Med

What mom’s cancer and dad’s Viagra taught me about American healthcare

It’s all about relationships.

My mother was a potpourri of medical maladies. Heart disease. Breast cancer. Rheumatoid arthritis. Lymphedema. And those were just the big ones.

At any moment, mom was preparing for, recovering from, or in the throes of a sickness, diagnosis, or operation.

Or worse, enjoying it.

Once, after a particularly rough bout, she exercised her right to a dying wish: she would tell everyone what she really (really) thought of them.

To say it went poorly would be generous — particularly the part when we had to notify her after her disclosures that she was not, in fact, terminal.

Mom had specialists. Lots of them. They presented opinions and spoke in dead languages about pathologies and best practices, with each diagnosis adding some new eye of newt to the mix. Every Saturday evening, a kitchen table alchemy would transpire. Dividing and sorting over orange plastic containers and a blue pill box.

Mom ultimately died of a complication of the flu.

Despite her ensemble of specialists, she didn’t have a primary care provider — no navigator, no coordinator, no giver of flu shots.

Which brings me to my father.

Six months after mom’s death, dad finally began attending to his own health. Caregiving for the chronically infirmed exacts a heavy toll, and my father’s health had long been relegated in the interest of his wife’s. So upon hearing the news of his first exam in nearly five years, I was delighted to chaperone the patient.

After a twenty-minute wait, we were called to the back for the familiar shuffle — moving from room to room to be weighed, measured, and evaluated. One anonymous figure after another taking turns.

Now I should mention that my father is a man of a certain generation — the kind of man who still dons a suit for airplanes, Sunday dinners, and, yes, doctor’s appointments. In the weeks leading up to his visit, he’d left a sheet of paper tucked into his 1938 Remington typewriter, where he added questions for the doctor — a pain in his knee after a morning of yard work or an episode of sleepnessless he couldn’t shake.

He was unfolding the sheet of paper when the physician eventually arrived in the exam room. My father cleared his throat.

And then she began — the doctor — settling in her chair with fingers aflutter on a keyboard and eyes affixed to a screen.

His disappointment was palpable.

Midway through her intake, she came to that question — the one I knew he was dreading.

“Are you sexually active?”

His pause summoned her attention, as she finally spun around to meet his stare.

“Sir, have you considered your options?”

Within a few minutes, this stranger was offering my father — a proud, grieving widow — a prescription…

… for Viagra.

He didn’t say a word, except to nod and fold his sheet of paper back up.

You see, Dad didn’t need Viagra. He didn’t need Viagra any more than mom needed an extra operation or some elixir.

My parents were both victims of the system.

The nips and tucks of modern medicine

My parents weren’t unique. Indeed, none of us are. We all quietly, complacently tend to broken bodies in a broken system, hardly raising an eyebrow when another “efficiency” is introduced.

There was a time when our physicians were our first — our only — real contact with the healthcare system. They had first names and direct lines, weaving advice for our back pain with commentary on our child’s middle school band concert.

And although nostalgia omits much in recollection, it was comforting. Because for most of us, our stomach bugs or aching backs aren’t what bring us into the office, and thus an antibiotic rarely the cure. Our pains are symptomatic of a dozen other things a prescription can’t resolve — the stress of parenting, relationships, pink slips, and bills unpaid. The rapport, then, with our clinicians isn’t so much about fostering their acuity to diagnose; our relationships with our healers is about fostering our sense of belonging. They remind us that our whole selves matter — that we deserve to live our best lives for as long as we can and in manner that’s consistent with our values.

Somewhere along the line, however, our healthcare system “evolved” — and with it, our expectations. We adapted to the new changes — a few more clicks of a mouse for our providers, a little less time in the exam room. A nip here. A tuck there.

In time, our clinicians became a name on the “in network” list, and we became a number in an EHR.

And it’s no different for providers— victims of buying, selling, merging, and “quality improvement.” Their expectations of relationships with patients, colleagues, and communities are similarly unmet.

Our broken system

I’d posit that the root of this detachment came when we began thinking of healthcare as a system.

To be fair, literally, it is. It’s the system— with a workforce, rules, economies, customers, and failures. The system exceeds three and half trillion dollars. The system is burning out more than half of clinicians. The system doesn’t work if you’re poor, minority, trans, or disabled. The system is broken.

Also: We are the system.

We are the workforce. We make the rules. We grow the economies. We are the customers. We fail.

By dissociating the people from the system, we took humanity out of healthcare. Where we once had patients, healers, and researchers, we now have users, data clerks, and corporate interests. And this replacement of relationships with transactional care has consequences. It’s why we overprescribe to “fix” symptoms rather than treat people. It’s why we’re able to “reduce enrollment numbers.” It’s why burnout and depression has reached epidemic rates — not just for providers, but for all of us.


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