So many layers.
It always amazes me how we bring many lenses to any situation and these are how we see the world. Some, well maybe most of us, have several lenses, or maybe should. What do you think? Which lens rises to the top depends on so many things.
In the story of today, shall we look at this through the just get the person to safety lens? How about the really weird, as in I can hardly believe I felt this and though it cannot be close, here I am, standing in another’s shoes lens? Or the health-care system, it really can be better lens?
Or all of the above. They all fit for me. I like the notion of multiple views.
It was a busy week back at the ranch, er job: several evening events, a night on call, but no matter. I had made plans to take Friday off and even arranged coverage for Monday; we were going to the snow, heading for Canada. “We” would be my neighbors and me. They drive, I have the housing arranged: me in one room, their daughters in the other, the parents in the living room. A close friend’s daughter with a season pass wanted to come too and she could sleep in my room. All set.
Then my friend, mom of the kid who would be my room mate, decided to rent a place in the same building and come as well with another friend of ours. All good….except she was tired and it was a long week and she was ambivalent. Her daughter and I both talked with her, and in the end she decided to come.
Thursday evening we all (including my friend’s husband) were at a fund raising dinner, and all seemed ready for the next day. I arose Friday, packed, and my neighbors and I hit the road. Many hours later my friend, her daughter, and our other friend arrived. My friend did not feel well, was nauseated and had abdominal pain all day. She had not eaten since the night before.
Saturday morning it seemed clear that my friend needed to be seen at the clinic. She, our mutual friend, and I (all family medicine doctors) feared appendicitis. While my neighbors, my friend’s daughter, and I went to ski, the other two went to the clinic. By lunch, we knew. Her daughter and I headed down the mountain: appendicitis.
We were in a location with no hospital. We knew the ones along the way from there to Seattle. Her husband was not with us because he had been on call, but had gotten sleep and was able to drive to the border and meet us. We knew there were surgeons in Squamish, then Vancouver, then Bellingham, then Everett, hoping to get her to Seattle.
The punch line is that she did get to Seattle, had her surgery around midnight Saturday night, and was home Sunday evening.
But that in not the point of this post.
I mentioned three lenses above.
Get her to safety: Who should go, where to go, who helped us know? We had many possibilities. Who should go? Should her daughter drive her to Seattle? What if she got sicker along the route and a doctor was not with her? How luxurious that there were two other doctors along. And who should go?
Stand in shoes: The two doctor friends (Diane and me) decided to drive her to the border. Had we crossed the border, the wait to go north was close to two hours. We did not want her husband driving across. And she did not want us crossing to deliver her and face that wait. We opted to park at the Canadian border, talk to the guards, walk to the US border (about an 8 minute walk, in the pouring rain, our friend doubled over, us carrying her bags), talk to a US guard who by cell phone instructed her husband how to get to us without getting in the 90 min line, and delivered our friend to her husband. Something hit all three of us, only shared after the fact. What we felt walking across, pouring rain, was a sense of vulnerability. It was a trek.
Although we knew we had what we needed to get our friend across to the USA and us back into Canada, we were nervous and vulnerable. How is it for others for whom the border cross has even higher stakes ?
We stood in line at the US station for pedestrians. There were border patrol folks milling around. It looked like they were not attentive to the lines and were not doing work. We stood there. Our friend was getting more and more hunched over. We were scared. How much time did she have until she ruptured that appendix? Finally we asked for help. The guard heard us and did help and a few minutes later our friend was on her way south and we two others were trudging back to Canada.
What do others feel in that walk between borders? Really, we all knew ours was only 8 min between the two borders in that nomad’s land and yet each of us silently felt that anxt: what if it does not go well? We all have enough life experience to know that what we felt had to be, given the certainty of our getting across, just a tiny fraction of what many millions feel when crossing a border under duress.
And the health care system: Our friend had lab results and CT scan that showed the appendicitis. We had seen the monetary charges: they were half what they would be in the good old USA. Yet people complain about single payor. Really?
OK, once we handed her over to her husband, they were in the good ol USA. One hospital/ surgeon on call would require she go to the ER. Even if they accepted the CT scan and labs, there is that charge on top. (and by the way, there would be the delay and risk of rupture) A second hospital/surgeon would admit her straight to a room and then the OR. Guess which was chosen? Surgery that night, home the next day.
Patients or money first?
What do you see in this story
There are so many issues here, Sharon. First is the whole “expect the unexpected” scenario. You are planning this trip and all these anxieties and ambivalent feelings surface, only to somehow reach a peak in the diagnosis of your friend’s appendicitis. The metaphor of being between borders is also powerful, as you were not only literally between borders, but also between fear and relief, health and surgery, being a friend and being a physician and the difference in relationship that brings…..
The other issue is health care in the US vs. other places such as Canada. The most recent news I heard from the Central Valley in California is that the main physician group associated with Community Medical Centers in Fresno is opting out of the Obamacare plan, which has left many patients who had signed up for it at a loss as to what to do now for health care. Several were interviewed as entirely confused about what to expect, as they followed all the rules and did what they needed to do, only to be told they were going to encounter a challenge in finding a doctor to take their new plan. It’s going to be interesting to see how this plays out in the next year or two. This impacts every one of us.
Thank you for your comments Nancy. Yes there were a number of borders.
I cannot tell from your note if you think the problem is Obama Care or the Fresno Doctors or what you think would be better. So I will jump in and say, if we had a single payor, this would not be an issue. What we have is doctors pitted against hospitals pitted against insurance plans, all vying to preserve their profits.
At the same time, millions are getting coverage…so fewer Americans losing everything from trying to pay medical bills, and we know the leading cause of bankruptcy in our country is from medical expenses.
We all are responsible. Are we will willing to have a narrower choice of who will provide our care so that millions can be covered? Are we willing to tell our legislators to get over partisanship and do a single payer plan? We have a system that spends too much on unwarranted care, too little on prevention, too much to insurers and some physicians and with current structures, that is not going to change. What about lifestyle choices and how they impact health? What are you or any of us willing to do?
I personally am grateful for this limited compromise. My son has a very serious illness. No one would have insured him when he aged off my plan. His care last year, had he not been insured approaches what I bring home, if he had been paying full freight as an uninsured person. My other son is in Americorps and signing people up for insurance and has many many stories of people who are so full of gratitude for what they have gained by him helping them sign up.
Am I willing to have the complications, the limits? In this moment, yes. My hope is that people will get past the limits and see the gain…and push for an even better system which is the single payer. When we keep focusing on this doc group opting out, or this plan not contracted with that group, or the web page not working…well that is useless energy in my mind. Spend it in helping people get covered, navigating the imperfect system, and advocating for a single payer. This problem is not on ObamaCare…it is on our divisive congress, which apparently represents the American will, and on our national unwillingness to make health care a right.
Sharon: what an excellent ‘real life’ case study on important ethical and economic factors in our healthcare system! You could develop it/submit to Health Affairs Narrative Matters as it is such a compelling personal story along with illustrating current health policy issues.