Mortgage Insurance Removal Request Form: Fill & Download for Free

Your car loan is an installment loan and as such, doesn’t figure in your credit utilization ratio. In other words, paying it off is unlikely to affect your credit scores at all. Paying off credit card balances (or paying them below 30% of your credit limits) will definitely boost your scores.Lenders use risk-based pricing to set the rates they offer to individual borrowers. The loan-level pricing adjustments (LLPA) come from Fannie Mae and Freddie Mac, so they are consistent across all lenders who sell their loans to those two giant investors—in other words, almost all lenders.If a borrower with a 740 can get a rate of 4% with 20% down today, a borrower with a 700 score will likely get a rate of 4.875% for the same loan. Your loan officer should be able to advise you about which accounts to pay off or pay down if you need to increase your credit scores to get a better rate. They can request a “rapid rescore” from their credit report vendor. They would forward documentation showing, for example, reduced credit card balances, and the vendor would submit these directly to the credit bureau(s) to expedite updating the credit files and the scores. It takes about five business days to accomplish this.Your loan officer should have access to some form of FICO simulator to determine in advance the effect of paying down balances or other changes.You should also be familiar with the function and cost of mortgage insurance (PMI). Lenders require this to limit their risk when their loan is more than 80% of the home’s value. Contrary to what some appear to believe, PMI is not a penalty for making a smaller down payment, and it is far less expensive than many would have you believe. The cost of monthly PMI depends on a combination of the borrower’s credit score and the loan to value ratio. A borrower with a 760 score and a 10% down payment will pay .30% for mortgage insurance—about $69 per month for a $300,000 purchase. With a 5% down payment, the cost would be about $97 per month. PMI drops off automatically when the loan balance reaches 78% of the home’s purchase price. This takes about seven years for a 90% loan. Borrowers can request early removal by providing an appraisal showing a higher market value and an 80% loan to value ratio.I hope this is helpful. Good luck!

What is the most callous thing that hospital staff have done in your presence?This was said to me three weeks ago today, on March 5, 2020 at 8:45 am, by the heart surgeon for my partner of 13+ years, who was at that time in the hospital’s ICU unit, on a respirator and in a coma…“Oh, then you can’t really make decisions for him, not really…”He slapped his palm on the countertop of the nurses’ station, as if he had just proved a point or won a bet. To me, he sounded relieved as he said it.I’m not afraid to mention names, because there were witnesses who heard Dr. Robbin Cohen (CA license # G45914) say this to me, particularly my partner’s nurse Maria, who loudly and pointedly called out from behind me, “Ross said Dave was to make all decisions for him, he said it several times before he went on the respirator, Dave makes all decisions on his behalf!”Having just arrived at Huntington Hospital in Pasadena, California, I had barely taken a peek into Ross’ room, just enough to see that he’s finally sleeping peacefully for the first time in weeks; I hadn’t even sat down yet when this was how I found out that Ross’ condition had actually deteriorated sharply and he was now on life support, after waiting ten days for an unplanned, hour-long emergency procedure to remove the source of a life-threatening infection.After pulling me quickly into a nearby waiting room, Dr. Cohen updated me on Ross’ current condition, adding that if it were up to him, as the lead physician in the case, he would cease treatment altogether at this point; it’s risky and very costly. He made sure to bring a witness with him; I had nobody but myself and my state of shock. “You mean he’s dying, Ross is dying?!?”A few minutes later, after I’ve pulled myself together, the three of us - Dr. Cohen, Dr. Cohen’s witness and myself - followed by an orderly or nurse, returned to Ross’ room, and after listening to some alarming revelations from Dr. Cohen, the room looks different now. Ross is in bed, asleep for the first time in days, tilted slightly up, pale and grayish; his head rolled over to the far side, his eyes shut, his mouth open. A blue plastic hose big enough to fit a vacuum sweeper has been shoved down his mouth and throat. Tubes, wires and plastic lines hang down from above, plastic bags and drip lines surround him and hold him captive. He’s fallen asleep in a spider web; he’s in trouble, real bad trouble.One step into the room, another, another. I’m still processing the surreal that Dr. Cohen had told me just moments before, when I hear a voice trembling, it’s my voice, distant words forcing their way up and out. “Oh, God… Ross… Ross…” My knees don’t work, they’re gone; the floor flies up at me and the room goes black.WHAT HAPPENED?Let me back up a few days.Ross had been admitted nearly two weeks earlier through the ER on Friday, Feb 21 with chest pains, dry cough, difficulty breathing, shortness of breath, dizzy, painful to lie flat or reclining. On Medi-cal, he is admitted for testing and observation. Diagnosis was made over the weekend: strep infection has attacked his heart valves, causing blood to flow backwards into his lungs. There was an established protocol: (1) antibiotics for the bacterial infection, (2) removal of infected tooth or teeth, and (3) followed by open heart surgery to replace damaged heart valves. Oral surgery must precede heart surgery to prevent reinfection; without these surgeries, Ross will die.It’s serious but the protocol was known and even with the risks, survival rates were 80%. Ross being middle aged in otherwise good health should not have trouble recovering. If all went well, he could be back home in 2 or 3 weeks to recuperate and be himself again by Memorial Day. He’d have to be monitored regularly, but most patients who experienced this went on to live normal lives.Antibiotics were started immediately. A team of cardio specialists was assigned to him, as well as an infections specialist, a pulmonary resident, and an oral surgeon was brought in for consultation on the teeth. The consultation lasted no more than 10 minutes, and ended with Dr. Tiner (CA license #A87203) saying, “You have seven infected teeth that need to be pulled. I charge $250 per tooth, so that’s $1,750. I don’t take your insurance, so how would you like to pay for it and when?” Ross was taken aback, saying, “I don’t know if I have that kind of money immediately available; I’ll have to ask.” Dr. Tiner told him to let him know; and as soon as he had an answer he would schedule the surgery. He left. Ten minute consultation, tops.Ross relates this to me in the afternoon when I visit. “Does that mean if we don’t have the money, he won’t pull my teeth, and the heart surgery won’t happen, and I just die? Can they do that, would they really just let me die?”That has to be illegal, I tell him, surely he’ll put it on a payment plan like any other dentist. Ross seems skeptical. He had told this to Dr. Cohen, heart surgeon; he didn’t like Dr. Tiner’s bedside manner, which was “mechanical and cavalier,” to use Ross’ words, and he was worried about this payment in advance. Dr. Cohen brushed his worries aside: “Yes, we have had problems with him in the past and there have been some complaints, and I’ve spoken to him about that, but he’s one of the best at what he does, and he is who we use here.”“Can you believe all that?” Ross asks me.No, I can’t, it’s outrageous. What if it had been $20,000; would we still have to pay in advance? Would the hospital just let you sit here and wait until we come up with the money? It’s hard to believe. I’ve been a patient here before, and the doctors and care were outstanding. I can’t imagine a doctor here acting like that or being so nonchalant about it. An acknowledgment of past problems but he is the one they use? What kind of complaints and problems, what kind of corrective action was taken, who spoke to whom about what? Ross didn’t know, it was all rather vague, and anyway, there is no other oral surgeon available. Did anybody look? Ross doesn’t know; he supposes Cohen and Tiner must be personal friends outside the hospital; that’s the impression he had. Tiner was brought in from outside and Cohen didn’t seem worried about Ross’ apprehension.This can’t be right, not at Huntington Hospital. Surely they’ll put the dental work on the bill. No, says Ross, he already asked. It’s separate billing. Dr. Tiner had an assistant with him too, who didn’t say much, but he looked very uncomfortable when Dr. Tiner talked about payment in advance. He wouldn’t make eye contact with Ross. Dr. Tiner spent more of those ten minutes talking to his assistant than he did to Ross; he didn’t even ask if Ross had any questions or concerns about the procedure. Just open your mouth, let me see, and he called out some numbers, then the payment part and that was it. “I might as well have not even been here for most of it,” he says. “It was like I was a demonstration dummy for teaching a class.”Were the complaints about his personal style or about payment, and were they formal or just talk? Ross didn’t know. “We’ll file our own complaint and make it official with the state board. You and I would be required to report it.” Ross agrees; we both have advanced degrees in psychology; he has a PhD, I have an MA, we’ve both had experience as counselors, and we know the laws and ethics that apply. I imagine they must be fairly similar for physicians. Ross has also had a career as university faculty and administrator too, Dean of Students. He’s had to document student behaviors and conversations; he’s had to deal with the courts and the licensing boards before, and he agrees to document those conversations.There is still the matter of payment. “Do we have that much in the bank? It’s the end of the month.” No, I just paid the mortgage on my way here. I could stop payment on it, and… “No, we just got out of forbearance, don’t muck it up now.” We’d been going through a rough patch this year, and nearly lost the house three months earlier. This would be the second payment since ending the forbearance plan. I could try to do an early withdrawal from my retirement account; that would get here by next week, maybe the end of this week if I can convince them it’s an emergency. I can send the paperwork first thing in the morning. Let’s try that.I spend the night sleeping in the window sill of his hospital room: they are wide enough to support a small mattress and long enough to support an average height person. A little cramped for a six-footer like myself, but I can make do. I am at least better off than Ross; the poor guy is miserably uncomfortable. If he tries to lie flat, he can’t breathe; if he sits up, he has chest pains, and so he spends the night tossing and turning. “If I could just get some sleep…” he mutters a few times during the night.But all that afternoon he has had a look on his face that I’ve rarely seen; Ross is not normally a worrier, he’s always upbeat and confident. Not today. He looks dejected and defeated. He’s worried, very worried, a premonition. “What if we don’t have the money, does that mean they would just let me die?”Apparently it means exactly that. In any case, that is how it plays out.WHAT WENT WRONG?Tuesday Feb. 25, morning. Ross calls me at home. I tell him I’m about to send the request to my retirement account, it should be here by Friday, four days away. Ross says Dr. Tiner can’t put Ross in his billing system but he does take credit cards. That’s strange; Ross is in the hospital and Dr. Tiner is going to operate on him; how does that make him not a billable patient? Who pays for hospital surgery by credit card when they have insurance; why do we have insurance at all then? Something is wrong with this picture. I know, says Ross, but everything else is ready and he’s nervous about waiting; he really hates to ask this, he knows finances are tight but can I put it on a credit card? More than embarrassed, he’s scared, I can hear it. Of course I’ll do that, don’t even ask, don’t be embarrassed. I give him the card number over the phone and tell him I’ll bring the card itself later. When I get there, he says the surgery will be the next day, Wednesday.That’s a relief. It’s been five days since Ross was admitted. I spend another night sleeping in the window sill.Wednesday Feb. 26, midday. Ross calls me at home to say the surgery has been canceled; credit card payment was declined, over the limit by a couple hundred dollars; they must not have actually processed it yesterday but waited until this morning. Can’t they do the surgery anyway with what’s available, and let me pay the balance another way? No, payment in full first. Why didn’t they call me directly and let me take care of it right away? The credit card is in my name, not Ross’ name. Ross doesn’t know, it’s done through Tiner’s private office, not through the hospital. And nobody thought to call the actual card owner? I could have corrected that in two minutes.A call to the credit card company confirms it: four attempts were made to pay on that credit card that very morning, all between 10:00 and 10:15 am. There were no attempts made the previous day, and nothing after the fourth attempt this morning. And nobody called me, the credit card owner, to let me know; they just put it back on Ross to deal with it… Ross, who is worried, in pain and hasn’t been able to sleep. Apparently there is no sense of urgency on the part of the medical team. Dr. Tiner is dragging his feet and nobody is noticing or doing anything about it.So I bring all my credit cards with me today; we’ll spread the payments out if we have to. Another night in the window sill. listening to Ross trying make himself comfortable. It’s getting noticeably, audibly, worse each day but still, no sense of urgency.I’ve never heard of such a thing as this, having to pay by credit card for a patient already in the hospital with a life-threatening infection. Something is wrong here, really wrong.Thursday Feb. 27. Payment goes through. Done. Surgery rescheduled now for Friday afternoon, a full week since he was admitted through the emergency room.Friday Feb. 28. overnight. With his heart pumping erratically and blood flowing in the wrong direction, leaking out backwards into his lungs, unable to sleep properly and get some rest, Ross had a sub-dural hematoma during the night. Once again the extractions are canceled, but this time the reason is medical, not financial.We all carry strep bacteria in our mouths; it helps protect the teeth from other bacteria, but the danger is that if it gets into the bloodstream and it gets to the heart, it colonizes on the heart’s valves. This is why strep throat can so dangerous; it’s why a dentist puts you on antibiotics before and after deep tissue work on your gums or teeth. Once the strep gets on the heart valves and colonizes, it builds deposits which interfere with the valve’s ability to open and close. Blood can be sent in reverse, it can overflow and go into the lungs; the pieces of deposits that break off are sent through the body. If a piece of that debris gets into the brain, it can cause a stroke. It might get caught in the liver, or anywhere the blood takes it. Some infections take longer than others to attack the heart, but they all do it in time. It can be seen and measured in scans, and the more that debris builds up, the more dangerous it becomes. With each heartbeat, a little more infection is pushed through the body, a little more catches onto the heart valves, a little more growth builds up. 100,000 times each day, and if not stopped, it will be fatal. Always. This is why the source of the infection has to be removed first and quickly followed with surgery to clean, repair or replace the heart valves afterwards.It’s been a week since the emergency room admitted him and five days since the initial consultation: 500,000 more heartbeats have passed while waiting for an hour-long dental procedure that is never going to happen. The clock had been ticking and both doctors knew it; they had begun prepping him for heart surgery to follow while waiting for Dr. Tiner to do his part. But a piece of debris broke off from Ross’ heart valves and went to his brain, and he had a stroke. That means he can’t have anesthesia for either surgery; we have to wait to see how he responds to the stroke. In the meantime, the infection is still working on his heart valves, and blood is still backing up into his lungs, 100,000 times every day.Why did they make him wait a whole week when they knew this could happen? They knew what this infection could do, they had told us what it could do, so why were they all waiting around and letting Dr. Tiner hold up their work?If I had known he needed a dentist, and if I had known that the only oral surgeon Huntington uses is permitted to bill separately from the hospital, and that lack of financial oversight allowed him to delay or cancel treatment until he gets paid first even though the patient has insurance for it, and the condition is unpredictable and potentially fatal, I would have taken Ross to any other hospital. But we didn’t know what was making him sick. Huntington is nearest, they routinely earn the highest ratings and reputation nationwide for their quality of care. I’ve been a patient there myself and had excellent care and praised them to my friends and colleagues. Of course that’s where I would take him.Who could have guessed a hospital hires an oral surgeon who does not take dental insurance?Or who bills separately, away from the scrutiny of the hospital’s accounting systems, and is the only oral surgeon they use? That does not make sense. I truly believed I had placed him in the best and most capable hands around, but Ross was held hostage for $1,750 and by the time I was able to pay the ransom, it was too late.CAN ANYTHING BE DONE FOR ROSS?I am not going to attempt to describe the conversation that night after he had the stroke and was transferred to the ICU. It’s too hard, it’s private and personal, and too painful. I trust the reader can imagine it without having to undergo the actual experience of it.I’ve been told I don’t have “standing” in a case like this; Ross and I aren’t married, and we didn’t file as domestic partners either. Our mistake. We’ve only lived together as partners for 13 years in the same house and with shared incomes, but it’s not “official.” That is the reasoning behind Dr. Cohen telling me I can’t make these decisions for Ross, “not really.”Never mind that we’ve known each other nearly 20 years, and that we’ve been living together for the last 13; or that we’re colleagues with similar backgrounds and advanced degrees; or that I took Ross into my home when he had no place else to go; or that he pulled me through a serious bout of suicidal depression five years earlier; or how we replaced the kitchen floor after a flood; or that he learned to cook and brought down my A1C from 13.2 to 6.7, my daily glucose from 300 and 400 to low 100s; or that we raised $10,000 two years in a row doing the AIDS Lifecycle Ride together; or that I’d been teaching him to speak German these last months; or that we do each other’s laundry; or that we’ve been writing a book and website for LGBT people who come out in mid-life; or that we argue at the grocery store; or that he gets mad at me for leaving a dish in the sink…Never mind that I paid for those extractions to clear the way for Dr. Cohen himself to perform that heart surgery…Obviously Dr. Cohen, the heart surgeon, knows nothing about us, our history or our relationship, and even though it was the last thing Ross had said before being sedated, he tells me I can’t be the one to make these decisions on his behalf, “not really…”The “not really” is the most insulting part, especially when nobody had told me that I “can’t pay for those extractions. not really.”I don’t care about standing; I don’t care about a piece of paper, I only care about Ross coming home again; that’s all. That was what I had trusted this hospital to do.; that was why I had brought him here and not somewhere else. That’s why I paid for the extractions, that’s why I was willing to risk the mortgage. Now the lead doctor on the team, who was in the best position to make sure it happens but had done nothing about it, is telling me to let it go.This is not about standing; this is about personal morals and values, and I don’t need standing to talk about those. This is about understanding why Ross is not here anymore. His life is just as valuable as the next person’s whether I’m in it or not.I don’t know if Dr. Cohen would agree with me about that; some of the things he says over the next few days leave doubts in my mind - scare me out of my wits, to be honest.Ross did not deserve what was allowed to happen to him. I’m not afraid to be a pain in the ass when Ross’ life is at stake.HOW DID IT GET THIS BAD?This Thursday morning, after nearly another week has gone by, I got a phone call from the hospital at 4:30 am, asking if I give permission for Ross to have a blood transfusion. What for?!? Why does he need a transfusion, and why are you asking me, why aren’t you asking him? (It’s 4:30 am, and I’m not awake yet.) My first thought is that they must be preparing him for those surgeries. Finally! It’s been taking them long enough. Yes. of course, yes, whatever he needs, do it. I’ll come early today. I had other errands planned for the morning, and to go to the hospital later in the afternoon, but I can switch those around and come after breakfast, as soon as visiting hours are open.So now I arrive at 8:30 to find that Ross is on a respirator, leaving instructions that I am his partner and I am to make all decisions for him, but his heart surgeon is telling me, “Oh, then, you can’t really make decisions for him, not really…”Funny, nobody had objected when I prepaid for his oral surgery and nobody had objected when the surgery was delayed or canceled. That was all okay, but now that the situation has turned, it’s not okay for me to make the biggest decision imaginable?I would have thought Dr. Cohen to be disappointed or frustrated if I were unable to make the decisions, I would have expected him to want someone who can make these decisions so it would not fall on him. But he sounds relieved and he would persuade me to stop treatment now; that’s the recommendation of the doctor who ten days earlier had dismissed Ross’ concerns about this very possibility.THE WRONG DOCTORI’m going to jump ahead a few days to let the reader know something that I did not yet know at this point, then I will return to this Thursday morning to pick up the narrative of my experience.It turned out later that Ross’ insurance would have covered those extractions if they had been done by a licensed dentist or oral surgeon. Dr. Tiner is licensed for plastic surgery.This was not plastic surgery, this was not an elective, this was a necessary precursor to a life-saving operation, and it was covered by Ross’ insurance plan… when performed by a licensed dentist. There was no need to waste days scrambling and swapping credit cards around to pay for this. Why is a five-star hospital relying on a plastic surgeon who delays a life-saving surgery until he gets paid instead of a licensed dentist who takes dental insurance? How can the lead cardiologist be aware of it, knowing that there have been problems in the past, but do nothing about this? Ross had the insurance to cover it all that time; they’re using the wrong kind of doctor, and the lead physician on the case is fully aware of that; he defended the plastic surgeon.How did I learn about this? A week later, in Ross’ duffel bag I will find papers and forms he had signed. One of them he had signed that same day that I had prepaid the second time, and it was from Dr. Tiner’s office, Ross had checked a box on that form that said, “Yes, please submit my claim to my insurance company.” Then why were we told our insurance wouldn’t cover this procedure, when right there on Dr. Tiner’s own form, it says “Yes, please submit my claim to my insurance company?” The letterhead explains: Cosmetic and Reconstructive Surgery. WTF? This isn’t Cosmetic or Reconstructive Surgery. This is an emergency, requiring the removal of strep infected teeth or he will die, and it’s covered by his dental insurance, but strangely enough, this guy doesn’t take dental insurance… well, of course he doesn’t take dental insurance: he’s not a licensed dentist.Still, there was another way out. The insurance plan has a clause for emergencies: a “qualified physician” may perform the extractions in an emergency or life-threatening situation. As a plastic surgeon who does facial reconstruction, he is qualified to remove teeth, repair jawbones, and other oral surgeries. Despite what he says about Ross’ insurance plan, he is covered and would have been paid, 100%. There is no reason from the insurance company’s point of view for Dr. Tiner to tell us insurance won’t pay for it. The ombudsman confirmed that for me in a five-minute phone call.“One of the best at what he does” Dr. Cohen had said, but does that mean plastic surgery or dentistry? His website displays successful boob jobs, tummy tucks, and cheesecake photos, and buried away in there, it also mentions facial, oral surgery. Neither Ross nor I were aware of this; one of Ross’ previous partners will discover that some days later while I’m at the mortuary.Does hospital administration know the “oral surgeon” they’ve contracted with to perform dentistry - and the only one they use! - is not a licensed dentist, doesn’t accept the patient’s dental insurance, and can bottleneck a life-saving operation? How does this escape notice when the patient voiced his concerns; where is the patient advocate? The hospital is either aware of and complicit with it, or unaware and complacent. I’m not sure which is worse.I had assumed Dr. Tiner was a licensed dentist - who else does oral surgeries? Surely he would work with us on a payment plan, pull the teeth now and send us a bill. I had suggested we go to my dentist - he might not be “the best at what he does” - but he’s very good, he’s done emergency extractions for me, and he certainly won’t demand payment in advance. I even suggested we go to the public health clinic three miles up the road where dental service is done pro bono. But there is a wait to be seen there, and Ross didn’t have the luxury of time, nor was he in any condition to be transported. We’re stuck with what we’ve been offered.By the date Ross signs this form, Feb 27, he is sick, very sick, he’s not been able to sleep, it’s hard for him to breathe, he can’t eat, he’s desperate and frightened, he’s suffering, drowning in his own blood, and hours away from having a stroke that will render the extractions impossible.His worst fear was about to come true.PLAYING GODSo here it is a week and a half later, Ross is in a coma on a ventilator, he’s had the blood thinners in preparation for the heart surgery, and the teeth have been paid for but they remain in place, the infection is continuing to do damage, and after being told by Dr. Cohen that I can’t really make these decisions for Ross, he tells me that if it were his decision, he would discontinue treatment at this point.Ross had expressed his concerns from day one to his lead physician who had done nothing about it even after admitting there had been problems with him in the past. No wonder Dr. Cohen wants to stop treatment now, no wonder he sounded relieved when he thought I can’t make those decisions. It took Ross’ nurse to scold Dr. Cohen loudly and publicly for him to back down, but first he pulled me into a private room and brought a witness with him. And what he tells me goes against everything I’ve ever heard about the medical and legal profession; it certainly goes against every ethical and legal training I’ve had as a therapist. It’s the first time in 61 years I’ve heard a medical professional say anything remotely like this.When the three of us were in that room that morning, Dr. Cohen explained that in cases where there is no next of kin, no spouse or children, such as an elderly patient living alone, or a nameless, homeless person, such as often happens with under-insured or uninsured patients who have nobody to make these decisions, it often falls upon him, the doctor, to decide whether or not to operate or provide treatment, to perform procedures and tests that are “risky and very costly” (he uses that phrase frequently over the next few days), or whether it makes more sense to do nothing more than comfort care and let the patient die.Is he letting me in on some sort of professional secret? Is this insider information that only practitioners know and discuss in whispers in quiet rooms? Morally and ethically it sounds dubious to me, let alone legally; what if he misjudges the patient’s situation or makes a decision too quickly? I thought that was the job of a patient advocate, a legally appointed guardian assigned by a court so that such a decision cannot be left to an individual who might have ulterior motives or a conflict of interests.Anyway, what does this have to do with Ross? I don’t get it, he’s not alone, he’s not homeless, he’s not elderly, he has insurance, I’m listed as his emergency contact, our address and phone number are in his file; the night nurse got hold of me at 4:30 that very morning. A Google search of our address would show that we’re only 10 minutes away from the hospital, and that we’re within walking distance of the sheriff’s station. An assigned patient advocate would have discovered that much within 5 minutes. Dr. Cohen must not know anything about Ross, he wouldn’t be telling me this if he did. Those stories don’t fit.But then it hits me. Oh. My. God. He has just admitted to me that he sometimes decides on his own what is “risky and very costly” and sometimes he lets that person die. And now, knowing nothing about Ross, he was justifying a decision he had made.Ross’ had predicted this: they were just going to let him die. In an instant, grief turned to horror: I was sitting across from Dr. Jekyll, Dr. Frankenstein, Dr. Moreau. I had scraped together the money to prevent that, and believed I had brought Ross to the best hospital around, but $1,750 later I realize I’ve delivered him to Moloch.That may sound melodramatic, but that was my reaction. Until this morning, I had thought a doctor’s goal was to save life; I had never heard a doctor say he decides what is “risky and very costly” and ends life instead. What would I have met with if I had arrived half an hour later? What if I had been out of town, or sick in bed, or unreachable?That was why I fainted when we returned to Ross’ room afterwards; it was because of this conversation. I had been looking the devil in the face and he had Ross in his hands.Was I over-reacting? In hindsight, I don’t think so, and here’s why:The witness Dr. Cohen brought with him hasn’t said a word the entire time. It’s weird and uncomfortable; who is she and why is she here if she’s not participating in this conversation?She’s not one of Ross’ doctors or nurses, I know that much; I guess she just happened to be there and he had grabbed her to come along. A bit younger than he, with long brown hair about halfway down her back, green scrub suit, she’s pretty; that’s all that registers at the moment. No idea who she is, and I won’t see her again for several days and when I do, it takes me a moment to recognize her. She is the examiner who pronounces the time of death; that’s when I will see her again.It was not a random coincidence that she was waiting there with Dr. Cohen this Thursday morning.Thank God nurse Maria spoke out when she did.But all of that is anticipating somewhat; those realizations are to come later and gradually, a day at a time. Right now, on this Thursday morning, I’m in shock, I’m horrified at the stories Dr. Cohen has just told me, and my first thought is to protect Ross from this monster who prefers to let Ross die and nearly made it happen.Before I can make any decisions for Ross, I need an explanation for why the extractions had been delayed for a whole week, when that had been his one and only chance to come home alive, and Dr. Cohen knew that was his only chance. Why didn’t it happen, why hadn’t anything been done? He tells me it won’t matter now anyway. That was not what I asked but I’m too much in shock to notice the deflection for what it was.I didn’t know it then, but that was the first in the pattern to follow: there will be other deflections, distractions, evasions and excuses, even insinuations that I’m the one who is harming Ross, but nobody explains the reason for that week-long delay. Instead, over the next ten days, I am going to be pressured subtly and not-so subtly to terminate Ross’ life.I cannot do that to Ross, not without understanding the reason for it.Of course my decision is to fight for Ross; he was admitted with the expectation this had its risks, but everything had been prepared except the oral surgery. If there is any chance at all, no matter how slight, I am going to choose life, not death. I know Ross, they don’t, Dr. Cohen has made that frighteningly obvious. If I hadn’t been in a state of shock I might have asked for more precise definitions of his criteria, for example, how much exactly is “very costly” when saving someone’s life; what’s the number? And how is not operating less risky when that means he will die? I don’t want to hear about “very risky” or “very costly.” Risky is still better than dead, it means there is still a chance, and “very costly” is mine and Ross’ business, not Dr. Cohen’s.What does “risky and very costly” mean when it comes to saving a person’s life? In other words, it’s not wise to try saving him because something might go wrong, and it isn’t economically sound, it’s financially imprudent. Ross isn’t worth the effort and expense required to take a chance on saving him; it’s safer and more cost-effective to let him die. Ross isn’t worth it; that is what “risky and very costly” sounds like to me.(Imagine the captain of the Titanic telling his passengers they can’t take to the lifeboats, it’s too dangerous, they might tip over, and besides that, lifeboats are expensive.)Ross had trusted me to make the decision for him, and his nurse knew that; I have to believe Dr. Cohen knew it as well; he backed down immediately and pulled me away into this private conversation. How does he imagine he can take it upon himself to overrule Ross’ expressed intent? Ross’ question ten days earlier was eerily prescient: “Would he really let me die, just like that?” It seems to me he was ready to do just that.That was why I had fainted.A MIRACLEFriday March 6th. It is decided that Ross, although comatose on a ventilator, is able to undergo the extractions. No need to wait. (That’s actually the tagline of Huntington’s current marketing campaign, currently seen throughout Pasadena on buses, billboards, and their website.)No need to wait ten days for an emergency procedure that could save a person’s life. (I guess Dr. Tiner and Dr. Cohen didn’t get that memo.)Huh. Just 24 hours earlier I had been told he was a lost cause, terminal, treatment should stop. But now Dr. Tiner is finally going to do the job he was contracted to do, after making Ross wait ten days due to a billing issue. Is this a miracle? Or an attempt to cover up a mistake too late?Before I go on, I have to say this. The nurses, the support staff, the technicians were all amazing. Whatever they earn, it’s not enough, they deserve double whatever they get paid. I have nothing but the greatest respect and praise for them, every single one. Cynthia, Clara, Eric, Erik, Erin, Jennifer, Lucas, Tamara, Christa, Maria, Marta and anyone whose name I missed.. Ross thanks you, and I thank you, more than I can ever say. I’m sorry if I did or said anything offensive. You all seemed to understand where I was coming from every moment and had the patience of the gods. Thank you for being there. You are a rare type and you deserve so much more.I finally meet Dr. Tiner myself late in the afternoon, up to this point I’ve only heard Ross’ description of his bedside manner, and the insistence on prepayment. Mind you, he has my $1,750 now. What do I have? Ross in a coma, dying before my eyes… because this man could not be bothered to do anything until he had my money first.Tanned, casually dressed, all smiles and handshakes, he strikes me as slick, more politician than medical man. He strides into Ross’ room, checks the monitors and IVs, gives Ross a once-over, says everything looks good. (Really? Did you notice the respirator over there and the big blue tube going down his throat? How and why did that get there?) I would have thought that, as one who surely must realize that he is the reason for this, he might be humble or apologetic or at least careful about what he says, but he doesn’t address me at all beyond a perfunctory and obligatory introduction. So I make an effort at interaction.I’ve had two extractions myself, each one took about a half hour, and I ask Dr. Tiner how long he expects this to take? “Oh, about 45 minutes to an hour,” he says. “Really, for seven teeth, that seems awfully fast…” “Hey, man, that’s how good I am at what I do…!” and with a snap of his fingers, he saunters out the door.No wonder Ross didn’t care for his bedside manner. Jeez. Mechanical and cavalier? I’d add narcissistic too. This took no more than ten minutes, just like his first consultation. Not so much as “Any questions?” (Just this one: why couldn’t you have done this a week ago?) or, God forbid, “I’m sorry about this; I’m going to fix it.”It might sound as if I resent Dr. Tiner having $1,750 from me, but that isn’t it. I’d have paid ten times that and more to have brought Ross home alive. What I cannot understand is how, knowing the seriousness of Ross’ condition, a trained professional could not or would not spare “45 minutes to an hour” to apply his special skills and knowledge so that someone might live. I’d have paid any amount he asked, I’d do menial labor for him, I’d have mowed his lawn and washed his car for a year, I’d have given his kids free piano lessons, I’d have worked something out somehow to repay him. It’s not about $1750; it’s about being able to save a person’s life but choosing not to do it. I don’t understand that.Soon an anesthesiologist, two nurses and a pair of orderlies arrive. The orderlies begin preparing Ross to be rolled out. Nurse 1 calls out to Nurse 2 different instructions, confirming what is to be done. Between calls, Nurse 1 puts a piece of paper in front of me: “Sign here.” And another one. “Sign here.” And another one. Another one. By now the orderlies are rolling Ross’ bed toward the door. I don’t know if I like this; Dr. Tiner caused this after all, and he barely said a word to me, and now they’re taking Ross to him when just yesterday Dr.Cohen had told me Ross could die on the operating table; this was risky; very costly; he would stop treatment now. So I’m more than nervous here, I’m scared. Will Ross be alive when he comes back?“No, wait a sec, wait!” I tell the orderlies, and they stop where they are. “Give me a minute..” They stand back while I lean down and whisper in Ross’ ear. Come on, Ross, be good, you can do this, get through this; it’s only an hour, I’ll be here when you get back. I kiss his forehead and then to the orderlies: “Be good to him, take good care of him.” They must think I’m nuts, but who can blame me? His own doctor would have let him die, and they’re wheeling him now to the doctor who screwed this up. Neither of them has said, “I’m sorry this happened; it wasn’t supposed to be like this.” Instead his lead doctor has tried to justify why he would have allowed Ross to die. I think I have grounds to be paranoid.The anesthesiologist was watching, and after Ross was gone, he tells me he’s been doing this for 30 years, he’s seen this before, and he can’t promise of course, but he’s pretty sure it’s all going to turn out alright. I hope so. It’s the last good news I’ll hear.WAITINGRoss survives the extractions, and the plan is to reevaluate his condition on Monday. It will be a long weekend. One morning over that weekend after I’ve spent the night on the little sofa bed next to Ross, I ask if it’s possible to lower the sedation just enough so he and I can talk? Sitting on a footstool next to me, Dr. Mauer gently and humanely advised against it; it would cause Ross to suffer. Oh, then, of course not, I don’t want to do that to him. He is thinking of Ross first and appropriately so. But Dr. Cohen’s initial remark that I “can’t make these decisions” has left a bitter aftertaste; that was poison. My voice cracks, “I just want Ross to know I’m here with him, that’s all.”Dr. Mauer: “He knows. We all know. We all see it, we’ve seen you spending the night here, we’ve seen you with him, we can see it, we all know.”Does Dr. Cohen know, can he see it too? He sounded so relieved to think otherwise. I thanked Dr. Mauer for saying it; he’s decent, he has a good bedside manner and his concern is genuine. He has that talent of hearing the real question behind the surface question and he goes there. I’m not too sure about anyone else yet.Two of my brothers have been taking turns watching over Ross so I can take care of matters at home, shower, change my clothes, and come back. Today it’s my older brother who is there with me.Dr. Cohen enters on his morning rounds with what I suppose must be interns following behind. He explains the case to them: there is a slight chance to do something, a one-shot deal, a Hail Mary, and the case will be reevaluated on Monday. He explains this is “one of those cases they will inevitably see, where tough decisions have to be made, and this can be hard on doctors and support staff and hospitals, hard for all of us…” and then to my brother “…and the friends and families too,” and finally to me, “to have this dumped on you…”I wonder how he’d react if our places were switched and I had said that about his wife. Ross didn’t “dump this” on me; Dr. Cohen and Dr. Tiner did. My brother gives me a look that tells me he’s thinking the same thing I am.PONTIUS PILATEMonday, March 9th. Morning. Outside Ross’ room, Dr. Cohen beckons me to come out there, a little smile or smirk. “Can you stand up, can you walk?” he asks. Of course I can walk; does he think I’m going to faint again, did he think that was funny? I am told Ross is still inoperable, and again he recommends no follow-up heart surgery, and I should “prepare for the worst.” I intend to fight for Ross if there is even the tiniest chance. He tells me the surgery is risky (I know that); it’s very costly (that’s not your concern); there are no guarantees he’ll survive (but you told me he’ll die without it), chances of survival are slim (I’ll take slim over none). No, I will not sign a DNR order, not just yet, not when there is still a chance, I am not going to make any such decision prematurely. Dr. Cohen assures me, “It won’t be premature.”Seriously? Nice touch, thanks for the comforting words. It must feel good to be so smart.But it’s really a mixed message. My brother agrees. Yes, of course it’s risky, but Ross will die without it; it’s riskier not to have the surgery. And costly? Ross’ insurance covers it. Dr. Cohen hasn’t said it can’t be done, he has laid out the odds for why he won’t do it. He can’t wait to rid himself of this, that’s the message I’m getting. He could have intervened to prevent this two weeks ago, but he didn’t; he had defended Dr. Tiner and then stood by, and now he’s washing his hands of it: Pontius Pilate.The critical care unit takes over now, and that is the last time I see Dr. Cohen, who apparently is no longer on the case. No, actually, that’s not quite true. I do see Dr. Cohen a few days later: during the early morning break between visiting hours when I’m sitting in the lobby, he comes in the front doors. Besides the person at the information desk, I am the only other person in the lobby, and he has to cross in front of me to get to the elevator bank. Does he stop to say hello, or ask how I’m doing, or “we’re all so sorry about this” or even make eye contact? No. He strides on past; I am just another piece of lobby furniture on his way to the elevators. At least he didn’t ask why I was still there.In contrast, a little later I bump into Dr. Mauer in the cafeteria; I’m on my way out, he’s on his way in. He gives me a nod of recognition and a “Hello.”The critical care team valiantly tried everything they could to restore Ross to a condition where he has at least that slim chance to undergo heart surgery, but nothing is working. It is a gradual, steady decline, and he never comes out of that coma.Tuesday, March 10. The infectious disease specialist stops by to see where things stand. Dr. Joo is very precise in his language, calm and soft spoken, and his explanation of the strain of strep that has caused this is clear.Ross indicated in his notes that he liked Dr. Joo, and I can see why; they both stick to facts, they both have a dry sense of humor, and they are both true scientists at heart. There are a few things I don’t understand yet: is this strep contagious, do I need to be tested or concerned for myself, since Ross and I live together? No, he explains, we all have strep in our mouths. It’s only a problem if it gets into the bloodstream. Okay, then if Ross’ blood is clear of active infection because of the antibiotics, why couldn’t the heart surgery be done, why do the teeth have to come out? Because the antibiotics will clear the bloodstream, but they don’t get to the root of the infected tooth, and the infection could flare up again. Ah, got it. The biology of what is happening is clear to me now.Just one more question then. Was there any reason the teeth could not be extracted once the blood was clear of active infection? Not that Dr. Joo was aware of, no; but I’d have to ask Dr. Tiner about that. “No, I don’t want to see Dr. Tiner, he’d better not come anywhere near this room while I’m here.” A short, barely audible and probably involuntary chuckle escaped under his breath. I was only half-kidding. Grief and horror were turning to anger.CONFUTATIS MALEDICTUSWednesday, March 11. Someone from the “Customer Relations” group calls on me in Ross’ room, and I ask my question: why weren’t those extractions done, why was that surgeon allowed to delay that for payment, in a life-saving operation? She evades that; even if the extractions had been done, Ross still might have had a stroke, and he’d still be in this condition. That’s not an answer, that’s a deflection. I tell her, “True, we don’t know what else might have happened, but we do know what should have happened and didn’t, and if it had happened the way it was supposed to happen, we wouldn’t be having this discussion right now, we’d be having a different discussion.” She agreed and dropped it. Ross is dying here; I need to understand why. All I know at this point is Dr. Tiner cares more about money than Ross’ life, and Dr. Cohen did nothing about it and he’d rather let Ross die now. That’s what it looks like to me.Dying from infectious endocarditis is one thing, and it’s already hard enough. Dying from infectious endocarditis after waiting a week for treatment from a doctor who insists on being paid first is quite another. It might be the same infection, but they are not the same death.THE MACABREI’m hearing a strange rumor in the afternoon - I am not going to say from whom - that the goal for Ross has been changed. It’s no longer to see if Ross can be revived enough for heart surgery, it’s to see if he can be brought out of sedation enough to ask him directly himself, does he want to continue treatment for a chance at life, or would he rather die? (Of course it isn’t phrased that way; they do have more tact than that, but that’s ultimately what it means. Lipstick on a pig.)I am speechless. Can you imagine? A few days ago, to bring him out of sedation would cause him needless suffering when I had asked for it, and I had understood and accepted that the humane response was to not do that to him. So all of a sudden, it’s okay for them to bring him around, causing the same needless suffering so he’ll grant permission for them to give up and let him die?What the hell is that, I ask the chaplain, who is in Ross’ room with me this afternoon. Do they think they’re being merciful to Ross because I am being obstinate with them? I don’t know who to trust, maybe I’m becoming paranoid but it’s obvious that something is wrong here. I don’t trust anybody now. Will I be present when they ask Ross that, or will they wait until I’m in the cafeteria?The chaplain looks at me sideways with a knowing look. “It’s like they’re trying to do an end-run around you, isn’t it?” Yes, exactly. But who and why? (The answer should have been obvious, but I didn’t have all the facts yet.)The chaplain answered my next question, what kind of surgeon holds up a person’s life for money that way? with another sideways look. “I was told he’s the only one we use.” And he’s allowed to hold up surgery for cash; the hospital allows that? Do they even know he’s doing that? How is this possible?I’ve known Ross for twenty years, and for 13 of those years he’s lived in my house with me. You’ve all known him for two weeks, and he’s been unconscious for half of that time because your guys screwed up. And you expect me to give you permission to let him die now? It’s unreal.I decide to go home, have dinner, change my clothes, get the mail and come back later, probably spend the night again. It might be a good idea to take Ross’ duffel bag home, along with his laptop and cell phone, maybe people have been trying to call him without knowing what’s been going on. In the mail is my alumni directory from Harvard: this year will be our 40th Reunion. I can bring that back with me, it’s something to read anyway. After dinner I empty out the duffel bag, and find the notes he had made during his first week before the stroke, along with some authorization forms and other papers. Looks like he signed this one on Feb. 27, the same day I had paid the second time, the night he had his stroke. “Yes, please bill my insurance company…”Whoa. I thought Dr. Tiner doesn’t take our insurance; what the hell…? The letterhead on this form does not mention anything about being a dentist, it says cosmetic surgery. The only one they use and he’s a plastic surgeon? Dr. Cohen had to have known that when he told Ross “Yes, there have been problems with him in the past… but I’ve talked to him… he’s a fine surgeon... the one we use here…”Nobody at any time had referred to him as a plastic surgeon. Nobody. It was always either “dentist” or “oral surgeon.” In fact, the Supervisor from Palliative Care will tell me… but I will let that wait until the time comes.It was time to go back to the hospital. I can look into this a bit more from there.THEY LIED TO USIt had been raining the last several days and tonight was no exception. It’s a bit late by the time I get to the hospital, but it shouldn’t be a problem, visiting hours in the ICU are practically 24 hours, except for during shift changes. It’s a little after 10 pm when I arrive at the main entrance. Security tells me sorry, front doors closed already, I have to go in through the ER, all the way around the other side of the hospital. Arggh. But it’s raining, can’t I… No, sorry, you have to come in through the ER, all the way around… So it’s off to the ER parking lot and entrance.It’s a long hike from the ER to the ICU, and for a first timer, something of a maze, but occasionally there is a window so I know I’m headed in the right direction. At one point I come across a long corridor with portraits hanging on the wall, the various committee members and their titles, the board of trustees, different specialists. There’s Dr. Rosenberg; he was my doctor about ten years ago, he went to battle with my insurance company to get me some expensive and experimental medicine I needed, and it had worked. I’d probably not be here today if he hadn’t done that; great doctor (and Harvard too!). Oh, and there’s Dr. Shriner, another of my former doctors. She continued seeing me pro bono once when I was between jobs and without insurance. Another time I had a swollen rash on my elbow; she didn’t like the look of it and arranged a referral with a specialist for the first thing the following morning; she didn’t wait around. Fortunately it turned out to be nothing serious. Another great doctor; both of them were exceptional. They went out of their way.I wondered what either of them would have done if a colleague had delayed treatment for one of their patients who had a potentially lethal infection? I can’t imagine Dr. Shriner would sit still for that, or Dr. Rosenberg either.At the ICU I settle in for the night, but first I check the insurance company’s website. Extractions are covered when performed by a licensed dentist or oral surgeon, or, in case of emergency, they may also be performed by a qualified physician. So that’s why Dr. Tiner said he didn’t take Ross’ insurance. Then why does the hospital give us someone who doesn’t accept the insurance for the very procedure he’s expected to do? Who makes a decision like that?Next stop, Huntington Hospital’s website. How is Dr. Tiner listed there? Plastic Surgery first, Oral Maxillo Facial Surgery second. So then if he is qualified and if an ongoing, lethal infection is an emergency, he would have been covered by Ross insurance. Scrolling backwards through the listings, one catches my eye. What was that one? Dr. Stephens, oral surgeon, licensed. What the f*ck!! There is another oral surgeon here after all, and a real oral surgeon, one with a license?Who is running this place?This is unreal. They lied, and here is Ross on this ventilator waiting for treatment, never knowing that we had been told a lie. And Dr. Cohen tried to tell me I don’t have the right to make this decision, “not really...” Lying there unconscious, Ross has no idea this has been going on; that’s the only saving grace in this. It’s a nightmare that started out as a lie.Whether that was deliberate or incompetent, I don’t know, and I don’t really care either way. What I know now is that we had been misled from the very start. How much of what followed was an attempt to cover it up?“IT WON’T BE PREMATURE”Wednesday-Thursday, overnight. I wasn't sure I wanted to tell this next part because it's really hard and to write it I have to relive it, but in the context of Dr. Cohen's certainty that "it won't be premature," I do think it belongs here. I’ll simply describe it and let readers draw their own conclusions.“For those who believe, no explanation is necessary. For those who do not believe, no explanation is possible.”Before dawn the night shift would always lower the sedation a little bit to see if Ross was responding neurologically, if he would respond to commands like "move your finger" or "open your eyes." It was questionable, I'd say, but there seemed to be something there. Was it Ross or not? There was no way of knowing. This night a different nurse was on duty, and he did the usual procedure, and the response was about the same. Hard to tell. But then he told me, "You talk to him." So I moved over to the side of the bed, and just said his name, "Ross...? It's me, I'm here, I'm right here."His left hand twitched and shifted and then it rose up off the bed an inch or two in the air. That was more movement than I had seen since this started. I grabbed his hand and held it. The nurse was standing in the doorway watching, a big smile on his face and he nodded for me to continue. "Ross, you're okay, everything's okay, I'm right here next to you," and his other arm reached out, trying to find where I was holding his left hand; he fumbled about in the air. I grabbed that hand in my left too, and with my right hand, I stroked his hair and rubbed his neck, and patted him about the head.I don't know why I did this, but I started talking to him as if he were a little boy or a puppy. "Good boy, Ross, that's good, atta boy." His head rolled slowly toward his left shoulder, in the direction of the sound of my voice. "Ross, when this is over we're going for a bike ride, we'll get the bikes out and fix them up and go for a ride to the beach, we're going to do that, I promise." (He was always trying to get me to go for a ride with him, but I usually made up some excuse.) As I was saying this, his brow and forehead wrinkled and furrowed, his eyelids squeezed rapidly as if he were trying to blink and open them but couldn't do it, and his head wobbled to his left side, nodding up and down like a bobble-head toy while I stroked his hair. I think he was trying to figure out where I was, so I tried to position myself where he could rest his head against my shoulder, but the bed was too wide and in the way. I positioned myself instead where he could see me, if he could just open his eyes.I looked over at the doorway to see if the nurse was still watching; he had grabbed the nurse from the next room over and they were both standing in the doorway, wide-eyed and smiling, big broad smiles. The other nurse said it, "He's interacting with you."I had to let go of his hands for a minute to wipe my eyes, they were dripping now, but Ross' hands reached about trying to find where mine had gone. I grabbed his hands again and held on, this time I wasn’t going to let go for anything. I said all kinds of stuff, I called him by his nickname, I repeated some German words and phrases I had been teaching him: “Guck mal hier!” and “ich hab’ dich lieb,” and other stuff, I don't remember all of it."Ross, be good, get well, you have to get well, everything's going to be okay, I'm right here with you, I’m not going anywhere, don't be afraid, I love you, Ross," and I can't remember what else I said. All this time his eyelids were squeezing and blinking, his head turned toward my voice, I was holding his hands and rubbing his head, and his head bobbed up and down at my touch. The nurse let us have a few minutes before he had to put Ross back under sedation. As he relaxed back into his sleeping position, I kissed his hands and his forehead, told him to go back to sleep, everything’s all right, I’m right here, and he drifted off to wherever he was now. But that was enough to tell me, he's still here; Ross is still in there somewhere.Thank you, nurse Erik, for doing that.No, I am not going to give DNR, not as long as he shows me that. I am not going to make any such decision prematurely, so stop asking me; I won't do it, and that’s why I won’t do it. I know Ross; you don’t. Screw Dr. Cohen and his "it won't be premature." It must feel pretty good to think so, but you don't know everything; “there are more things between heaven and earth, Dr. Cohen, than are dreamt of in your textbooks.”Don’t get me wrong, this is not some magical, dreamy, romantic Hollywood moment; it’s awful. Awful. This should not have happened, look at what you’ve done to him! He didn’t do anything to deserve this, he trusted you and believed you and this is what you did to him! It’s heart breaking and pitiful, but he’s still in there somewhere. Stop asking me to give up on him.THE HIV EXCUSEThursday March 11. Dr. Banta, head of ICU, with a team of three interns in tow, stopped by to explain how things stood. Ross was still not responding. Again, the talk about stopping treatment, DNR, letting Ross go, quality of life even if he did pull through, tracheotomy perhaps, or feeding tubes, or bedridden... prognosis is poor. Yes, I know all that. He asked me how I was doing.I had been staring at the floor, listening to this same speech again. The day before, I had taken Ross' duffel bag and laptop home, and I had read the notes he was making for the formal complaint to the state board; I had found the form he had signed and I had talked to the ombudsman at the insurance company. I know now what happened. I didn’t look up at Dr. Banta; I knew I had better not."I'm angry," I said, still staring at the floor. "I'm really angry. You have a doctor associated with this hospital who held up Ross’ life for payment, a life-saving operation, and we were told he's a fine surgeon, the best at what he does, and this is what happened. He held up that surgery for money. Who does that? Is that what they teach in medical school? That's not a fine surgeon, that's a bad surgeon, and I can't believe Huntington Hospital associates itself with that, I can't believe they allow it. I'm angry; I am really, really angry; and I hope you're hearing me because I don’t understand why this happened, and I need an answer. Why weren't those teeth taken out as soon as you knew that’s where the infection was? Why was Dr.Tiner allowed to wait like that; what kind of doctor does that?"Dr. Banta sat down on the footstool and started, "Well, don't be angry at just one individual, be angry at the systems, at viruses, at HIV..."Oh, fer Chrissakes... I waved him away; I wasn’t going to listen to that, I certainly hoped he wasn't suggesting it was because of HIV. "I know about HIV, Ross and I have raised money for HIV, I’ve lost friends to HIV, I know about being angry at HIV, and this is not about that. This is about one of your doctors who held up surgery for money and another one who knew about it but brushed it off. This has nothing to do with HIV, nothing; so don't try that with me." Dr. Banta didn’t respond; after a moment's pause, I looked at the interns, "I hope you're learning something here." They were looking down at the floor.Dr. Banta stood up and said they would keep trying, there were still some things they could do, but he couldn't promise anything. I understood that, but stop asking me to give up. Your guy made this mess; now fix it. I told him about the night before, when Ross had been brought out of sedation, that two of their nurses had seen it too, and as long as Ross shows me that, I am not going to give up on him. I know Ross, you don't. He had responded to things that only he and I would know, and you can't ask me to kill him as long as he does that, I won't do it. They left.I know I’m being a pain in the ass, I know that, but this is Ross, and I trusted you to take care of him, and I was expecting to get him back fixed up and good as new, that was the deal but now he’s coming back dead and the doctor in charge who didn’t do anything has the nerve to tell me I can’t make these decisions. Really? Hello? I paid for that surgery - twice! I have credit card statements to prove it. Do I get a refund at least or a new replacement for Ross; does Dr. Tiner’s service come with a money-back guarantee?You think I’m angry now? You haven’t seen angry yet.STANDARD PROCEDUREOne after another from the hospital will stop by to talk during these days, and I will ask that same question. Why the delay for those extractions; why was it held up for payment in advance? One of the Palliative Care specialists (Dr. Abilene Enriquez) sits with me one of these afternoons. I ask her that same question that nobody wants to answer: Why weren’t those teeth removed immediately, what kind of surgeon holds up life-saving surgery for payment in advance? She smiled sweetly as she explained it: “That’s standard procedure.”Is she freaking kidding me? Don’t treat me like a child, not when I’m watching my partner die because of your policies. My response came out as a hiss and a growl: “It is not standard procedure, and you know it is not standard procedure, why would you even say something like that? Do you want me to believe the hospital’s standard procedure is to demand payment in full before they’ll save someone’s life, is that what you want me to think when I walk out of here, can I quote you; should I tell that to all my friends?”She shook her head sadly but said nothing more. At least she knew to stop before she made it worse. Instead she batted her doe brown eyes at me and tried to lean her head on my shoulder in her best attempt to beg forgiveness or approximate empathy; I’m not sure which, but I scooted out of the way. Yeah, I was a jerk about it but I don’t care. If it’s not genuine, I’m not interested. Whatever else you do, don’t lie to me and don’t offer fake sympathy. I’m not here to take care of your feelings now that you all screwed up.Later that day I had a chance to ask her Supervisor that same question..INCOMPETENCEDiogenes had a lantern; all I had is my question but it has become my litmus test for honesty: Why was Dr. Tiner allowed to hold up that surgery for money?Supervisor tells me he’s not on staff at the hospital (got it, it’s not the hospital’s fault), he was brought in as a consultant (which means you hired him), and his billing doesn’t go through the hospital anyways; he’s just a dentist.I’m not sure what it means to be “just a dentist,” but in any case, then he must use a dentist’s billing service, right? Supervisor wouldn’t know about that, he’s just giving me information (translation: he’s protecting the hospital). Okay, but none of that answers my question, and besides (Supervisor must not know this part yet), he’s not a dentist, he’s a plastic surgeon. If he’s “just giving me information,” the least he could do is make sure the information is correct first.Epic Fail.Parents often warn their youngsters: “I already know what you did so just tell me the truth now and it will go easier for you. But if you lie to me now, you’re going to make it a lot worse for yourself.” Palliative Care - charged with bringing comfort and peace to the dying and bereaved - chose to make it worse.What does it mean that I know by now that Dr. Tiner is really a plastic surgeon, but Palliative Care thinks of him as “just a dentist?” Do they really think he’s a dentist, or are they too trying to represent him as one to me? Or did they just not bother to check first? And dentist or not, why does the hospital allow him to delay a life-saving procedure for payment in advance?PROFITS FIRSTWhy does everybody seem to be defending this guy? From Dr. Cohen on down the line, one after the other offers an excuse or an evasion, but nobody offers a medical explanation for the delay and nobody tells me I misunderstood about the payment..All I understand now is that we were misled from the start, then Ross’ concerns had been acknowledged but ignored, I’ve laid out very plainly what I’m thinking now, but nobody wants to address it and correct me if I’m wrong or explain it if I’m right. At this point it looks like they are aware they made a serious mistake, that’s how we ended up here, and now they just want it go away. Ross isn’t dying fast enough and it’s embarrassing and inconvenient and potentially trouble and it needs to disappear; that’s what it feels like to me now, that’s the message I’m getting. Why?Because everybody knows those extractions were delayed for payment, but nobody is willing to say that was wrong.I’m sitting here watching Ross die and I’m expected to be polite and pretend not to notice that everybody else is pretending this is normal.I get it. This is a serious legal problem now. Obviously. You all know it, and I know it; we all know that we all know it. But your guy caused this, not me, not Ross, and he warned you about it and asked you to do something, but you didn’t. Now everybody’s out to protect their own asses, their money, job, reputation, status, license, institution, whatever, and it’s just too darned bad that Ross has to die now, but it’s not our fault. I get it, this has put everybody in an untenable position, but Ross didn’t do that to you and I didn’t do that to you. One of your own did that, he put you all in this horrible predicament, but all of you are protecting him now with your silence. Why?You’ve all taken a vow to heal, save lives and do no harm, but what good is that vow if you don’t hold each other accountable for it?Of all the people I asked that question, not a one of them offered a medical reason for why those extractions hadn’t been done. By the time they were extracted, Ross was in far worse shape and I had been told the day before that treatment should cease. There never was a medical reason for that delay; that’s why nobody can answer it. This was not a medical mistake; it was a financial decision and someone made that decision and everybody is okay with it. That’s what it looks like now.I can’t keep saying it, and I don’t know why they aren’t getting it: but I can’t and won’t end Ross’ life without knowing why.THE DAY I COMPLETELY LOST ITOn Thursday of that week, I leave the hospital at noon to go home and wait for our pharmacy to deliver refills of Ross’ and my own routine prescriptions, one of his antivirals is not available in the hospital’s pharmacy, and he is just about out of them, and I’m almost out of insulin. Plus I can shower, change my clothes and clean up in the meantime. After a couple of hours, the phone rings; it’s the ICU; Dr. Honlee asking me to give verbal DNR approval, that Ross is in distress, and I could spare him this if I approve DNR now. I refuse until I see for myself. He assures me they “expect” to be calling “Code” in the next 15–20 minutes, and they can spare Ross that if I give verbal DNR now.What does that mean, they “expect” to be calling Code? If they can anticipate that in the next 15–20 minutes, why aren’t they doing something about it right now before it gets to that point? Dr. Honlee describes the horrors Ross will endure if they call Code, but I can prevent it with verbal approval: chest compression, broken ribs, electric shocks… This is too much, it’s my fault now that Ross is suffering, and before Dr. Honlee could finish his sentence, I lost it: “This is all Dr. Tiner’s fault, it never should have come to this, this was supposed to be routine but he canceled it and waited until he got paid, that’s why this happened; this is Dr. Tiner’s fault and you all know it, Ross didn’t deserve this, and I want justice for Ross!”Caught off-guard, Dr. Honlee paused for a beat, then his voice dropped, quieter and slower now: “Well… yeah, I know… I know… and I want justice for Ross too...”Then I was right; that is how this happened; someone else sees it too and has said so. I’m not crazy and I’m not imagining it. This nightmare really is what it is, and it’s not over yet.Dr. Honlee is still talking, “…but right now it’s about Ross being comfortable and sparing him any more pain and letting him go peacefully and with dignity.” That’s a little better, it’s about Ross. “Then wait until I get back there so I can say good-bye to him, let me do that, I can be there in 10 minutes.”He didn’t expect that; he is immediately apologetic: “Oh! Well. Yes, of course, of course you should do that, yes, certainly, of course, drive safely.” Arriving at ICU, I expect to see activity around Ross’ room: “Code,” emergency equipment, flashing lights, buzzers, hurried personnel. But there’s none of that. Ross looks exactly the same as he had when I was last there just a few hours earlier. No sign of distress or unusual activity; nobody is there to explain what had happened; nobody waiting with DNR papers for me to sign.What am I supposed to think at this point?What is wrong with you people? Don’t you get it? This is Ross, this is the man I’ve known for 18 years, lived with for 13 years, loved him, trusted him, argued with him, laughed with him, taken him into my house, gone grocery shopping with him, done the dishes with him, replaced the kitchen floor with him, watched movies with him, slept next to him, come home to him, gone on trips with him, been living my life with him… Put yourself in my position for one minute, and try, just try, to imagine it: that’s your wife, husband, child in that coma because the expert, the specialist, “the best at what he does,” demanded payment first before saving his life, and you all know that’s what happened. Do you really think I’m going to give you permission over the phone to stand around and let him die now, just like that; it’s as simple as picking up the phone and ordering a pizza? Have you all lost your minds?I probably owe apologies to a few people for my behavior and attitude that afternoon. I don’t remember everything I said and did, or to whom. I know a lot of it wasn’t nice and probably unfair and undeserved. But a week of evasions, deflections, obfuscating when I’ve been pleading to be given the truth before making this most painful decision; for the unintended suggestion that I’m the one causing Ross to suffer now, when everybody knows how it really got to this point…Yeah, I lost it. I think anybody would.At least Dr. Honlee had agreed, “Yeah, I know, I know… and I want justice for Ross too…” The significance of that was lost on me in the moment but I have to give him credit for that. Had someone pressured him to make that phone call? I don’t know, but if so, then I was unnecessarily harsh with him, and I would apologize to him. What I do know is there seemed to be no reason for that call when I got back to the hospital, and I was just in time for them to have been calling the predicted “Code” and nobody was there to explain it.CHAPLAINCYHuntington has two chaplains on staff. They seem to be somewhat independent of the official company policy; at least, they were more receptive to my thoughts and suspicions which I was no longer holding back. One of them apologized for being unable to comment on anything medical or finance related for not being privy to that information, but offered the observation that if my thoughts were correct, if that was how all this had actually happened, then it was inexcusable, unconscionable, indefensible, and my reaction was utterly justified and I should be making noise about it; it’s not right and something should be done about it. The other chaplain agreed: “You wouldn’t want this to happen to someone else, would you?” No, I wouldn’t, but I don’t want to believe doctors could be so mercenary and uncaring either. “But what if they are? Why don’t you want to believe what you’ve seen with your own eyes?”Chaplain was right: I wasn’t seeing it and accepting it because I hadn’t wanted to see it or accept it. It’s too painful to believe it but it’s true nevertheless. Ross was dying now because two of his doctors just didn’t care enough. That’s hard to take. Dr, Honlee had more or less agreed if not in so many words, and both chaplains have told me to trust my eyes and ears, and what’s wrong is wrong; there are some doctors whose motivations are not as noble as their peers, and that’s the truth. Believe it.Now it’s just about dinner hour when my cell phone buzzes, it’s the pharmacy delivery driver, he’s at my front door, where am I? Oh, jeez, I’m back at the hospital, so sorry, can you deliver here, or can we try again tomorrow?[Side note here: Doctors, nurses, staff… when you have to notify family that their loved one’s death is imminent, don’t call them at home to ask if they’re finally ready to just let it go now. Gently suggest that perhaps they should return to the hospital, or if they would like to say their good-byes, this might be the appropriate time, or… I don’t know what, have the chaplain call them if you don’t know what to say, but don’t ask for permission to stand by and do nothing and just let them die. That’s not showing compassion, that’s covering your ass, and it’s not nearly as compassionate as you’ve convinced yourselves. You see this routinely; it’s just another day at work for you,; you’ve developed an immunity by now, and anyway, everybody dies. Yes, of course, everybody dies someday but you’re not talking to the deceased here; you’re talking to those left behind, who have not built up an immunity to this. And in Ross’ case, Dr. Tiner and Dr. Cohen already did that anyway; it’s why Ross is dying now. Do you think I’m going to give you permission to do it again?]I wanted Ross to come home with me, alive, that’s all, but if he can’t and never will, help me understand why not. He hadn’t done anything to hurt anyone. Why were they allowed to do this to him and why are they allowed to get away with it?THE RIGHT DOCTORThere was one doctor who did say the right thing at the right time. He was one of the cardiologists and he too was no longer directly on the case, but still he’d stop by to see how things were. “I’m just a bystander now,” he had said earlier in the week but at least he was still interested and concerned enough to be there. This was Dr. Mauer, of course. He’d look at the monitors, then at Ross and answer my questions or just observe silently. Never once pressured me to make a decision; he was there to see for himself. A day or two after that phone call from the ICU, Dr. Mauer stopped by again. As he looked over the monitors, his demeanor seemed different this morning, sad but resigned. He leaned his back against the wall, and asked me how I was holding up. I shrugged, I had spent the night again. I was tired. He nodded and looked down at the floor, describing how sad and frustrating this was for the whole team; nobody had expected “this situation;” it had tied the doctors’ hands behind their backs from the start; everybody wished there was something they could do to fix it and make it right, some miracle, but their options were running out now, this was so hard…(Oh, please, cry me a river… No, actually, I wasn’t thinking that at all, I was listening and following; but you’re going to be taking Ross away now, and it’s forever, and those two are going to get away with it. Why? What did we do? I know it’s not staff’s fault but don’t ask me to pretend this is okay, Dr. Mauer, it’s not okay. That’s not fair. How would you like it if that were your wife or child in “this situation?”)He was still looking down, describing how “this situation” had put all of them, the doctors and even the hospital itself now in a bad spot, between a rock and a hard place, this situation was bad for all of them and there seemed to be no way out or around it… then he looked at me again: “But I can’t imagine how hard this must be for you; I can’t imagine having to go through that; I just can’t imagine how hard that would be.”Out of all those doctors and staff, he was the only one who stepped up and said that.I had nothing to add; he had said it all. I merely nodded and mouthed the words, “Thank you.” Someone had finally understood and sympathized. He waited another moment or two silently looking at Ross, then he turned and left.So different from “not really” and how this had been “dumped” on me and “it won’t be premature.” How snide and cocky; who says something so dismissive and condescending to someone who is losing his partner and best friend after entrusting him to you, and you looked the other way and allowed this to happen on your watch after you had been asked to do something about it? Dr. Cohen couldn’t wash his hands of this mess fast enough, but had to insult me first on his way out. “so ein Feig.”Dr. Mauer didn’t have to be there now anymore than Dr. Cohen, but he was, and he didn’t try to dodge the issue; he didn’t hide behind distractions; no irrelevant red herrings such as HIV; no deflecting with what else might have happened; no hint of “risky” or “costly;” no pretending this was business as usual.; no bullshit about “standard procedure;” none of the poisonous dismissal in “not really.” The exact opposite of all that defensiveness; an exposed and humble acknowledgment that as awkward and precarious for them, how unimaginably horrible for Ross and myself. He put himself in my position and he got it, and he didn’t try to pretend. That’s what real empathy looks like and a doctor who does that is “ein echter Mensch.” He’s the one you can trust.I imagine the hospital won’t be happy to hear it, I can imagine the hospital would rather he not have said any of that, but I can’t put in words what a relief it was to finally have someone be honest with me, to tell me what was really going on behind the scenes, and not make me feel I was being unreasonable or crazy. I hope he isn’t reprimanded or penalized for it; he should be rewarded; and I’ll be the first to stick up for him. He kept alive the last flicker of faith I had in Huntington Hospital; it had almost been snuffed out after so many obvious attempts to obfuscate, each one making it worse than the one before. In my view, he shot right to the top alongside Dr. Rosenberg and Dr. Shriner for saying it.Sunday, March 15. I sat next to Ross on the little footstool, stroking his arm and holding his hand, leaning over the side rail of the bed. It was a matter of hours or even minutes, I knew it was coming and not far off. A little after 12 noon, the charge nurse came in with a respirator technician; seeing the position I was in, she offered to lower the side rail; that might be more comfortable for me. No, that’s okay, I told her; I could barely get the words out, but I wanted to ask her something: would it be alright if I moved some of the tubing and drip lines out of the way, could I clear a little space on the side so I can lay next to Ross; would it be alright if I hold him while he goes through this? She dropped her head and looked away for a moment; the technician turned his back. The charge nurse turned back toward me again and nodded, saying, “Yes, I think we can do that. Let’s do it like this,” and she and the technician quickly cleared a little space on Ross’ right side of the bed and she showed me how to do it safely. They drew the curtain and stepped out of the room. It was just about 12:30. I crawled into the bed alongside Ross, careful of the tubes and wires, and slipped one arm underneath his head and the other across his chest and held him for the last time, feeling his heart beat grow fainter and slower. Around 12:45 his heart must have stopped, it was so quiet and calm, I didn’t even realize it until the nurse came in and told me: Ross is gone.REQUIEM AETERNAMChair. Sit. Staring. Numb. There on the bed, flat, first time in weeks. White sheet, head at one end, ankles and feet at the other. Quiet now.Ross, I’m sorry, I am so, so sorry, I tried but….There is a knock on the wall behind me, and the curtain is parted. “May I?” Yes, of course, come in. She’s wearing a doctor’s white coat, stethoscope - do they still use those? - she’s carrying a clipboard and flashlight. Before she starts, she says, “I’m very sorry for your loss. This won’t take but a minute. You can stay if you like, or you can step outside if you prefer.” Thanks, I’m fine. I’ll stay. I’m too tired to move anyway, I may as well watch.She moves quickly, efficient but respectful. She checks the eyes. She listens for a heartbeat, runs through a few other checks. Two or three times she glances over at me. She looks familiar, I know her from somewhere; I’m sure of it. On the far side of the bed, she is bending forward, her hair falls forward around her shoulders; long brown hair that hangs halfway down her back. When she straightens up and brushes it back, now I remember… she was with Pontius Pilate that morning; she was Dr. Do-Nothing’s witness.Now she’s at the foot of the bed, almost done. I wonder if she heard about my outburst on the phone the other day; I’m sure I was on the agenda before morning rounds this past week. Our eyes meet; of course she’s heard about it. She sees death every day; is she also going to play along and pretend this is all normal? I have had no interaction with her at all until now; I have no idea what to expect from her.She starts to say something, but stops, then asks how I’m doing.I don’t have a word for this, I’m running on empty, just blank, I don’t really know how I’m doing, so I shrug my shoulders instead; that’s all I have left.A moment’s pause, then she says it too: “I can’t imagine…”SOME OBSERVATIONS:Not one person answered my question with a medical explanation for that initial delay, and not one person told me I must have misunderstood about prepayment. I didn’t misunderstand it; I prepaid for it twice! The very premise was never questioned; it was assumed, taken for granted. Palliative Care (of all departments!) even told me it is “standard procedure.”Huntington Hospital has always had a stellar reputation, and they’ve earned it… as long as things go well. But when someone makes a bad decision in bad faith? They can’t or won’t own up to it, probably thinking they have to protect that reputation, and not realizing that it’s having the opposite effect. What respect I had had for them prior to this has evaporated now and they did that to themselves. I want to be clear about that: I didn’t lose respect for them because Ross died. I lost respect for them because they would not be honest with me about how it happened and rather than explain it or apologize, they protected the person(s) who did it. In my eyes that makes the hospital complicit and culpable, morally and ethically if not legally.This wasn’t a medical failure, it wasn’t a misdiagnosis or a botched surgery or a flawed procedure. It was a failure of priorities and character; profits before people, and fear of admitting the truth. Ross died of endocarditis and heart failure following a decision where finances took precedence over his life. They can come up with all kinds of forensic explanations to explain the biology of it all, but that won’t erase the sequence of events that led up to the final outcome. Dr. Tiner delayed treatment until he was paid first, Dr. Cohen did nothing about that; and the hospital’s lack of financial oversight created an environment that allowed it.And the final slap in the face: Ross died for $1,750, which would have been paid by his insurance plan. I paid it out of pocket so Ross could come home again, alive. Instead I have a cardboard box with his ashes now. I would have preferred a proper burial and resting place for him; $1,750 would have let me do that. Instead, I did what I could afford, cremation for $975 and no urn - half the cost of the surgery that came too late. Added together, that’s $2,725. It seems crass to reduce the tragedy to this, but that’s two mortgage payments for us. I’m right back to where we started, but now without Ross.The hospital refuses to give me copies of the records I need to submit a claim for reimbursement from the insurance company… a claim that wouldn’t have been necessary if the hospital had properly vetted Dr. Tiner to begin with. A claim that Ross would have submitted if he had survived. But since I don’t have standing, and since I can’t really make those decisions for Ross, now I can’t have copies of the medical records that are required to be reimbursed. It was suggested that I write it off as a gift, a charitable donation, but that also requires records and proof.Nobody objected when I paid for Ross’ surgery in advance; only when I asked for the proof that it happened.“Can they do that, if we don’t have the money, would they really just let me die?” It’s what happened, they didn’t do anything when he asked, so I guess they would just let him die. They can say what they like, but that is what happened.Since first telling Ross’ story, I have received countless emails and comments from others who have been put through similar and worse experiences. Hundreds of thousands of dollars, bankruptcies, foreclosures, lives and homes lost. In comparison, I have to consider myself fortunate to some degree; $2,725 is pennies compared to so many others. But those pennies took priority over a person’s life. That is standard procedure far too often; Palliative Care’s explanation was accurate in ways that weren’t intended.We rely on the good faith of those who have taken a vow to heal us and do no harm. No such oath is required of our insurance industry, nor of the administrators, accountants and managers who have fiduciary responsibility for the health care industry. That gap between the physicians and the providers and the administrators fostered an environment that punishes honesty and encourages silence and obfuscation even when honesty is healing and silence does harm.There is a gaping hole in our health insurance industry. Consumers are required to carry health insurance, or else pay a fine. But health care providers are not likewise required to honor our health insurance plans. Why are we required to carry it if they are not required to honor it? Who set up such a lop-sided system where money goes in, but does not always come back out? Politicians, lobbyists and the private, for-profit insurance companies.I am going to tell Ross’ story whenever and wherever I can. I have to. For me to remain silent would mean I too have become complacent and complicit in Ross’ death.DAY OF WRATH, DAY OF JUDGMENTIt may be presumptuous of me to offer these, but it’s impossible to go through a tragedy like this and not come away with some thoughts about what went wrong, what might have prevented it and what could have led to a happier outcome.There should be a federal law that makes it illegal to require prepayment for any emergency or life-saving medical procedures, including procedures that must precede or follow emergency procedures. I would call it “the Tiner law” and name it for the person whose actions necessitated it. When telling Ross’ story I had one person ask, apparently in defense of Dr. Tiner: “But you expect to get paid for your work, don’t you?” My answer was, of course I expect to get paid… after I’ve done what I was hired to do.Colleagues in the medical profession should be mandated to report practitioners who require prepayment for emergencies. Failure to report should be treated as complicity. Doctors should not protect colleagues who violate professional ethics. The “Cohen law” would be named for the person whose lack of action necessitated it. If it were up to me, those names would be associated with the reasons those laws are necessary. That would be one form of justice for Ross, and it wouldn’t be premature.The resolution process must invite and include open dialogue and follow-up with the patient when a patient expresses misgivings about his practitioner. “Yes, there have been some problems with him, but I’ve spoken to him and he’s the best and he’s the one we use” is not a resolution; that’s dodging the issue. Ross had a right to know what those previous problems had been and how they were resolved before entrusting his life to that person.Third party billing for in-hospital procedures must stop. All in hospital work should be funneled through the hospital’s billing department without exception. The hospital must be made aware of how its facilities are used, and how they are to be paid for. One billing system with oversight and familiar with insurance providers would have known that the extractions were covered by Ross’ insurance plan.Care workers should be rewarded for calling out ethical violations, not intimidated into silence. The reason I kept asking questions was to figure out who I could trust now that Ross’ life had been held up for payment and I had been told I could not make decisions for him even after I had paid for an operation that hadn’t happened. Nobody was willing to say that the way it happened was wrong: the real “standard procedure” apparently was to remain silent and look the other way. That destroys trust and credibility and creates the appearance of complicity.Two other concerns remain unresolved for me.In the absence of sufficient socioeconomic information about a patient, for a doctor to decide on his own whether that patient will be treated or left to die… I can appreciate it as an academic ethical dilemma for its philosophical discussion points, but I’m left wondering what the parameters are in a real-life situation, or if there are any. “Risky and very costly” is too ambiguous for me. It is putting a price-tag on a patient’s head. How much is “very costly” and for whom? And what could be riskier than dying? As difficult as it is to have to make that decision for someone you know and love, at least you have familiarity enough with the person who has trusted you to make that ultimate decision. But to make that decision for a stranger about whom you know nothing? Maybe others can, but I couldn’t do it; it’s not my place. I didn’t give that stranger life; what right do I have to take it away? That was one of the most frightening rationalizations I’ve ever heard, and to have it presented under such circumstances as this, with such nonchalance. What would have happened if I had been out of town, or overseas, or under a Covid-19 quarantine, or unconscious myself in another hospital…? It was horrifying enough to have made me faint.This last one is the most bewildering to me.Federal law requires us to have medical insurance but it does no good when a hospital provides someone who doesn’t take that insurance and offers no other solution, especially in an emergency or life-threatening situation. If that is to be permitted, then why do we have insurance at all? This was not an elective, it was not planned, it was not plastic or cosmetic surgery. The need here was to remove the source of an infection before it proved fatal; a clock was ticking, but there was no sense of urgency. Payment took priority.I don’t understand how that was allowed to happen. It’s a crack in our health system. Ross had the proper insurance but when he fell into that crack and hollered for help, none of the rescuers paid attention to his cries, and he disappeared forever. Would somebody please explain that to me?And to be clear, I am not asking about the cause of death; I am not asking about endocarditis or strep infection. I am asking about how a pittance of payment was permitted to take priority over his life, and when he objected to that, nothing was done; it was defended instead. That wasn’t a medical mistake, it was a decision.CONCLUSIONSThere are some people I need to thank, and point out the goodness and give credit where credit is due.As I said before, the nursing staff, the technicians and floor workers were all of them outstanding. Whoever hires and trains those groups is doing it right, and that person deserves a great deal of credit for Huntington’s reputation.Dr. Honlee’s intentions were, I think, in the right place when he rephrased his request for DNR to clarify it was for Ross’ sake, to prevent Ross from suffering further. That wasn’t immediately clear because of the pressure placed on me to make a decision over the phone, after everybody had to have witnessed how desperately I had been fighting for Ross in person for more than a week. And to arrive and find Ross in exactly the same condition as just hours before was baffling. But then again, Dr. Honlee did say, “and I want justice for Ross too.” That counts for something.From the first time I saw him interact with Ross until the very end, it was clear that Dr. Mauer’s concern was real and genuine and human. I don’t know how to explain it but I just know. We all know the difference in how our doctors treat us, sometimes it’s easy and other times it’s harder to define, but we know. Dr. Mauer was the one, the only one, who gave me a clear picture of how Ross’ case was affecting people behind the scenes, and as bad as it was, how much more horrible for me and Ross. That’s empathy. And courage. It takes courage to be honest and exposed at the hardest times. I can’t thank him enough. He saved what was left of Huntington’s reputation in my mind.The chaplains who empowered me to trust my eyes and ears and instincts, and to do something about it. If it’s broken it won’t get fixed until someone points it out, otherwise it will happen again. With one of them I had a talk about ethics and morals and psychology theories, along with my father’s background (he was a liberal Lutheran minister and had begun his career as a hospital chaplain), and with the other I had a long talk about my Harvard education and the summer of 1974, after my high school sophomore year when I had been an exchange student to East Germany, one of the first U.S. students allowed to do so. I had been teaching Ross some basic German phrases over the last several months. That had been fun, and he was getting pretty good at it.And the medical examiner, with whom I had very little interaction to speak of, but as the last one to be with me and Ross in that room that last day, to simply say that she too could not imagine… after she had also been there as Dr. Cohen’s witness only 10 days before. That meant a lot.And of course, Nurse Maria, for that first morning, for publicly and without hesitation scolding Dr. Cohen’s “not really.” (I don’t think he has any idea how poisonous that was; I think it was blind, self-protective instinct on his part.) If Maria had not been there and said what she did in that instant, who knows… I owe her immeasurably.But then there are the other, unanswered questions and contributors.Ross’ fate will haunt me for a long time to come. I am always going to have that unanswered question: why didn’t they do anything when they knew the danger? Were they really as inhuman and indifferent as Ross had feared when he asked, “What if we don’t have the money, would they really just let me die?” It’s hard to affix a motivation for it; but nevertheless, that is exactly what happened.Yes, there was a bacterial agent, and yes, there were microscopic events, but those were known and foreseeable. And possibly preventable. But now we’ll never know. What we do know is that there was a protocol, and that protocol was never given a proper chance, because we didn’t come up with $1,750 in time.Huntington Hospital accepts government subsidies and support via Medicare, Medi-cal, Covered CA, and the like. Yet they provided a surgeon who does not or would not accept those insurance plans from the patient, even after the patient warned about that and asked for something to be done about it. How is that possible, legal, ethical, sound business or medical practice? It is a clear violation of EMTALA law. How was that allowed to happen, at a hospital with a reputation as sterling as Huntington Memorial?Because I don’t have “standing,” this is, as one lawyer told me, “a clear-cut case, but one without a client.” I believe this is why Dr. Cohen sounded so relieved: if I can’t pursue justice for Ross, who can?I can’t get rid of the thought that Ross was treated poorly because he was perceived to be poor and therefore he could sit on the back burner and wait, not worth the risk or the cost; poor people die all the time and he was just another one. Focus on the profitable patients. I don’t think it’s conscious and deliberate so much as it is systemic, a mindset that has crept into our health care system because the system is driven by profit.What is leading me to think that?Dr. Tiner’s insistence on payment in full in advance because he had trouble collecting in the past;Dr. Cohen minimizing Ross’ concerns about that;the rationale to not treat elderly or homeless people if “risky and very costly;”knowing this infection is serious but no sense of urgency;having the medical examiner at the ready that morning,that Ross’ situation had been “dumped” on me (excuse me ?!?);the inconsistent responses to my question about how and why this happened,my repeated question of how a hospital allows a doctor to delay a life saving operation for advance payment was never refuted or corrected; it was assumed; I was told it was “standard procedure.”What am I supposed to conclude?I have yet to hear a medical explanation for that delay. I asked plenty of times. The silence leads me to conclude that there is no explanation; that Ross was ignored because he was thought to be poor and payment took priority over his life, and everybody was complacent with that, it was business as usual until disaster struck. That’s my experience of what happened here; I don’t know what else to make of it and with no other explanation forthcoming, I am expected to pretend that this was okay..Yes, he may have died anyway. I know that. But the fact remains, nothing was done about a routine but necessary preliminary surgery until payment had been received first. That is the question on the table.It was known that this was a life-threatening infection, and though the source of that infection had been identified, it was allowed to remain in place for nearly two weeks because we didn’t have the money in time, and the procedure was finally done only after it was too late to do any good. How can anyone be expected to conclude that this is sound medical practice?It’s really hard to sit with your partner after he has been moved from the cardio wing to the ICU because he had a stroke the night before, and to have that inevitable talk about what might happen next and what he wants you to do if it should come to that. The hardest part - and I wouldn’t wish this on anyone - was looking into his eyes when this would not have happened if I hadn’t paid the mortgage so early or if I had used the right credit card or if I had… But he knew me and he knew what I was thinking and he said it wasn’t my fault. So when the unthinkable came to pass, to be told that I can’t really make these decisions, to have my questions circumvented and unanswered, to be asked to let it go instead… after discovering this did not have to happen, insurance does cover it but nobody did anything when he had asked… “would he really let me die, just like that?”Yes, apparently so, and worse, everyone seemed to be okay with that; after all, everybody has to die someday, right? Ross is just one more. Oh, well. Standard procedure.Huntington Hospital is frequently recognized as a five-star, first class hospital… and it probably deserves that reputation when all ends well. Based on my personal past experience, I’ve always thought they earned it and it was well deserved. But how are they when it comes to admitting a mistake, or answering questions in order to heal an injury they or their associates have caused? One associate, and only one, made the attempt and he did so voluntarily and on his own. The rest failed, miserably so; they made it worse. I wouldn’t be telling what happened to Ross and still looking for answers if it were otherwise.Doctors, nurses, medical staff… we know honest mistakes happen, but we know the difference between an innocent mistake made by a doctor who cares, and wanton negligence, blatant greed and bored indifference. We figure that out by what you say and do, by the words you use and the actions you take on our behalf, as well as what you don’t say or do, and the actions you don’t take on our behalf. Everybody knows that our current health insurance system has flaws. and because of that, doctors and hospitals must guard against frivolous lawsuits, that you have to be careful about what you say. But when $1,750 is valued more than a patient’s life, who really is the frivolous one?So many violations and ethical failures:,EMTALA violationsFailure to treat in a timely mannerFailure to treat due to billing or payment issuePatient abandonmentPracticing outside scope of licenseAiding and abetting practice outside scope of licenseBut the perpetrators can escape exposure, correction or punishment because we did not have a specific piece of paper to make our relationship official. Think of the ramifications of that. A single person could experience the exact same sequence of events, with nobody to fight for his case. Indeed, that is what Dr. Cohen himself professed to do when he deemed proceeding to be “risky and very costly.” Best friends, roommates, life-long pals, business partners, and so on… those most immediately affected, most able to make a decision, but unable to do so, or to intervene to prevent a similar situation.Dodging, avoiding, covering up, evading and distracting look like complicity and complacency. This was failure to treat due to a billing issue, a report-able ethical failure (yes, I looked it up), and while everybody seemed to know that, nobody would say this was wrong and should not have happened. What do you imagine a person fighting for his partner’s life is going to conclude from that? If you’re not against it then you are permitting it. It’s a crucible for you certainly, but remember your oath to do no harm. It means nothing if you remain silent knowing one of your own violates it. Your silence causes harm.ROSSI knew Ross for nearly two decades, and he was, first and foremost, a humanitarian. He was always the first to pitch in and help anyone who needed it; he volunteered with numerous agencies and charities; he supported the underdogs of society and stood up for them.One time we were riding our bikes and passing through a not so great neighborhood. Ross was not a big or intimidating guy, about 5′ 9″ and medium build, but he could be fearless when pushed. He was pedaling about half a block ahead of me. On the sidewalk even further ahead was a young couple, arguing loudly and it was rapidly escalating, and then the pushing, slapping and fists started. Ross zoomed right over on his bike, “Hey! Cut it out, right now! Don’t you hit her!” The guy was clearly drunk when he turned to see who was challenging him, but Ross charging straight for him on his bike distracted him enough that she broke loose and ran. “Leave her alone, you coward!” Ross hollered at him, circling back around. I followed her to make sure she got far enough away while Ross kept the other one at bay. That was Ross.A few years after we had been living together, I was diagnosed with diabetes. It runs in the family on my dad’s side; all his brothers had it, as did a few of his sisters, so it wasn’t that surprising. In fact, a few months later, one of my brothers was diagnosed and another found he was borderline. I struggled to bring it under control, a combination of not knowing what I was doing, not paying attention and not monitoring it, along with denial of how serious this could be, and it was going in the wrong direction. After several months of this, Ross announced he was taking over the groceries and meals, and he was brutal about it. Breakfast, lunch and dinner were planned, measured and monitored; he wouldn’t even make lunch or dinner until I had done my blood test; he was that strict and committed. Within three months he brought my stats down from dangerous to merely high, and soon afterwards, from elevated to acceptable. Yes, I grumbled about it the whole time, but he paid no attention and it worked. I owe him, and to be told now that I can’t make these decisions for him, not really, was beyond the pale.He demanded one thing of everybody he encountered: that they treat every other human being with respect. Whether you like them or not, get along with them or not, agree with them or not, you respect them for their humanity until they prove themselves undeserving of it, and you forgive them for a mistake if they learn from it. That was Ross.He did not deserve what happened to him here, he was a victim of what he deplored: lack of concern for another human being. It wasn’t deliberate or planned; there was no conspiracy to murder him here; that’s not what happened. But it seemed clear to me that Thursday morning that neither Dr. Cohen nor Dr. Tiner had any idea or interest in who Ross was as a person. He was Medi-cal. It’s small comfort, but at least he was spared the insult and indignity of having to listen to the excuses and distractions and obviously bullshit answers for why he was ignored to death.However, Ross was not a vengeful type. I know that he could and would forgive if the people involved learned from it and turned his tragedy into something positive. He was more generous and forgiving than I could ever be.I have never asked readers to share one of my answers, but this is one time I feel I must. For Ross’ sake, please take that extra step and share or let someone know about his story. The best way I can memorialize Ross is to do everything I can to make sure this never happens to anyone again.One last way I want to memorialize Ross, is to remember him in happier times. On Day 3 of the 2008 Ride to End Aids comes the notorious long, steep hill known as “Quadbuster.” Many riders dismount and walk their bikes up that last half mile. Not Ross.Here he is, having the time of his life, triumphantly reaching the crest of Quadbuster.I miss him.

I learned a new word concept today!Thank you for asking What does PropTech mean?What are the hottest PropTech investments?Right now I would say the marriage between Zimco and SnapDocs[1] would be pretty hot!Snapdocs raises $25 million to streamline mortgages with AI.Nov 7, 2019 - Real estate tech company Snapdocs today revealed that it has raised $25 million in series B funding to further develop its products and ...Atlant is making an effort to create a decentralized real estate marketplace. They try to achieve those results with tokenized ownership and p2p rentals. Tokenized ownership makes it easier to operate real estate assets and boosts their liquidity in the secondary markets. With peer-to-peer rental company endeavors distorting the monopoly of real estate agents, they are significantly reducing fees for tenants and landlords.[2]What is “proptech” Technology for Real estate?Bowery is redefining the industry of real estate appraisals with their cutting-edge technology, expertise, and big data. Bowery offers a cloud-based appraisal writing software that automates and speeds up the process compared to their leading competitors. The software utilizes a natural language generator and robust backend database. The software is easy to use and has a mobile application.[3]Zimco Stands for Zero Interest Mortgage Corporation[4]https://www.quora.com/What-is-a-zero-interest-mortgageBuildiumThis is an intuitive and efficient cloud-based property management software. It is affordable and perfect for the medium size property management and small landlords. It allows users to efficiently manage all day-to-day operations in one place.EnertivEnertiv digitizes the physical infrastructure to streamline the management and operations of large buildings. They install circuit-level sensors on every valuable piece of equipment, track the crucial indicators and analyze the data streams. These open tremendous possibilities for enhancing the safety and efficiency of elevators, boilers, exhaust fans and air conditioning.FlipFlip provide a digital communication platform for rentals. They provide flexibility for renters and landlords. They provide a seamless experience for those looking to sublet or search for a home for a short period of time. Flip manages the entire process from screening the potential candidates to the payment of security deposits.FixfloThis innovative software solution effectively connects commercial and residential properties and maintenance professionals. This is a communication and business tool that provide a seamless experience of repair.FoyrFoyr was created in Bangalore, the Indian Silicon Valley. It was the first online interior designer. With the simple interface and request forms, Foyr tailor specific design solutions for your home. They measure the key indicators of your interior and adjust it to your cultural background.hOMThis company is a ground-breaking technology-centered amenities provider for large residential and office facilities. They partner with third-party vendors, like event planners and fitness trainers to organize on-site events and activities. They create a unique living and working experience without the need to hire PR professionals or entertainment teams. If you want to entertain your tenants or employees this is the place to go.MashvisorMashvisor is a real estate data analytics company which helps investors find lucrative traditional and Airbnb rental properties. Their platform uses big data and predictive analytics to analyze the investment potential of properties. They use AI and machine learning to match buyers with the most appropriate investment properties.LandbayIt is an online platform for peer-to-peer lending. It matches lenders with borrowers and creates a venue for alternative investment. Landbay lets regular customers benefit from the British property market through investment and direct ownership. They offer a personal approach and tailored solution for specific needs and circumstances.No AgentThe monopoly of brokerages and real estate agencies plagued the industry for years. They established a firm grip on entire regions, positioning themselves as the only gateway for renting and selling property. Their position allowed them to charge high commissions with minimal effort.Property owners can try to market property themselves, but usually, they lack even the basic expertise. No Agent is changing this and enables landlords to manage their property professionally. No Agent’s advanced knowledge and technological toolkit allow landlords to operate the process autonomously with minimum spendings.Open Door LabsThe company serves as a digital intermediary for the sales deals. This company frees you from all the hassle of selling a home. They purchase a property from you and take care of the rest. They use big data and advanced market assessment algorithms to give a fair price for your property.Open ListingsThis company streamlines the process of buying a home, making it easy and affordable. Open Listings innovative platform allows anyone to buy a house without the assistance of the real estate agent. Prospective buyers can manage all the process online with the self-service platform and in-house consultants. The platform saves up to half of the money that would usually go to the commission of the real estate agent.Property DetectiveThis digital service allows you to asses the area you are planning to move to. It compiles a comprehensive report on various neighborhoods about the quality of schools, crime rate, and many other factors.Purple BricksThis is a digital real estate agency that provides a full package of services for a fixed fee. Instead of hiring an agent or broker, you pay a one-time fee and let the digital professionals market and advertise your property.PeerStreetPeerStreet takes an innovative approach to real estate debt and peer-to-peer lending. They provide interested investors access to the market of real estate debt. PeerStreet enables investments in high-yield mortgages and real estate-backed loans. It is a great tool to diversify your investment portfolio and enter the lucrative market which was previously monopolized by big banks.RavtiRavti is the ultimate outsource option for air conditioning, heating, and ventilation (HVAC). It removes the headache of dealing with sophisticated technical equipment for big property management. Ravti procures, tracks, and manages HVAC for big residential and office buildings.RealtySharesRealtyShares is a pioneer in real estate crowdfunding. This industry is aiming to provide access for small investors to big real estate development projects. RealtyShares enable investors to buy shares in pre-vetted real estate properties with as little as $5,000.RentberryRentberry is an innovative rental platform that enables direct interactions between tenants and landlords. It is an all-in-one platform that allow users to submit rental applications, track maintenance, requests candidate screenings, and e-sign rental agreements. One of the unique features of Rentberry is the custom offer feature that allows tenants to negotiate the rent price transparently through the platform.RepositSecurity deposits are a blessing and a curse. On the one hand, it provides security and confidence to the landlord. On the other hand, security deposits require tenants to pay a large sum of money which may or may not be returned. The British startup, Reposit, is offering a healthy alternative to this system. Tenants pay a one-time non-refundable fee equivalent to a half-months rent, while the landlord receives a half-year of the property insurance.RileyModern sales and business development are all about leads. Leads come from everywhere, and it is hard to access their quality and relevance. Riley offers lead qualification as a service. Real estate agents and brokers can send leads to the Riley’s Concierge service, and in a matter of minutes Riley will assess and qualify them and pass them back to the agent.SeeableReal Estate is all about digits: median sales price, closing price, crime rate etc. It is hard to navigate in this word of raw data. Seeable aim to transform this grim situation and provide a powerful visualization tool for real estate. They create 3D Building Information Models that make all the information about the asset visible and accessible to a large audience. It is especially useful for regular non-professional users that need to access crucial information in a simple form. Seeable offers 3D and 2D applications for various platforms.SquareFootThis company focuses on commercial real estate leasing. They customize the leasing process from initial search and open-houses to lease negotiations. SquareFoot is an online listing platform that provides tools for effective renting.TrussleThis company provides cutting-edge financial advice on mortgages. Trussle provides a comprehensive assessment of the various aspect of the market as well as personal finances. It calculates what you can borrow and does a search of thousands of available mortgages and shows you the best offer.VR ListingThis company focuses on the immersive technologies of real estate marketing. They offer various turn-key packages and solutions to real estate. They work on the cutting-edge augmented reality and interactive technologies for real estate agents.Disclosure: The above companies may be under consideration for acquistion by subsidiaries of the Infinite Freedom Foundations of Earth International and the data was curated from this and other links found online: 25 Innovative Real Estate StartupsFootnotes[1] snapdocs raises $25m - Google Search[2] 25 Innovative Real Estate Startups[3] Bowery Valuation[4] Why is a zero interest mortgage not the same thing as a free no-cost mortgage?