Wednesday, October 10, 2012

Killing you softly.


"Strumming my pain with his fingers  
Singing my life with his words  
Killing me softly with his song  
Killing me softly 
with his song  
Telling my whole life 
with his words  
Killing me softly 
with his song. . ."

~ from Killing Me Softly by Roberta Flack

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A brother was raising his younger brother. His brother with a chronic disease that required frequent lifesaving treatments and that would and could lead to hospitalizations when those lifesaving treatments either didn't work or weren't available. Fortunately for the younger brother, as a minor he qualified for state medicaid so dutifully that older brother made sure those appointments were kept and those medicines were not only picked up from the pharmacy but taken exactly as prescribed.



A brother was raising his younger brother. But not because they were orphaned in the literal sense. It was more because they were orphaned in that way that many young folks I've seen have landed in that position. One parent AWOL from the start or so close to the start that neither of the brothers can remember a life with that parent in it. The other parent checked out and emotionally unavailable. Maybe because of substance abuse. Maybe because of mental illness. Maybe because of just being tired as hell from slugging it out against the world and left without one drop of anything to give to some kids or anyone else for that matter.

Or just maybe all of those reasons at the same time. Maybe. Maybe not.



But yes. I met this brother who was raising his younger brother. And, see, this older brother was born with bootstraps that he had pulled on like hell from as early as he could get his mind around. Because he had only two choices. It was either grow up or die. Which really is no choice at all. So he manned up. Damn, he did. Not even ten years older than that younger brother but talking to him and seeing about him exactly like he was his daddy. Sure was. And you'd better believe that that younger brother was looking at him and listening just like a son is supposed to.

So yeah. That part was all fine and good except these brothers had a problem. Even though Big Brother had been seeing about Little Brother for what seemed like 'ever, since that checked-out parent technically lived with them, Big Brother never became his brother's legal guardian. Even though he was. So Big Brother finished high school and trade school and got himself a damn good job with good benefits, too. But seeing as Little Brother already had medicaid there was no urgency to make this whole legal guardian thing happen.

Nor anyone advising them to.

So guess what? Bay'bruh grew older. And when he did he outgrew that medicaid that covered him when he was just a little Peachcare kid. By the time Big Brother realized it, his little brother was uninsured. Turns out that the process of making someone over eighteen your dependent and beneficiary is pretty hard. Oh, and try getting that same over eighteen person onto your insurance plan with their pre-existing condition and see how that works out for you.

Answer:  Not so good.



So here they were. Big Brother and Little Brother. Sitting in front of me at this safety net hospital talking about this whole thing and asking what they should do. In real time and three dimensions, not hypothetically or out at some campaign rally as somebody's talk point. They were right in front of me asking what should they do. Asking what they could do. To afford the medicines that keep this young man out of hospitals and emergency rooms. To receive the care that would allow him to go to college as his Big Brother had planned for him. The same college they were postponing because they feared that his uncontrolled medical problems could ruin.



Now, listen. I have carefully listened to some compelling arguments opposing the Affordable Care Act or Obamacare or whatever you prefer to call it. Some of those individuals have been thoughtful and mindful and I've appreciated that.

But some haven't. Like the billboards I saw high up in the sky on interstate 75 over and over on our way to DisneyWorld with these shucking-and-jiving cartoon likenesses of our President--the President of the United States--coupled with less savvy arguments. Or rather captions. Which, whether someone is for Obama and his health plan or not, is offensive as hell.

As hell.

But forget all that. Forget somebody reducing the President of the United States to caricatures and buffoonery on gigantic posts on major highways. Forget that. Instead let's get back to the fact that there is a man under the age of twenty who is not insured and who can't get insured. And who has a life-threatening disease that can take his life if he consistently goes without care and medications. Let's talk about that. Let's talk about this uncomfortable fact that killing people softly still counts as killing them. And I don't know if it's just how I'm wired but I see killing them as killing me, too.

Okay. I admit that my view is skewed. Skewed by the countless people like these two brothers who I know for certain will benefit from being able to have health coverage--even if it involves some growing pains for America. And even if it costs me and my privileged life some sacrifice. I'm looking straight into the faces of people like them every day. These are not criminals or moochers or whatever percentage of people that somehow are deemed lost causes. And even if they were, shouldn't we struggle with letting them die, too? 

And yes. I meant to use that word "die." Die. As in death. Because when someone has an emergency department as their only pressure release valve, that means they don't get preventive care. When someone is home gasping for air because they can't afford to get their medicines, even when they are on the WalMart list, they can't work. That makes matters even worse. You're damn right it does.

For some, the death is swift like a swinging machete. But for many, many, many people. . .it is slow. Like the slowest deadliest quicksand that you just can't get out of without a helping hand. A big strong arm pulling as hard as it possibly can. Not some slippery finger tip flicking you off and telling you how lucky you are to live in a land of opportunity.

I will quote my patient just as I have many times before:

"FOLKS IS LOSING OUT HERE. LOSING! DO YOU HEAR ME?"

Losing. Losing. Losing insurance. Losing opportunities. Losing chances to be all the things that every person with resources gets a fighting chance to be. And I'm tired. Tired of hearing all the sides of it because that makes it too complicated. 'Cause see, for me, it isn't. It just isn't. Not at all.

Forget all this abstract stuff. What I see is concrete. Concrete, do you hear me?



A brother was and is raising his younger brother. And as sure as you are reading this and I am typing it, unless somebody somewhere does something fast, he won't have to raise him at all.

Was that too abstract? Too nebulous? Well, let me be concrete: His little brother is UNINSURED. Today. Right now. Right this second. And unless he gets his medications, he will eventually land in an emergency department somewhere surrounded by crashcarts, critical care interventions and eventually crying. In other words, he will DIE.

See? This shit is urgent. Urgent, do you hear me? Right here, right now, real people, real problems urgent.

My solution? I didn't have one, really so my quasi-solution was to offer to buy one of the medications myself. The one not on the WalMart list. And this? This is pathetic because it's a bandaid on a massive heart attack. It is. It so, so is.

Pathetic.

Yes. I'm unpacking. But sometimes. . . sometimes you just have to unpack. Unpack all the concrete things that people stuff down into the junk drawer hoping that you won't notice. But what are you supposed to do when your heart tells you that human beings don't belong in junk drawers yet there are people around suggesting otherwise?

Somebody. Tell me. Please.

Sigh.

A brother is still raising his younger brother. The best he can. And because he is logical and responsible he acknowledged that, though very nice of me to even consider, accepting money from a doctor that they'd just met was no solution. He politely declined and suggested that I'd be broke or crazy if I did that all day on my job. He even scolded me and said that it probably wasn't even appropriate, even if my heart was in the right place.

I told him he was right. So that was it. That was that.

"We'll be okay," he said. "Hopefully everything'll work out for us."

You know what? I hope so, too. 

Damn, I do.


"What do brothers do? They stick together."

~ Isaiah A. Manning 

***
It's Wednesday, y'all. Thanks for reading because I needed to unpack.

I love Ms. Flack's version, but I like this version, too. . . it's the one I'm hearing in my head . . .

42 comments:

  1. A call to arms from the front lines, for sure. You see the faces behind the politicking every day...thanks so much for sharing this story. I'll be praying for those boys too.

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  2. You look into our eyes every day, that's why you see us. It is so easy for everyone else to say "All those fat people with heart disease, diabetes, cancer, etc...they did this to themselves. They all just need to put the salt shaker down, push away from the table and take a walk. No wonder they are uninsured. They are too lazy to get a job." It's not that simple. In fact, it is infinitely complex. But we are people, and some of us fight like hell to stay alive. I am blessed to work for a company that provides good insurance. But I don't kid myself, this is all a gift. It could be gone tomorrow and wouldn't be able to afford the chemical cottail or the 16 specialist that keep me alive. Thank you for speaking up for us.

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    1. Thank you for speaking up for us, too.

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  3. I hear you. I'm sick and tired of the way politicians are playing with lives. Our health care situation in this country is a disgrace. Dammit, why do they spend my tax dollars on bombers when people need health care? WHY?

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    1. Sigh. I just don't know. I am just hoping if somebody realizes the urgency that it would make a difference. That's all.

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  4. Replies
    1. It's all a dialogue. Sometimes we just have to unpack.

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  5. You're killing me softly with those pictures!

    See, here's why I can't work at Grady: I'd be trying to pay for someone's prescription EVERY WEEK! But I know that's just a bandaid. Grrrrr. It's frustrating.

    Love this post.

    ~Biz

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  6. You're killing me softly with those pictures!

    See, here's why I can't work at Grady: I'd be trying to pay for someone's prescription EVERY WEEK! But I know that's just a bandaid. Grrrrr. It's frustrating.

    Love this post.

    ~Biz

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    1. Whoops. That comment was so nice I published it twice. LOL. Can't wait to see you.

      ~ Miz

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  7. Amen. Because why is it okay in America for us to deny people access to basic healthcare? Somehow other countries in the world have figured this out, London was so proud they featured their healthcare in the Opening Ceremonies of the Olympics for goodness sake! Maybe our politicians should do work for once (cause let me tell you, if I was as ineffective as they are I would've been fired a long time ago) and fix this problem!

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    1. No matter what happens we're just going to have to go through some growing pains to get there. I just wish we could, you know? Find some way to all agree that people losing is not okay. Thank you for your comment.

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  8. No words, just tears.....

    Karen

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    1. I'm so glad that God somehow equips some folks with just a little bit more to handle hardships. That brother was strong. Wise like an old man and mature beyond his years.

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  9. Dr. Manning -

    I can’t imagine being in the place of these brothers. I know that I would not have been as strong as the older brother and I have nothing but respect for him for being able to take charge of his younger brother’s health – it is truly inspiring. And even though they are in a terrible situation, I am happy that they found a doctor like you to listen to them and spread their story.

    Having said that – stories like this don’t change the way I feel about the ACA. You know what really scares me? The idea that healthcare spending will continue to increase to a point where we just can’t sustain it anymore, and then we will be left with NO safety nets at all. I saw that as a Peace Corps volunteer, where the hospital in my village was basically a bunch of dirty rooms for people to spread infections and die (not that I’m saying that we are headed to that extreme – but that DOES exist in this world today). I’m afraid that if we pretend that the ACA fixes the system and stop looking for real solutions to the issues that make health care unaffordable for so many Americans, we’ll end up losing what little safety net we have today.

    The situation IS urgent. But I don’t think the ACA is the answer. It may seem right in the short run, but in the long run, it will end up hurting the very people it is supposed to help – the poor. In fact, there are signs that it is already happening – like the fact that Darden Restaurants (which owns Olive Garden and Red Lobster) is cutting full-time positions in order to avoid paying newly mandated health care costs (http://www.huffingtonpost.com/2012/10/09/darden-restaurants-obamacare-part-time_n_1951103.html). It’s not because they’re evil – it’s because they are a business, and it’s too expensive for them to pay for health care coverage for workers. Until there is a REAL reform of the system that truly reins in health care costs, the situation will only continue to get worse.

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    1. I'm sorry -- I read this over again and it sounds rant-y! I really appreciate that you were willing to publish it anyway even though you don't agree :) Thank you! And let me just say . . . I read every post and as a future physician I always find something to inspire me to be the best doctor I can be!

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    2. Hey little red. . . .

      Here is what I love about you: You are one of the thoughtful ones who respectfully articulates your opposition to ACA. I deeply appreciate that. So thank you for taking the time to share your opinions-- which I absolutely do respect.

      That said, we continue to agree to disagree. Little red, I truly think that our country is at a terrifying crossroads. A gridlock with red and blue staring each other down and not being able to get past fundamental differences.

      Me? I'm sad that us being able to do right by people gets tainted by things like large corporations making sweeping decisions that affect lives and us excusing them as not being wrong because "it's business." Business? I KNOW it's possible for corporations to take stands and do what THEY believe is right for human beings even if it costs them money. It's not just "business." It's decisions. And somebody, somewhere is making that decision. That decision to cut full-timers in order to not pay for coverage being a business move? Please. It's a moral move.No one can say anything to convince me that Red Lobster or Olive Garden would go out of business if they did,either.It's greed. Plain and simple.

      Look at the highly controversial Chik-fil-a corporation. . .imagine how many MILLIONS of dollars they lose week after week by not being open on Sundays! Yet they do it. Every single Sunday. Why?Because someone, somewhere has decided--based upon their fundamental beliefs--that affording their employees the chance to go to church on Sunday was WORTH those millions. Perhaps billions. So that "business" argument? I say Darden should call Chik-fil-a and see how they've managed being closed one of every two weekend days.

      And yes, I am a Christian who regularly attends church so this isn't some tongue-in-cheek agnostic stab at them. Instead I am pointing out that anything is possible if someone thinks it's worth the sacrifice. These doomsday projections about ACA hurting the working poor seem to overlook the clear fact that somebody, somewhere has simply made a decision on the worth of bottom lines over people.

      I'm sorry to unpack again. But honestly? I heard it with my own ears. Governor Romney stood at the edge of that table told that group of donors that some people think that healthcare is "a right." He said it like it was the most ridiculous thing in the world, too. And this? THIS is the clearest example of that fundamental disconnect to me. It is. I am NOT a moocher and I pay my taxes. But to imagine that someone in his position and many others would believe in his heart of hearts that healthcare is not a right and that an ER is a good fix. . .sigh. . .that hurts my heart. And if THAT is really and truly how a majority of Americans feel about other Americans? Let me tell you-- those brothers and many like them don't stand a chance in hell--no matter who gets elected.

      I do not think there is any easy fix. But I continue to feel strongly that a lot of this just comes down to some fundamental beliefs about what is and is not a human right. Healthcare, to me, is a right. Period. End of story. My life is not more important than that younger brother or the homeless man that asked me for a dollar when I walked in Grady today. Not to me it isn't. As for changing my perspective because a greedy corporation wants to save money--even at the expense of human beings--it never will.It's NOT too expensive. Nothing could be more conservative than Chik-fil-a--yet they're still rolling in dough despite being closed every Sunday coupled with being in the center of a bunch of controversy.

      I'm proud of how you express your opinions and believe that we would be in much better shape if all of us could find ways to share our passionate views with logical perspectives.

      For the record: Your input is always welcomed here. I deeply appreciate you continuing to be here in this community of thinkers with me.

      Dr. M

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  10. You are a true advocate / champion in every sense of the word. Keep fighting the good fight.

    Maria,fellow Meharrian

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    1. Thanks, sis. You know they taught us at Meharry that it was our charge "to serve the underserved."

      Kimberly, fellow Meharrian

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  11. Oh, Dr. Manning, you are breaking my heart, but I don't mind at all. I wish you were on the tv, fighting to be heard amid all the NOISE this election, I wish people saw the real, the concrete, not the abstract, the nebulous thing that truth has become.

    Your pictures just about broke me. That you wanted to pay because there was no other option, that just about broke me. That there is no safety net, no solutions and damn near no hope for these young men makes me sick. When Romney said we do have care in this country, it's called an emergency room, I thought, game over, clueless rich guy, game over. But this race is not over, the greed and carelessness seems to be gaining momentum, and I don't know how I will cope in a land ruled without compassion.

    Bless your heart, for caring, for trying, for unpacking for us to share.

    xo

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    1. 'preciate you, Mel. Bless your heart, too, for reading my crazy train of thought.

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  12. Just another dreamerOctober 11, 2012 at 10:18 AM

    The fact that one can claim that healthcare is a right to be earned, not guaranteed for being a HUMAN BEING, is simply unbelievable. And to claim that everyone who faces numerous difficulties in life is either lazy, mentally ill, a moocher or someone society should shun is possibly the narrowest and most warped and most amazingly infuriating point of view I have come across.

    Companies, corporations, governments spend and spend and flush money down the drain on the most trivial stuff, then have the gall to claim that securing healthcare for everyone would set the organization/country/whatever in turmoil. Society has enough money for lifelong top-notch healthcare for politicians and countless other extravagances, but not for people who only ask for the absolute necessities to live? Somehow I don't think so. Tightening belts in times of financial distress is of course necessary... but healthcare is NOT optional. It CAN'T be optional. It should never, ever, ever be on the list of things to cut corners from. So that we all can, you know, live.

    What does this say about us? About our priorities and values? You may get routine check-ups because you were born into a wealthy family. You may not fill your prescriptions because you never had a childhood, a school to go to, the chance to fight and build yourself a future. You may not get that bypass because you're obese and it's your own damn fault you didn't stop eating and we all should look like anorexic models anyway. Will future generations look back and be grateful they weren't born in a time when they would have been "disposable" or "optional" citizens?

    As a student, I am fortunate enough to have parents with insurance. I'm lucky. The Little Brother, who is eager to learn and do good as an educated citizen but can't attend college isn't. Tough luck. Right? WRONG. On so many levels. And this isn't political. It shouldn't be political. Instead of disputing whether all should have this right (when the answer is painfully obvious), we should be discussing what the best way would be. Without finger-pointing or blaming. Without the main issue being on which "side" one is.

    I had better stop writing, else I might end up with a post longer than yours, Dr. Manning. But this post was so heartbreaking I simply had to unpack as well. Thank you for caring and sharing your views with such a beautifully written post.

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    1. I sure do appreciate you. You and you unpacking. Yes. We are the fortunate ones and I like your points.

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  13. You say this so much better than I could. Thank you. I shared it on my Facebook page and I can only hope your words shed light to my friends on why the Healthcare Bill is a good first step. Nothing is ever perfect the first time and hopefully when the pieces and parts get moving the adjustments to the bill will be made to make it the best legislation.

    On another note, if the younger brother is going to a 4-year school, he may be required to get the school's insurance. Most 4-years have a mandatory health insurance rule and provide it for those who aren't eligible through their parents. I think that once something is mandatory they'd have a hard time denying him for pre-existing conditions.

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    1. Hey Sarah,

      Thanks for sharing this on Facebook. I was a bit perplexed by the upswing in my traffic--sounds like you have quite the FB following. Kevin told me you'd shared and I am honored that you did.

      I think it was a 2 year college but I am to see them again soon. I will look into that part and appreciate you very much.

      Best,

      Dr. M

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    2. Wait--I just realized I mistook your name for someone else. I think Kevin (one of our med students) told me that another of his friends posted this on Facebook. So forgive me if you are wondering who in the world I was referring to! LOL! Thanks again, Sarah.

      'preciate you! Dr. M

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  14. This was touching. Thank you for sharing. I wonder if the younger brother could qualify for Medicaid after he turned 18? If not, why not? If so, were the medications not covered? Things can get very complex at this point, I know, but I would like to know more, to hopefully understand a little bit more about our health care "non"-system. And I'm not suggesting physicians should know every nook and cranny about the dehumanizing health care policy mess we've created in this country. I would just like to know more. Thanks.

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    1. There are some that qualify for medicaid or SSI but he is an example of a mostly healthy person who technically isn't "disabled." He just has the kind of problem that could be disabling if unmanaged. You're right. It's all quite complicated.

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  15. Continue to unpack. You are the best unpacker.
    xo

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    1. And you are just awesome. Hugs to you and the Rosenberg boys.

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  16. This is the sound of my two hands putting themselves together in agreement with your words... and my eyes filled with tears.


    Kristin

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  17. Whew, who knew? I'll tell you, you knew that some critical issues needed to be "un-packed". Who knew that you would "un-pack" me during you cleaning session...I lost my job 2 1/2 years ago, with it went my healthcare. I, like millions have desperately looked for work, work that would replace the job I lost, the things I lost. None more important as I get older, as health insurance.

    One year before I lost my job I found out I had MS, with it chronic migraines. Losing my insurance meant I couldn't go for my visits to my neuro, get my scheduled meds, go for my "Well woman's" visit, the list goes on. Thanks to the grace of the God I serve I've been without an episode...Unlike your post, I have no brother, no sister and even if I did, they couldn't put me on their insurance, I've truly aged out. However, I do identify with the need, the need for insurance and the need to be uplifted..."He ain't heavy" and neither is she...Thank you for "unpacking", thank you for "unpacking" me.

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    1. Wow. I so appreciate your testimony. Wishing you health and longevity and gainful employment. Thanks for reading here. 'Preciate you.

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  18. WOW! This is real. Plain and simple. Now, let me make sure my privileged self takes myself some place to early vote and spread the word to all of my other privileged friends, family members and acquaintances.

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  19. That is a POW – EAR – FULL post, Dr. M

    Broken… system, promises, hopes, hearts.

    Hard to hear and harder to see, but this is a mirror that we all need to look into because just as there are so many already in this situation, there are so many more who are on the precipice.

    And yet, while you un-pack your day, one who wants to speak for all of us, tells us of an alternate reality.

    http://tinyurl.com/peopledontdie

    Apparently, there is no crisis – we are saved. All we need to do is wait for the big white ambulance to whisk us off to the hospital where someone will save us and someone else will pay for it!

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    1. Yeah. . .I've read that and remember that story on NPR. Super unfortunate, you know. Emergency care is not a back up. Preventive care saves lives and prevents disability. ER's don't offer that.

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  20. You've probably seen this, but just in case, this opinion piece from publicintegrity.org really echoed your post:

    http://tinyurl.com/98casnr

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