I have had employer provided health insurance since 2010. In the period from April 2010 to November 2016 I worked for three different Alaska companies, two small IT firms and a large telecom (the second IT firm I was working for was acquired by a telecom company). All three provided good insurance but had a high deductible – around $5.000 a year for the small firms and $2,500 for the telecom. The monthly premiums were around $1,000 a month, the employers paid all or most of that.
I did not use the insurance much except for the occasional visit to the doctor or my yearly physical. I did have a surgery in 2014, which was one hell of a learning experience. I had struggled with nasal polyps for years. They are benign growths in the sinuses that make it hard or impossible to smell or breathe. Living with them makes for a very bad quality of life. The surgery to get them removed was so expensive that I was not able to do it for a long time. Luckily I was able to have them removed, literally, Russian style.
In 2011 I was visiting a good friend in Russia in a town called Cheboksary. Both his mother and father in law happened to be doctors. While at dinner one night his mother in law asked me if I was sick (the polyps make you sound like you always have a cold and you are constantly having to blow your nose). I told her no and explained that I had nasal polyps. In a typical Russian way she said, “Horosho, tebya nada govorit c vrachom” (Ok, you need to speak with the doctor). I told her thanks but I was good. Truth be told I was a bit nervous about going to a Russian hospital. Turns out my friend’s mother in law is the head of a major hospital in Cheboksary. She insisted I go see her friend, Galina Mihalovna, who is an ear, nose an throat (ENT) doctor. I agreed.
I can speak Russian quite well but when it comes to specialized topics like politics, science or medicine I sometimes struggle understanding because of words I don’t know. My friend Max told me he would go along with me. This was all during New Years. If you don’t know, Russia basically shuts down for ten days during New Years. It is an awesome party, I highly recommend spending a New Years in Russia. My friend’s mother in law set me up with an appointment to see her friend, the ENT.
Max and I headed to the hospital on a cold, Russian winter morning. The hospital was packed because New Years had just ended and people were getting back to their normal routine. I thought we were going to have to wait for hours but because I had my Russian svyazi (connections) I went right in to see the ENT. Max ended up waiting outside, so it was just me, the nurses and the doctor. This hospital was something else. It made me feel like I was in the Soviet Union. Long, dark and cold hallways. A lack of the kind of technology we see in doctors offices in the United States replaced by medical equipment that was from a different time. I was nervous. The first thing I did was go to a room with a large x-ray machine. They took an x-ray of my head for the doctor to look at.
The doctor came in to see me. She was wearing one of those mirrors on her head that looked like a big cyclops eye. She sat down in front of me and, in Russian, asked me what was wrong. I explained to her that I had nasal polyps. She looked at the x-ray and told me my sinuses were totally blocked. She then asked me to lean my head back, opened my nostrils up with a medical instrument, and shined a light to take a look. After about ten seconds she looked at me and said, “Da, y tebya ect polypa, nam nuznho deleat operatsiya srazy!” (Yes, you have polyps, we need to do a surgery right now!). My initial internal reaction was fuck that! I previously had surgery to remove nasal polyps back in 2005. It involved being put under anesthesia and took a week to recover. I was leaving Russia in five days.
At this point I really wished Max was around. Apparently he left the hospital and was going to come back later to get me. I told her, very calmly, “Spacibo no ya ne hochu. Ya ylichu skoro i ya ne hochu operatsiya kotori nyzhno anastezii” (Thank you but no. I am flying back soon and I don’t want a surgery that will require anesthesia). She looked at me puzzled and responded, “Eta ne Amerkia, tebya ne nada anastezii, ya chas deleat” (This is not America, you don’t need anesthesia. I will do it right now). I started to get more nervous but at the same time I thought to myself how bad my quality of life was with these damn things. I also weighed the fact that I was in a hospital with a doctor that was recommended from my friend’s mother in law, a highly respected doctor in Russia. I wanted to talk some more with her about what exactly she was going to do. She looked at me and said, “Tak, yestli hochesh operatsiya, davai. Yestli net, horosho. Ny ti videl skolko lyudey zhdet” (Look, if you want the operation let’s do it. If you don’t that’s fine. You saw how many people are waiting).
I weighed everything and said to myself fuck it. I told her, “Horosho, davai deleam operatsiya” (Ok, let’s do the operation). I had no idea what was going to happen. She left the room and I waited alone. I can’t recall the last time I was so nervous. Thoughts were racing through my head – what the hell is she going to do? what if something goes wrong? She came back a few minutes later with a nurse and some medical equipment. This was the point of no return.
She sat down in front of me. The first thing she did was get a vile of some kind of local anesthetic. I asked her what it was, she said dekacaine. Best I could figure was it was something in the caine family, the same family as cocaine… She then took out a very long and thin metal wire, placed some gauze on the end of it and dipped it very liberally in the anesthetic. She then told me to tilt my head back. Now it was getting real. She stuck the metal wire in my nose and went back very deep into the nasal cavity, at least two inches. She repeated this process many times. My nose and face started to feel numb. I also started to feel very anxious and high energy, I wonder why… She then took out a syringe and a different vile. Before she inserted it in my nose she told me, “Ne perizhivaesh, tvai serdtse mozhet nachat bystro bitsya” (Don’t worry, your heart may start beating fast). It was adrenaline, and damn she was right. I guess it was meant to reduce bleeding but now I was really starting to freak out. My heart was beating like I just sprinted a mile!
Now we were ready for the procedure. She took out an instrument called a snare. You hold one end between your two fingers and thumb, the other end has a wire that contracts when you pull your fingers and thumb together. She gave me a small bowl and told me to hold it below my face. She placed the snare in my nose, grabbed the first polyp and started yanking on it really hard. I could not feel a thing because of all the anesthetic. The first one she pulled out was about half the size of my thumb. She put it in the bowl. She kept doing this in both nostrils, pulling out a lot of these nasal polyps. Soon after she began I started bleeding, not a lot but enough to concern me. I asked her, best I could in the position I was in, “Ect mnogo krov, evso normalno?” (There is a lot of blood, is everything ok?). She immediately responded, “Mnogo krov, xaxa, eta ne mnogo. Ya tebya pokozhu mnogo. Ti muzhik ili devushka!” (A lot of blood, haha, that is not a lot. I will show you a lot. Are you a man or a girl!). Welcome to Russia folks.
Surprisingly not long after she started removing them I was able to breathe through my nose and even smell a bit. I had not been able to do either of those for years. It took her about 30 minutes to remove them all. One of my first thoughts was why don’t they do this in America? Likely because it does not cost nearly as much as a full surgery. A nasal polyp removal surgery I later had in Alaska cost a total of $50,000! (more on that later). Max had come back to the hospital. She gave me a list of medicine to get – some antibiotics, nasal steroid spray, and some saline solution to irrigate my sinuses. She also told me to take it easy for a few days. We went to the pharmacy, located in the hospital and got everything she told me to get. It cost about $15, I think it would have been ten times that or more in the United States. And then the part you won’t believe. When I asked her how much the bill was she said no charge. I tried to pay her something but she would not take it. I was a guest. I still can’t believe it. I sent her some nice flowers and thanked her for helping me.
Max took me back to his apartment and I went to sleep. I did not feel like I just came out of a surgery but I did feel a bit off. After a day I felt totally back to normal. I could breathe and smell! I was so happy I decided to go through with it. I returned to see her a few days later so she could take a look. She said things looked great. I thanked her again and we wished each other all the best.
As soon as I returned to Alaska I made an appointment with the ENT I had been seeing so he could take a look. I got to his office and explained what the Russian ENT had done. He looked at me in near disbelief. He told me they stopped doing that procedure in the United States back in the 1970’s. I asked why? He said it was more dangerous and also does not fully remove the polyp. The biggest risk is a cerebrospinal fluid (CSF) leak, which can lead to meningitis. I explained that while maybe more risky and rudimentary, it did work. How many people who cannot afford the surgery could benefit from this procedure?
He was right about one thing, it was not a long term fix. The polyps had begun to reappear about a year later. I went back to Russia two more times in the following two years to have the same procedure done. Galina Mihalovna and I became friends. I even tried to get her to come to Alaska to do an exchange. I had come across a different ENT in Anchorage, Dr. List, who studied in Russia and spoke Russian. We soon became friends. I also told him about my Russian surgery experience. He was less surprised but also said that was not something ENT’s do anymore in the United States. Dr. List agreed to host her for a week and let her shadow him at his office. I offered to buy her a ticket but she ultimately decided against the long travel.
I actually ended up getting the American version of the surgery in 2014. Dr. List performed the operation. Three years later things are still good. However, that surgery had a whole different set of challenges, namely insurance challenges. Stay tuned for the next piece where I talk about navigating the complex insurance system in the United States and how a two hour procedure ended up costing $50,000.