Over the course of the decade-plus that I’ve been writing and editing material on healthcare (cancer research and treatment, in particular), people have asked from time to time whether my interest is driven by some personal stake in the matter. While I (like most people) do know people who’ve died from cancer, close relatives included, these instances haven’t necessarily spurred my desire to learn and write about drug development and other biomedical issues.
In fact, I’ve often wondered whether I would think differently about a given situation if it were happening to me personally. It’s one thing to consider the expense of a cancer drug when you’re not the one who needs it. It’s quite another thing to be wondering whether a certain medication might give you an extra few weeks with the people you love, and who cares about the cost. At what point does one’s thinking change, if at all? Am I qualified to write about healthcare if I haven’t been faced with each decision on a personal level, leaving my addings-up untested? Humanity seems to be, in part, about striking the right balance between reason and emotion. In the world at large, economy tends to trump humanity, and that is one of our great downfalls in caring for the sick. But what about how each of us thinks on an individual level?
So when I heard that a close relative of mine was in the I.C.U., it raised a lot of questions. First and foremost: would she leave? Then, when she did, how on earth would she pay the bills? And I had to wonder how to think about the whole chain of events.
Things went south for her while she was far from home. Or, actually, at her home in a small village in Cyprus where she grew up before coming to the U.S. in her late teens. One afternoon, out of nowhere, she turned yellow and began vomiting. The village doctor rushed her to the nearest city (Limasol), where the ER doctor informed her that she had gallstones. Some days later, a decision was made that the stones would be moved so she could eliminate them. But instead of moving down the body, the stones moved up. Her blood became infected, she had to undergo emergency surgery to remove the stones and her gall bladder, and she spent days in the I.C.U. She’s back at her village now, recovering very, very slowly.
That recovery is no doubt being impacted by some serious sticker shock. Medicare doesn’t cover overseas care, even in an emergency. The bill for her care came to more than $15,000. Were it not for family ready to rally to her aid, it’s unlikely that she would ever crawl out from under the mound of credit card payments.
So – what to make of it all? Each stop in the chain of events raises questions. The doctor-patient interactions, the fact that we can’t know the full story because of (1) what gets lost in translation, Greek to English, and (2) what gets lost in translation, doctor to patient. Then there’s the question of why a senior citizen’s Medicare coverage doesn’t extend across an ocean. Should it? (That is, without needing to purchase supplemental insurance.)
There are also very pertinent questions about prevention. She had many known risk factors: over 60, female, overweight, and a family history of gallstones (her mother had them), a diet that was not high in fiber but was high in fat/cholesterol (at least in her past). Did she know that she was at risk? Did she have a doctor telling her that she was at risk? Would gallstones have come on her doctor’s screen as something to warn her about? Would she have heeded the warnings? And if they could have been prevented, then how to think about the huge treatment expense?
For someone who writes frequently about healthcare, there is a strange, if short-lived, comfort in the fact that watching this story unfold raises the same questions as any other news story. But I have been surprised by some of the new thoughts that this particular circumstance has prompted. First, a gratefulness for modern medicine. Treating gallstones isn’t necessarily the latest in medical breakthroughs, but this woman’s life was saved because of medical expertise. In the quagmire that healthcare has become, it’s easy (at least for me) to lose sight of all that’s been accomplished. My relative would have died in another ten minutes (so I guess we also have to be thankful for the quick response and speedy driving of the village physician who knew exactly what to do).
There is also a heightened awareness of how, in the end, we are each responsible for our own well being. Yes, medical care can be marvelous, and as I said, it just saved my loved one’s life. But she should have been doing more to help herself stay healthy. She fell into trap after trap when it comes to poor health, and also carries a deep-seated attitude of resignation (“It runs in the family – what can I do?”). We know too much about the role of diet and exercise to abscond responsibility when it comes to related diseases. And why didn’t she make sure she was covered for overseas emergencies as she headed off for a six-month stay in another country? How we think lies at the heart of so much of our lives, including our health. I’m not talking about positive thinking as a panacea; I’m speaking about how we let our attitudes and thought patterns determine our relationship to our health, the healthcare system, and the people who assist us in our desire to stay well. It’s not that my relative is blaming the system for anything; she isn’t. But we tend to view ourselves as at the mercy of an infrastructure, and that’s only part of the story.
There’s definitely more to be understood about overseas care, about language barriers in medicine, and about the other language barrier (those who speak medicine and those who don’t). But those will wait for another day. For now, I’ll just be grateful my children still have their yia yia.