Day 6 Dispatch (7/2) – Columbia City, IN to Ft. Wayne, IN

Morning at the Days Inn in Warsaw and while my hotel has been set up, I’m wondering how to get my bag—the large piece of luggage out of which I live for the month—will get to Ft. Wayne. At the front desk is a young man, his name is Scott, with a big smile only half-filled with teeth. I smiled back.

Sheila, Uprendra’s wife and co-operator of the hotel, had called me down to the desk and she, with a bright smile too, handed me an envelope. With a bow of her head, she said, “Please take this, it is something small, but we hope it will help you with your trip.” I thanked her and wondered if I should refuse what was likely a cash gift. Of course, the walk would not be possible without donations, but then again, they were clearly living on the edge, and had already helped immensely and graciously. Later when I opened the envelope and found $20, I shook my head in amazement at the generosity of people, whatever they’re circumstances may be (Uprendra and his family, as mentioned in the last dispatch, are uninsured and get some of their medicines from ‘free samples’ donated by their brother, a retired physician).

Scott was standing there watching the proceedings. Not knowing whether he had time or a card, I decided to ask: “You wouldn’t happen to be able to take my bag to the hotel in Ft. Wayne, would you?”

“Sure,” he replied, in a calm cheerful voice and after some discussion, we agreed that he’d take the bag (and me) to Ft. Wayne and then drive me back to my walking point at Columbia City. It’d be $40 for the whole deal which was a win-win situation because he was unemployed and I needed to get my back to the next stop. And, as we drove together, he had stories to tell …

Scott: “I’ve been unemployed and don’t have no insurance. But, I’ve been pretty healthy, ‘cept my teeth here—gotta work on that sometime.” I nodded. His girlfriend called (this was a common occurrence as she seemed to call every five minutes). “But the difficult story is with my girlfriend. She works part-time and also no insurance. She makes too much for HIP (Indiana public assistance program) so that’s that. A few months ago, she had a kidney stone and the local hospital wouldn’t take care of her so they sent her to Indianapolis. The pain was so bad and she ended up having some operation there.” He said that there was no way they could pay any of the bills being that they were barely making ends meet. We drove by the trailer park that was their home and he told me how they were lucky, that the next trailer park up in Columbia City had been recently hit by a tornado and a few homes destroyed. Throughout the trip Scott was glowingly optimistic. But as he was about to drop me off, his face turned sour. “Tell those knuckleheads in Washington to get with it out there.”

The walk was long and relatively uneventful—endless fields tapering off into the horizon, curious cows, heavy clouds above. The road was straight and true, sometimes so straight as to be unreal. One surprise was a road off the Lincoln Highway called “Butt Road.” Reaching the Days Inn up near the Interstate, I checked in, unpacked and stopped downstairs for coffee and to talk with the family. Here are some of their stories.

Trushar: Last December he fell down in an ice storm and, as it turned out, broke his left wrist. He has no insurance and waited a week to have it eventually seen by a family friend, who was a doctor. By this time it had gotten quit swollen. They ended up spending about $500 for various x-rays, the visit to the doctor was free, but he was told that if it had gotten worse, the surgery for it would cost about $25,000. If that came to pass, the family had decided that Trushar (who is a U.S. citizen) would go back to India to have the surgery.

Hina: Hina’s one of the workers at the hotel—doubles up as back-up front desk and housekeeping. In fact, it seemed like everyone had a hand in all aspects of the operation. Hina’s had what she called a “muscle lock” in her neck which sounded to me like a cervical muscle spasm, perhaps even a herniated cervical disk. Hard to tell. In any case, she’s had no insurance and hasn’t seen a doctor or been to a hospital for it. She remains in pain, housekeeping work is hard, and this is making it harder. She looks warily around. I know that this hotel staff is like family, and they likely wouldn’t fire her for a situation that is undoubtedly compromising her productivity. But in a crueler world (which is quite common), she’d be out, replaced by someone else healthier, but also without insurance. Hina, in a way, is lucky.

© 2009, Ogan Gurel, MD

ogan@walk4healthcare.org

Day 5 Dispatch (7/1) – Bourbon, IN to Warsaw, IN

Writing this dispatch three days after the first of July, it feels as if it were years ago (and certainly many miles and a state away as I am now, as of this writing, in western Ohio). The walk began with Keith (the taxi driver I mentioned in yesterday's post) and I talking my bag to the next hotel in Warsaw (many thanks to Uprendra and the Days Inn for a free night’s stay!). Keith brought me back to Bourbon to begin the long walk along New US-30. The plan called for me to meet up with Katie of Grassroots Media (many thanks to that wonderful group!) to shoot some documentary video of the walk towards Warsaw and hopefully tape some interviews with people.

The air was cool and refreshing but as the wind was still, the truck fumes (new US-30 is a major highway) lay stagnant and choking, I stopped four miles down at the 19 & 30 in Etna Green. From there I decided to head along Old US-30, running parallel south of New 30 and much more scenic and less carbon monoxide-laden . But before leaving (and after a breakfast pizza), I had a chance to speak with Brian—the owner of the 19 & 30 gas station & restaurant.

Brian: “I believe government should not be in healthcare,” he said, though he added that he’d like to see some regulatory changes to actually increase competition, ensure personal responsibility and decrease prices. “The system is sure not working,” he told me.

And so I took off for Etna Green and, reaching Old US-30 headed east. Four miles later I was in Atwood—a small town where you could throw a stone (if you were good) from one end of the town to the other. There I met with Katie where we shot video of the walk, did, in fact, meet with several people along the way and in Warsaw. At one of the truck stops, Harold, a tanker driver, eyed me and with curious interest. I told him about the walk and asked, “What’s your story?”

Harold: Gruff but friendly, and with a face that oozed sincerity, Harold answered, “The insurance—80/20, but my wife is totally disabled so she’s on the Medicaid … and I got a $5,000 deductible! Every year, it just tears me up. We get good care over there at Lutheran in Ft. Wayne but it’s outrageous. When the doctor gives a regular prescription—not the generic stuff, and the pharmacist automatically gives you the generic, makes you sick and then you have to go back to the doctor to get the right stuff to send to the pharmacist, that don’t make no sense.” I asked Harold if he had any choice of insurance or if he had to take this type of insurance. “There’s no choice,” he told me. Indeed ...

Reaching Warsaw, I spent some time contemplating the War Memorial (officially the Kosciusko County War Memorial). As some may know, I was inspired to do this Walk for many reasons among which were the shockingly selfish arguments I began hearing from industry lobbyists and other groups over in Washington in efforts to derail healthcare reform. What ever happened to the notion of a greater good and self sacrifice—principles for which the hundreds of men and women listed on this memorial paid the highest price of devotion.

And so, with somber thoughts in mind, we headed farther into town along Lake Street. There we met a smartly dressed man—Scott.

Scott: He said that, “There should be less government involvement. I really think it should be left in the hands of the people.” He added that he used to work in the orthopedic device industry (there are many in Warsaw). “What I feel that would do, if healthcare was nationalized, is that it would undervalue the products they are making. In the end, I think it would work out as what they would lose in sales, they would get in volume, but I really feel that the healthcare scenario needs to be left to people, not the government.”

The most telling story came to us in a Mexican restaurant down the street. I spoke with one of the counter people, who wished not to be identified. She told us that she did have insurance (through her husband) and that she was happy with the system and that she would not change anything. Then, next to the register, I noticed a posted sign with a picture of a young boy in a hospital bed pleading for $100,000 to help with a kidney transplant.
Here's the sign ...

Doesn't that tell it all?

So the videographer and headed back up Lake street where I met with Krystal in front of the Warsaw courthouse.

Krystal: I explained my walk, its purpose. Krystal asked how many pairs of shoes I have and so I showed her the extra pair strapped in a bag to my backpack and told her of the several more in the luggage at the hotel. And we that, we began talking about healthcare. “Insurance rates are sky high,” she told me, lamented further that, “like I was talking with my doctor, you almost have to call the insurance companies to get the approval for what drugs you can prescribe—insurance companies are driving the show … they give the discounts or I think they’re in the cahoots with some of the drug companies. They say ‘Oh, we’re having a special on Lipitor' and so they push Lipitor.” We talked about the pharmaceutical companies and that drug costs just seemed to be too high.

And from here I finally arrived at my hotel—The Warsaw Days Inn. There I met the manager, Uprendra, who graciously offered a complimentary room and who told me his story. His pleasant and always smiling wife, Sheila, joined in the discussion.

Uprendra: He does not have insurance—nor does heila, or any of the staff. He has diabetes and gets his insulin, when he can, as free drug samples from his brother, who is a retired doctor. It was an interesting sidelight to the discussion I had with Krystal about pharmaceutical drug costs. Pharmaceutical marketing costs billions of dollars a year and includes not only the ubiquitous television ads but also the free samples that Uprendra takes. Of course, for him, it is very helpful … but don’t you think it’s a bit (to understate the matter) inefficient? I’ve talked to Republicans and Democrats alike on this trip and, I think the common agreement is that this healthcare system, in its varied manifestations, just does not make much sense …

© 2009, Ogan Gurel, MD

ogan@walk4healthcare.org

Day 4 Dispatch (6/30) – Hamlet, IN to Bourbon, IN

I woke up to raging, searing blisters. I could barely walk to the breakfast area, two doors down. While this is a walk, at an average of 24 miles per day it is more like a lengthy 'sprint!' As this walk, the stories I’ve been getting and its overall mission, was too important to jeopardize, this morning would have to be a rest day (subtracting 15 miles from the total walk distance.) Besides, I don’t have health insurance and a major foot infection could not only knock me out of the walk (letting down many people) but also drive me into bankruptcy or worse. My “Living Will / Advance Directive” states that if I am incapacitated, I do not wish lifesaving measures to be taken. That’s the reality.

So, I took a break in the morning (walking, though, every day) updating dispatches, sending emails, and doing other logistical matters. Besides a small rally was planned and I wanted to be ready for the long afternoon walk to follow. I had a chance to talk with some people at the Days Inn in Plymouth. Here are some of their stories.

Jay: Jay is the manager of the hotel and he told me the story of his uncle who had a heart attack and required a triple bypass operation. Unfortunately he was uninsured and the operation would cost about $118,000. There was no way that he could pay that money—the money that would save (or at least extend) his life. And so he ended up having the operation in India which, with airfare, cost about $35,000. Jay (and his staff) were enormously gracious and generous (they provided a complimentary room) and when I told him of the difficulties of such a long walk and my blisters (thankfully, I’ve got no major tendinitis or other connective tissue issues) he told me “remember Ogan, slow and steady wins the race,”

Mike: Mike’s the fiancé of the front desk attendant. He doesn’t have insurance having recently lost his job. “I still owe a bunch of doctor’s bills,” he told me. “I broke my hand and right now its better but I owe $12,000.”

And so that afternoon a bunch of us gathered—Cassie, Mike, and Keith and we headed the two miles downtown and back. We talked about life in Plymouth, all the people losing jobs and many stories of others who had lost insurance and experienced a whole set of healthcare woes.

We saw some interesting sites in Plymouth. Apparently, one can buy artillery shells there! After returning to the hotel, and feeling better (though distressed, of course, at all the hardship I’ve learned of), I walked another five miles to bulk up my miles. During that walk I went to dinner (Burger King) and stopped at a Walgreen’s to buy seven tubes of Neosporin and other supplies, preparing for a night of ‘minor surgery.” At the store, I met two women who shared with me their stories.

Val: Val is 58. She told me, “She and her husband have worked all their life, had insurance all their life and were both laid off in November. We’re both looking for jobs and have had no health insurance for the first time. We’re too young for Medicare. We don’t know what we’ll do.”

Ginny: Ginny lost work and took early retirement at 62 but, she told me, “The bad thing about that is that there’s no health insurance.” I nodded. “I make too much for the Indiana health care program, but not enough to pay for medial insurance. It costs at least $300 a month. I’ve got diabetes and high blood pressure and five grandchildren that live with me. My daughter is legally blind so if something happens to me, I don’t know what will happen, who will care for, the children.” Perhaps that explains why I look pretty grim in the picture. I'm inspired, and humbled, by the bravery of regular, hardworking Americans.

With pain from head to toe (in my mind from hearing these stories and down below in my feet from blisters), it’s difficult to keep walking. But I did and, thankfully, I am here to bear witness to what is becoming increasingly apparent to me as a national catastrophe of epic proportions. This must change.

© 2009, Ogan Gurel, MD

ogan@walk4healthcare.org

Day 3 Dispatch (6/29) – Valparaiso, IN to Hamlet, IN

While at breakfast (again, waffles, hard-boiled eggs, bagels, and OJ) I talked with some guests. Erin, visiting the Dunes from Indianapolis, told me a story.

Erin: Her mother has multiple sclerosis by doesn’t qualify for SSI (Social Security disability) or Medicare. Her medication costs are so high that there’s no money left for anything else. Her symptoms involve significant diplopia (double vision) and she can’t work but nevertheless has not been able to be on disability.

I checked out and thanked the wonderful staff at the Fairfield Marriott in Valparaiso (kudos to Jackie!) who provided a complimentary night’s stay. Here’s me heading out in the brightly sunny morning.

The day was hot (though not as bad as Saturday) and fortunately there was a stiff breeze which diluted the truck fumes from the US-30 / Lincoln Highway. My route called for me to walk along the new US-30 (which while not an Interstate, is a pretty heavily travelled truck route). Later on in the Walk, I take the old US-30, which is a more traditional two-lane road—more scenic and … safer. Here are some scenes along the highway. Endless cornfields (some soybean fields), dotted with farmhouses, and every so often flowers by the roadside. It was long and straight and the only thing to do was simply to keep going.

About ten miles out from Valparaiso, I had lunch at the Subway in Wanatah. These are small towns so it makes sense to use the direct article ‘the’ rather than the indirect ‘a.’ There is only one Subway in Wanatah. A group of people traveling back to South Bend, recognized me from the Chicago news. “I thought I recognized you,” one of them said. “You’re that doctor walking to Washington, DC.” And so, after foot-long turkey and a change of shoes & socks, I spoke with Michael, one of the sandwich artists.

Michael: He told me he had no insurance. “Do you get sick?” I asked. “Well, I try not to,” he answered. “If I must, I go to these clinics, but the appointments are way off, there are long waits, and sometimes it’s impossible. I mean I can’t miss much work, either. And dental’s really expensive. I could have gotten a job that provided insurance but I’d actually end up making much less.” I then headed out for the six mile walk to the town of Hanna.

Upon reaching Hanna, marked by a railroad crossing, I took a rest on the grass by the roadside. I tweeted the following post:

Rest in Hanna by the railroad crossing. Listening 2 Rodrigo Concierto de Aranjuez. He was blind but all-seeing. Is Washgton seeing but blind?

And then back again for the ten mile walk to Hamlet. At this point my feet are really killing me and it is getting dark. I arrange for a cab to pick me up by the roadside a little less than five miles from Hamlet. No: this is not necessarily ‘cheating’ as the motel is often not exactly on my route and I usually arrange some transport to take me back and forth. Also, I live out of a large suitcase for the month and this is shuttled separately each day from one lodging to the next. In any case, discretion is the better part of valor and to miss a few miles is better than walking on a major highway at night or getting gangrenous blisters. So Keith (of All-American Taxi in Plymouth) picked me up and he told me his story.

Keith: A few years back he lost his job at the yoghurt factory in town. This provided health insurance but now as an owner of a three taxi cab small business, he doesn’t have health insurance. He has significant heart disease and has had six heart attacks, the first one at age 32. For this he’s gotten seven stents (a device placed in the coronary arteries that keeps them open). The first two were covered by insurance but since then he’s racked up $56,000 in bills which he has paid down to $12,000.

[Interpretative note: I know a bit about stents and I was surprised to hear he had so many. But he did tell me that they continually get blocked up and he takes Plavix—a form of ‘blood thinner’—to prevent further blockage. I didn’t ask him but perhaps he has the less-expensive, bare-metal stents as compared to the much more expensive drug-eluting stents which are designed to reduce the possibility of blockage, or restenosis. While only speculative, I would not be surprised if bare metal stents were to be preferentially used for patients without insurance. Unfortunately that might mean less cost per operation but it typically results in more operations, ending up in even greater cost.]

And so I arrived at the hotel, the Days Inn in Plymouth. Many thanks to Jay Patel, the manager, for making possible a complimentary room. He also paid for the cab ride! And Jay has a story to tell but more on that in my Day 4 dispatch …

© 2009, Ogan Gurel, MD

ogan@walk4healthcare.org

P.S. If you want to see the aftermath of over 70 miles of walking in three days, click here.

Day 1 Dispatch (6/27) – Chicago, Illinois to Hammond, Indiana

We had a great launch in Chicago with several people joining me for the initial part of the Walk. Four of the major local networks covered us.

WGN

ABC7

NBC5

CBS2

Website

In these dispatches I will be mostly sharing the healthcare stories of real people. Details of the Walk (places visited, meandering thoughts, meditations, etc.) are covered in the Twitter feed (@walk4healthcare). For all stories published here, written consent has been granted for public posting and a full paper trail of such documented. I am deeply grateful for all those who have spoken with me and it is my privilege and obligation to present them to the wider world. These stories speak to the heart, to the mind, and represent, in the fullest sense of the word, the bedrock of “government of the people, by the people, for the people, shall not perish from the earth,” which I hope shall not perish from the earth.

Martha: Joined us on the walk. She finds it shameful that a country can’t provide basic healthcare for its citizens like any other developed country does. “Civilized nations care for those in need,” she added. She especially noted that the connection of healthcare insurance to employment status was a big problem as it is, of course, not uncommon that those who are sick become subsequently unemployed.

Addison: Addison’s a young college student who has just voted for the first time in the last election. He is enormously patriotic but as he embarks on a Study Abroad trip to Italy this coming fall, he is embarrassed that back in the U.S. there isn’t healthcare for all as he has learned is the case in Italy.

Ron: This is a gentleman I met along Martin Luther King Drive on the south side of Chicago. He was working painting a fence. He waved his hand towards the streets beyond and said, “Yes, there’s many people here without health insurance. Yes, without healthcare.” He shared a story of a old lady he knew who had a change in insurance that now made it too expensive to get her insulin for her diabetes. What happened was that this lady was on Medicare and was in the hospital for some time. An insurance salesman actually met her in the hospital and convinced her to change her insurance (Ron didn’t know the exact name but it was something like “Well Care”). But what happened was that this ‘new’ plan didn’t cover the old lady’s particular type of insulin so she ended up spending out-of-pocket $129 a month for her medication.

Rev. Joseph Felker: Rev. Felker is the Chairman of the Chicago Baptist Institute who I met as I stopped by one of their outdoor events. It was a ‘Healthy Walk” event actually. He told me, “we should have had healthcare for the uninsured years ago. It is a travesty but hopefully the change we are seeing is a start.” The Rev. Dr. Clifford Tyler (President of the Chicago Baptist Institute) concurred, saying that, “Healthcare reform is long overdue. With the wealth of this country, it’s a shame that people don’t have healthcare.” They were very nice and gave me a couple bottles of water and lots of best wishes for the journey onward to Washington, DC.

Well: those are the people I had a chance to interview along the way. I did meet a few more people but I had to make time so I could reach Hammond before dark. I’ve ran marathons and, yes, even while walking one can ‘hit the wall.’ It happened around the 20 mile mark (approximately the Illinois – Indiana border) and I felt like giving up. I know its hard to believe but, yes, I felt like turning back. But hearing these stories not only is important for the world to hear but also gave me inspiration to keep going. I reached the Hammond Fairfield Inn (many thanks to them for providing a complimentary room) at 10:30 at night. My hopes of walking only during daylight hours was a bit ambitious but I made it …

Ogan Gurel, MD

ogan@walk4healthcare.org