A LOVE AFFAIR WITH MEDICARE

One day, Beverly Breathless was diagnosed with sleep apnea and was sent by Dr. Referrall to Dr. Milkit, a specialist in sleep studies. Dr. Referrall warned Beverly that sleep apnea could lead to a heart attack and death. He explained that a new study showed that patients with sleep apnea were much more likely to die of heart attacks between the hours of midnight and 6 a.m. than people without sleep apnea. (But he didn't tell her that the same study showed that people with sleep apnea were much less likely to die of heart attacks between the hours of 6 a.m. and noon, when heart attacks hit most often. And the study never made clear whether sleep apnea patients were more or less likely to die of heart attacks than people without sleep apnea.)

Fearing the thought of facing the Grim Reaper in the dark, while wearing only a flimsy nightie, Beverly Breathless quickly made an appointment with Dr. Milkit. Her resolve was solidified as she was leaving Dr. Referrall's office and Nurse Grabbit shouted something after her.

“What did you say?” Beverly asked.

“Medicare will pay!” shouted Nurse Grabbit.

Three weeks later, Beverly was sitting in Dr. Milkit's office, where he suggested she undergo a sleep study.

“A sleep study?” Beverly asked.

“Don't worry. Medicare will pay,” soothed Dr. Milkit.

“But what is a sleep study?” Beverly asked.

“You come to the office with your night clothes about 10 p.m. and we bed you down in one of our sleep rooms. But don't worry, Medicare will pay.”

“What happens in the sleep room?” Beverly persisted.

“We fit you with a face mask, which is connected to a hose, which leads to an air pump, so that we can pump oxygen into your lungs through your nose. But you needn't worry. Medicare will pay.”

“But why do you pump oxygen through my nose?” Beverly asked worriedly.

“Because your report from Dr. Referrall states that when you sleep, your mouth opens and your jaw drops back, forcing your tongue over your windpipe, which blocks your oxygen intake. This problem causes you to have sleep apnea. But Medicare will pay.”

“How do I know whether this face mask thing actually helps me?”

“We accomplish that by measuring your breathing on an electronic machine attached to the mask. The first night we measure your sleep without giving you oxygen, and the second night we measure your sleep when you receive oxygen.”

“I have to do this on two nights?” Beverly wailed.

“Oh, yes, we need a pre-post measurement, but don't be concerned. Medicare will pay.”

“What happens if I end up needing the sleep mask?” Beverly worried.

“In that case, we refer you to MediBreath Company, which will outfit you with a mask and the whole apparatus. They rent their equipment in ninety-day periods.”

Seeing herself permanently hooked up to a monster machine caused Beverly's fears of a nightie-clad meeting with the Grim Reaper to lessen considerably. “But .....”

“Oh, don't worry,” Dr. Milkit soothed. “Medicare will pay.”

“But what if I start with just the strap on the mask that holds my mouth shut, so my mouth doesn't open and my tongue doesn't slide back over my windpipe?” Beverly asked.

“You could do that, but I recommend the whole apparatus. Medicare will pay.”

“Well, I think I want to get into this more gradually. I'd like to start with just the strap.”

“I don't know whether MediBreath will rent a chin strap without the rest of the apparatus...” Dr. Milkit said in a soft, disappointed voice.

Eventually, Beverly agreed to go through with the two sleep sessions. During the first one, the mask was so irritating she couldn't get to sleep. The motor running the pump was so loud she thought she was in an aircraft engine factory. She finally fell asleep at 3 a.m. But she awoke with a start two hours later when two nurses barged into the adjoining office and conducted a loud conversation about their children and their schools. The test readouts confirmed that she had sleep apnea, and at times her oxygen level fell to 85, somewhat below the target of 90.

The second session with the mask and pump was even more difficult, but there were four hours of readable results obtained over an eight-hour period. A small improvement was noted.

After the second session, Beverly called MediBreath to order a chin strap to keep her mouth shut while she slept.

“Oh, we don't rent straps alone. You have to get the whole apparatus. Medicare will pay,” claimed the MediBreath technician.

“I want to start with the strap first. So just send the strap out.”

“I'm pretty sure we can't do that. I'll have to consult with my superior. Please hold the line.”

After a protracted wait: “We can let you start with the strap, but we can't send it out to you. We have to have a technician come to your house and show you how to strap it on. Medicare will pay.”

“You don't think I know how to put a simple strap on?”

“It's important that it be done right,” insisted the MediBreath phone voice. “Medicare will pay.”

A week later, a MediBreath technician came out to the house and showed Beverly how to put on the strap to keep her mouth shut while she was sleeping. The procedure was somewhat less complicated than tying a shoelace.

That night, Beverly put on the strap and slept all night with it on. But in the morning her jaw ached from the pressure. The pain was similar to a bout of TMJ she had gone through ten years before. Not wanting to exchange a painless problem for a painful one, Beverly consulted her husband, who was very creative.

“Well, Beverly, if the objective is keeping your mouth shut at night, why don't we simply tape it shut?”

“Tape it shut? That seems too simple.”

“The best ideas usually are,” he replied.

After experimenting with several different kinds of tape to accomplish the mission without irritating the skin, Beverly now sleeps with her mouth shut and feels more rested in the mornings.

Beverly buys her favorite tape at Office Depot, where the cashier has never once said, “Medicare will pay.”