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Ken's index finger in a bandage and splint
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Ken standing outside a hospital

One week before I started nomading, I found a lump.

I’m no stranger to needing healthcare: I have at least a dozen surgical scars and have been under general anesthesia a half-dozen times. In most cases, I know exactly what I’m getting myself into, whether it’s wisdom teeth coming out or a titanium rod going in.

But a lump — I didn’t know what that could be. That scared me… and the timing couldn’t be worse.

Radiology

The doctor recommended an X-ray, but the window to have it performed was narrow: I was leaving Boston on October 15 for two weeks in the Netherlands and one week in St. Louis. But on November 4, I would be driving from Boston to Syracuse along a route that would take me past my hometown hospital. I scheduled my radiology visit for that precise day and time.

I was in Syracuse a week later when I received the results, which indicated that the lump itself was benign, but it could be a symptom of something more serious; a CT scan would be needed to investigate further.

Fortunately, I found a doctor in Syracuse who accepted both my insurance and my previous doctor’s findings. I wouldn’t need to start from scratch; I could pick up my healthcare in New York where it had been left off in Massachusetts.

Having cleared that hurdle, I encountered the next one: scheduling the CT scan. Looking two months ahead, the receptionist asked, “How’s January 7th?” But nomads are constantly moving and can’t always plan that far out: “I’m moving out-of-state on December 30th,” I told her. She put me on the waitlist for a cancellation and was able to get me in on December 3rd. After getting the scan, we played the same game to schedule a separate appointment to review the results.

A week later, I was sitting in an exam room, waiting for the doctor to come in to discuss his findings, when a nurse arrived instead. “Ready for your cystoscopy?” she cheerily inquired.

Those were not the results I was expecting.”I’m sorry, my what?”

“Oh, well, I’ll give you something to take the edge off, then we’ll snake this camera up your urethra and take a look around to see what’s going on up there!”

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If that’s what the situation called for, I wouldn’t object — but nothing in our previous discussions or documentation had prepared me for this. I would accept only so much poking, prodding, and scanning without more information.

“I thought I was here to review my CT results,” I objected. “Could you please confirm you have the right patient, and explain to me why this diagnostic test is necessary?”

She did have the right patient, but she had to leave the room to get the answer to the second question. She came back with a smile: “Computer glitch! You don’t need that test.”

Adding to my relief, the doctor came in shortly to say the CT results were negative, and I had nothing to worry about.

Not for another week, anyway.

Urgent care

It was four days until Christmas, and I was preparing some sweet potato quinoa chili to keep me warm. I was dogsitting for a Syracuse family that was spending the holidays in the United Kingdom, and I was enjoying having access to their fully stocked kitchen, including a slow cooker, which I’d been missing in my travels.

What was less familiar to me were their knives, which were particularly sharp. They say sharp knives are safer than dull knives — but only if you know how to use them. And I hadn’t yet checked “take a knife skills class” off my to-do list.

So it was that, while chopping an onion, the knife slipped and went into — and through — the tip of my left index finger. I’d cut myself while cooking before, but this one looked particularly bad: nothing had been detached, but there was a definite “flap”.

So I did what anyone would do: I finished getting dinner into the crockpot so it’d be ready when I got home. Then I drove myself to urgent care.

A bowl of chili
What? It was good chili.

In hindsight, I’m not sure how I knew to go to urgent care instead of an emergency room; I’d never been to an urgent-care facility before. Perhaps it came from five years of working in the healthcare system, or more generally from having older relatives. But a nearby one was easy to find on Google Maps, so off I went.

En route, I used voice-to-text to get a confidence check from my friend Johanna that I was doing the right thing; though not a healthcare professional, she is a parent, and I figured she’d seen her share of accidents and injuries. She confirmed my decision while opting out of receiving photos of the wound.

Once at urgent care, I didn’t have to wait long before being taken into an exam room. I was concerned when the nurses said they would need to “finish what the knife started”, but they confirmed nothing had been severed and everything would heal in full. They gave me a local anesthetic, mesh dressing, and tetanus shot, and sent me on my way — just in time for me to go contra dancing that night.

Rules of thumb

I’m fortunate to have good insurance through my employer, which I take advantage of to see as many doctors as I can: every year, I have at least one appointment each with a primary care physician, dentist, dermatologist, optometrist, and chiropractor. In the past, I’ve also seen urologists, psychologists, and massage therapists as necessary. I am not a hypochondriac: healthcare is easier to retain than it is to regain, so instead of waiting until I am sick, I engage in maintenance and preventive care.

That didn’t prevent the unplanned emergencies with which my nomading got off to a rough start, but at least they weren’t expensive: after insurance, the total cost for the lump was $157.35; for the knife wound, $10.80.

Not everyone has access to affordable healthcare, and the ways in which our country can fix that are many. I don’t have advice for those individuals or politicians, but I do have some general advice for those needing healthcare on the road:

  1. Know where to go. As a nomad, I find myself in a different city, town, state, or country every few months. Before I arrive, I spend ten minutes on Google finding the nearest hospital, urgent care, and other healthcare providers I may need, noting their names, addresses, and phone numbers. I may not have time to find this information if I wait until I need it.
  2. Ask for recommendations. When I arrived in Missoula, Montana, I couldn’t find a dentist within 100 miles that accepted my insurance. Fortunately, I had a co-worker in the area, which meant he had the same insurance. I asked him what dentist he used, and he pointed me in the right direction. When the dentist’s receptionist had trouble finding my insurance, I was able to drop my co-worker’s name, saying I had the same plan. These sorts of connections eliminate variables and quickly establish a foundation for good healthcare.
  3. Get regular checkups. I originally thought I’d be traveling back to Massachusetts often enough — at least twice a year — to continue seeing the same practitioners I’ve had for decades. The pandemic ruined those plans, but I’ve nonetheless tried to not let my travels disrupt the frequency of my healthcare. In Missoula, this meant seeing a dentist and a dermatologist that were not my own. When the dentist recommended an expensive procedure, I was still able to call my regular dentist back in New England to get a second opinion. Later, I securely emailed him a copy of my new X-rays, adding them to my record so that there’d be no gap in my file.
  4. Keep copies of all your records. Your doctors will change as often as your city, scattering your medical records across the globe. Waiting for one doctor to get information from another doctor’s office can be tedious and filled with HIPAA red tape, whereas you always have full rights to your own medical records — so it’s on you to become the canonical source of truth. If you have a test performed, then ask for a copy of the scan or results, whether it’s in print, on CD, or emailed. When you pay your bill, don’t settle for the credit card receipt; ask for an itemized invoice listing every diagnosis, treatment, and cost. If this documentation is provided in hardcopy, use your phone to scan it into a PDF.
    Having this information at your fingertips can be invaluable. When I was at urgent care, they asked when my last tetanus shot was. I pulled out my iPhone, logged into my cloud backup in Backblaze, downloaded a PDF of my immunization records, and showed them to the nurse.
  5. Advocate for yourself. This is especially true when you’re a nomad and don’t have nearby friends and family who can accompany you to your appointments. “Can you schedule my follow-up any sooner?” “Is this test necessary?” “Can you prescribe a generic alternative?” You have more invested in these answers than your providers do. Healthcare is like democracy: asking questions isn’t rude; it’s healthy.
  6. Take a knife skills course. Seriously.

One reason I’m nomading now, instead of waiting until I retire, is because I may not be physically able to travel in 25 years. Nomading while healthy means staying healthy. Whether you’re at home or on the road, take care of yourself, and you’ll have many adventures ahead!

What issues have you had — or wonder if I had — getting healthcare away from home? Leave your stories and questions in the comments!

Ken Gagne

Digital nomad, Apple II geek, vegetarian, teacher, cyclist, feminist, Automattician.

2 Replies to “Healthcare on the road”

  1. Just a word of caution on using Backblaze to store healthcare info: they are not HIPAA compliant. You may want to ensure you have enabled at least password protections on your backup, or exercise other cautions.

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Ken's Itinerary

West Linn, OR

Nov 21, 2020 - Dec 26, 2020