When you have breast cancer for three hours

"Everything looks good... well except for that breast lump, that we need to look at closer."

I suppose some people expect the diagnosis to be cancer, and have symptoms or find it on their own. However, if you're 31 years old and go into the gynecologist for a regular full-body physical, you aren't expecting bad news.

Before we continue, I want to clarify that I do not have cancer. So calm down. This post is not here to notify you or scare you. It isn't a precautionary tale.

This is an ode to medical care in Thailand. This is also a shout-from-the-rooftops declaration that the American healthcare system is more broken than most Americans can comprehend.

The scene: BNH Hospital Gynecology Centre, Bangkok, Thailand. I'm in a long, soft robe in a clean, serene office. The OB/GYN for my visit, which was booked for me by my male primary doctor, is an early-30s Thai woman with large tortoise-shell glasses and a disarming giggle that follows most of her questions. She's awkward and I immediately like her.

This is an unusual visit. Most women my age don't even have a breast exam -- statistically it kind of just scares you and leads to unnecessary and potentially dangerous procedures. However, in preparation for a remote job assignment, I need an extensive exam. The doctor agrees that it's silly.

Towards the end of the exam, the doctor pauses, directs me to a small lump over a rib, and asks if I can feel it. I couldn't then, but I can now. She doesn't look too concerned but says I'll need further testing. My blood runs cold. This was not in the plan!

The exam is over, I get dressed, and she gives me a nearly-clean bill of health. With a wide grin, she tells me, "Everything looks good... well except for that breast lump, that we need to look at closer." She's a sweet lady.

Now is the part of the story that usually (in America) goes like this:

  • Pay my bill and hope I don't get another one from the insurance company in a few weeks in the mail. Oh god, are they going to cover my cancer treatment? I'm going to be broke!
  • Book an appointment for a scan as soon as possible, for about 3 weeks from now. That's the earliest they can get me in, sorrynotsorry.
  • Tell my family that I might have cancer, then tell them I probably don't and lie through my teeth that it's not a big deal.
  • Spend three weeks debating my own mortality, strictly budgeting, reading insurance manuals, and scaring myself with internet articles about cancer and chemo and survivors and...

...but I wasn't in America. I was in Bangkok, Thailand. I wasn't using insurance and I didn't even have time to think about the rest of it. Here's what happened to me:

I left my appointment and the front desk had me sit for about five minutes, during which time I broke the news to my husband Warren. He... wasn't thrilled. They set up an ultrasound and sent me a few floors down. I changed into a different robe, and had another appointment with a friendly nurse and quiet doctor, in a dark room with an ultrasound machine. I could see the screen and couldn't help but think of seismic data. The results are that I either have full blown cancer or a distinct pressure differential at about 3000 meters. I dunno, I'm not a doctor.

After my ultrasound, we had time to eat lunch.

We grabbed some Thai street food, then I debated my mortality and was surprisingly OK with it (I'm young so they'll just cut off my boob or whatever, I'll get an Amazon warrior-style tattoo on my breast plate). I determined that there wasn't really anything I "had to do" before I died, and started thinking of funny things I could make people do at my funeral. I decided I like a dedicated bench instead of a headstone. It's gotta say how I died though, because that mystery always bugged me in graveyards.

This bench is dedicated to Monica.
She died young of breast cancer, which isn't very unique or exciting.
It's also not surprising, because she was pretty average if you really think about it.
 
(Then there'll be a carving of an angel blowing bubbles or something.)

Warren was less upbeat of course, but he followed my lead pretty well. I imagine my mood would have shifted significantly if I had had more than about an hour to process this whole thing. We headed back to the hospital for my appointment with my main doctor.

His calm demeanor was a good sign, and he didn't even open with, "You don't have cancer!" He simply reviewed our overall physical results, and in passing said, "your ultrasound results were fine, just a regular lump, probably fat or something. Nothing to worry about."

And that's it. In a few hours, my GP booked me in for a gynecological exam, a breast lump was discovered, I had it analyzed by a specialist via ultrasound, and the results were returned that I was cancer-free. Then, I paid my bill. The cost of this entire cancer scare? $185.


OK, so I don't have cancer. So what's the point?

1. BNH hospital was clean, friendly and efficient. They're better than any doctor or hospital I have been to in the United States, ever. Warren agrees. If I ever need a serious medical procedure, have a baby, or want elective surgery, I will fly back to Bangkok to go to BNH hospital.

2. Medical care shouldn't take weeks and shouldn't leave you wondering about your health. In the United States, the stress of thinking for weeks that I have cancer would have been much more damaging than the actual cancer I didn't have.

3. Most importantly, medical care doesn't need to cost tens of thousands of dollars. Yes, Thailand is cheaper than the US, but I have received care in Australia and Japan, at 10-100x cheaper than the United States. The main difference? Socialized healthcare. Keep in mind that I didn't have a government healthcare card, therefore I had to pay the full amount to hospitals and medical clinics. Still, the universal healthcare system cuts out unnecessary costs and forms and allows good, clean, safe, preventative care to be provided affordably.

I cannot overstate this: the US medical system is a disaster, and you should receive care elsewhere as often as possible. I've been to doctors in five counties outside the US, on three continents, and they have all left me shocked at how desperate the situation has become in America. There's really nothing left to say.

(Oh, except this: A funny outcome of my test is that I spoke with my mother a couple of days later and told her this story. Apparently my test results are normal for her, too, but she never mentioned it because... why talk about something that isn't a problem? Well, now we know why: genetics!)

Read about my cheap medical care in Sapporo, Japan, too, and comment below if you've got great medical stories in foreign countries (or cancer scares you want to share).

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