With no insurance, he used enemas to treat colon cancer. Now he’s going to die.

A few weeks ago I wrote an article here claiming that doctors were becoming less conservative and more liberal (with exceptions like throwbacks Rand Paul, Scott DesJarlais and some other extreme right-wingers.)

I cited the position of the New England Journal of Medicine (NEJM), which came out in an editorial favoring some form of universal health care since Massachusetts (site of the NEJM) has had a similar plan for years. And I explained how the American Medical Association, as well as some specialty medical boards, have gotten behind health care for everyone as well.

Well, the NEJM has done it again.

They’ve published a brief, and moving article by two physicians from St. Louis, Missouri, Michael Stillman, M.D., and Monalisa Tailor, M.D., who are on the faculty of the University of Louisville Department of Medicine. They describe their encounter with just one patient, Tommy Davis, who could have benefitted from the ACA. Instead, because he was uninsured, he’s going to die:

The week before this appointment, Mr. Davis had come to our emergency department with abdominal pain and obstipation. His examination, laboratory tests, and CT scan had cost him $10,000 (his entire life savings), and at evening’s end he’d been sent home with a diagnosis of metastatic colon cancer.

The year before, he’d had similar symptoms and visited a primary care physician, who had taken a cursory history, told Mr. Davis he’d need insurance to be adequately evaluated, and billed him $200 for the appointment. Since Mr. Davis was poor and ineligible for Kentucky Medicaid, however, he’d simply used enemas until he was unable to defecate. By the time of his emergency department evaluation, he had a fully obstructed colon and widespread disease and chose to forgo treatment.

Mr. Davis had had an inkling that something was awry, but he’d been unable to pay for an evaluation. As his wife sobbed next to him in our examination room, he recounted his months of weight loss, the unbearable pain of his bowel movements, and his gnawing suspicion that he had cancer. “If we’d found it sooner,” he contended, “it would have made a difference. But now I’m just a dead man walking.”

The doctors warn that this patient’s case is far from unique. They see many similar cases, almost on a daily basis at their clinic. Multiply that by the other clinics, hospitals, urgicares, private and group practices in St. Louis. Then add those in the rest of Missouri and the rest of the country, and you can only imagine the staggering number that happen every day, every week and every year. This patient is an adult. But similar things happen to children as well.

The article discusses delays in treatment because of lack of insurance and the money to pay for treatment out of pocket. And it shows the consequences of those delays. In other cases, those delays have caused deaths, prolonged illnesses, loss of work, disabilities, handicaps, psychological trauma and other consequences.

This piece will only take about 5 minutes to read. It’s simple and direct, no intense science, no medicates, no statistics or graphs, no Latin. The 5 minute read should be followed by about one minute of thought to get an idea of just how vast, and horrifying this problem is.

Incidentally, this article was the one that was most often read by physicians in that issue of the Journal. Read it and see why.

Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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24 Responses to “With no insurance, he used enemas to treat colon cancer. Now he’s going to die.”

  1. Mona Tailor says:

    Hello, Thank you for highlighting our NEJM piece in your blog. We are physicians in Louisville, Kentucky, providing care for those that don’t have it. Which in our state is almost 700,000 people. We are number 1 in all the wrong things- highest rates of smoking,lung cancer, obesity, just to name a few.The ACA could truly make a difference for this population. If you could be so kind, Please correct your article to indicate our state, please.

  2. Whitewitch says:

    I for one even regret voting for him…which is beyond sad because I was so full of belief. This is but one reason that I think it was a mistake…sadly I suspect it would have been worse under the other choice – BUT at least them it would have been them doing the evil…not us.

  3. karmanot says:

    We can thank Obama specifically for that fail. He promised us Universal coverage and delivered us a scam serving the interests of Insurance companies. I, for one, will never forgive him.

  4. karmanot says:

    “profoundly depraved society.” — exactly so Naja.

  5. karmanot says:

    There is at lease one who treads these boards–me. Two months before Medicare kicked in I went through prostate hell and finally went to the ER, where they caught multiple complications in time. 4 ER visits cost my entire life savings, but my some considerable luck I was saved my Medicare.

  6. Naja pallida says:

    Hundreds? I’d venture to guess there are millions of cases of people foregoing medical care because they can’t afford it. Maybe not all are so dramatic as this particular case, and certainly not all result in death… but any situation where someone is forced to just deal with pain, discomfort, or whatever other symptoms of a medical condition, simply because they can’t afford treatment, bespeaks of a profoundly depraved society.

  7. Jill Scoggins says:

    Thank you for highlighting the work of Dr. Michael Stillman and Dr. Monalisa Tailor. However, they do not practice in St. Louis. They are on the faculty of the University of Louisville Department of Medicine and practice in Louisville, Kentucky. I hope you can correct the article. Thank you – Jill Scoggins, University of Louisville

  8. LanceThruster says:

    The invisible hand of the market finds yet another way to weed out the ‘takers.’


  9. Chef Kowalski says:

    When Ted Cruz arrives in the afterlife, Lucifer will throw up his hands and tell him, “I can’t compete with you. Take over!”

  10. Chef Kowalski says:

    It depends on what kind of colonoscopy procedure you get. The one involving barium enemas is relatively inexpensive. The one where the sedate you and put a probe up your colon to trap polyps can be very expensive. My doctor recommended the latter and my insurance company coughed up only the cost of the barium procedure, so I got stuck with $6,500 of the remaining cost. I paid it off over 18 months in monthly installments. Much to my surprise, I was later told that for a mere $1,400 I could have had the same procedure at a Planned Parenthood clinic (the clinic isn’t just for pregnant women). Naturally the opponents of Obamacare also want to defund Planned Parenthood.

  11. Hue-Man says:

    The resources are there for universal care: U.S. governments spend more per capita on health care than Canadian (and most other developed country) governments with the outcomes you cite AND huge portions of the population which see almost no government health care dollars.

    Even under socialized medicine, being poor is bad for your health. A Canadian Medical Association report from earlier this year: “Most major diseases including heart disease and mental illness follow a social gradient with those in lowest socio-economic groups having the greatest burden of illness. Those within the lowest socio-economic status groups are 1.4 times more likely to have a chronic disease, and 1.9 times more likely to be hospitalized for care of that disease.” http://www.cma.ca/multimedia/CMA/Content_Images/Inside_cma/Submissions/2013/Income-inequality-Brief_en.pdf

    If you’re working two jobs, it’s hard to make time for a doctor’s appointment (even if it costs zero). Getting to an appointment might blow your budget for the month. If you didn’t graduate high school, you may not understand the doctor’s medical jargon. If your mother tongue is different from your doctor’s, you may not have the vocabulary to understand the medical advice. More broadly, rich “squeaky wheels” who have the time and education to research their condition can challenge their family doctor to consider more tests, scans, and medications. Now, add the U.S. financial gate-keepers which bar the uninsured from accessing any care outside the ER…

  12. Bill_Perdue says:

    We need socialized medicine. Obamacare/Romneycare is a scam.

  13. slideguy says:

    The US spends more per capita on health care than any other country in the world, but our outcome statistics, according to the World Health Organization, are ranked at 37th, just after Costar Rica. Remind me again who this makes us the “best medical system in the world”.

  14. rextrek says:

    hey Merikkka – we still no#1 ????? Pathetic America…..Pathetic and absolutely SHAMEFUL!!!!!!

  15. Melinda Li says:

    Aren’t there hundreds of stories like this throughout the US? Please, physicians, come forward as these two have! Tons of disinformation have been dumped into the media like toxic waste. This is the sort of thing that cuts through all that and should shame the media into getting their facts straight.

  16. Melinda Li says:

    He need to move directly “Burning in Hell” status for that one.

  17. Hue-Man says:

    But under the tyranny of socialized medicine, we have rationing and death panels. My province’s surgical wait-times website shows “bowel resection with suspected cancer” had 200 patients waiting at Sept 30th, 50% had surgery within 2.4 weeks (period July 1 to Sept 30), and 90% within 5.7 weeks. (His medical status would probably be considered an emergency and he wouldn’t be on a waiting list.)

    Absent medical malpractice, his condition could have progressed as far as it did under socialized medicine only if he deliberately avoided seeing his doctor about his worsening symptoms, failed to get the diagnostic lab tests, and refused to undergo a colonoscopy.

    This man’s family must take comfort knowing that they live in the exceptional country which has the best medical system in the world (they just happen to be denied access through economic rationing).

  18. GarySFBCN says:

    And a $1,000 colonoscopy (still overpriced) every 5 years could have saved his life.

    PSA: For those of you over the age of 50, talk with your physician about getting this icky test – the colonoscopy, especially if there is any family history of colon cancer. The day before the exam is not fun – clear liquids and laxatives for 24 hours. They put you to sleep for the test so you don’t really feel anything.

    The incredible thing is that is isn’t just a diagnostic text – they also remove any pre-cancerous (and non-cancerous) polyps which is actually preventing cancer.

    I just got this test last Friday. I’m good for another 5 years.

  19. Badgerite says:

    And Ted Cruz gets the Heartless Bastard Award for comparing health insurance to kids wanting more sugar than is good for them.

  20. judybrowni says:

    I had a friend die last year of ovarian cancer: no health insurance because of a “pre-existing condition” and by the time she was destitute enough for Medicaid, it was too late.

    She put herself through four bouts of chemo then, in the desperate hope she’d be able to see her daughter through high school, to no avail.

    But if she’d be able to get treatment earlier, she would have lived.

    Obamacare would have saved that mother and daughter needless pain and suffering.

  21. keirmeister says:

    Pro-Life indeed.

  22. RepubAnon says:

    Remember when the Republicans at a presidential candidate debate cheered at the phrase let him die? Easy to do in the abstract – not so easy in person for most humans.

  23. Whitewitch says:

    This is moving and reminds us why we need single payor…oh my gosh to think of all the suffering people in this country…excuse me while I go weep.

  24. Fill2 says:

    Sounds like our friend Jimmy, diagnosed in May, died the end of August at 50 yrs old.

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