51-pound tumor removed from woman

Photo courtesy Riverview Medical Center. NSFW: Reveal / Blur

New Jersey surgeons removed a rapidly growing, 51-pound (23-kg) cancerous tumor from a woman who had delayed treatment for more than a month until she became eligible for health insurance, her doctor said on Tuesday.

"She was a skinny lady with a huge belly. I mean it looked like she was literally pregnant with triplets," said Dr. David Dupree, who led the surgery on the 65-year-old woman, at Riverview Medical Center in Red Bank, New Jersey.

"She was just all belly," he said in describing his first meeting with the patient, a homemaker from nearby Union Beach, New Jersey, who asked to be identified only as Evelyn, her first name.

About six to eight weeks before she showed up at the hospital, Evelyn noticed discomfort in her abdomen and that her normally 120-pound frame was rapidly ballooning. Dupree said she sought medical help on June 4, just days after her 65th birthday, when she would qualify for Medicare, the U.S. healthcare program for seniors.

"The reason she didn't go earlier was because she had no insurance," he said.

By now, she weighed more than 170 pounds, her legs were swollen with trapped blood, she was badly dehydrated, and, scans showed, the tumor - a malignant sarcoma - was crushing her inferior vena cava, one of the main veins returning blood to the heart, and putting her life in danger.

With her body too weakened to be operated on immediately, Dupree scheduled surgery for the following Monday, allowing time for her to become rehydrated and for her blood pressure to be brought under control.

But after she became short of breath on Sunday evening, Dupree brought the surgery forward.

"I knew that she wasn't going to make it through the night," he said.

"Either she goes now or she dies tonight," he recalled thinking.

Opening her up, Dupree and his team found the tumor, which appeared to have originated out of the fatty tissue around her large intestine, had engulfed many of her internal organs, and had to be sliced away "millimeter by millimeter" over the course of the five-hour surgery.

Evelyn was still recovering from the operation in a rehabilitation center on Tuesday, Dupree said. She declined to be interviewed.

Although the immediate threat to her life has passed, she must still see an oncologist about treatment for her cancer, which may not have been completely eradicated by the surgery, and may require chemotherapy or radiation therapy.

Dupree said he would advise uninsured patients to see a doctor immediately if they knew they were unwell no matter how near their 65th birthday might be. He said the hospital would have operated on Evelyn regardless of her insurance status, but added he did not know whether doing so would have cost her more money.

Story by Jonathan Allen / Reuters. Editing by Barbara Goldberg and Steve Orlofsky.


  1. Such a great country… people regularly putting themselves at risk because death seems better than hospital bills.
    Really says something about America… and its not good.

      1. some tumors (teratomas precisely) have a lot of the parts of a person, such as epidermal tissue, hair, teeth and eyeballs.  All in one gooey package.

        /Disgusting pedant

    1. Some people just miss the good old days of regularly finding people dead in their homes.

  2. “He said the hospital would have operated on Evelyn regardless of her insurance status, but added he did not know whether doing so would have cost her more money.”

    What a disconnect from reality this doctor has.
    I was uninsured and sought treatment for things and 3 experiences stand out.
    1 – In an ER unable to move without screaming in pain as a nice “patient advocate” stopped by to tell me about programs that offered for the uninsured.  Funny the piece of paper managed to hit the floor and she never made it back to me to replace it so I could read about them, and then a few weeks latter getting an offer for a medical credit card with a 30%+ interest rate, that when I called them out on they pointed out because I was unemployed I wouldn’t have qualified anyway.

    2 – Having a resident doing an exam chiding me for not having insurance, behaving like it was something one could just hit the corner store and get.  I enjoy being lectured about things I need to do and if you leave out the part I was just above the poverty line and qualified for no type of assistance it sounds like I was just being silly by not putting entire weeks of pay into getting bad insurance and falling behind on other bills.

    3 – Having to stop and look at a resident and an attending and pointing out I am paying for all of these tests you order out of my own pocket, is running the same test that has been run on every visit for a while going to establish a better “baseline” as there have been no changes at all the last 9 times.

    It is sad that they don’t seem to understand insurance isn’t a right, or cheap and easy to get.  That there isn’t this great system helping out the “less fortunate”, that they charge the poor more than insured people and still seek to get paid even after they get their costs back from the system. (Just like defaulted student loans, they get repaid and still chase after the money).

    1.  In the case of a life-threatening condition, a hospital is required to do what is necessary to fix the immediate condition, regardless of the patient’s ability to pay. Now, that doesn’t mean the hospital, doctors, labs, etc., won’t try to collect funds after that.

      1. People are screaming bloody murder about any suggestion of mandatory national insurance yet they don’t seem to understand they will pay for it anyway when someone staggers into an ER.  Then the problem is likely far more expensive to treat than it would’ve been if they’d been able to see a doctor under insurance.

      2. I was commenting on the Doctor’s complete disconnect from the idea that coming in for care without insurance could have financially ruined her.
        Yes they have to provide care, but having your social security money ripped away to pay those bills isn’t really useful.

        1.  I am (once again) so very happy to live in a country with a working health care system (Germany)

          1. Careful, with all that socialist health care and well funded schools and unions and excellent sausages you’ll end up like Greece in no time! Yes, I’m an idiot.

  3. Agreed. Come now, doctor, how long have you been practicing in the U.S.? She waits for Medicare and she’s covered. She doesn’t and she has a six-figure bill. Wake up.

    1. I don’t know how great I actually think that is. Moving from a country with a single national health insurer (Australia), paid for proportionately from everybody’s taxes, to a place where I am legally required to purchase health insurance in a semi-regulated insurance market where I can be refused by all reasonable, local insurers for being foreign, having pre-existing conditions and being a freelancer (Germany), I really miss the Australian system. The German system works well for German-born, full-time employed people in long-term relationships with their employers. For immigrant freelancers such as myself, there’s quasi-legal-but-still-expensive foreign insurance that covers nothing much more than scraping me up off the road if I get hit by a bus. I still have to pay out of pocket for every treatment I actually need.

      On the very significant up-side of that, however, is the fact that actual health care costs are shockingly cheap here. Like I said, I pay the entire cost of all doctor visits & medications out of pocket. It costs 10-30€ to go to the doctor, 20€ for a prescription, and when I had a major wisdom tooth infection a few weeks back, the entire experience (antibiotics, x-rays, 5 dental visits in one week) cost me less than 150€. This is not being subsidised by my insurer, who wanted nothing to do with this- this is actually how much it costs. That is astonishingly, astoundingly cheap compared to Australia or the US (once you disregard the additional, next-to-useless 300€ a month I am required to pay to my insurer). So the market here is getting something right.

      1. Bingo. The German system is great, but it has the weaknesses inherent in all the old Wilhelmine/Thirdreichian Syndicalist remnants that got ported over or reintroduced into the Rhine Republic after the war.

        It’s just not designed for people with Unusual Life Choices.

        It’s not a one-size-fits-all system. Far from it, it’s very flexible and accomodating,  but the flexibility and accomodation is based on a few factors which just really really don’t work for modern  ‘guns-for-hire’. Or for ex-pats.  Or for anyboday who might decide they want to do something different at an age above about 25. The whole concept of ‘I’ve done dozens of different jobs in my life’ that seems to be the stock-in-trade of many Americans would both horrify most Germans and confuse this system hopelessly.

        It basically recognizes only a limited number of life scenarios, and if you wind up outside of these, your seen as on yer own, matey:

        a) You have a job as a normal employee in a recognized industry. Everything’s hunky-dory. Your employer pays a contibution toward your health insurance. Nothing to worry about. The system works as designed. Even if you’re made unemployed.

        b) You are self-employed as a member of a recognized trade (say, a plumber) or member of a recognized caucus (farmers, for instance). Note that for most of these, you can’t just turn up and pay membership dues- there’s usually an apprenticeship or practical eduction scheme involved at some point. The system is very much geared towards a job-or-trade-for-life model. You start an apprenticeship at 16 or 18 and work your way through and up (there’s even provision for you to upgrade to degrees in engineering and agronomy, for instance, via technical colleges). But there is more-or-less zero provision for somebody turning up at age 45 and saying they’d like to join the club.

        c) You are self-employed in a high-income profession (Law and/or Medicine, for instance) or a company owner, and thus judged by default wealthy enough to afford the private health insurance you are obliged by law to have if your income exceeds a certain threshold.  The system changes in this case. You have to pay up front for your medical treatment, and get reimbursed. Insurance isn’t cheap. 

        d) You’re a pensioner. The state pension pays your employer contributions towards health insurance. Everything works out OK, too.

        e) You receive some sort of payment from the myriad possible sources that indicate you are unable to work due to ill health (from an industrial accident, for example). Whoever is providing the payment probably also pays  your health insurance coverage in the same insurance you were in before you got ill.

        f) You fall into one of the recognized categories of charitable wackiness that already existed in early postwar Germany, and more-or-less date back to various charitable orgnizations from the Empire or Weimar. Basically, special provisions are made for trades (like journalists, freelance writers, merchant seamen and itenerant showmen)  with highly irregular incomes, as well as artists (and artistes) of various stripes.

        g) You’re completely destitute- social services pay your health insurance. Except in some very odd scenarios. Most of which admittedly require a great deal of fault on your part to get into. However, once in, you can be more-or-less screwed.

        The system causes any number of severely bonkers problems for people who manage to fall through the cracks. As a German national who hasn’t lived and worked abroad for any time you have to really, wilfully, work at it, but you can, and the results are deeply unpretty. I’ve seen it once in the case of the alocholic husband of a relative, who managed to get himself expelled from his trade health insurance for non-payment of dues. Resulted in his wife being unable to go to the doctor for a while, except for cash payment.

        The other way to do it is to try something entrepreneurial, make lots of money for a short time, and then screw up. Bankrupt your one-man company, fail to pay your employer’s contributions to healthcare, or your private medical, and things get very messy very fast.

         The basic private health insurance (which they’re now luckily _obliged by law_ to sell you independently of status) if you can’t wind up in a normal employee’s health insurance because you’re  over the income threshold or self-employed, is around €600 per month. The problem is that the income threshold is retroactive, so if you have a fat year, you may be forced for quite some time, possibly forevermore,  to pay private even if your income isn’t very high now.

        The other place it has severe problems is Furriners of all shades. Specifically, ones like glittertrash who aren’t really part of the German system from youth, and not from the EU (where lots of mutual agreements kick in for short term visitors) and aren’t in regular employment. 

        And that tends to include any Gernan nationals daft enough to have left the embrace of the Fatherland and then demonstrate the temerity to return sufficiently far in the future without their fortune made….getting back in to health insurance if you’re not an employee (or wealthy enough to afford private) can be next to impossible as most of the obligations to take anyone who’s still warm expire for health insurers in the case of ex-pats.

        Oh, and ‘downshifting’- really really bad idea in Germany- screws up your state pension provisions. The pension state calculation heavily favours people with both long years of service and very high incomes near the end of their career. If you quit and do a low-income job for a few years you can actually wind up with less pension than if you’d stayed unemployed….

        Let’s not even get started with the the weird banding in progressive taxation which means you can have a literal take-home pay cut by being paid more….

        So the system is not nearly as perfect as some would make out. It works, invisibly most of the time, for the ordinary citizen. But if you ever have need to see or interfere in the underlying machinery you may well run the risk of being ground up in it.

        1. Yes, this is a very thorough and accurate-to-my-experience breakdown of the situation, as normally enumerated over Feierabendbier with other frustrated furriners.

           “if you ever have need to see or interfere in the underlying machinery you may well run the risk of being ground up in it”

          Quoted for truth. But, I do appreciate that for the vast majority of my German friends, it is a smooth, invisible care-taking, and that the system is leagues ahead of, say, the USian system.

  4. “…a woman who had delayed treatment for more than a month until she became eligible for health insurance…”

    Pre-existing condition. Coverage declined.

  5. Of course the opposition to single payer originates from those who are riding the gravy train. They find easy support among right wingers through the usual propaganda techniques and astroturf orgs such that normally functional humans will ignore the fact that the US pays more than everyone, covers fewer people and has worse outcomes.  There is no better example of our national pastime of voting against our own self interests. 

    Universal healthcare covers more people with better outcomes at lower cost everywhere else. In fact with government health care programs the overhead is down to a couple of percent -as opposed to 10-25% for the insurance companies and their phalanx of people who do nothing but find reasons to deny care. 

    But facts don’t matter to right wingers anymore. If Romney gets elected and (heaven forbid) Republicans keep the house and take the Senate, we’re in for decades and decades of ever declining health care. Not to mention all the other misguided ideological evils that will ensue -and Americans will have brought it all on themselves.

    1. If Romney gets elected and Republicans keep the House and Senate, *and if the United States suddenly and miraculously changes into a functioning democracy*, then Americans will have brought it all on themselves.

  6. Whereas here in the sunny UK, if you turn up to a hospital, youll get treated, pretty much no matter where you come from or how long youve been in the country..in fact I dont think that an NHS hospital would even have a clue *how* to bill someone…

    Do I think its wrong that just anyone can rock up at a hospital and get treatemnt, even if theyve never had a job, been in the country ten minutes, or is an ilegal immigrant?


    But I would far rather that than this hideous situation where if you havent got the money, well, sorry bout that, but can you please just piss of and die quietly..

    Surely keeping the populace healthy and able to work and contribute in all the myriad ways that people do to a society is cheaper in the long run than letting these money grubbing corporations bleed us all dry by making profit from healthcare….

  7. I’m in the U.S.  I have a friend who is going blind because he cannot afford all the treatment he needs for diabetes.  He is an artist, and had various jobs as a framer, dry-wall technician and delivery driver, and hopes that applying for disability will kick in before he goes blind beyond treatment.  His doc wants $60 to come into the door to consult about treatment options, might as well be the moon because of their income level. Much less any costly tests.

  8. Just so Americans will know, you can enroll in the Pre-Existing Condition Insurance Plan right now https://www.pcip.gov/

    To be eligible for the Pre-Existing Condition Insurance Plan,
    You must be a citizen or national of the United States or reside in the U.S. legally.You must have been without health coverage for at least the last six months. Please note that if you currently have insurance coverage that doesn’t cover your medical condition or are enrolled in a state high risk pool, you are not eligible for the Pre-Existing Condition Insurance Plan. You must have a pre-existing condition or have been denied coverage because of your health condition.

    I’m 59 & pay $426 a month to be in PCIP.

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