As my username says, I'm an RN. And as my bio says (if you dig that deep), I work with Bone Marrow Transplant and Oncology patients. I see people who are as sick as people can get, and I watch a lot of them lose their battles with cancer. But I also watch them lose their battles with their insurance companies. This inevitably ends their war, regardless of the fight they were putting up beforehand. This is not new to any of you reading DailyKos.
It's inexcusable.
A couple of my most recent patients have really touched me, especially in light of the healthcare reform debates hitting the airwaves nowadays. Watching people - Repubs and conservative Dems alike - gloat over killing healthcare reform, to me, is watching people gloat over killing my patients.
WTF?
Almost a year ago, I admitted a 21 year old with an advanced sarcoma. He was barely able to walk because his left leg was nearly three times the circumference of his right leg. He was in pain, and he was both angry and scared. Many patients begin their treatments angry - and understandably so. There are no answers as to why they are facing the road they have found themselves on. With some forms of cancer, they are hijacked from their path and set off on a frightening new course within a matter of days. Unsettling is an understatement - they are terrified, and they lash out at those of us who initially represent and embody their predicament.
We began preparing "Mario" for treatment, and I built up a relationship with him over a few nights working with him. He began joking around with me, despite the pain. He cleared his head through the anger and pain to ask questions about his upcoming journey, and he began to share his life story.
"Mario" was the oldest of five being raised by his single mother. He made it through high school, and was taking some college classes, while working to help support his family. He had a girlfriend, but his family and her lived many hours south of San Francisco and they could rarely afford to get up for a visit. His younger siblings never did visit.
As his treatments began, "Mario" began to respond fairly well. His pain was still fairly intense, unfortunately, but as the swelling in his leg receded, he was able to walk more and more. After a month, he had recovered from his first round of chemotherapy with some nice results. And he was scheduled for further rounds of treatment to keep the cancer in retreat, with the hopes of a complete remission. He went home.
"Mario" repeated his visits and his treatments and was progressing extremely well. He was actually starting to make some plans for the future, the first time I'd heard him talk about what he was going to do "post-treatment." He went home, and then we didn't see him again for about three months.
As you can tell from my lead in, and from my use of the past tense, "Mario"'s absence was a critical lapse in his treatment. When he did finally return, his leg was once again swollen out of control, and his pain was once again overwhelming. This time, when he began developing headaches, the scans showed cancerous metastases in his brain. There was nothing that could be done. He lived about 2 weeks. He hadn't ever made it to his 22nd birthday.
What happened was that "Mario"'s insurance had decided to question his treatment plan. I don't pretend to know exactly what basis they used to delay his treatment, but they effectively allowed "Mario"'s sarcoma off of the mat. The delay allowed the tumor to do an about face from its retreat, and when it returned, it was resistant to further treatment. Sure there's no way to know how "Mario"'s story would have ultimately ended, but had his treatments continued unabated, it certainly would have allowed a few more chapters to unfold. So much potential snuffed out to save a few bucks and line some big wigs' pockets.
My second story is much briefer, less sad, but I still think rather poignant and indicative of healthcare in America. I admitted an elderly gentleman with a poor prognosis. He hadn't wanted to go to the hospital, but his son had finally talked him into seeking treatment.
I only took care of "Henry" that first night, although I've seen him more on his return visits. I began the admission process by asking for a medical history, orienting him to his room, and trying to answer his questions. He asked me if he could have a soda, and I said sure.
When I got back to his room with the can, he asked me how much it cost. Now, for 9 years of nursing, I have always tried to joke around with my patients to keep things as light as possible in the face of their struggle. It's trite, but I think a smile and a laugh is great medicine - I honestly do my best to lift people's spirits, and I've always had a good way with my bedside manner - not to brag or anything!
So, when "Henry" asked me the cost of the soda, I repeated a joke that I've used forever when asked anything along those lines - "Don't worry, we'll just charge the insurance company for it." I've always seen that as a way to mock the healthcare insurance mafia, and I've always gotten a smile or laugh when I throw any form of that little joke out. It's not George Carlin, but it always elicits a smile and an eye roll - it puts me on their side in what I know is a difficult situation. NO ONE IS HAPPY WITH THEIR INSURANCE WHEN THEY TRULY NEED TO ACCESS IT FOR CARE!
When I automatically tossed that line out, "Henry" pulled back from the can. "I don't want it," he said, and then he teared up. I was stunned. I told him I was joking, but he continued crying. It turns out he didn't have insurance - his son had begged and pleaded with "Henry" to seek treatment, finally agreeing to pay for the care himself. I have no idea how much money his care would cost, or how his son planned to pay for it, but "Henry" was hyper-sensitive to anything that might cost his son one extra cent.
I had never EVER considered how my 'joke' could be interpreted as an actual financial burden. As far as I know, no other patient had ever taken me seriously, whether they had insurance or not. I spent a long time explaining that the soda was free, and that I was sorry. I felt like shit, and I haven't made that joke again. "Henry" is still fighting his battle, and while I hope he wins, I still pity his son for the financial abyss he will surely face.
As I watch the healthcare debates rage on, I keep looking at my patients as pawns in this monumental war on insurance companies. I hear people talking about "Obama-care" leading to increased abortions and the euthanizing of the elderly. As if the current system isn't pulling the plugs on the sick and dying - as if they aren't actively denying the plugs to begin with. It's amazing. It's sad. It's disingenuous.
It's inexcusable.