Going undercover at the bus shelter

‘Can you get treated for brain cancer in Australia or do you need to come here?” Randy asked earnestly, as his wife, Britney, affectionately adjusted his beanie to cover his scars.

“We’re so lucky to be American,” she piped up, “with the best doctors in the world. Randy would certainly be dead if we lived somewhere else.”

Some background…

Bus-stop-009At 5.06pm, I’d arrived at a deserted suburban bus stop to catch the scheduled 5.07 bus. At 5.08, an overweight middle-aged woman rushed up, panting. Betsy reminded me of a stereotypical loud brash American tourist — but this was in America and I was the tourist.

An excessively long exchange about bus timetables ensued, involving detailed speculation as to whether the bus had come early or was running late. Just as the logorrhoeic discourse was blessedly winding down, Randy and Britney arrived, eager for bus-related news. Betsy was only too happy to oblige.

She was one of those kind-hearted yet strongly opinionated women who have no qualms about asking personal questions and giving unsolicited advice. To be fair, she was equally unfazed about sharing her most intimate details with strangers: financial, health-related and romantic.

To my surprise, Randy’s response to Betsy’s “So, what’s wrong with your head?” was a frank and detailed description of his 13-month journey with cerebral malignancy.

As an undercover doctor, I found this all very intriguing. I’m used to hearing strangers spill their guts, but it is usually within the safe confines of a consultation room, where trust is given freely and confidentiality is assured.

It is an honour and a privilege with which I’m comfortable but I don’t take it lightly.

But Betsy, Randy and Britney did not establish my credentials. I could have been a criminal mastermind, who would use such intimate details for self-serving purposes. Or a writer, who would pounce on their confidences and write about them for self-serving purposes … hang on.

The point is, I could have been anyone — an axe murderer, a doctor, both, neither — and as such, I felt unworthy of their trust.

The conversation turned from the glories of US tertiary healthcare to its personal cost. Randy’s five neurosurgeries, radiotherapy and ongoing chemotherapy at Mt Sinai Hospital had not come cheap. His boss had kept him on unpaid sick leave so that his employer-paid medical insurance could continue, but after 12 months Randy was forced to resign. No insurance company would cover his “pre-existing condition”, leaving Randy uninsured and facing financial ruin.

It made me, once again, realise how lucky we are in Australia.  In recent times there has been outcry over rising out-of-pocket health expenses and the proposed GP co-payment. While these are of legitimate concern to Australian patients and doctors, our system is pretty darn good. A 24-year-old Australian with cerebral malignancy doesn’t have to go into debt to receive quality medical care.

However, my pointing this out to the now-crying couple was not going to help, and for once in my life I didn’t quite know what to say.

Luckily, Betsy did. Having had a two-decade-long battle with Medicare, Medicaid and other social services as a result of her chronic back pain and fibromyalgia, she knew all the tricks of the trade. She told Randy where to go, to whom to speak and to what he was entitled, as well as providing her phone number to call if he needed help. Randy and Britney were really touched, and when the next bus came there were hugs all round.

It was the most meaningful hour I’ve ever spent at a bus stop. I’m glad I missed the bus.

All names have been changed.

First Published in Australian Doctor on 20th  September, 2013

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