[cancer] Class privilege and chemotherapy

I was having breakfast with and this past Saturday morning at Portage Bay Cafe in Seattle’s U district. The wait staff were moving back and forth, every one of them fast on their feet, when it occurred to me to wonder how someone with a job like that would have fared through the chemotherapy regimen I just endured.

That in turn unfolded to realization that most people working in the service industry would be at risk of their livelihood in my situation. I spent the last two months of chemo sitting down, and moving very slowly when I was up, the two months before that not so much better. A job that required me to be on my feet all day, or driving a vehicle to service calls, or shifting stock or pulling parts, would have been impossible.

How would a waiter, or a plumber, or bookstore clerk, maintain their livelihood through such an experience?

I am lucky. I have a well-paid job that mostly involves sitting still and thinking. Or reading and writing, but those are still essentially sitting and thinking. I have a job I could meet the requirements of even through the worst of chemo. A high-end, white collar job open only to someone with a decent-or-better education and the life skills to navigate corporate politics and policies, and the intricacies of American business.

Even then, if I’d been a daily commuter, I’d have been sidelined badly. That my sit-down-and-think job is work-at-home employment meant I was almost perfectly suited to continue through chemotherapy without financial or workplace disruption.

This strikes me as class privilege, a benefit of being a (relatively) high end white collar worker with seniority both in my field and with my employer. And therefore, ultimately a benefit of the accident of my having been born white, male and middle-class into a household with high educational and professional expectations that was able to raise me with the skills to meet those expectations. I cannot imagine the stress of making my living as a waiter at Portage Bay, then having to accept the time and energy limits I endured in the chemotherapy process. That’s completely outside the narrow medical issues, and even largely outside the issues of insurance coverage and so forth.

Do oncologists take this sort of thing into account? Do employers with shift work and hourly wages allow this much latitude to their employees? Watching the wait staff made me realize how damned lucky I have been, and continue to be. As brutal and difficult as this all has been, I keep finding new things for which to be thankful.

13 thoughts on “[cancer] Class privilege and chemotherapy

  1. Desiree says:

    Some employers do take such things into account, when they can. I went through Breast Cancer treatment several years ago at age 31, working for a Title Agency in a rather active admin position. When I knew I would be going through chemo, he asked me to train someone to cover for me. The few days I was off sick I had someone who could do my job (which was a feat) and when I was there, I had someone to go behind me and make sure I hadn’t missed anything due to chemo-brain. He even offered to give me a cot in the archive room if I needed it for naps. Granted, it was an office, but I only spent half the day on my chair, the rest was on my feet. Doing the same kind of thing in the service industry would be far more difficult, but not impossible.

  2. Same thoughts when I broke my leg. I was back to work in two weeks (which my orthopedist thought was insane, but 1) only employee in business and 2) no sick time or vacation time to use – crappy employment situations/benefits are a staple of the design world). Many of our vendors or clients would remark about how they knew somebody with such an injury (9″ plate, 13 screws plus an osmotic screw that held my fibula together and then reattached it to my tibia at the ankle) and how it sidelined them for six months (my “full” recovery time). I kept wondering if my boss ever got the hint? Probably not. (I no longer work there). So yeah, the fortunes that gave me a job where I mostly sit in front of a computer (although we were on the second floor with no elevator – my own personal whine point).

  3. Leon says:

    Dude. You are soooo my hero.

  4. Jen says:

    My mom went through chemo for stage 3 colon cancer while working full-time as a librarian and volunteering at her church. She took all of two weeks off for the surgery itself. She worked through her entire treatment, often excusing herself to use the restroom. She remained on her feet, shelving books and moving carts, through ten months of treatment. Even when her veins turned black and she developed sarcoidosis in her lungs.

    She is the strongest person I’ve ever met.

    1. Jay says:

      Wow. Just wow.

  5. During my postal career, one of the benefits was a pretty generous sick-leave-earned-per-hours-worked ratio. Came in useful back in 1995, when I was off work for three months.*

    Other employees I knew, who had long-term illnesses (usually cancer) that kept them off work for even longer periods would sometimes burn through their accumulated sick leave and have nothing left, leaving them in a no-pay status if they continued off-duty. But there was a program where other employees could donate some of their own accumulated sick leave hours to the sick employee; for some employees, it was the only thing that saved them from financial ruin.

    (Don’t thank postal management for that program. They didn’t think of it, and wouldn’t have. It came from the union, and was pushed through by the union. And yes, non-union members could take advantage of it too.)

    *(The bad news about those three months is that I could have actually gone back to work after a month, but I’d pissed off and embarassed people in management, so they dragged their feet on the paperwork clearing me to return to duty, making me burn about 400 more hours of sick leave than I actually needed to. That little incident was one of the main reasons I retired from USPS almost as soon as I could. It’s not as if I’M THE SLIGHTEST BIT BITTER ABOUT IT, y’know.)

  6. Cora says:

    Like I’ve said before, it’s very hard for me to imagine that the US healthcare system would force people to work through chemotherapy, because this would not happen in Germany and most likely not elsewhere in Europe either.

    In Germany, your employer will continue to pay your full wages for 6 weeks. Afterwards, your health insurance chimes in and pays you 70% of your last pre-illness wage for a maximum of 78 weeks within a three year period for the same illness. If you somehow exceed the maximum payment period (which can happen with recurring cancer), you have to go on welfare or disability benefits. This regulation also applies to self-employed people, though I think it’s elective. In addition you can also get private disability insurance in case you are permanently unable to work.

    So in short, your system sucks.

    1. Jay says:

      So in short, your system sucks.

      Yes, it surely does. And I say this as someone on the *good* end of our system.

  7. Lois2037 says:

    In reality, the waiters and other service employees, and most self-employed people, wouldn’t even be able to get chemotherapy, or perhaps any treatment at all. Most have no insurance, and if you have no insurance, oncology offices expect payment in full, up front. If you don’t have it, they show you the door. The drugs can cost upwards of $3,000 a month, also out of their reach. This also applies to folks who can’t get insurance because of pre-existing conditions. Medicaid and state and county programs aren’t available to people who make much above the poverty level. It surely is a class privilege, and while I’m happy that you and others can qualify for it and receive it, I don’t like to think what it can mean for the rest.

    1. Jay says:

      Just as a point of reference, my drug cost on chemo (including infusion center charges) was about $18,000 every two weeks at the nominal bill rate. The insurance company paid far, far less, but if I’d been paying over the front counter, that’s what they would have billed me.

      And yes, I am well aware of the coverage gap between poverty and privilege. This is actually something I was critical of years before it became a personal issue.

  8. Alexis says:

    I often thought the same thing during treatment. I didn’t have all that much paid sick time but I could and did take unpaid sick leave. At least I could afford to take time off anyway. (This didn’t stop my boss from punishing me for taking that sick leave. In fact the only communication I got from her was a phone call from her secretary 2 months after I started treatment, asking why I was taking medical leave.) And at least I had great health insurance. I would be dead now without Herceptin, which I could never have afforded myself, not to mention the $1000 shots, the scans and tests, the repeated doctor visits, etc, etc, etc. Of course now, I’m toxic. No way can I ever be without some kind of insurance or I would wind up without ANY insurance ever. Some ‘priviledge’ right?

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