The smell was unmistakable. I recognized it immediately – a fungating infection. It’s what happens when a cancer breaks through the skin and the puss oozes out and aerosolizes, producing an unsurprisingly foul odor. This is what late-stage cancer looks like if left unchecked, like many cancers were 100 years ago and still are today in the developing world. But I encountered this case this month, and Yvonne, the woman who sat crying before me, lives in Los Angeles. She lost her job two years ago, and when her insurance expired, she was too ashamed to seek help for a mass she felt in her right breast. Now the tumor had replaced her entire breast and blasted through the skin. Being cared for now — so late in her illness — was surely not what she would have wanted; and just as surely, it could have been avoided. How did we let this happen in America?
I was volunteering at the CareNow Free Clinic in the Los Angeles Sports Arena, where more than 700 doctors, nurses and health professionals had turned out to serve the local community. CareNow is a nonprofit founded to bring medical care to underserved communities, and the Los Angeles event was organized by Don Manelli, the indefatigable president of the group. He was aware of what we would see that day, as was I, having volunteered at similar clinics in Little Rock, Ark., and Moorsville, N.C. We also conducted our own clinic for The Dr. Oz Show in Houston in 2009 and saw more than 1,800 patients in one day. But simply having been down this road before does not mean you’re ever fully prepared for it.
My radio crackled, and I was called to see David, a 25-year-old overweight Latino man with a blood sugar of 355, far above the tolerable level of 100. He had come to the clinic because of eye problems, a common complication of diabetes, but he had not seen a health care professional as an adult and did not appreciate the classic symptoms of frequent urination, constant thirst and lethargy. I pressed on his gums and pus poured from abscesses cause by the untreated elevated blood sugar. As I walked him to the dental clinic on the floor of the arena, he asked insightful, targeted questions about his condition, a conversation that should not have happened by chance at a free clinic. The simple advice David collected could help him avoid the rusting of his blood vessels and the amputations, kidney failure, strokes and heart attacks that would otherwise define his life and cost the health care system much more than a timely consultation. I witnessed the surreal effect of David’s teeth being treated where pro athletes usually dribble basketballs until a young mother asked me about a problem with her mouth. She had come to the clinic because, while her children had health insurance from the state, she was not covered.
It’s this tide of disease and despair that CareNow exists to fix. The group was informally established by a team of first responders who’d learned the art of swooping in to help after hurricanes, earthquakes, wildfires and tsunamis. In May 2009, they held the largest free clinic ever, also in Los Angeles, and a breathtaking 8,000 people showed up. After that, CareNow was formally founded, with the goal of providing care when there is no natural disaster. And on an otherwise unremarkable Friday afternoon in the fall, I was a small part of that effort, gently offering what encouragement I could to a weeping Yvonne.
At what point, I wondered that day and still wonder now, will we finally say enough? The medically underserved are, most commonly, the medically uninsured, and they number in the tens of millions. Many don’t have jobs, but just as many do. Their companies may not offer health insurance, or they simply may not be able to afford the monthly payroll deductions that would be required to enroll. Since we held our first clinic in October 2009, federal health care reform was enacted to address this. The law is challenged in many states and ultimately will be decided by the Supreme Court within the next year. I don’t underestimate the complexities of implementing a health care reform law that we can all live with. As with most entitlement programs since the Great Depression, we will have to perfect health care reform over time, just as Social Security, Medicare, veterans’ benefits and others were.
But we’re not perfecting the law; we’re fighting over it. Politicians dither and people die. Lawyers argue the merits of this or that technical point, and more blameless Americans grow sick and slip away. This isn’t just a failure of politics and policy; it’s a failure of basic morality. I don’t have to convince you of that. All I have to do is make sure you get to know Yvonne and David, and show you their pain and their fears and their X-rays.
Surgeons like me have to be irrational optimists, so I am going to apply this trait on a grand scale. If enough people start to say enough, we will get somewhere. I love working among the selfless people who staff these free clinics, who show patients that someone cares about them. But every time I finish a day’s work, I silently pray it will be the last one we need. Get to know the Yvonnes and the Davids, and then let your frustration guide us to an America where free clinics are the stuff of history and the simple dignity of the chance to be healthy is the living reality.