May 14th, 1887
Prairie Home, near Abilene, Kansas
Dearest Aunt Celeste,
I hope this letter finds you in good spirits there in Indianapolis. The prairie is greening at last, and Father says the wheat looks stout this spring, though he still mutters about grasshoppers. Mama has begun her rhubarb pies again, and little Samuel insists that the new calf follows him like a pup. I spend my mornings fetching water and my afternoons reading what books we have, which are few, but growing—thanks to kind souls who lend them along the post road.
But oh Aunt, nothing could equal my delight last week when the post rider brought me the most marvelous document—DL40259: The Proposed MolDx Local Coverage Determination for Genetic Testing in Hereditary Thrombophilia. Imagine my joy! To think, while the men about here argue only of fence lines and rail spur routes, I may pore over the distinctions of Factor V Leiden heterozygosity versus prothrombin G20210A, as if they were characters in a serialized novel.
You cannot conceive my astonishment at the section where it declares that “panels including MTHFR variants shall not be covered”. Sharp, and how decisive! What a fine man the medical director must be. I read those lines aloud to the chickens as I scattered corn, and I declare they clucked with approbation. I confess, too, that I have long suspected Protein C and Protein S deficiencies to be rarer birds than most suppose, and now the policy confirms it. What a comfort to find my suspicions shared with the august American Society of Hematology!
Papa says I ought not trouble my head with such “modern contrivances,” but how can I not? To know that the recurrence risk of venous thromboembolism is 20% at five years—why, it makes the dangers of rattlesnakes seem paltry in comparison. I even told Samuel that should he ever take ill with a clot in the cerebral veins, he must inquire of his doctor whether indefinite anticoagulation be warranted in light of the ASH conditional recommendations. Samuel rolled his eyes, but I know someday he will thank me.
So you see, Aunt Celeste, life here on the frontier is not without its refinements. Though we lack gaslight or trolley cars, we have the prairie sky above us, the wind in our hair, and—most unexpectedly—the thrill of federal draft coverage policies to brighten a farm girl’s days.
Give my love to Uncle Horace, and tell him that while his letters on crop rotations are informative, they cannot rival the elegance of a well-reasoned LCD.
With all my affection,
Your devoted niece,
Annabelle
