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.