pay insurance companies the privilege of paying $58 rather than $527 for medicine.
5pm: I am still shaken by the price of the ointment. I go home and look it up. It's already a generic (which means its patent has expired and it can be produced for cheap, as opposed to drugs which are on patent and can only be sold by 1 company. Those can cost up to hundreds of dollars for 1 pill) and yet, has a cash price of between $380-$500, depending on which pharmacy you go to. I am angsty.
6pm: I go home and take my pills. They are huge. The doctor has given me the highest possible dosage and the pills are larger than the nail on my thumb. I swallow it anyway. I research my doctor. The tiger mother in me swoons: Stanford undergrad, bio and English double major, Harvard MD and PhD. I feel like if anyone can figure out what's been plaguing me all these years, it'll be him.
And now, I am here, waiting for the pills to work. In 2 weeks, I get the pleasure of repeating a similar process in hunting for same-day appointments for my follow-up, since this doctor is actually booked through till September. But that will be a story for another day.
