I continue to be astonished by the disparities in our "health" care system. Yesterday brought that into light even more. I admitted a young woman with severely neglected locally advanced breast cancer; she's had her "sore" for nearly two years and because of depression, embarrassment, lack of insurance, and lack of knowledge she didn't seek care until she became symptomatic from the severe anemia the large wound was causing. I feel that my profession has somehow failed her - how did this happen? I can't imagine how isolated she must have felt to have not been able to trust someone enough to ask for help. She hasn't seen a physician ever in her life, and she's now in a hospital bed frightened and alone, feeling even more ashamed and embarrassed while the litany of consultants I have called (heme/onc, breast surgeon, wound care, nutrition, social work, physical therapy) parade through her room.
During the midst of my internal struggle to understand this difficult situation, a young insured woman came into clinic with a minor complaint. She said she wasn't going to come in but figured she may as well use her insurance. Reading the chief complaint while standing outside the exam room, I was mad. Mad that this patient seemingly had nothing better to do than come see me for nothing while my other patient is likely dying because she couldn't/wouldn't/didn't see a doctor. But then, taking a deep breath, I realized an opportunity was presenting itself.
I suppose I shouldn't continue to be surprised at these disparities - like education, employment opportunities, housing, and other "benefits" there are simply those without stars upon thars (to quote a favorite Dr.). I am carrying with me a sorrow for my young patient that will become a part of me as a physician and hopefully help my patients to become able to entrust me with their problems big and small. I will carry forward this gift of a lesson learned, a lesson of the importance of being present for each patient, each visit - providing a safe haven and friendly hand. After all, sometimes the complaint turns out not to be so minor after all.