I was called to Medical this morning to see Physician’s Assistant Mike Greene. He was responding to my request for information concerning the status of my second liver biopsy and treatment for hepatitis C (HCV). Also, since my blood exhibits an out-of-range and elevated AFP (a blood marker for liver tumors), I had inquired if testing for liver tumors weren’t also appropriate, although it wasn’t done at the time of the biopsy.
P.A. Greene started out fine, sharing information and answering my questions. He told me the biopsy found I had “Stage 2” liver disease, with “Stage 3” fibrotic changes – meaning I wasn’t too far gone to treat [though far enough to know that the earlier denial of treatment, based on a ‘sub-optimal sample,” was a mistake]. He was still doing fine when he told me that he had requested approval for treatment from the Alaskan correctional authorities.
But, then I asked about the test for liver tumors – you know, cancer – and his eyes changed. I, literally, saw him shift into 4-wheel dissemble, high prevarication gear. “The biopsy is the definitive test,” Greene told me. Then added, “When they did the biopsy, they did ultrasound and they would have seen it then.” He went on to educate me about the process, explaining that “they do the ultrasound to find the most damaged part of the liver to take the biopsy sample from, so if tumors were there the results would show it.”
P.A. Greene didn’t know that I had spoken with the Radiologist, who did the biopsy, asking him if he had seen any tumors in my liver while doing the ultrasound, explaining that I had an elevated AFP. Greene also hadn’t heard the Radiologist’s answer” that an entirely different test is required to visualize liver tumors – preferably a CAT scan – and that it hadn’t been ordered. Greene also didn’t know that I’ve actually received training as a radiologic technologist, nor that I’m married to a health care professional. So I know ultrasound is used during the biopsy procedure to accurately locate the lobe of the liver chosen for biopsy, as well as it’s major blood vessels in order that they may be avoided to minimize the threat of serious bleeding. Ultrasound is not used to test for the early development of liver tumors.
P.A. Greene shifted gears and switched the subject back to the requested HCV treatment, telling me that treatment would begin about two weeks after Alaska approved treatment, since the medication was “off formulary” and had to be ordered special.
Greene didn’t know that I knew that the medication they will be ordering will not be the Pegasys and Ribavirin, adjusted to weight, as was originally recommended by Dr. Sahagun, the Gastroenterologist in Alaska, but, instead, I’ll receive the less effective and cheaper Pegintron, with its greater expected side effects.
Then I asked when I could expect that Alaska would approve treatment, and Greene told me that, since the medication was expensive and this was the last month of Alaska’s fiscal year, approval would most likely be delayed until after the first of July. He explained that he believed this to be the case, because he had worked for Alaska corrections before coming to work here, and that was “just how things worked.” He didn’t know that I already knew that he had worked for Alaska corrections, nor that I was aware that he had traveled here with the Court Appointed Compliance Monitor, John Hagar, and was responsible for reviewing this facility’s medical department’s compliance with the contract with Alaska. Of course, that was before he sold his soul to Beelzebub’s butthole buddy, Corrections Corporation of America, and began working for them, instead of checking up on them.
The first time I met Physician’s Assistant Make Greene was within a few months of my exile to this private, for-profit prison. What I remember best, was his asking me: “Do you read?” When I answered in the affirmative, he stuck a couple of evangelical Christian religious tracts in my shirt pocket and steered me toward the door. Apparently, I’m good enough to convert, but not good enough to be the recipient of the spiritual qualities he claims to espouse: honesty, trustworthiness, and truthfulness. Nor, evidently, am I worthy of a real test to see if I have developed liver cancer.
Anthony Brown CCA/FCC 6/14/5