In November 2009 I volunteered as a physician at a one-day free medical clinic in Little Rock where 985 people--without health insurance and desperate for care--were treated. Again and again, so many described their situation: No insurance, no doctor, no medical care.
The memory of their faces and stories still haunts me. If Obamacare is repealed, I fear the stories of the people I saw that day will be repeated throughout America.
When I learned the National Association of Free Clinics was sponsoring the clinic, I took a day from my primary care practice in Boston to fly to Little Rock, arriving the night before.
The patients lined up early in the courtyard outside the historic Capital Hotel. Inside, the entire lower level of the Statehouse Convention Center was set up with 76 blue-curtained cubicles prepared for the stream of patients. Asked to triage people as they arrived, wearing my white coat over a red volunteer T-shirt, I made my way to the doors. When they opened at 9 a.m., 150 people were waiting.
The first person I encountered was a middle-aged heavy-set Caucasian man with a below-the-knee amputation, calmly waiting in a wheelchair surrounded by his brothers. A self-employed plumber, he'd lost his leg in an accident six months earlier and hadn't worked since. Determined to support his family, he'd traveled over 100 miles to the clinic hoping to get a prosthesis he couldn't afford without insurance.
An hour later, I saw more than 250 had gathered in the hotel courtyard--the biggest waiting room I'd ever seen.
I met five African American middle-aged men, bantering about the University of Arkansas' football team. All had untreated high blood pressure. All were overweight. Three had run out of their medications. Without insurance, they couldn't afford a doctor's visit to have their prescriptions rewritten. One was taking his medicines every third day because he couldn't pay to take them daily. One hadn't seen a doctor for five years. All worked. Neither their full-time nor part-time jobs provided health insurance.
After lunch, an emaciated white woman with tangled black hair, wrapped in a trench coat, told me she had epilepsy and her seizures had recurred three times in the previous two weeks. She also said she'd been losing weight. Reassured she would be helped, her broad smile exposed a mouth of splintered teeth--crushed from the force of her seizures. Chewing caused such terrible pain, she barely ate--very likely the cause of her weight loss. Health insurance would have provided her the means to have her own doctor who would have controlled the seizures and prevented the damage to her teeth.
Later, a young African American teenaged girl dressed in a crisply ironed yellow sun dress ran up pointing to her father slouched in a wheelchair, his shirt soaked with sweat, skin clammy, and struggling to breathe. Eight days earlier, he'd been hospitalized for shortness of breath and chest pains. Discharged 72 hours later, he wasn't told the medications he'd been sent home with were to control his symptoms caused by a weak heart. Without insurance, he couldn't afford the prescriptions, so five days later the symptoms returned. His daughter, having seen the announcement of the clinic, insisted he come. Listening to his lungs, I found them filled with fluid and called for an ambulance. Except for the clinic that day, he might have died.
Several people told me that because they were uninsured they'd gone to emergency rooms for care. Later they'd received a several hundred-dollar bill for the visit. Embarrassed that they couldn't pay, they wouldn't return. Instead they came to the clinic.
Concerned that a depressed-looking disheveled young man might hurt himself, I told him to go directly to our mental health station. Later, I learned from the nurse who'd cared for him that he was suicidal. His plan averted, he'd been referred for psychiatric care. A tall, well-dressed middle-aged woman had had breast cancer surgery but then had been laid off, lost her insurance, and didn't have the funds to complete chemotherapy. An overweight diabetic woman in purple University of Arkansas at Little Rock Trojan sweatpants was using her brother's insulin, unable to afford her own. It had been more than four years since she had had any blood tests for her diabetes.
A blonde college graduate, wearing lipstick, who was recently hired to teach grammar school, couldn't pay for a local doctor to do her pre-employment physical. She'd driven from Oklahoma City to have it done in Little Rock. A frail, elderly Hispanic woman said she had glaucoma but without insurance couldn't continue her prescribed eye drops. Instead she borrowed her sister's over-the-counter eye drops. When she showed me the vial, I saw they were for allergies, not glaucoma.
I vividly remember that day in Little Rock as the most disturbing in my 35 years of clinical practice. Without insurance, so many people had so many untreated diseases, and so many preventable complications. At 10 p.m., leaving the clinic, I asked myself: "Was this America or a Third World country?"
Now I ask those wanting to repeal Obamacare, "Do we need to repeat this scene?"
Dr. Ralph Freidin, retired after 35 years of practicing general internal medicine in Lexington, Mass., is currently evolved with palliative care and bioethics at the Mount Auburn Hospital in Cambridge, Mass., and teaches teach medical students at Tufts School of Medicine in Boston.
Editorial on 01/15/2017