“Why do you want to be a doctor?”

I answer without hesitation, “I want to help people.”

“There are many ways to help people.”

“I want to save lives.”

“There are many ways to do that too. So I’ll ask you again, why do you want to be a doctor?”

“Because I believe in it.” 1/

I think about that exchange now and then, some times more than others.

Why do we do the things we do?

What do we really believe in?

My next clinic patient is one I’ve known for many years. He is visiting me today via Zoom.

I always look forward to talking to him. 2/

As soon as the visit begins, I notice that his camera is angled off-center so I can’t get a clear look at his face.

I ask if he can adjust it, but he says he’s having technical issues.

No problem. I can adapt.

It isn’t just the camera though.

Something feels off today. 3/

Almost immediately I can tell that he sounds subdued. He isn’t cracking his usual jokes.

I’m comfortable with silence, even in the heart of a busy clinic day.

Silence is often where the healing happens.

After asking how he’s doing, I let the silence between us grow. 4/

The question, when he asks it, is one I don’t expect.

“Doc, which kills you faster? Blood pressure you don’t control, or blood sugar you don’t control?”

The surprise on my face must register, because he explains further.

“I just can’t afford all these medications anymore.” 5/

He continues.

“The way I see it, doc, I only need to stick around 4 or 5 more years. That’s how long my pet dog has left, then I ain’t got no more family and it’s me all on my own. So I figure maybe take the diabetes ones and skip the blood pressure? Or every other day?” 6/

As I review his meds and start discussing our options with him, he adds one last remark.

“And I’m real sorry doc. I know we go back a ways, but I can’t afford my co-pay. I’ll pay you later. Promise.”

And just like that, I understand why his camera is angled. 7/

And just like that, I’m again struck by the cruel illusion of what I do.

The system I’m part of.

This patient did everything right; got insurance, paid his taxes. And he still has to barter years of his life.

And he can’t bring himself to look me in the eyes as he does so. 8/

Our healthcare system is too often unethical, immoral, unsustainable.

The insurance paradigm is focused on revenue generation. It strips the basic human dignity from patients, to the point where they can’t even make eye contact anymore.

I know that I’m part of this system. 9/

He’s old enough to be my father. Some part of me imagines that he is my father. Tears threaten my vision, as a hot anger floods me.

Now I wish I could angle my camera away.

I ask him if I can write about him. Because people need to know.

His response lingers with me. 10/

“Sure you can doc. But people already know. Lots of people deal with this. It ain’t that people don’t know. It’s just that nobody cares. Nobody gives enough of a damn to change anything. Nobody... cares.”

The visit ends.

My Zoom window closes.

His window closes too. 11/

I feel it.

There’s something insidious here.

A casual cruelty we’re all complicit in.

“I can’t go to rehab, insurance won’t cover it.”

“Insurance won’t pay for that medication.”

“I can’t afford any of this.”

“I’m uninsured.”

This isn’t right. None of this is right. 12/

Twenty years ago, I gave a medical school interview.

I wore my best suit. I sat up straight.

I said I believed in medicine. I meant it.

Some part of me once burned brightly, but that fire is down to flickering embers.

Our lives mean more than this.

More than this.