Have you ever looked into the eyes of a child after telling his desperately ill mother that you couldn't help her? I have. It was the worst experience of my life, and it's made me feel that I am part of a health care system so fundamentally flawed and unfair that we as Americans should be ashamed.
We should be ashamed that in a country of unmatched wealth and prosperity we simply allow people to suffer and die if they don't have the money to pay for our vast array of medical technologies and services.
We should be ashamed that, with everything we have to offer, people who work hard to support their families frequently find that there is nothing for them when they are sick. Why? Because they can't afford health insurance.
That is why my patient, a 36-year-old mother of five whose husband earns about $30,000 a year, may not live to see 37.
I am a nurse at Greater Baden Medical Services, a community health center in Brandywine, Md., that offers care to the uninsured, using a sliding scale based on income to determine charges. Most of the people we see are the working poor. They're in low-wage jobs that don't offer health benefits and don't pay enough that they can afford to buy health insurance on their own.
When they get sick, they generally do nothing--but wait, and worry, maybe try some home remedies. Often, by the time they come to us, they are very sick. Problems that may be perfectly treatable in their early stages can escalate into crises, which we may or may not be able to solve.
That is what happened to my patient, whom I'll call Lucinda for this story. Although she brings her children in regularly for their checkups, she waited several months after noticing a swelling on her neck before making an appointment for herself.
When she came to see us for the first time in February, the swelling was massive. We knew right away that something was wrong. Because Lucinda speaks virtually no English (she and her husband are both legal residents), we tried very carefully to explain the urgency of the situation to her without scaring her to death.
Then we scrambled to get her a basic evaluation, pulling every local contact we had. We managed to get her a sonogram and arranged for her to see a surgeon. A biopsy confirmed that she had cancer. A local oncologist agreed to evaluate her and found that she needed to see a specialist, both because of the type of cancer she had and because the disease at this point was so advanced.
Our local doctors were wonderful. They did a lot of work for no pay. The surgeon inserted a special device into her chest to prepare her for chemotherapy, at no charge to her. The oncologist arranged for her to see a specialist at a world-class hospital.
The specialist examined her, told her she would die unless she got treatment, then told her to come back when she had the money to pay for it.
After hearing this, Lucinda went home and did nothing, because she didn't know what else to do. Meanwhile, I thought that she was getting treatment. I didn't realize she was sitting at home, getting worse.
About a month later, she called me in tears because her pain was so severe. She was short of breath, couldn't sleep at night and was having difficulty taking care of her children. Our doctors were able to give her medicine for her pain, which helped a little. Then I got on the phone and started calling everyone I knew and asking for help.
Our executive director contacted a doctor at the University of Maryland, who agreed to see her. He says that for her type of cancer, the only hope of a cure is a bone marrow transplant. That costs $100,000, which, obviously, Lucinda and her husband don't have. The alternative is chemotherapy, which, if started early enough, could buy her a remission of 10 to 15 years. The University of Maryland is providing the chemotherapy to Lucinda every week at a great discount. But it may be too late.
I used to work in an emergency room. I've seen people die. But at least when I went to break the news to their families, I could tell them that we did everything we could. I can't say that to Lucinda's husband--or to her five children.
Her case shows too clearly that late diagnosis and treatment can have devastating consequences, especially for uninsured cancer patients. Research bears this out. A study of more than 4,600 breast cancer patients found that uninsured women had a 49 percent greater chance of dying after diagnosis than women with private insurance.
Lucinda is just one of more than 44 million uninsured people in this country. Yes, we should be ashamed. And then we should do something about it.
The writer is a nurse in Maryland.
© 2000 The Washington Post Company
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