Wednesday, October 17, 2012
Life at Grady: Killing you softly
A brother was raising his younger brother. His brother with a chronic disease that required frequent lifesaving treatments and that would and could lead to hospitalizations when those lifesaving treatments either didn't work or weren't available. Fortunately for the younger brother, as a minor he qualified for state Medicaid so dutifully that older brother made sure those appointments were kept and those medicines were not only picked up from the pharmacy but taken exactly as prescribed.
A brother was raising his younger brother. But not because they were orphaned in the literal sense. It was more because they were orphaned in that way that many young folks I've seen have landed in that position. One parent AWOL from the start or so close to the start that neither of the brothers can remember a life with that parent in it. The other parent checked out and emotionally unavailable. Maybe because of substance abuse. Maybe because of mental illness. Maybe because of just being tired as hell from slugging it out against the world and left without one drop of anything to give to some kids or anyone else for that matter.
Or just maybe all of those reasons at the same time. Maybe. Maybe not. But yes. I met this brother who was raising his younger brother. And, see, this older brother was born with bootstraps that he had pulled on from as early as he could get his mind around. Because he had only two choices. It was either grow up or die. Which really is no choice at all. So he manned up. Not even ten years older than that younger brother but talking to him and seeing about him exactly like he was his daddy. Sure was. And you'd better believe that that younger brother was looking at him and listening just like a son is supposed to.
So yeah. That part was all fine and good except these brothers had a problem. Even though Big Brother had been seeing about Little Brother for what seemed like 'ever, since that checked-out parent technically lived with them, Big Brother never became his brother's legal guardian. Even though he was. So Big Brother finished high school and trade school and got himself a good job with good benefits, too. But seeing as Little Brother already had Medicaid there was no urgency to make this whole legal guardian thing happen.
Nor anyone advising them to.
So guess what? Bay'bruh grew older. And when he did he outgrew that Medicaid that covered him when he was just a little Peachcare kid. By the time Big Brother realized it, his little brother was uninsured. Turns out that the process of making someone over eighteen your dependent and beneficiary is pretty hard. Oh, and try getting that same over-eighteen person onto your insurance plan with their pre-existing condition and see how that works out for you.
Answer: Not so good.
So here they were. Big Brother and Little Brother. Sitting in front of me at this safety-net hospital talking about this whole thing and asking what they should do. In real time and three dimensions, not hypothetically or out at some campaign rally as somebody's talk point. They were right in front of me asking what should they do. To afford the medicines that keep this young man out of hospitals and emergency rooms. To receive the care that would allow him to go to college as his Big Brother had planned for him. The same college they were postponing because they feared that his uncontrolled medical problems could ruin his chances.
Now, listen. I have carefully listened to some compelling arguments opposing the Affordable Care Act or Obamacare or whatever you prefer to call it. Some of those individuals have been thoughtful and mindful and I've appreciated that.
But some haven't. Like the billboards I saw high up in the sky on interstate 75 over and over on our way to Disneyworld with these shucking-and-jiving cartoon likenesses of our President--the President of the United States--coupled with less savvy arguments. Or rather captions. Which, whether someone is for Obama and his health plan or not, is offensive as hell.
But forget all that. Forget somebody reducing the President of the United States to caricatures and buffoonery on gigantic posts on major highways. Instead let's get back to the fact that there is a man under the age of twenty who is not insured and who can't get insured. And who has a disease that can take his life if he consistently goes without care and medications. Let's talk about that. Let's talk about this uncomfortable fact that killing people softly still counts as killing them. And I don't know if it's just how I'm wired but I see killing them as killing me, too.
Okay. I admit that my view is skewed. Skewed by the countless people like these two brothers who I know for certain will benefit from being able to have health coverage--even if it involves some growing pains for America. And even if it costs me and my privileged life some sacrifice. I'm looking straight into the faces of people like them every day. These are not criminals or moochers or whatever percentage of people that somehow are deemed lost causes. And even if they were, shouldn't we struggle with letting them die, too?
And yes. I meant to use that word "die." Die. As in death. Because when someone has an emergency department as their only pressure release valve, that means they don't get preventive care. When someone is home gasping for air because they can't afford to get their medicines, even when they are on the WalMart list, they can't work. That makes matters even worse. You're damn right it does.
For some, the death is swift like a swinging machete. But for many, many, many people. . .it is slow. Like the slowest deadliest quicksand that you just can't get out of without a helping hand. A big strong arm pulling as hard as it possibly can. Not some slippery finger tip flicking you off and telling you how lucky you are to live in a land of opportunity.
I will quote my patient just as I have many times before: "FOLKS IS LOSING OUT HERE. LOSING! DO YOU HEAR ME?"
Losing. Losing. Losing insurance. Losing opportunities. Losing chances to be all the things that every person with resources gets a fighting chance to be. And I'm tired. Tired of hearing all the sides of it because that makes it too complicated. 'Cause see, for me, it isn't. It just isn't. Not at all.
A brother was and is raising his younger brother. And as sure as you are reading this and I am typing it, unless somebody somewhere does something fast, he won't have to raise him at all.
Labels: Life at Grady, Patient Protection and Affordable Care Act
posted by Kimberly Manning, MD, FACP at
7:00 AM
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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:
Albert Fuchs,
MD
Albert Fuchs, MD, FACP, graduated from the
University of California, Los Angeles School of Medicine, where he
also did his internal medicine training. Certified by the American
Board of Internal Medicine, Dr. Fuchs spent three years as a
full-time faculty member at UCLA School of Medicine before opening
his private practice in Beverly Hills in 2000.
And Thus, It Begins
Amanda Xi, ACP Medical
Student Member, is a first-year medical student at the OUWB School
of Medicine, charter class of 2015, in Rochester, Mich., from which
she which chronicles her journey through medical training from day
1 of medical school.
Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and
general internist in the Division of General Internal Medicine at
Johns Hopkins. His research interests include doctor-patient
communication, bioethics, and systematic reviews.
Controversies in Hospital
Infection Prevention
Run by three ACP
Fellows, this blog ponders vexing issues in infection prevention
and control, inside and outside the hospital. Daniel J Diekema, MD,
FACP, practices infectious diseases, clinical microbiology, and
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hands).
db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating
medicine and the health care system.
DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about
health topics for patients and health professionals.
Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more
than a decade and is an Associate Professor of Medicine at an
academic medical center on the East Coast. His time is split
between teaching medical students and residents, and caring for
patients.
Everything
Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science,
medicine, health and healing in the 21st century.
FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the
Internal Medicine Residency and Assistant Dean of Scholarship &
Discovery at the Pritzker School of Medicine for the University of
Chicago. Her education and research focus is on resident duty
hours, patient handoffs, medical professionalism, and quality of
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of medical practice and the complexities of hospital care,
illuminates the emotional and cognitive aspects of caregiving and
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Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the
University of North Carolina School of Medicine, and the Program
Director for the GI & Hepatology Fellowship Program. He
specializes in diseases of the esophagus, with a strong interest in
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I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an
interest in basic and clinical science and education, with
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informatics, new medical education modalities, pre-code/code
management, palliative care, patient-physician communication,
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Informatics
Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical
Informatics & Clinical Epidemiology, Oregon Health &
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David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned
authority on nutrition, weight management, and the prevention of
chronic disease, and an internationally recognized leader in
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Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of
hematology and medical oncology. His blog is a joint publication
with Gregg Masters, MPH.
KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites
for influential health commentary.
MD
Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of
medical practice, including controversies in the doctor-patient
relationship, medical ethics and measuring medical quality. When
he's not writing, he's performing colonoscopies.
Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics
in medicine, health care news and culture. Her views on medicine
are informed by her past experiences in caring for patients, as a
researcher in cancer immunology, and as a patient who's had breast
cancer.
Mired in MedEd
Alexander M.
Djuricich, MD, FACP, is the Associate Dean for Continuing Medical
Education (CME), and a Program Director in Medicine-Pediatrics at
the Indiana University School of Medicine in Indianapolis, where he
blogs about medical education.
More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice
internist, returns with "volume 2" of his personal musings about
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Distractible Kind).
Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a
small community hospital in Connecticut. His blog is a series of
musings on medicine, medical care, the health care system and
medical ethics, in no particular order.
Reflections of a Grady
Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being
a doctor in a community hospital in Atlanta.
The Blog of Paul Sufka
Paul Sufka,
MD, ACP Member, is a board certified rheumatologist in St. Paul,
Minn. He was a chief resident in internal medicine with the
University of Minnesota and then completed his fellowship training
in rheumatology in June 2011 at the University of Minnesota
Department of Rheumatology. His interests include the use of
technology in medicine.
Technology in (Medical)
Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in
education, social media and networking, practice management and
evidence-based medicine tools, personal information and knowledge
management.
Peter A. Lipson,
MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and
teaching physician in Southeast Michigan. The blog, which has been
around in various forms since 2007, offers musings on the
intersection of science, medicine, and culture.
Why is American Health Care So Expensive?
Janice
Boughton, MD, FACP, practiced internal medicine for 20 years before
adopting a career in hospital and primary care medicine as a locum
tenens physician. She lives in Idaho when not traveling.
World's Best Site
Daniel Ginsberg, MD,
FACP, is an internal medicine physician who has avidly applied
computers to medicine since 1986, when he first wrote medically
oriented computer programs. He is in practice in Tacoma,
Washington.
Other blogs of note:
American Journal of
Medicine
Also known as the Green Journal, the American Journal of Medicine
publishes original clinical articles of interest to physicians in
internal medicine and its subspecialities, both in academia and
community-based practice.
Clinical
Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP
Member, associate program director at New York University Medical
Center's internal medicine residency program. Faculty, residents
and students contribute case studies, mystery quizzes, news,
commentary and more.
Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so
he can create an independent, clinician-reviewed space on the
Internet for physicians to report and comment on the medical news
of the day.
PLoS Blog
The Public Library of Science's open access materials include a
blog.
White Coat
Rants
One of the most popular anonymous blogs written by an emergency
room physician.
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