Community in action

In the last week I saw a community in action…well, it was a small group within the little town of Craig, AK. But these people accomplished a feat. They were able to get a man, virtually homeless and penniless, to the care of physicians at Duke University Medical Center in Durham, North Carolina.

This is the story.

Rob and I came to this clinic to work for three weeks on November 28. During our first few days, there were several conversations among clinic staff about a man who was in dire need of medical attention. He has no insurance, no money, and almost no support structure in Craig. I learned he had come here some time ago to take care of his mother, who died last year. He has some social issues, to put it politely. To put it bluntly, he is dirty, agoraphobic, and has a noticeable odor.

This man became a patient when he’d recently experienced a change in his voice. 50-ish, he has been a long-term smoker. A man in town who befriended him persuaded him to come to the clinic a few weeks ago to get checked out. A large tumor was found to be pressing on his vocal chords and impacting his airway.

The front office staff began to work on getting care lined up. You do not treat cancer in Craig. You leave and travel to a large medical center to get access to the various specialists your condition requires. From this region of Alaska, that resource is most often found in Seattle, WA. But in this situation, sending this man away with no funds and no support wasn’t an option.

It was discovered that there is a brother in North Carolina, living near Duke, one of the largest medical research facilities in the country. A medical referral was made; social workers contacted. The brother there agreed to receive the brother here. Medical costs will be underwritten by Medicaid.

But…Alaska is a looong way from North Carolina. It is expensive to make a trip like that. And this man couldn’t get there on his own. Turns out the brother is in financial difficulties too, so also unable to finance such a trip. Typically Medicaid will cover travel costs, but for some reason, not in this case.

So an application was made to a national organization that provides free air travel for medical emergencies…just like this situation. For a few days there was faxing and phoning back and forth. The office coordinator spent hours of her time working out details, making calls to solidify plans, meeting with the patient to reassure him of progress.

Then three days before the patient had to travel, the flight plans fell through. The organization was willing to cover travel to Seattle or Anchorage, but not to a location so far away, and outside the standard medical destinations for needy Alaskans. The manager was very polite…he wished they could help everyone, but this was clearly outside their policy parameters.

So, back to square one, with the clock ticking.

Someone suggested the local community cancer coalition might help. The office coordinator called, and within half an hour, two ladies representing the coalition were sitting in the clinic, listening to the story. Turns out they provide up to $1500 to cover travel expenses for medical care. You make an application, make the travel arrangements, and apply for reimbursement.

Someone produced a credit card. Airline ticket, ferry ticket to Ketchikan, airport ferry ticket were all purchased. The coalition would reimburse with a check.

The ferry travel to Ketchikan was full price, but when the accountant for the ferry company came in to the clinic for an appointment, the office coordinator mentioned to her that the staff was trying to assist this patient. The ferry accountant immediately offered to get the fare discounted, which she promptly did.

A nurse from Ketchikan with family in North Carolina was already scheduled to fly back and offered to escort the patient through the travel stages. The friend who brought the patient in escorted him to Ketchikan so he had no time on the journey that he was alone or without support.

So, a small town that supports a local cancer coalition, clinic employees, a caring friend, a nurse traveling home, a brother a long way off, social workers and medical providers on the other side of the country all worked together. And they pulled it off.

I don’t know how this story will end. I don’t know if this patient has a chance of surviving. I do he would have had no chance if he had stayed in Craig. Whatever happens, he has the gift of possibility this season. And the gift came from the community, given freely, knowing there would be no payback for the time, money or energy that it took to be successful.

Even more poignant, this man is not from Craig; he is not a pillar of the community; he is barely known here. But they helped anyway. No one will get credit, or special notice, for this effort. But this man will get a chance.

This isn’t a Christmas story of a gift given because of the time of year. Timing had nothing to do with it, except that the need was urgent. But it shows me the best of small town life. Small communities don’t have large medical centers. They don’t have unlimited resources. But when you need to get something done in a hurry, you know who to call. You’re not a faceless application form in someone’s email. And that’s the second part of this story.

Small towns can show off the best of community. And I just had a front row seat.

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Reality check

I went for a little ride yesterday. No, I wasn’t at Disneyland or driving some stretch of highway. I was lying on a table in the ultrasound room of the Women’s Imaging Center, waiting for the results of a breast exam. It was a long half hour.

I had a mammogram a few weeks ago, just a routine screening. I got a call on my cell from my gynecologist’s office while I was in Arizona for Riley’s birthday. I needed to come back for a follow up. The radiologist had requested “more views.”

“This happens all the time,” the woman on the phone said. “They just like to be sure they haven’t missed anything.” Well, I was in baby mode, birthday mode, and it was comforting to accept that opinion. I didn’t lose any sleep over it, but I did make an appointment to have the second screening when I got back to Ketchikan.

I went downstairs for the second mammogram yesterday morning. Fortunately for my peace of mind, the radiologist read the images right away. She was still not quite satisfied, and recommended the next step, a breast ultrasound. I agreed; better to be safe than sorry. Since I work in the hospital, I asked the person scheduling to work me in whenever she had an opening. It might be a few days, but she assured me she would do that.

Two hours later I got a call. Could I come down at 2:30? Yes, I was happy to get this done, get it out of the way. A little voice in my head wondered if this was really just a sudden opening, or if there was something the radiologist had seen that pushed me up in the urgent queue? I hadn’t picked up on any concern. But isn’t that the job of professionals? Don’t alarm the patient. Remain calm. And after all, they do this every day. I’m the novice. I can still count on one hand the number of mammograms I’ve had.

The staff in the imaging clinic is extremely nice. I am polite and calm as I check in. The gowns are warmed. The lighting is soft.  No one is excited here, we all know this is just routine. If they don’t seem alarmed, why should I? I could have taken a nap during the ultrasound, except that it’s a bit difficult to relax with gel on your breasts and questions going through your mind every time the tech lingers over a specific spot. What does she see? Why is she slowing down? I know it’s not appropriate to ask the technician to tell me what she thinks. Although I’m sure anyone in that role has enough knowledge to recognize an abnormal tissue mass, it is not the tech’s responsibility to discuss findings with the patient. So I resist the urge to pepper her with questions. I’m a model patient, shifting and adjusting as she completes the test.

Again, the radiologist will read the views right away. And again I wonder: is that normal, or do they seem something that requires urgency? The tech steps out of the room to confer with the doctor, and I’m left to stare at the ceiling and question.

I think the things that I assume most women think: this will be fine. Nothing to see here. I comfort myself. I don’t have a family history of breast cancer. I feel fine. I’m only 50! (Cliché alert: as they say, it looks younger every day!)

Then, for just a moment, I allow myself to imagine. This is how it starts sometimes. Just a routine exam, a little question, another test. And then, something definite. A diagnosis is made. Suddenly the lists are not about errands or chores, they are about appointments, tests, surgery, follow up, treatment. I watched my dad go down this path with colon cancer. I’ve seen others go through this. Why do I think I’m immune from this possibility? Why do any of us think the age old “it won’t happen to me?” I already know the end of the story. I know someday I’ll die of something. But I’m only 50! And that eventual reality is comfortably distant, isn’t it?

I think about the times in life that have focused me: the birth of my children, the loss of a loved one. Or on rare occasions, the poignant moments that stand out, that are frozen in my memory: the good stuff. Why, I ask myself, why can’t I keep the truly important things at the top of the list? Why do they always slip down below the urgent? Why is so much of life about keeping milk in the house?

Maybe we aren’t built to stand the intensity of the deepest emotion, the pinnacle experiences, on a 24/7 basis. They’re intense, these times of insight. They’re beautiful, magical. But intense. Who could live at that level all the time? And maybe, the very fact of routine in life is what keeps the magic in the other moments.

It seemed like a long time the tech was out of the room. Maybe it wasn’t. I was just rounding the corner of all of this in my mind when the door opened. “Ok, just keep up with your scheduled screenings. Looks good.” She smiled and opened the door for me. I went back to the dressing room to change, reassured and feeling vindicated that I had known I was fine all along. Nothing to see here.

Yes, it was all routine. Except for those few minutes on the exam table. They were a sharp reminder of what’s important in life. Funny how the extremes, good or bad, wonderful or frightening, can have the same effect. I left the clinic and walked back to my office, smiling, thankful that this wasn’t the day to switch out my lists. I have to remember to pick up milk on the way home, and the dry cleaning, not schedule a surgery.