When we are Dying

We recently had an Hispanic man on our service. He was 41 and came to the hospital feeling tired and weak, and had a hemoglobin of 4.6.  It’s a number that doesn’t mean much unless you are familiar with hemoglobin numbers. It’s a number for blood.  If the number is below 13 for men, he is anemic. Blood transfusions usually happen under 10.  As you can imagine – 4.6 then is VERY VERY low.  Although he was Hispanic, because the low blood count caused him to be quite pale, it gave a khaki/beige appearance to him. We did a lot of tests; the haunting suspicion was that he had myelodysplastic syndrome, a kind of precursor to leukemia. We did bone marrow biopsies, transfusions, and all sorts of blood tests. We got to the point we were ready to let him go home, needing for him to come back in a month for another bone marrow biopsy.  That’s when it hit us – a kind of afterthought – this guy doesn’t have insurance. In fact, he’s not even a citizen, he’s here illegally. How will he even hope to afford his bone marrow biopsy? Let alone treatments for his condition? The morning we discharged him from the hospital we spent some time reconfirming his inability to pay for services. In Spanish he told how he hadn’t even been to see a doctor in years because he had no money. He knew something was wrong, and he was getting sick, but also knew he couldn’t afford getting better. I can still hear his next words translated by a Spanish speaking resident, “The only reason we come here (the hospital) anyway, is because we think we are dying. Then the money doesn’t matter because we will soon be dead” Does that seem right?  He is one of thousands, unable to get help in this land of plenty. He is one of many people sick, knowing something is wrong, who continue to be ill because they cannot pay to get better.  

There is good news for him, this single father of 2. The hematologists who do the bone biopsy are donating it for free. As for future treatment – I am not sure who will pay.

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