I remember picking out my lunch box. I had already decided it needed to have some sort of mechanism to keep its contents chilled for up to a few hours. It had to shield its contents from the sun to avoid spoilage. It had to be soft enough so that glass would not crack when hitting the sides and large enough to carry several small boxes tossed in with the occasional small bottle. I found just what I needed at a major national chain store in the United States known for its cheap prices and relatively cheap quality: a red rectangle- shaped lunch box made out of pliable plastic with a gray vinyl lining, a zipper that sealed the 3 sides of the opening at the top, and a matching gray racing stripe all around, replete with 2 pockets for gel ice packs (included). I chose a model large enough to fit about 6 sandwiches stacked on top of each other and perhaps 2 small cartons of milk in the space left over.
I stored my lunch box on top of my refrigerator. That way, when needed, I could easily find it. I religiously froze the gel packs to ensure they were ready every time I needed them. The funny thing is, my lunch box never carried a morsel of food or a drop of drink. Rather, every 3 weeks, it carried my chemotherapy drugs.
In May 2008, a fainting spell and a case of severe anemia led to a cancer diagnosis. At the time, I worked in a border town in Northern Mexico. I had access to the medical facilities and programs at a local university. At no cost to me, these facilities and programs covered everything from my diagnosis to the entire chemotherapy regimen that followed. The only wrinkle was that I had to go to the university’s pharmacy every 3 weeks, collect my multitude of chemotherapy drugs, pack them carefully into my lunch box, cautiously walk to my car and place my lunch box on the front seat next to me, transport myself and the drugs to the nearby local hospital, leave my lunch box filled with potent drugs with the nurse who happened to be attending the nurse’s station at the time of my arrival, accommodate myself in my hospital room, and wait for the drugs to be administered.
I never quite got comfortable with this lunch box system of transporting drugs, though I did get used to the routine of bringing the doctor’s drug orders for my next session of chemotherapy to the university’s pharmacy each time I finished a session and, a few weeks later, packing up the drugs right before the following session. Sometimes, I would get more drugs than could be stored in my lunch box (either because more had been ordered or because the quantities available— packages of 10 vials instead of 5—were larger than usual). On those occasions, I would place the surplus medications in an extra bag I had brought along, making sure to place those that had to be kept cool in my lunch box. Other times, the necessary drugs did not come in as planned. On those occasions, I would place all the available drugs in the lunch box, carefully putting paper towels from the university pharmacy’s restroom in between bottles. No matter what the situation, my time at the pharmacy window would always end with the zipping up of my lunch box and the kind words “Que se mejore” (“Get better”) from the pharmacist.
I do not know if every patient in Mexico needs to carry his or her own chemotherapy drugs to the hospital. I do know that I was one of the lucky ones who had access to the drugs and treatment, and at no cost to me. Clearly, I know the cost got picked up somewhere along the system (taxes? university fees? a public–private bargain among the university, the hospital, and the city or state? a private–private deal between the pharmaceutical companies and the hospital?). Regardless, it was a shared cost. Right now, if I were still in Mexico, somehow I and others would be directly, maybe through a fee, or indirectly, maybe through taxes, paying for the treatment of an unknown individual if he or she belonged to the same system as I did. My sincere hope is that the person has a positive outcome, regardless of who he or she is.
I also know that 4 years later, back in the US and receiving treatment at one of the best cancer centers in the world, I do not look back with nostalgia at the days when I carried potent chemotherapy drugs—or at least those available on that particular day—in my red lunch box made out of pliable plastic. I really do not have time to think about it much; now I have to worry about how I can possibly pay for all these drugs and treatments not covered by insurance, not whether they will break or not in my lunch box. From a patient’s point of view, I often wonder what matters more: my health or the money I have to spend on it?