1.5 Million
As I stand in front of the bathroom mirror the words on my T-shirt catch my eye. “Yoda Best Dad Ever”. The T-shirt is new. My kids got it for me for Father's Day in honor of the terrible Yoda impression I do to make them laugh. Suddenly, I think about 1.5 million dollars, and the weight of it is like sandbags on my chest. The price of a life.
I got the email from a friend. There is a 4-month-old baby in his fiancé's hometown in Southern Poland with a cardiac condition. It’s called Tetralogy of Fallot, and it’s one of the most common cyanotic heart defects in babies. The defect is comprised of four basic lesions: a hole between the bottom two heart chambers, obstruction of blood flow to the lungs, a large right-sided heart chamber and an overriding aorta. The severity of illness is dictated by the degree of obstruction of blood flow to the lungs.
My friend says the baby needs to come to the United States—the operation is too complicated for the team in Poland. At first, I’m surprised, but as I read on, I realize the extent of the baby’s illness. The blood vessel that is supposed to take blood from the heart to the lungs is atretic. Maybe even absent. Instead, blood flow to the lungs is supplied by multiple anomalous collateral blood vessels feeding from his aorta. Likely, these blood vessels will constrict over time, cutting off all flow to the lungs.
Attached to the email is an estimate from the US hospital. It looks like any other estimate – I have similar ones for house or car repairs. The difference is the patient’s name at the top and the number of zeros at the bottom. 1.5 million is a lot of zeros.
I’m reminded of a story in Anthony Doerr’s Memory Wall. A father, Pheko, stands in line outside a clinic in a South African shanti town. Mothers and children sit on upturned onion crates and sleep on blankets and the wind gusts through the town, lifting dust and shaking the lampposts. It’s 2 AM and the line doesn’t move. His son is listless and febrile. His son soils his clothes twice and the father leaves the line to clean him. Doerr writes, “Every hour or so a bleary nurse walks up and down the queue and says, in Xhosa, how grateful she is for everybody’s patience. The clinic, she says, is waiting for antibiotics.”
As I read the words I drown in despair and frustration. I think of the millions of parents across the world who, like Pheko, are unable to provide the medical treatment their children need. Now, when I give my children medicine, I think of that story. I think of that father. Sometimes I think of that story when I order antibiotics for a septic baby or when I place a baby on a ventilator, and we drip milky white surfactant into their lungs. I think of how I don’t have to consider the cost. I can care for my patients without checking to see if their parents can pay. I don’t have to turn anyone away.
I’m reminded too of a podcast I listened to in which Joseph Stern, MD tells of his volunteer work with One World Surgery in Honduras. He tells of how a femoral fracture can lead to permanent disability for the thousands of people who cannot afford an operation. What would be a painful inconvenience to someone in my town is a life sentence of immobility, unemployment, and marginalization for someone in the mountains of Latin America.
It’s difficult to think of how the baby in Poland may never feel the rumble of a jet engine under his body or hear the foreign words of an American doctor—there may never be enough numbers in his father’s bank account. 1.5 million may as well be infinity. It is beyond the scope of my imagination. Perhaps a corporate donor will step forward. Perhaps a nonprofit will bridge the gap. In the morning I will email a cardiology friend at Duke to see if he can help. It’s a long shot but it’s all I can do.
Note: The day after writing this, my friends texts me to tell me the baby in Poland died. His name was Kuba.