Cancer educates a med student
The resident who'd been helping Wong looked confused. How could a medical student be uninsured?

Lilienstein understood. His medical school professors rarely discussed health insurance. He remembered a single lecture during his first year that was so complicated, even the instructor threw up his hands.

"It's sort of this space in our healthcare system," Lilienstein said.

He had to leave surgery for a noon appointment at the county oncology clinic, so he did not tell the resident the latest news: He had been told he would soon be insured.

University officials had recently notified him that the student health plan was switching from Anthem Blue Cross to Aetna. He was eligible to enroll, despite his pre-existing condition and lapse in coverage.

Wong was winding down, preparing to stitch up Nueva Espana's incisions. Lilienstein left for his scheduled CT scan. The resident shouted after him.

"Good luck on your CT!"


Lilienstein walked briskly across campus, still thinking about Nueva Espana's surgery, considering decisions the surgeons made and how they would affect her recovery.

At the diagnostic and treatment tower, he did not have time to take off his white coat before he reached the metal detector, where security guards again waved him past the line. He found the fourth-floor CT scan waiting area nearly empty, a television in the windowless room blaring a World Cup soccer game.

A radiology technician appeared and told him he had just missed the morning rush.

"Usually, the line is out the door," Lilienstein said.

The technician handed Lilienstein two bottles of a chalky, banana-flavored drink full of barium, a metal that would increase the contrast on his CT scan, allowing doctors to better examine his internal organs for signs of cancer. Lilienstein choked it down, making faces.

Back in Palo Alto where he was raised, his parents were watching the phone. So was his girlfriend in New York.

He thought again about his future and whether he should specialize in radiology, which would mean less time with patients.

"I get a lot out of being with patients," Lilienstein said. "It's very reflective. You're constantly thinking about what it is to be sick, what it is to be a patient, what it is to be alive."

He walked next door to a darkened room where the white CT scan machine loomed like a spaceship. The equipment, which the technician said was purchased when the new hospital building opened in 2008, was a "vast improvement" over the old county hospital facility next door and better than what Lilienstein had been examined with at Norris Cancer Center, he said.

He lay down on the machine as the technician retreated to a nearby room full of computer monitors. Moments later, the screens flashed images of Lilienstein from breast bone to groin. He got up walked over to examine the images.

"If I do have disease, it's not grossly evident," he said.

He pointed to the space where his spleen used to be, the surgical clips left over from his last operation, the missing chunk of his liver, scar tissue and white spots that might be the beginnings of tumors.

A radiologist reviewed the scan and attempted to connect to the computer system at Norris. She wanted to compare the scan to Lilienstein's last one in February. But the computers failed to connect, a frequent problem, she said. She promised to call him once she found his records.

Lilienstein walked back outside, headed for clinic consultations. He noticed there was still a line at the metal detector.

Suddenly, his cellphone rang. It was the radiologist. She had walked over to Norris and checked his records. His CT scan was unchanged.

"Great news," Lilienstein said as he typed text messages to his parents and his girlfriend. "It's a great day."