Analgesia, Mon Amour

Brooding about health care is a pain in the neck

In the spring a young man’s fancy lightly turns to thoughts of love, but for an old fart like me, north of 50, shuffling between pools of streetlight on a soft May evening, it’s all about the aches and pains. My hands are feeling arthritic, my oft-dislocated shoulder is looser and grumblier than usual, my back is stiff, and my shins are killing me. What the hell did I do to produce this shin agony? Oh, yeah—I played softball. Which involved sprinting. Well, it felt like a sprint to me, but it probably looked like a moderate amble crossed with a chicken dance. The pain is genuine, though, and so is the promise of relief embodied in the jar of jumbo ibuprofen gel caps that’s waiting back home on the kitchen counter. For a moment, the loveliness of spring—lilac-scented darkness, the day’s warmth still rising from the pavements—actually does turn my fancy to thoughts of love, but it is love of pain relief, and from there it’s a short trip to a long brood about health-care reform.

Here’s a question I like to brood about: What if, by some political/economic miracle, we are soon able to provide health insurance to all Americans? Will there be enough physicians to go around? Currently, one reads, there are 47 million uninsured people in this country. How many of them, once they get their coverage, will choose my doctor as their primary-care guy? How much will this influx of new patients increase the time that I have to spend sitting in his flickery fluorescent cave of a waiting room? And what about the parking? It’s already practically impossible to find a spot in the ramp. Will there now be dozens or hundreds more people circling and cursing and slapping their steering wheels, their blood pressure soaring, their cars pouring tons of gunk into the air, thus perpetuating their own ill health and ensuring that more local kids end up with asthma? Then there’s the question of the ramp itself. Every time I go there it’s festooned with orange pylons, each one blocking a parking space that has been deemed unsafe due to falling chunks of cement. What if the added traffic brings this ramp down in a smoking heap, occasioning both great human suffering and dramatic opportunities for medical heroism? Will I see my doctor on the news, his face caked in concrete dust, his damp eyes haunted by the things he’s witnessed, aw-shucksedly regaling America with tales of the lives he’s saved? And will he subsequently become so popular that I can’t get in to see him at all?

Something else to brood on, traipsing through the fragrant night in my big, super-padded, glow-in-the-dark, Chinese-made shoes: Why do ruminations on health-care reform so quickly devolve into fears about my own comfort and convenience? Am I alone in this? No, I don’t think so. Does it mortify me? Yes, it does. It also, by some bizarre process of synaptic legerdemain, makes me remember the Snack Cake Inhalation Incident of 1979. Maybe it’s just two instances of embarrassment calling to each other across the years. In any case, there I am once again, perusing the vending machines in the cramped basement canteen of a major university hospital. It’s 3 a.m.; I’m on my lunch break. I’m trying to decide between the ham on white and the frozen burrito when in strides a world-famous surgeon. He goes straight to the candy/dessert machine, pops in his quarters, bends over, fishes around, and comes up with a package of Twinkies. By the time he reaches the doorway again, the Twinkies are gone and I’m standing there alone, red in the face.

Why? It’s hard to remember now. I probably felt that a bona fide legend who saved lives with his bare (well, gloved) hands should not eat crap like that. Upstairs, in the surgical intensive-care unit where I worked as a nursing assistant, the man had a magisterial aura. To see him in the basement, a short gurney ride from the morgue, sucking down those gummy, crème-filled bullets of nutritional obscenity—well, it soured me on auras, anyway.

Walking, brooding; brooding, walking. If you handed me a Twinkie right now, I’d eat it and kind of enjoy it. Would it hasten my death? Do I belong to the church of the heroic intervention? Do I believe there’ll be a stent or a bypass there if I need one, and a magic-fingered doctor to perform the procedure? It’s interesting that we use the word perform; then again, we do love our medical drama. In that ICU where I worked so long ago, there were two modes of behavior on display—the dramatic and the quotidian, the world of without-a-net performance (open-heart surgery, organ transplants) and the world of steady, repetitive, more or less thankless care (everything the nursing staff did). Heroic intervention is expensive and finite, because either the money runs out or the ingenuity does. Nursing, and nurturing, are far more affordable and not intrinsically limited. Whatever happens with health care, policywise, it seems clear that we have to start unlearning our love for the dramatic and somehow embrace the quotidian. (Note to self: instead of watching House, get your fat ass off the couch and walk around the neighborhood.) And as long as I’m brooding out loud here, isn’t a system of care that withholds its benefits from a sixth of the people about 47 million times more obscene than the nastiest snack cake?

Muscles good and warm by now, shins less achy, I turn the corner toward home. Is medicine just a Ponzi scheme that trafficks in hope? Is life? Which will provide more happiness, more overall societal benefit: coronary bypasses for 10 old coots or prenatal care for 100 women who would not otherwise get it? Viagra for every middle-aged dude who wants it or antidepressants for the homeless? What kinds of questions are these? Who gets to decide such things?

I do, say I. It’s what every brooder says, and there’s the rub. I stand on the sidewalk in front of my gold-windowed house, cooling off, drawing the dewy lilac night into my lungs. How many such nights does a person get in life? How many does he deserve? In my mind’s eye, dammit, the image of a Twinkie—the exact golden color of the light from my windows—hovers like a spacecraft from a friendly planet. I am a 10-minute walk in either direction from a convenience store; I could toddle over and back and no one in the house would be the wiser. Still, it bears remembering that my younger boy was born by emergency cesarean; in my grandfather’s day I might have lost both baby and wife. My older son was born prematurely, 6,000 miles away, and came to be here via more than one miracle. A warm spring wind, moving in the new leaves, brings a whispered question: Do you ever wonder how many heroic interventions the average family gets? I do; I wonder all the time. I believe it has a lot to do with luck, and with the quality of your insurance. Beyond that, who can say? Eventually, one way or another, I expect I’ll find out.

Contributing editor Jeff Johnson once saw a world-famous poet wolfing down Kentucky Fried Chicken in a parked car.