July 5th

MENLO PARK » JO-ANNE

Mark is a very unusual dialysis patient — Most patients get pretty depleted from dialysis, but Mark rarely even naps and seems more energetic after the session than before it. Except for favoring his left arm from the needles. Susan was kind of like that too, but she seemed somewhat depressed. I think she moved up to Redding. I hope she likes it up there: I hear the redwood trees are magnificent.

Mark also asks _a lot_ of questions. Not questions about his treatment, which is pretty normal although lots of patients just trust their doctors are doing the right thing. Social questions like “How are you doing?” , “How is your husband handling chemo?”, and the like. It is bizarre that he remembers that my husband is in chemo treatment, let alone that is how he starts a conversation with me. In spite of having a machine pulling blood out of him while we talk, he is worried that I might be having a rough week. He is engaging like a salesman, except he isn’t selling anything. Asking a lot of questions though.

Today he asked how people pay for dialysis, and whether some people stop coming because they can’t pay. In general dialysis is paid for by medical plans or Medicare. It costs most insurers about five hundred dollars per session although Medicare has a three hundred dollar rate that is publicly documented — transparency is an advantage of social medicine. I have never heard of anyone paying for it out of their pocket. Whether three or five, when you multiply by more than fifteen thousand, you get a very expensive yearly cost.

If you aren’t covered by medical plans or Medicare, different states have different levels of Medicaid coverage. Even with Medicare, transportation to and from a clinic may not be covered, in which case you can theoretically get dialysis but may practically be unable to get to dialysis. It would be like getting free take-out meals from a place you can ’t reach. “Ironic” , as Alanis Morissette might

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say.

I told Mark about all these different aspects — and gave prototypical examples of different kinds of patients I knew throughout the years. I mentioned Ms. Ramirez at the Medicare office as someone he could talk with to get more information. I happened to know her from both perspectives: she helps some of my patients and she is a patient herself at the Sunnyvale Voyager.

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SUNNYVALE » DR. A.

“Yes, you can go to Sunnyvale. ” Mark’s explanation is not particularly clear, but he says the commute is bad from Menlo Park to San Jose if he gets a position at the new Google campus, and would like to try the commute from down there. He only wants a couple weeks, and we can shuffle both vampires and patients around during that time, given the locations are only about thirty minutes apart. I guess an hour extra commute every other day is quite a bit of lost time. Probably much worse during rush hour.

Mark has been acting a bit distant lately, so I am hoping making him happy with this will help bring him back. It is almost like he is flipping personalities. One is his historically affable and sometimes loquacious demeanor, and the other is terse to the edge of being rude. The timing of the change seems near to the senate bill project, but it doesn’t match that exactly. And that went so well: the committee was very pleased.

“Is there anything else you would like to talk about? Working for Google would be exciting wouldn’t it?”

“I have other projects I would rather be working on: you know about my ending-homeless endeavors. If I could work on them full time, that would be great. Any chance Amasa is willing to buy or give away some land to let homeless people live in freedom? It would be nicely located if it was anywhere near the campus.”

“I don’t think Amasa’s charter includes that goal, sorry. And Amasa has to protect its assets for future needs. ”

“Amasa has a project that needs thirty billion dollars? Is it about to provide a college education and degree to everyone in the United States for free?”

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“Above my pay grade, sorry. ”

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