by carlocmd

An elderly couple shuffled into the clinic. She had a smile on her face. He was pale. It was immediately apparent that the man was sick. There followed a musty, sour smell in the clinic air, the smells of aging and its little indignities.

“What happened?” I asked.

“I need endoscopy, doctor,” the man said.

This was the third hospital they’ve visited. They were in line at the outpatient department of the first hospital. This was a follow-up of the hemorrhoidectomy his wife had a week ago. They got hungry and went to the cafeteria to share food, a bowl of soup, to eat. After the third spoonful, the man felt dizzy and fell head first into the table.

He was rushed to the hospital’s emergency room. Vital signs were stable, but he looked pale. He had been taking several pain relievers for his joint pains. Pains that were increasing in severity because of all the legwork he was doing while his wife recovered from surgery. He described passing black stools. He described a vague, gnawing pain in the upper abdomen. An examination of his rectum showed black, foul-smelling stool — the stool you find when bleeding starts from the stomach and mixes with stomach acid. His red blood cells were low, and the doctor immediately transfused him with a unit of blood.

Then the doctor told him, “Sir, we need you to undergo an upper GI endoscopy to locate the source of your bleeding and stop it. We, however, do not have this facility in our hospital. Please go to another hospital to have this done.”

He was discharged and with his wife spent the next few hours looking for another hospital. The next hospital did not have a gastroenterologist on staff. A few hours later, they were at my clinic.

Her wife continued to smile at me, which made me a little uncomfortable. She continued to nod and smile even as I was describing her husband’s condition and our intervention.

“She has mild Alzheimer’s,” the man explained.

“We have children,” he continued, “but we cannot depend on them. They have their own lives. So even if my wife needed surgery, it was only me dealing with the doctors and all the paperwork. Even if I am sick now, there is no one else to help us.”

If there is one thing you can say to someone whose daily job is helping and healing others, it was this, the quiet and desperate plea for medical aid.

“We do not have much, doctor. Just a small pension that does not seem enough,” he continued. “But my doctor has recommended an endoscopy, so here I am.”

I agreed that he needed the procedure, explaining its risks, benefits, and costs. And yes, we can do the procedure here. But, there is a better way.

I described the hospital’s service arm. An interview with our friends at social service would make him eligible to all the medical benefits he needs, without its high costs. I detailed the steps he needed to do. He repeated these few steps verbatim, indicating his understanding. I gave him a note of support. And I gave him the medications he needed to take for the next few days, to control the bleeding.

“How much do we need to pay now, for this consultation and these medicines?” the man asked.

“None,” I said, breaking my rule of charging all patients according to their ability to pay. Because they did not have enough to eat today. Because we still had a long way to complete his treatment.

His wife continued to smile. “You are a very good doctor,” she said.

They went on their way.

They shuffled out, the post-operative forgetful smiling lady, hand-in-hand with her concerned but bleeding husband. It was unclear who was supporting who. It looked like they were helping each other.

I sent a prayer to watch over them, to guide them as they go through these last few steps to finally be able to get the medical care he needs.

It sometimes feels like I have not done enough. I think that I should have admitted them into the hospital right away. But I could not force them into getting the care they needed, which would bring them into deeper debt in the process.

It is a balancing act, this vocation of caring for people in a holistic way.