It’s probably the sense of gratitude that silences many patients. An acute awareness of their luck to live in a time when the word cancer is not necessarily a death sentence; to be able to take (almost) for granted the expertise and care of health professionals; to assume the availability of procedures and powerful, miracle drugs for which they bear just a tiny fraction of the cost.
A rough calculation from my VHI statements, for example, put the cost of a fairly standard seven-week course of radiotherapy in a private hospital at around €30,000.
Add to that the cost of surgery, the chemotherapy drugs, the regular €1,200 injections, the endless sophisticated scans, the inevitable complications and hospital stays. Cancer is a costly illness to treat.
When I quibbled briefly about the horrible prospect of chemotherapy, a specialist interjected gently to say: “You know, there are cancer patients in America who go to court in order to be given chemotherapy.” It’s the sort of thing that gives perspective – not to be confused with that appallingly abused word positivity.
Of course there is no such thing as a typical patient. Some are resigned, some are madly cheerful and some are furious. The body, mind and spirit handle treatment and fear and the loss of that cheerful, casual sense of invincibility in many different ways.
Financial implications
But often, in the drowsy longueurs of the chemo ward, it is not the differences but the similarities that come to the fore. You will hear tips for dealing with side-effects; concerns about family members’ over- or underreactions; and too often, you will hear someone’s dawning horror at the financial implications of long-term illness.
A 48-year-old father of three in a stressful public service job is out of work six months, which means a catastrophic salary cut is looming. A woman whose 22-year-old daughter strops around the ward complaining that her mother is “always f**king tired”, frets about how her infection-prone body will cope with a freezing farmhouse.
An elderly farmer gets agitated about the kindly neighbour who drives him from Laois for the many appointments and chemo sessions, and who has to pay €2.50 an hour for the hospital car park, on top of the cost of petrol and the canteen food. A patient’s partner has received sudden notice of redundancy, accelerated, he suspects, by frequent absences from work while he accompanies her to medical appointments. A woman who runs her own small business sees it going downhill by the day.
These are worries that loom large in any life, but within these walls, people feel obliged to downgrade them. Gratitude rules and in a way, is the great silencer. “It’s only money; your health is everything,” they say. “When you get a blow like this, it puts everything else in perspective.” Everyone agrees.
Maybe so, but the reality is that when illness strikes the need for a reliable, steady income is more pressing than ever, because in day-to-day terms, illness costs.
This week, an Irish Cancer Society survey revealed that the average monthly cost of cancer to a patient is €862. That's over €10,000 a year and the estimate is probably at the low end.
For those without a medical card or health insurance, the effect on families already on a tight budget is horrific. Even for those with either of those, the impact of leaving the heating on all day, for example, will destroy the most careful plans.
Assumptions challenged
A common assumption of the able-bodied that they will never need a car and will always be able to cycle or walk to the train or bus – if they’re lucky enough to be anywhere near public transport – will be seriously challenged.
People whose proudest boast is that they wouldn’t even take an aspirin will suddenly find themselves scrutinising a thing called the Drug Payment Scheme.
The good news is that they will never have to pay more than €144 a month for prescription drugs. The bad news is that many will find themselves paying out the full €144 a month – on top of everything else.
Brave face
Suddenly that hard-won control and predictability over budgets and lifestyle, essential to peace of mind and recovery, will become a distant memory. A patient’s wife takes a heating bill out of her bag; it amounts to €700, for just two winter months. She will not feature in any survey of fuel poverty but to a proud, careful woman already battling to maintain a brave face to her sick husband and young children, it seems insurmountable. It’s no accident that the cost of home heating ranks high in the ICS survey, as does the cost of travel (nearly €200 a month on average for
Leinster
people living outside Dublin), and incidentals such as hospital car parking (€62 a month on average).
Illness changes lives. Gratitude and perspective are probably its greatest lessons. But they must not be allowed to silence people for whom life is already a terrifying struggle.