Goodbye, California.

Since it was the middle of the night, my county only had one ambulance in service. The hospital I needed to go to was in the middle of downtown San Francisco. After a quick call to their manager, the paramedics got approval to take me to the requested hospital after they explained why to their supervisor. In case of emergency, there were 2 other counties right near mine who could cover in case somebody else did need an ambulance though. 

I arrived at the emergency room, greeted by nurses who once they started to triage me quickly went to registration and verified I was the patient they were waiting for. The on-call cardiologist that put orders in for me was the head of the Advanced Heart Failure team, the head of the Cardiology Department, and the head of the Heart Transplant team. I was being admitted directly to the cardiology floor where my attending physician was probably in her 40s, young for an attending I though, who ordered an entire lab worth of bloodwork and panels for me. I'd had gotten very little sleep thay night.  

The next morning, a man name Dr. Pham came to meet me. This was the man who was able to get me admitted without question and ordered tests from behind the scenes. He explained to me the barrage of tests that I would be going through, the counseling I would receive, the therapist I would meet, and he explained why I would need a heart transplant. In the simplest terms he could explain them to me, the toughening of my microvascular vessels was going to worsen with time and the only treatments available would be to slow the heart down, which didn't solve the problem of the thickening microvessels, or to try years of medication focused on preserving the heart tissue and slowing the progress of the damage to these vessels. In summary, I could get a likely 10 good and healthy years with a new heart , and even retransplant if I was doing healthy, or I could try to spend years on medication and therapy for trying to manage my symptoms but none of them would address the actual issue. It wasn't until months later I learned that Dr. Michael X Pham was an internationally published and awarded heart transplant expert who was frequently a guest speaker at cardiology conferences about patient outcomes. His patients always had the highest satisfaction and even if they didn't live, they made the most of the chances he gave them. 

I opted for transplant because I wanted better years ahead of me. The problem wasn't until insurance denied the transportation to Philadelphia because I was "in a facility registered and equipped to perform such procedure". This is where the politics came in to play. UNOS, the organization in the US responsible for transplants requires a person to have direct and immediate family in a local vicinity for all transplant patients, as well as living with immediate relatives or an equivalent that will be responsible for administering medications at the same time everyday. A registered home healthcare nurse can satisfy this requirement if there is lodging provided and insurance will pay for the administration of medication as well as tending to the patient on a 24 hour basis. Needless to say, I did not have a spare bedroom and my closest family was in Indiana. By definition of UNOS, I was not eligible for heart transplant. When Dr. Pham argued this to insurance, they would not cover relocation because I was in a capable facility already. After several appeals and phone calls by his department, my dad came up with an idea and told Dr. Pham it. He and my vdother would fly out tomorrow, pack all of my stuff up from where I was living, and drive me back to New Jersey and take me to a hospital that was prepared for transplant. Since the brick wall that insurance had placed, Dr. Pham agreed with hesitation and cautioned us about the risk for clots with me lying down for so long and stressed the importance of taking my prescriptions to prevent this, as well as stopping every few hours so that I could stretch my legs. I was discharged that day, to go home and enjoy my last night in California. Ever. 

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