Just Work: In the Trenches of a Sicko Nation

When I immigrated to the United States to pursue surgical training from Jamaica, I thought I was entering the center of advanced first-world healthcare. In many ways I was right: the U.S. has the most advanced technologies, the top doctors, and cutting edge researchers who are finding cures and fascinating discoveries for some the world's most menacing diseases. But in many other ways, I was naive.

Today, as I complete my fifth year, now as a Chief Surgical Resident at Harlem Hospital Center in Manhattan, I have learned that it's the extremes -- the huge disparities in the delivery of care -- that truly define the U.S. healthcare system. Just one day on my surgical ward paints the picture.

On its face, my day looks a lot like that of any other resident's. Starting at about 6:00 a.m., I conduct a round of the patients who stayed over night. I catch up with the night nurses, check X-rays and test results that came in during the night, and talk to colleagues and junior residents about the surgical case load ahead.

Then at about 7:30 a.m., I scrub in for the first of anywhere from three to ten scheduled surgeries. Trauma surgery, vascular surgeries including dialysis access, bariatric, breast, bowel, orthopedic, neurosurgery and thoracic surgeries are some of the most common at Harlem. On a good day, we'll receive no emergencies, no victims of car accidents or interpersonal violence.

And then at about 8:00 p.m. we're wrapping up, updating medical records, and finishing up other loose ends of a typical 14 hour day in the busy level I trauma center.

But there are key differences from the surgical wards at Harlem Hospital and those of any other private hospital across the nation. My patients are not the wealthiest, and many times, they aren't the healthiest when they get here. They represent the diverse ethnic groups of the city: African Americans who have lived in the neighborhood for generations, immigrants from the Caribbean, Central America, Mexico, and East and West Africa. But their diversity is overwhelmed by one common, determining factor: the majority are low-income minorities--the same group that is least likely to have access to primary healthcare and most likely to have the poorest health outcomes.

This means that for me, even with routine surgeries, I too often close the medical file knowing that the patient got to me too late. The cancer has spread too far, the diabetes has ravaged the body significantly, and the heart has become very weak. The opportunities to add meaningful years to my patients' lives seem to have been missed many years before. All I can do is make their last years a little more comfortable and of a better quality.

I can't tell you how frustrating this is from a medical perspective. It's not just that I know how many lives we could save if my patients had access to preventable care; it's also that I see the many millions of dollars that are wasted on expensive, emergency sick care.

It continues to baffle me that the richest nation in the world seems to be comfortable with being one of the sickest nations in the world. The statistics are clear: more than one in five African Americans are uninsured and they have the highest rates of death due to diabetes; heart disease; and breast, lung, and colon cancer than any other ethnic group. These numbers haven't improved since I've been here. If anything, they seem to be getting worse.

Recently, I have appreciated hearing the words "universal healthcare" thrown around by the 2008 Democratic presidential candidates, but I know better than to trust they will deliver if we don't take a strong stand. Since it's Black History Month, it seems as good a time as any to start taking responsibility for our healthcare failures. Let's start talking about it, lobbying members of Congress, and reminding everyone that we can build America's healthcare system into the ideal that I had dreamed it was and that I know it can be.

It's high time the wealthiest nation in the world become the healthiest nation in the world. And it's high time that patients like mine have the same opportunities to live healthy, full lives.

Comments

[pfezziwig]

The republicans are proposing business as usual for healthcare reform and Hillary and Obama are supporting more private healthcare insurance measures, which was overwhelmingly defeated in California this Jan,2008, don't expect the Democrats to propose anything new after it's failure in California.
Why create a new system anyways, other countries already have systems in place that delivery better care at less cost, in canada they pay out of pocket or through insurance for 40% of their healthcare, why not just copy canada, and no they are not some sort of evil communist empire. Staff HealthcareReviews.com

[dsarokin]

It's interesting to compare costs and types of surgery in different healthcare systems. Google Answers did a nice write-up of surgery in Canada, with a particular emphasis on costs compared to the US:

http://answers.google.com/answers/threadview?id=775660
Surgery Costs in US and Canada


It's worth a look, if you're interested in knowing a bit more about how healthcare operates in different countries.

[StephenSmoliar]

At the risk of being too reductive, I would say that this demonstrates the extent to which "health care" is about a vast network of for-profit businesses with fingers in the "care" pie, none of which give two cents' worth of attention to anything having to do with "health." As I have previously remarked, health is as much a matter of MAINTENANCE as it is of the TREATMENT of maladies:

http://therehearsalstudio.blogspot.com/2008/02/inconvenient-truth-about-health-care.html

However, those organizations that purport to be in the business of health maintenance have sucked all meaningful semantics out of both "maintenance" and "health." Unfortunately, there is no voice about health care reform willing to speak out about this "inconvenient truth," probably because any voice that can be heard is already beholden to all those for-profit business interests. We are, indeed, a "sicko nation" on a scale far greater than we dare imagine.

[Boboday555]

Uncle Sam: Mr. Taxpayer, I"d like you to meet Private John Doe. He"s dedicating his life to protect you and your family in the United States Armed Services so I"m asking if you"d donate some of your pay to allow him to do this...will you help Mr. Doe?

Mr. United States Tax Payer: Absolutely...and, thank you son, you"re a real Patriot.

Uncle Sam: Mr. Taxpayer, I"d like you to meet Mrs. Johnson. She teaches our children and could you help pay her salary?
Mr. United States Tax Payer: I"d be more than happy to Mr. Sam...teaching our children sure is a worthwhile endeavor...and thank you Mrs. Johnson.

Uncle Sam: Mr. Taxpayer, I"d like you now to meet Dr. Jacobs who works at the Center of Disease Control and has dedicated her life to protecting this nation from disease and biological terror so I"m asking if you could donate some of your pay so she can carry on her important work.

Mr. United States Taxpayer: Well, in the wake of the Anthrax attacks, I can see how important her work really is...so of course I"ll help pay her salary...and thank you Dr. Jacobs.

Mr. United States Taxpayer: Hey Uncle Sam, I"ve just been diagnosed with a pretty aggressive form of cancer and my HMO refuses to pay for treatments that will surly save my life, so I was wondering if you could help me out because the treatment is so costly and paying for it will bankrupt me and my family?

Uncle Sam: Sorry Son, I"d love to help you in the same way you"ve helped America with your selfless contributions to the Social Contract but the HMO Lobbyists in Washington are simply too powerful and won"t let me help you. Their job is to take in all your healthcare premiums and hand it to their CEOs and Boards of Directors without paying out a red cent! But, thanks for all your help in the past, America really appreciates it....may you rest in Peace!

[Boboday555]

The sooner every American realizes that the mechanism of this government has been re-tooled towards one goal and one goal only; to funnel ever larger sums of money into fewer and fewer pockets, the better off we"ll all be.
The republicans, over the past 30 years or so, have been able to convince their base that everything Liberal is bad which is why they vote against their own economic self-interest time and time again.
But, in the wake of the single worst president in modern history Dick Cheney and his toady George W. Bush, many die-hard repubs are waking from their self imposed slumber only to realize they"ve been played by their leaders and all for the benefit of their corporate owners.
Who knows, this may be the beginning of a new day for America...a day when We the People will finally benefit from our hard work and not some CEO propped up by his board of directors.
Let"s keep our fingers crossed because these modern day robber barons have almost limitless resources at their disposal and will not let their blood soaked portfolios vanish without a fight.

[GDliberal]

Yes we hear a lot about "universal healthcare" but it really is just "universal healthcare coverage" or as I call it "The fight for the right to buy insurance". If either plan should get passed don't expect a lot of change in the health of Americans. Even with all the built in gimmicks of the plans there will still be lots of people that will find out they still can't afford healthcare insurance and proper healthcare.

[schatsie]

You would love the book 'the Status Syndrome'. Understanding the ideas there make you realize how much impact status has on health, even more than drugs, obesity and smoking... (Incredible, it just seems like since Reagan we are trying to turn this country into a banana republic.)