The following manuscript was published as part of the February 2018 Social Medicine theme issue.
My last admission on my last call day of the year; only one patient stands between me and freedom. Freedom from the endless calls. Freedom from self-doubt and anxiety. Freedom.
She sits propped up in the ER bed, her husband dutifully by her side with an encyclopedic knowledge of her long medical history. She is visibly weakened by the daily fight, yet her smile radiates defiantly as if to announce, “I’m still winning, y’all.” Freedom.
It was a confidence she earned from her lifelong fight for fair housing and civil rights, for a better life. Now, her spirit is focused on the fight within. Her husband squeezes her hand softly to give her strength, and she smiles forward. Freedom.
The words “cancer” and “metastatic” are long familiar to this loving couple, hopeful for what lies ahead. He dotes on her sharp memory and quick wit; her brain was always a sanctuary from this unholy battle. Freedom.
I kneel at her bed to reveal the imaging findings. We discuss how this new brain mass likely caused her to suddenly lose grip of her favorite coffee mug this morning, her smile shattering into a thousand tiny worries.
We outline the planned course of action together. “Alright, honey. Let’s get to it then.” Everyone is on the same page, and her resolve strengthens my feeble confidence.
Before I leave to start the cascade in motion, we need to talk about her code status: what to do in the event her heart or lungs fail. ‘Fail.’ I tread delicately through this land mine of loaded questions, but even a roadmap fashioned from of years of similar conversations isn’t enough. Her eyes well with tears in the silence between answers. I know she is playing out the frantic scene in her head already.
But she was not crying from her advancing illness. She was not crying for her new weakness. She was not crying at the prospect of chest compressions and life support.
Her words pierce through streaking tears, “I want you to do everything, but I don’t think my insurance will pay for all of that now.”
She was crying because she lived through years of “no” before experiencing life with medical insurance, but now was terrified at the uncertainty of what lies ahead. A woman who spent her entire life fighting for her community and civil rights, for affordable housing, for something beyond herself, through chemotherapy and radiation and ER visits and the deluge and now this. Her indomitable strength felled by the country she adores.
Land of the free, home of the afraid.