Medicine and Inequality

Let me tell you about some of my psychotherapy sessions. I think I’m ready to discuss them with you now. As I’m leaving home on my bike, in the early hours of dawn, there is a haze in the air, with some patchy fog. There is rain in the forcast this afternoon, but I am certain I can make it back home before I get caught in it. My bike rides to Greeville are becoming routine now, I even see the same cars and trucks as they are commuting to work. The crops in the fields are doing fine, nourished by the sunshine and the recent rains.

I entered the city, and as I rode past the university campus, turning onto Greenville Boulevard, while I was traveling toward the Medical District, I saw a large billboard sign with a picture of an elderly man who was once a coach of a professional football team. He had received a heart transplant. The caption on the picture read: “Organ donars are this country’s most valuable players.” I’m sure he would feel this way. I once agreed to donate my organs after I died by indicating it on my driver’s license. I believed what the media told me about what a gift of life I could give to someone. As soon as I passed away, a physician could harvest my good organs, perhaps giving a child a new lease on life.

But something happened which made me change my mind. Dr Saba, my psychiatrist, told me I needed an EKG done on my heart, because on my psychotropic medications could pose a risk factor. I went over to the town doctor, to an establishment entitled Robersonville Physicians, one afternoon to have this taken care of. When I arrived there, there were no patients in the building, and the female doctor and the receptionist had nothing to do. The doctor seemed eager to handle my case. She asked me what insurance I had. “Medicare and Medicaid,” was my answer. Then the doctor suddenly looked downward, reacting towards me with an air of smug complacency, “I’m sor-r-r-y!” she replied, in her loud, sing-song voice. And I looked her in the eye. “You don’t want to take care of people like us, do you?” She paused for a second, then replied, “No, we don’t take care of you people.”

I walked out the door feeling humiliated and dehumanized. Why should I let them take my organs when I die when they deny me care while I am living? I found out about a child in an orphanage who was suffering because he needed a kidney transplant, but he wouldn’t get one because he couldn’t pay for it. Why should I let a surgeon take my good organs for free in order to sell them to another? The retired football coach could afford a new heart, along with the medications he needed to take care of the organ, because he was wealthy. I read the story of entertainer Gregg Allman, who destroyed his own liver because of his alcohol and drug habits, but he was wealthy also, and recieved a new one. He died anyway.

There was another vacant medical pavillion across the street from Robersonville Physicians, which was bought out by Martin Family Medicine a couple of years ago. They accept patients regardless of what kind of insurance they have. The doctor there just happens to be black, so now the affluent white people in town go to Robersonville Physicians, while most of the black people go to Martin Family Medicine. As I have demonstrated, racial segregation is still alive and well in the town of Robersonville.

But my current physician is in Greenville, and I am happy with her.

As I was turning at an intersection, and continued traveling down Arlington Boulevard, past the bike shop, past the television station, toward dentist offices and medical pavillions, I went past Vidant Medical Center, then entered the campus of the medical school. When I arrived at the Human Services Building, I spent some time in the library to cool off and to look at some books. Then I took the elevator upstairs to the Navigate Couseling Clinic, and Dana called me into her office.

I sat down in a chair and Dana closed the door. I told her about some problems I was having at the food bank. It is located at the housing projects in Robersonville, and some of the people were coming out of their apartments and breaking in line in front of the others, to get a better selection of food before it ran out. When Tina opened the door to the Community Center and allowed some people to cut in front of me, we got into an altercation. It made me feel awful. I was stern and stood my ground, while no one but Laura came to my defense. I was overwhelmed by feelings of aggression, agitation, and irritability. Aggression and physical violence was a learned strategy from my father, who was a narcissistic bully, who dominated my mother and myself. I told her about an incident in the state hospital, where I responded to an antagnizing nurse by throwing a cup full of water in her face. I also told Dana about a place I used to live where a neighbor was disrespecting me, and I wanted to borrow my stepfathers rifle so I could shoot him in the kneecap.

All the things I have told Dana — about family life, about life in the hospital — have the leitmotif of being bullied, with no one to come to my defense or support. We discussed ways to avoid future incidents at the food bank, like arriving later, so the line could start moving before I got there. Dana and I also discussed ways to be assertive instead of aggressive — this was very important if respect was what I really needed. We also talked about other methods to combat anxiety and agitation, including riding my bike and doing meditation.

Meditation means being in the moment, not engaging yourself in any thoughts of the past or future. You sit still in a chair, relaxing completely all the muscles in your body — your head, your neck, your shoulders, along with your arms and fingers, your legs, feet and toes. Then you focus solely upon your breath. The inhaling and exhailing is all you think about. If your mind should wander, as it is only natural to do, slowly bring your thoughts back to the breath. After several moments of this, you will feel calmer.

And Dana said that my concerns with what other people are thinking about me, along with their possible reactions, are connected to my attempts at being a kind and caring person. She challanged me to address the people I thought were hostile toward me with a friendly greeting, to find out for certain how they really felt.

So I left Dana’s office with the tools she gave me to cope. After I rode past the outskirts of town, I was out on the open road, getting ready to cross a busy highway, when Laura drove past me through the intersection and beeped her horn. We waved enthusiastically at each other. Then Laura turned her car around and met me down the road, asking me if I wanted a ride. She opened her trunk and we managed to get the bike in, tieing it securely with a bungee cord. When we arrived at my apartment, going inside to exit the summer heat, Laura sat in my recliner and said her back was hurting. She got up and showed be the bruises where her doctor had given her injections in her spine. I gave her some water to drink, then I got my umbrella and we went over to Laura’s so she could take her medicine and lay down on her bed. Pumpkin crawled up there, too, and layed beside her. Laura fell asleep to the sounds of Bach piano music played on my iPhone, as the summer rain began tumbling down.

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