A working man with metastatic colon cancer

I was on  rounds with the subinterns recently and I met a man admitted for GI bleeding and anemia.  He has a relatively straightforward presentation. On colonoscopy he had a mass found that was biopsied. Since I was not the attending of record, I was careful not to overstep how much I revealed to him.

The man saves me the trouble by volunteering “So, it looks like I have cancer, isn’t that so Doc?”

Colonoscopy reports are so efficient. You can, with a color printer, place a report with actual pictures of the patient’s lesion directly into the chart as a routine matter of care. The lesion was almost certainly cancer and he had lesions in his liver as well.

I ask the intern and students taking care of him where he will follow up after being discharged . they had not thought it through. In-patient care is very intense. Fill the tank with blood. Get a diagnosis. Discharge.

Key issue: “Does he have insurance?”  NO

“How will he come here for chemotherapy without insurance to pay his visits?”

THe man works full time as a carpenter. unfortunately, he works for a small business that could not possibly afford $15,000 a year per family plan for insurance. Full time work. Just enough to render him ineligible for medicaid, but not enough to afford ANYTHING we were doing for him today.

And…”How old is the patient?”  …..”54″

“So, at what age does screening begin?”   it’s an easy question. Colonoscopy is to begin at age 50. Time enough to have detected and removed the cancerous polyp long before it invaded his colon, and now his liver.

A working man. Just enough to live. Not enough to get him the colonoscopy that would have saved his life had he been screened at age 50 like all the patients with insurance get.

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3 Responses to “A working man with metastatic colon cancer”

  1. Joel "el mexicano chingon" Says:

    It is sad, now imagine in my country, people just sit and die. The only screening method available all around the country is the pap smear. 40 % of the population does not receive medical atention. But we are a developing country huh? That let their people die, and let them go to other countries because we can not offer them jobs.

  2. cadina Says:

    What’s “Doc” for?
    Immigrant?

  3. anagha Says:

    This scenario brings thoughts to mind everyday of my life when at work. Luckily but not enough, there are federally funded clinics like North Country Community Clinic in Northern Arizona. Such will accept patients without insurances for follow up care with many subspecialities working in conglomerance.
    Often I think about life back in india. Self pay in private hospitals and free care in hospitals run by government. The drawback though, even free governnment funded healthcare will not suffice to save lives when expensive medications or procedures are involved covering a billion people. A death of a 19 year old girl from the slums whose family could not afford acyclovir for her HSV encephalitis while she was being treated for free for her Meningeal TB, 56 Yr old woman who did not have 60000 Rs (approx. 1400USD) for paying towards the cost of her mitral valve replacement…the list goes on. Nothing is perfect. Maybe if each one of us volunteered a day of the month in providing free care at a facility…we could accomplish something but not everything.
    Every drop in the ocean counts towards making the ocean as massive as it stands/flows!

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