Jim called me late on a fall afternoon to report our mutual friend was in the local emergency room. “It looks like he had a stroke”. I immediately asked to speak to the ER doctor for the results of the CAT scan I knew would have been done. There were two metastatic tumors in the brain.
It has been over two years since my friend died. He was among the millions of Americans without health insurance. When his business declined, he found health insurance was an unaffordable expense. So when worrisome symptoms persisted, he did not immediately seek help, fearing the costs associated with the evaluation and treatment. By the time of his diagnosis, the cancer had spread and was inoperable.
When I arrived in the emergency room that evening, he was lying on a gurney, his appearance tired and pale. I spoke with the physicians and surgeons who had reviewed the tests. We agreed I would be the one to share the terminal diagnosis with him. It was not something I wanted him to hear from a stranger. He chose hospice, his friends taking turns to assist with his care since he had no family. He died only a few months later, in that time losing both his home and his business.
I had worked with this man over a decade before. He had given me a job when I was a student at the local university. At the time, medical school was only a dream. He was a unique gentleman, fiercely independent and stubborn with a soft spot for adopting the stray cats that had shown up at his doorstep.
I have thought often of him over the past year as the health reform debate raged. I have struggled with the flood of emotions that came in the wake of his death. Among those feelings, there has been a grief that still grips me even now, as I write this.
There has also been anger, anger over a system that has left so many without reliable access to health care. In the United States, an estimated forty four thousand people die prematurely every year due to the lack of health insurance. The uninsured, like my friend are more likely to face delays in the diagnosis of cancer and thus decreased rates of survival. Among those who are insured a cancer diagnosis can lead to bankruptcy.
There has been disappointment too, as I have discovered that the reality does not meet the dreams I had for a career in medicine. Although I have been in practice less than a decade, already I am seeing my colleagues leaving the field. Burnout and frustration have led many physicians to quit the practice of medicine, while our patients have lost faith in the system. The yearly struggle with Medicare over physician payments is a regular reminder of how little value is given to a physician’s time; instead we worship at the altar of technology and pharmaceuticals.
Finally though, it is hope I have chosen. I am hopeful that reform will bring about meaningful changes, improving access to care. I hope to see healing for healthcare providers allowing the passion they had for caring to be reborn. It is my new dream.
Aldebra Schroll is a family physician who blogs An Apple a Day.
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