Thursday, July 16, 2009

Special Dispatch: Ryan's Story

Ryan is a young American. 24 years old, sporting an unassuming t-shirt and buzz cut, he exudes a personality simultaneously reserved and forthright. He has a gracious smile, offered with a twist of the head but then when he looks at you, with a piercing gaze, his face turns serious. As a writer, he seeks to deeply understand people, yet some things, like healthcare insurance, elude even his keen comprehension.

Brought up in a family who never had health insurance, Ryan is, nevertheless, a man with energetic, ambitions. After an early honorable discharge from the Army—for medical reasons—and a fruitless search for a job, he is working to finish his first novel, Ever Street Road, a parable, as he calls it, for the choices in life that one makes. Yet, in this great country, bursting with infinite possibility, Ryan has few, if any, choices. Infinitude meets finitude—this is America.

The future is but an illusion. Not knowing whether there will be healthcare for all or only healthcare for some, Ryan and I, sharing dinner, are focused on the present and the past. This is the only thing we truly know. The future, a future where the young ambitions of earnest, yet thwarted souls, might reach their full potential, is only a dream. Reality is how I met Ryan and what brought him to run up the hill to meet me on US 30 as 18-wheelers thundered past.

Just east of North Versailles, about 25 miles beyond my initial walking point, the last few miles trundled on through with pain. My feet—a jumble of collapsing arches, exploding blisters, and hemorrhaging nail beds—were beyond rebellion. I would have ordinarily arranged a pick-up to take me to the next hotel—now about eight miles east—but this had not materialized. And the transport for the bag—the 70 pound suitcased monstrosity—from which I live, had not been arranged. And despite the physical tribulations of walking nearly 24 miles a day, the most challenging part of the Walk has been the logistics. Lodging, pick-up (often the bunk down place is not necessarily on my walking route), and bag transport had all to be arranged. If any one of these elements fell through, the Walk would come to a standstill. At this point, I was not worried so much about that. With the sun now setting, knowing that I would soon be walking in the dark—the time when sounds become more important than sights—I was worried about my survival, concerned about arriving at the motel—if I made it at all—well after midnight. At the bottom of the hill, I had stopped at a McDonald’s to replenish myself with water and recharge my phone batteries. I slipped on my safety vest and grimly headed up the hill.

A young man, gasping for breath, came up beside me. Cars rushed by and instinctively motioned him towards the narrow shoulder.

“Are … are you Doctor Gurel?” he asked, wide-eyed, disbelieving. I was on the phone, still working feverishly to arrange transport of my bag. Too tired to be surprised, I smiled at him, and nodded. “I was following you on Twitter and … and I just had to come and meet you.” I hung up the phone, and out of habit continued on forward, as the young man joined me. “I’m Ryan, Ryan Trump,” he added.

“Oh yes! From Facebook!”

“Yes,” he said, his face twisting, searching for words to describe a situation for which there was no precedent. “Wow, I can’t believe this.”


“That I met you here.”

I chuckled. “Crazy, isn’t it?” Ryan and I had exchanged some e-mails during the past few weeks on Facebook, and it was strange indeed that an entirely electronic friendship had materialized here on the not-so-isolated Lincoln Highway east of Pittsburgh.

And so we talked—talked with amazement about the GPS tracking technology that had brought Ryan to my very spot. We talked about healthcare. But I had to interrupt him. “Ryan, I have a problem.”

“What’s that?”

“My motel is about seven miles up, in Irwin. I have no pick-up to get there. Could you help out?”

“That’s the least I can do!”

I smiled weakly. Deliverance, in the form of Ryan Trump, shy but forthright, gracious but ambitious, had arrived. I was grateful for the wonders of technology and even more for the grace of initiative and real, not electronic, fellowship.

And so, after a couple of hours of back-and-forth driving, Ryan and I delivered the suitcase and myself to the motel in Irwin.

But that was the present. The following evening I had dinner with Ryan and we talked about the past. The present and the past: while this is what we know, we spoke out of hope for the future. A future with healthcare for all, and not just for some. A future where the imagined infinitude of possibilities cross with the crushing reality of no possibility.

“My family has never had health insurance,” Ryan told me. “My father worked in maintenance at the hospital for 36 years. And we never had health insurance but we could get care through the hospital.”

“That’s good,” I replied.

“Then the hospital closed, back in 2006, and he got laid off … but he was close to retirement anyway.”

“So what do you do now?”

“It’s difficult. My mom’s got a heart condition, had a heart attack back in 2000. You know it could always happen again. She’s got four types of drugs.”

“How do you pay for it?”

“It’s all out-of-pocket.”

“But you told me that you had troubles with the bank.”

“That’s just the way it goes—you pay for the medications when you can.”

I shook my head. “And how about for you? What’s it like to not have insurance?”

Ryan, who would usually look straight at me with those forthright, almost aggressive eyes, glanced down. “Well, you got aches and pains, but you think, ‘do I deal with the pain or do I go to the hospital and suffer accumulated debt? I’m 24 years old and my credit score is probably garbage. Can’t do anything in life with that, you know.”

I figured, listening between the lines, that Ryan had, in fact, gotten some healthcare, and the ‘accumulated debt’ he had referred to was real. “How’s the asthma?” I asked. (This was the reason for the honorable, medical discharge from the service).

“Oh, that’s not too bad. But there was this other situation.”

“What was that?”

Ryan thought for a moment, then looked up. “Well, I had a lump,” he said, pointing below the table.

24 years old young man, I realized that he was likely referring to testicular cancer—a condition made widely known by Lance Armstrong’s experience, and survival.

“Did you get it checked out?”

“Well, I was holding off for the longest time. But it was quickly getting bigger.”

My heart sank, but the fact of the rapid enlargement, encouragingly suggested to me that it wasn’t cancer. “And?”

“So I did go to the doctor eventually.” Ryan smiled and sighed. “He said it was some sort of hydrocele.”

“Oh yes, that’s good news.”

“They did an ultrasound … and, of course, I got all the bills. There was no way I could pay for them so I didn’t even open them up.”

An odd mix, a contradiction even, that with the wonderful news—namely that one did not have cancer—there came delivered a message of debt peonage that inspired even more despair than the dreaded diagnosis itself. It was almost as if the healthcare system itself was the cancer.

John in Braddock, Pennsylvania

John in Braddock, Pennsylvania
Originally uploaded by walk4healthcare

As an ambulance driver, John definitely notes that, “the uninsured come to us in a more severe state. They don't have a family doctor and so in the ER people end up having to wait more because these critically ill patients come it.” He told me it was not uncommon for them to wait six months to a year before seeking any medical attention.

Christina in Braddock, Pennsylvania

Christina in Braddock, Pennsylvania
Originally uploaded by walk4healthcare

As an EMT, she's seen diabetics without medications coming into the ER two to three times a week because their sugar gets "out of whack." They really don't have any healthcare access otherwise.

Zenobia in Braddock, Pennsylvania

Zenobia in Braddock, Pennsylvania
Originally uploaded by walk4healthcare

Zenobia has to see a doctor regularly for her prescriptions. “It’s really hard, because I have no insurance,” she said. “And I work hard. But since I’m part-time, Medicaid says I’m not eligible.” But since she’s working only 25 hours a week, she doesn’t apparently qualify for insurance through her employer either. “According to Medicaid, you’re working,” she said. But according to her employer, “You’re not working.” The cracks in the system she was facing, seemed, from her expression, to be more like gaping chasms, with no way out.

When she heard public assistance was no longer available for her, she called them, crying, “Why have I been dropped?” To which they answered, “You make more than $200 a month.” So she makes do with a hodge-podge of different programs and deals. She’s able to keep her medication bill down to $60 a month because the pharmacy has a special plan but her various other medical bills have accumulated to close to $6,000. “It’s all a mess, all so complicated,” she told me. “And if I really get hurt, I'm pretty much screwed.”

Rhonda in Pittsburgh, Pennsylvania (Roberto Clemente Park)

Rhonda in Pittsburgh, Pennsylvania (Roberto Clemente Park)
Originally uploaded by walk4healthcare

Rhonda returned to Pennsylvania to take care of her elderly family. She's had self-pay insurance via Highmark, the major insurer in the Pittsburgh market. “It's alright so long as you don't get sick.” Regarding the recent debates in Congress, she also added, “If you believe anything those execs put out, then you're a fool.”

She had a situation last year of right upper-quadrant abdominal pain. She went to the ER, which was an ordeal in itself. They started the work-up: a GI consult, surgical consult, ultrasound, HIDA scan were ordered and she was admitted for overnight observation. All the tests returned negative. Highmark denied the $7,000 for all the tests and the hospital stay, deeming that it was all 'medically unnecessary.' “There was no way for me to know they wouldn't cover it.” The hospital called for pre-approval, but the insurance company still had denied it. But Rhonda fought it, saying either the hospital was practicing fraudulent medicine or the company was wrong. They finally backed-off and paid.

Rhonda also described a story from a friend of hers who worked as a dental assistant. She had attended a conference on billing which the whole point of which was how to bill so the insurance company could deny the claim: what diagnostic categories to use, etc. The percentage of people who would NOT fight was estimated at 70%.

Picture from the 7/17 Pittsburgh Post-Gazette

Accompanying blurb: Dr. Ogan Gurel, of Chicago, walks along the Allegheny River on the North Shore as part of his trek to Washington, D.C. Dr. Gurel said that he will arrive in Washington on July 26. He said that he has competed in the "Head of the Ohio" and won twice. Dr. Gurel is trying to raise awareness about health care reform and is posting stories and updates to his Twitter and Facebook accounts as well as his blog.