An sad narrative on the state of the sick and dying in America. This is not just a Texas problem but one that plagues the whole country, the poor are basically given a death sentence because of their poverty. The powers that be, whether left right or middle need to understand how their actions and policies are killing the poor. One cannot pursue "life, liberty or happiness" if they are dead (or dying); the right to life extends beyond the womb.
The first patient who called me “doctor” died a few winters ago. I met him at the St. Vincent’s Student-Run Free Clinic on Galveston Island. I was a first-year medical student then, and the disease in his body baffled me. His belly was swollen, his eyes were yellow and his blood tests were all awry. It hurt when he swallowed and his urine stank.
I saw him every Thursday afternoon. I would do a physical exam, talk to him, and consult with the doctor. We ran blood counts and wrote a prescription for an antacid—not the best medication, but one you can get for $4 a month. His disease seemed serious, but we couldn’t diagnose him at the free clinic because the tests needed to do so—a CT scan, a biopsy of the liver, a test to look for cancer cells in the fluid in his belly—are beyond our financial reach.
He started calling me “Dr. Rachel.” When his pain got so bad that he couldn’t eat, we decided to send him to the emergency room. It was not an easy decision.
There’s a popular myth that the uninsured—in Texas, that’s 25 percent of us—can always get medical care through emergency rooms. Ted Cruz has argued that it is “much cheaper to provide emergency care than it is to expand Medicaid,” and Rick Perry has claimed that Texans prefer the ER system. The myth is based on a 1986 federal law called the Emergency Medical Treatment and Labor Act (EMTALA), which states that hospitals with emergency rooms have to accept and stabilize patients who are in labor or who have an acute medical condition that threatens life or limb. That word “stabilize” is key: Hospital ERs don’t have to treat you. They just have to patch you up to the point where you’re not actively dying. Also, hospitals charge for ER care, and usually send patients to collections when they cannot pay.
My patient went to the ER, but didn’t get treatment. Although he was obviously sick, it wasn’t an emergency that threatened life or limb. He came back to St. Vincent’s, where I went through my routine: conversation, vital signs, physical exam. We laughed a lot, even though we both knew it was a bad situation.
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The shame has stuck with me through my medical training—not only from my first patient, but from many more. I am now a director of the free clinic. It’s a volunteer position. I love my patients, and I love being able to help many who need primary care: blood pressure control, pap smears, diabetes management. We even do some specialty care. But the free clinic is also where some people learn that there is no hope for the chemotherapy or surgery that they need but can’t afford. When UTMB refuses to treat them, it falls to us to tell them that they will die of diseases that are, in fact, treatable.
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Perry’s refusal is catastrophic health policy. For patients, it means that seeking medical care will still require risking bankruptcy, and may lead nowhere. For doctors, the message was not only that our patients’ lives don’t matter, but also that medicine—our old profession, so full of people who genuinely want to help others—will continue to be part of the economic machine that entrenches poverty. When the poor seek our help, they often wind up with crippling debt.
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Among those consequences are the deaths of the poor. As Howard Brody, director of the Institute for the Medical Humanities, has shown, 9,000 Texans per year will die needlessly as a result of our failure to expand Medicaid. However, because dying patients are often too sick, exhausted and wracked with pain to protest, UTMB and states like Texas aren’t forced to reckon with the consequences of their policy decisions.
Because the very sick and the dying may not be able to speak about these issues, health-care providers—particularly the providers of the so-called “safety net”—must do so. It is in our clinics, in the bodies of our patients, where the consequences get played out.
I Watched My Patients Die of Treatable Diseases Because They Were Poor | Alternet
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