The total poison load in my chemo cocktail was reduced last week. The heavy head feeling was better, but the fatigue dragged on longer than ever. I made it to meetings Monday morning, then tapped out and took Monday and Tuesday off. On Wednesday, I was still running on fumes, but I pushed through.

In my good week, head clear, I'm back in CEO mode on my cancer journey. I continued researching CRS+HIPEC surgeons, and through a Facebook group — HIPEC Support Group — I found Dr. Armando Sardi at Mercy Medical Center in Baltimore. His name came up repeatedly in the threads, so I vetted him. He holds up against Memorial Sloan Kettering in New York and Atrium Health Wake Forest Baptist in North Carolina.

Facebook groups are the diamond in the rough of that application. We used them when we moved to Portugal, and they made the transition easier.

I submitted new-patient inquiries to Mercy, MSK, and Wake Forest via their websites. Wake Forest called back within hours — it was late in Portugal, and I was in family time, so I missed it. MSK went silent. Mercy emailed and called the next day.

I forgot to call Wake Forest back. I was already talking to Mercy and giving more weight to the feedback I'd seen about Dr. Sardi. Or chemo brain. Probably both.

I connected with Dr. Sardi's HIPEC coordinator and walked her through my situation — American living in Portugal, receiving treatment there, no U.S. health insurance.

No problem, she said. Plenty of international patients. The chart consultation is $500. That covers a document review, imaging review, a recommended treatment plan, and a 30-minute call with Dr. Sardi.

Then she moved to the surgery cost — not including pre- or post-care — $140,000. We accept credit cards, she said, same flat tone, same pace, like this is a number people hear every Tuesday.

I said nothing. I was speechless. Later, I thought: think of the credit card points I could earn.

Once the shock wore off, I told her I'd consider establishing Maryland residency to get coverage through the Maryland Health Connection — the state's ACA marketplace. She said they don't accept health exchange plans.

I wasn't sure if "health exchange" and ACA were exactly the same thing, but I didn't push it. She said she'd send an email with the insurance companies they accept.

The email came with a link to Mercy's accepted insurance list. I pulled up the Maryland Health Connection provider list and cross-referenced the two. UnitedHealthcare and CareFirst BlueShield showed up on both. I sent a follow-up to the coordinator with exactly that observation.

Her response:
Dr. Sardi's practice does accept CareFirst BlueShield PPO and UnitedHealthcare; however, plans purchased through the Maryland Health Connection marketplace are not accepted, even if they carry those names. Only commercial or employer-based plans from those carriers are accepted.

So marketplace plans are out, even if the carrier name matches. I'll follow up on what "alternative coverage options" means — that's worth a conversation.

The $500 chart review is happening regardless. A second opinion on my treatment plan from a surgeon at this level is worth it.

Next up: call Wake Forest and MSK.

Mercy also sent over a document list for consultation. I'll need the same package for all three facilities, so it's time to pull together two years of medical history — labs, chemo records, imaging, surgical notes, and pathology. Last time I requested scans from Champalimaud, they handed me a CD. I gave it to another hospital in Portugal and haven't seen it since. Finding a CD drive and converting Portuguese imaging formats to something transferable — Dropbox, a DICOM viewer, anything from this decade — is going to be its own project. On top of that, every report is in Portuguese, so I'll need translations before any of this reaches a U.S. surgeon.