Menlo Park » Jo-Anne

The problem is figuring out who to contact and how to contact them. The subset of patients we want to talk with are not on an email list we can buy from marketers. And I have no idea how to write the email to those people.

In theory, the vampires could contact their own patients, but even if influence could help with that interaction, it would look very suspicious to have vampires contacting all their patients. Plus vampires are a pretty general cross-section of humanity, and many of them are actually pretty anti-social. Nothing about dialysis encourages social interaction, so a vampire has to personally drive this patient contact and have the personality or influence to succeed at that. We want this to be as simple and successful as possible.

To lead to this success, I need a targeted contact list of patient and their non-dialysis addresses. Phones are unfortunately useless for most vampires, and patients are unlikely to have an easy way to video chat… some won't even have email addresses. So an old fashioned door-todoor salesman marketing list is the way to go. With the list being filtered by current dialysis patients, and possibly organized by income level.

I hope Jo-Anne, my dialysis social worker, can help.

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 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.