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Cancer in a Country With Socialized Medicine

When you're fighting for your life, you shouldn't have to worry about going into debt because of cancer-related costs
PUBLISHED March 26, 2018
A native New Yorker, Shira Kallus Zwebner is a communications consultant and writer living with her husband and three children in Jerusalem, Israel. Diagnosed in 2017 with diffuse large B-cell lymphoma, she's fighting her cancer battle and blogging about the journey at hipstermomblog.com
We've dubbed it "The Pharmacy." When we designed the cupboard in our living room, we put in a bookshelf with wooden doors that's slightly mismatched to the bookshelf with glass doors on the other side of the wall unit. At the time, I was annoyed with myself for this blatant interior design flaw. Today, I call it divine intervention.

The top shelf of this bookshelf has been cleared of all wedding albums and binders full of our children's kindergarten artwork. Gone are my “Norton Anthologies of English Literature and Poetry,” my favorite collection of short stories by Jhumpa Lahiri and my collection of works by Tim O'Brien and Earnest Hemingway. In its place are neat stacks of Clexane injections, a blood thinner that I inject into pinched fat on my stomach every night. The Pharmacy includes a box of prednisone as part of my R-CHOP regimen, a 30-day supply of Nexium for chemo-induced heartburn, anti-anxiety medicine for the days when I need to leave the house, two small jars of medical cannabis along with my medical marijuana license, Normalax for chemo-induced constipation, boxes of alcohol wipes, face masks and gloves. The top shelf of this cupboard is crowded with medication and medication paraphernalia, the doors closed and locked with an unused childproof lock we found hidden away in one of our kitchen junk drawers.

In our refrigerator, there's a shelf with my Neupogen shots for when my white blood cell counts are low and in the kitchen cupboard, next to bottles of vitamin gummy bears, Junior Epi-Pens and Benadryl, are now rows and rows of vitamin D, B12, C, and pomegranate extract capsules. I'm astounded by the amount of medication and vitamins that are needed to treat my cancer, and thankful that it's all subsidized by my health care providers.

When I moved to Tel Aviv from Manhattan 11 years ago, the fact that Israel was a country with socialized medicine wasn't really a factor. I was taking a sabbatical from my life as a communications consultant to pursue a master’s degree in creative writing from Bar Ilan University. My plan was to take two years to write a collection of short stories, enjoy being single in my 20s in this beautiful country, and then return to my quaint apartment on Manhattan's Upper West Side and resume my life as a public relations professional. Fate had other plans and I ended up meeting my husband, getting engaged and married, and moving with him to start a new life in Jerusalem.

Three children later, plus an excess of about 50 pounds, I decided it was time to take my health seriously. Turning 40 and struggling with high blood pressure convinced me to stop the yo-yo dieting in favor of bariatric surgery. In November 2017, after a pre-op stomach ultrasound for gastric bypass surgery, I was told that I had cancer that had already metastasized to my liver. I had no symptoms aside from some minor itching of the skin; my blood test results were all normal. It took four weeks of additional testing that included a CT, PET-CT, breast ultrasound and biopsy, a liver biopsy and a bone marrow biopsy before we had a final diagnosis: stage 4A diffuse large B-cell lymphoma (DLBCL), an aggressive form of non-Hodgkin's lymphoma.

To say that my world was turned upside down would be an understatement. I went from worrying about getting my daughter to swim practice on time or meeting a work deadline, to literally worrying about my life and these new cancer costs. I joined cancer groups on Facebook and discovered with alarm that while people in the United States were struggling with their diagnosis, many were also struggling with the cost to cure them of cancer.

Once we had a diagnosis, my husband went to work dealing with Meuchedet, our health insurance provider. Within days, my status had been updated and all of the tests: the CTs, PET-CTs, ultrasounds and biopsies, were covered by Meuchedet. Also covered by Meuchedet is my treatment at Shaare Tzedek Medical Center, which included getting a PICC line, R-CHOP every three weeks, plus weekly meetings with my hematologist and a staff of incredibly devoted nurses. During this process, we discovered that many of my medications were heavily subsidized while others were free. Neupogen, which costs thousands of shekels for each injection, is completely covered by our health insurance provider. I also don't have to compromise on my caregiver; I was given the option of multiple hematologists to choose from throughout the country and was able to select the best one to treat my cancer.

As I continue my fight to beat DLBCL, it's heartening to know that while my cancer costs were unexpected, they won't sink us into debt for years to come.
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