We are self-insured. We have substantial premiums, deductibles and co-pays. We navigated shifting corporate mergers that redefined who qualified as our caregivers. I dreaded seeing, and still dread seeing, the mail carrier approaching our home because I know a piece of mail may arrive that will consume hours of my time. I'll then be on the phone queuing through layers of touch-tone menus, or sending faxes, or trying to get anyone to give me a last name and/or a call-back number and generally help me unravel the messy business of health care administration.

Yet, I never saw a situation where Kathy's care was compromised by her coverage; maybe my sanity, but never her care.

While navigating insurance is maddening, and yes, it could be better, by far Kathy's most frustrating problem was the wholly inadequate communication within her "team" of health care professionals.

The days are gone when doctors lunch together in the hospital cafeteria, or otherwise socialize, or attend the same professional conferences. Doctors are rarely just together in the same place anymore where they can collaborate as colleagues (that is, until the patient is hospitalized and the end game begins).

Everyone's a specialist - some in private practice, some in teaching hospitals, some in high-volume clinics - and most practice at three or four different locations. Try getting any two specialists on the phone at any one time. Try feeling confident that any one of them knows exactly what the others are doing. One handles pain, another cancer, another infection and another metabolism. Throw in a surgeon, a few radiologists, a gastroenterologist. Where exactly do those functions overlap? The lines of responsibility are murky, and things often slip through the cracks.

In the middle stands the pharmacist, maybe the one person best positioned to know what everyone else is doing. And too bad Kathy had two pharmacists, and I don't think they collaborated, either.

To our team: nothing personal. I know you did all you could, and I'm grateful for your care, but I'm also happy with our insurance company.

Kathy McCarthy was diagnosed in April 2000, and died this August. Her husband, Mike, and their four children live in East Walnut Hills.

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