How a collarbone fracture made this physician remember her past


One of my most vivid early memories is from when I broke my collarbone.  In a first-grade relay race, kids were running at top speeds in opposite directions, so it was no surprise that I collided into a classmate.  I was knocked to the ground and cried in pain.  The school nurse called my mother, who came and took me home, carrying me all the way.

Now that I have a first-grader of my own, I realize that it was no easy feat, carrying a 45-pound sobbing child a half-mile.  But beyond the weight of her child, there was something far greater weighing on my mother’s mind.  We had no health insurance.

My father came to the United States to pursue his PhD in mechanical engineering, leaving behind a prestigious job at the Indian Space Research Organization, a large network of supportive family, and a comfortable life.  Here as a student, my father had access to basic university student health services, but my mother, brother, and I had no health insurance coverage.

My mother called our closest family friend, Meera Auntie, who happened to be a pediatrician.  When my father came home, we drove over to Meera Auntie’s office, where she examined me and ordered an X-ray.  She placed the film on a lightbox in her office and pointed out a hairline fracture in my collarbone (clavicle).  She told us it would heal on its own; I just needed to wear a splint for several weeks.  She procured a figure-of-8 splint for me and helped me put it on.  I remember thinking it felt like wearing a backpack, only with no pack.  I was not thinking about the medical expenses, but looking back on it, I suspect Meera Auntie’s solo private practice absorbed all the costs.

Lucky for my family and me, a clavicle fracture, especially a mild one like mine, requires little treatment.  It heals on its own with just a sling or splint to immobilize the bones.  Beyond the office visit, X-ray, and splint, there were no major costs to be incurred.  And because our extraordinary pediatrician saw us as family, she took care of everything without even letting us know the cost.

If I had sustained a different type of fracture, such as breaking one of the bones in my forearm, it would have required casting and multiple visits to an orthopedic surgeon.  I am not sure how my family would have afforded those expenses on the paltry stipend of a graduate student.

My clavicle healed well and has caused me no problems since.  However, my family and I carried that experience with us.  When my father completed his PhD and started a job that provided health insurance, we valued it more than the average consumer did.  We began to seek preventive care for our whole family.  My father was diagnosed with hypertension and began treatment.  Thanks to the vigilant health department, we had always been up-to-date on vaccines, but now we had insurance to help pay for things that were beyond the reach of the arm of public health.

Fast forward a quarter-century.  I completed college and medical school.  My earliest professional role model had made such an impression on me that I couldn’t think of a more ideal field than pediatrics.  After completing my residency, I decided to pursue a career as a community health center pediatrician.

It was at one of these community health centers that I again encountered a clavicle fracture.  I was working at a clinic where we provided primary pediatric care for children who were below 200 percent of the federal poverty line.  Having spent much of my childhood below the poverty line, this population was close to my heart.

One afternoon, a six-year-old boy came in with his father after a fall on the playground.  He had been to an emergency room and came in with an X-ray on a CD.  They did not know what the boy’s diagnosis was.  I suspect much of the emergency room communication was in English, in which this family had limited proficiency.   They were coming to see me to find out what the next steps were.  I examined the child and noted that he had limited motion of his left arm.  I left the room to view the CD images on a computer.  In a few minutes, I was looking at a left clavicle fracture.  It was more pronounced than my own had been (not just a hairline on the screen), but the clavicle was not displaced, and nothing appeared askew.

As I prepared to go back to the exam room and discuss the diagnosis with the family, I was taken aback by the emotion that overcame me.  Here was a six-year-old uninsured child with a clavicle fracture, the very fracture that shaped my views on health care at an early age.  Here was my opportunity to treat this child with the same tenderness with which I was treated.

As I explained to the father that his son had a fracture in his collarbone, I saw his face tense up.  I knew he was thinking of his son’s health but also of how he would bear the cost of the treatment.  I explained that he did not need to go see a specialist and that our clinic could provide a sling for him to immobilize the bones.  As his face relaxed, I asked the family if they would like to see the X-ray.  I showed them the X-ray on the computer screen, pointing out the anatomy and where the fracture was.  I could tell the six-year-old was fascinated.  He was too young to comprehend the significance of the situation, but in years to come, he would appreciate how fortunate he was to have only a simple clavicular fracture, how fortunate he was to have a well-funded health center in his community that could absorb the costs of his injury.  I knew he would because that six-year-old was me so many years ago.

Dhanya Puram Limaye is a pediatrician.

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