Double malignancy

Dympna Donnelly is not untypical of many in the U.S. battling cancer. The disease is her primary foe.
But she must daily fight a second and simultaneous battle against medical costs that make it impossible to concentrate her mind 100 percent on recovery.
The issue of monetary matters overshadowing purely medical considerations was brought into stark relief in recent days by the imbroglio surrounding a planned benefit in New York for Michael Duffy.
Duffy, who is from Letterkenny, Co. Donegal, has been receiving treatment in recent months for a rare form of kidney cancer at the world-renowned Mount Sinai Medical Center in Manhattan. The benefit, set for last weekend at Gaelic Park and featuring top Irish singer Mickey Joe Harte, was cancelled when Harte, his band and another group, the Revs, were stopped by U.S. immigration officials at Shannon airport.
Duffy, who is 63, came to the U.S. after doctors in Donegal said they could do little for him. And while the treatment Duffy has received at Mount Sinai carries no cast-iron guarantee, it is of a more aggressive nature than is available to cancer patients in Ireland.
Duffy’s family decided that the American option was worth taking. But it came with a six-figure price tag. Facing such a bill, organizers of the benefit concert were working hard this week to reschedule the event.
Donnelly, who is 36 and from Stradone in County Cavan, was the beneficiary of a fundraising event last April. Luckily for her, the bands that played at the benefit, held at Cranberries in Queens, were all local and did not have to deal with the ever higher hurdles of U.S. immigration law.
On another level, however, the kind of bills faced by cancer patients are unlikely to be covered by a single benefit event, especially, as is the case with Dympna Donnelly, when the beneficiary lacks full medical insurance to begin with.
Donnelly’s collision with breast cancer was both sudden and unexpected. So was the pace of the cancer’s spread.
“My cancer was very aggressive,” Donnelly said Tuesday while resting in her Sunnyside apartment. “A month was like six months for other cancer patients.”
As she spoke, Donnelly sounded tired and groggy. She was recovering from three hours of reconstructive surgery under full anesthesia that had taken place just a day previously at Jacobi Medical Center in the Bronx.
The hospital wanted Donnelly to remain overnight. But a bed costs money. Donnelly, with the aid of a friend, went back home.
Donnelly has been making choices like that for the best part of a year.
The first choice was fairly clear cut and was a mirror image of the choice faced by Michael Duffy: return to Ireland and avail of better medical insurance coverage there, or remain in the U.S., trying to get the very best treatment available.
“I decided to stay here,” said Donnelly, who is a permanent legal resident. “The treatment for cancer is more aggressive here and the nature of my cancer needed aggressive treatment.”
She said she was also aware that while the technology needed to battle her cancer was available in her native county, there were problems with matching the technology with trained staff.
Donnelly’s worst fears first took shape in October of last year when she discovered a lump on her breast.
At first, the news was reassuring. She was told she didn’t have cancer.
Upon further examination, however, Donnelly’s diagnosis was changed. What had apparently been a non-cancerous lump in October, had, by December, turned into an aggressive, stage 3B tumor, just one stage short of the most serious Stage 4 cancer.
Donnelly was admitted to Jacobi Medical Center just before Christmas for major surgery.
As her condition rapidly deteriorated through the fall weeks of 2002, Donnelly had been in touch with several hospitals in the city.
She had been working part time as a caregiver for the elderly, but the work did not provide health insurance. In order to qualify for the less than full coverage provided by Medicaid, she had to quit her job, a move that only increased the pressure on her limited finances.
“You still have to pay the rent and all the other bills, never mind the hospital bills,” Donnelly said.
One hospital Donnelly contacted recommended another facility that Donnelly did not think would be the best choice given her type and stage of cancer. The hospital also suggested a return to Ireland for treatment, but Donnelly had already decided against such a move.
Another hospital wanted her to go through its emergency room even though she already had biopsy results from a doctor’s office.
Jacobi offered to carry out the operation on the basis that Medicaid would kick in once Donnelly was no longer working.
In the months that followed, Donnelly traveled every week from Queens to the Bronx for debilitating sessions of chemotherapy. She simultaneously received radiation treatment at Elmhurst Hospital in Queens.
“I felt so sick, I had such a battle. All my lymph nodes were positive and that wasn’t good at all,” Donnelly said.
One thing she is certain of is that if she had enjoyed full medical coverage from the beginning of her illness, her diagnosis and treatment would have been earlier and her recovery faster.
Another thing she is certain of is that it was good to be a member of the city’s Irish immigrant community.
Donnelly is not married. “But I have one of the best boyfriends in the world,” she said. “People have been so good to me and still are. Irish people do pull together when someone is down with something. I am one of the lucky ones.”
Donnelly received supportive help and guidance from the office of New York City’s health commissioner. She also has a very particular circle of friends, other Irish women in Queens who are battling various forms of cancer.
The group’s members, about a dozen strong at present, meet and discusses their medical progress, or lack of it. The issue of medical costs is never far off the agenda during these meetings.
The time of the next meeting is in some doubt. One member of the group is now gravely ill in hospital. Another is going in for surgery.
“You have to go through this to understand,” Donnelly said.
She is now readying herself for that stage of her battle that will involve extensive, and expensive, drug treatment. She considers herself better off than many others.
“I got on to the right people and thank God I got help,” she said. “I even have a visiting nurse. But I know one girl with very serious cancer who left the hospital with nothing more than ‘bye bye, see ya.’ “
Donnelly reckons that her battle is far from over. But so far she has managed to keep it up despite the toll of her illness, its treatment and the steady drain on her finances.
“I’m fighting it,” she said. “That’s all you can do after the surgery, the chemo and the radiation.”