Free Clinic Purgatory – my experience and thoughts on the care of the poor and the sick

Like a lot of philosophical realizations, this one started out while in great pain. After all, wasn’t it Confucius who said “A healthy man wants a thousand things, a sick man only wants one”? 1

I had to go to the hospital emergency room a little under two weeks ago to take care of a minor-but-quite-painful foot issue. Because I was there on a Sunday morning, there was little wait time in the lobby; perhaps I picked the right window after the drunken brawls and before the after-church crowd?

All in all, it was around two hours of discomfort waiting on various tests and x-rays and then I was given multiple prescriptions and sent on my way. While convalescing in the triage bed, I began thinking of how the entire experience now as a forty-year-old with good health insurance is so much better than when I was a broke twenty-year-old kid who had to rely on free clinics when I was sick.

Down and Out, Circa 1998

I dropped out of college at twenty. I suffered greatly from major depressive disorder, but I didn’t get that diagnosed for well over a decade later. At the time, I just thought I was permanently screwed up by abuse from my childhood–my inability to complete classes or hold a job for more than six months was a sign that I was personally, irrevocably broken and I might as well surrender to my own failure. I’m sad to say it took a very long time to pull myself out of that mental nose-dive, but that’s a different story for a different day.

During that time, when I was no longer covered on my parent’s health insurance and I was on unemployment between retail gigs, I woke up with an immense pain in one ear. I knew it was probably an ear infection, but I didn’t have the money to pay for a doctor or ER visit directly, and the free clinic required standing in line for hours. I took a large dose of ibuprofen, went back to bed, and continued wallowing in mental misery with additional physical pain. Like I said, I didn’t always make the best decisions during that chapter of my life.

That night, I couldn’t sleep for more than an hour or two as the pain had now spread to both ears and the discomfort was so intense that I could feel my own heartbeat tapped out painfully within my ear. It felt kind of like someone had jammed a syringe needle inside my ear drum and was tapping out my heartbeat on the end of the syringe.

Enough was enough–I looked up the website of the local free clinic and their policies. I had to show up at a certain time at a certain place, and they would take the first 50 people in line. Simple enough. I planned on arriving an hour early–surely that would be enough time. I grabbed the necessary documentation and thankfully had a quarter-tank of gas to get there since there were no public transit options from the place I lived at that time.

I arrived at 7:00 AM–a full hour before the registration for the free clinic began–and there were a lot of people already in line. Maybe too many. I quickly parked, grabbed my papers and my book, and got in line. You can probably see where this story is going: I ended up with a number somewhere in the 60s and was turned away at 9:30 AM.

At that point, I should have said to hell with it and drove myself to the ER, but I was on my own now and I was so worried about getting into debt I couldn’t pay that I drove back to my place, took more Advil, and resolved to get there earlier tomorrow.

Free Clinic Visit, Take Two

It was a long day and a longer night, but I made my way through it and arrived at 5:30 AM at the free clinic the next morning. There were only five or so people there ahead of me this time. I was checked in at 9:00 AM and at roughly 10:30 AM I was told to come back at 8:00 PM that night to see the doctor.

“I’m sorry, I thought I was here to see the doctor right now,” I said.

The intake counselor, a motherly black lady in her forties with kind eyes, sighed. “No, honey, this is the line to get on the list to be seen, but you won’t be seen until after their doctor’s offices close, they have dinner with their families, and come back at 8:00”. You could tell she had to give this disappointing news out several times every day, and it was the sort of news that always took something out of one’s mental endurance. At least it would if I had to do it every day.

I nodded, tears welling up a little in my eyes. “Oh, okay.”

She grabbed my hand and squeezed it. “You’ll be alright honey. Come back at least an hour early to get back in line.”

Killing Time and Fighting Hunger

I had just enough gas to get home that day and I was broke until my $115 weekly unemployment check would arrive in the mail tomorrow. I walked back to my car, rolled down my windows, and prepared to hang out for the next eight hours. After an hour or so, I was sweating too much to continue reading my library book and decided I could spare enough gas to go to the library two miles down the road.

I don’t remember what I read at the library that day, only that I was glad to find a temporary escape from the South Carolina summer heat and a place where I could fill up the empty coke bottle in my car with cold water for free.

Honestly, I was in so much pain that day, I probably just sat in a chair and flipped through magazines, trying not to pass out so I wouldn’t get kicked out of the library.

At 6:00, I was desperately hungry and went back to my car to scrounge. I found $1.20 in loose change which let me buy a double cheeseburger from Mickey D’s. I also found an old pack of peanut butter crackers in my trunk and ate those immediately. They were stale and left a bit of a rancid peanut butter taste in my mouth, but they calmed my stomach and twenty minutes later the sublime greasiness of the fast food cheeseburger scoured the peanut butter taste from the roof of my mouth.

Back to the Clinic

I ended up in line at the clinic 90 minutes early–I wouldn’t get turned away again–one of the first people there. I saw other vaguely-familiar faces from the morning slowly arrive. A few of them questioned each other on why they had to jump through so many hoops to get basic care, while others expressed their thankfulness they were getting care at all.

I’m not sure if the staff kept to the order from that morning, but I can tell you that patients started to be called back at 8:30 PM and I ended up seeing the doctor at 11:30 PM. The doctor was a nice man I remember as being not young or old–he was probably around my current age–who was gentle but efficient. He confirmed I had a double ear infection and gave me a prescription voucher for antibiotics and prescription-strength Tylenol for the pain. The clinic had their own pharmacy, and after another wait in a long line, I ended up back in my car at around 12:30 AM with medication. Victory!

I spent the next 48 hours mostly sleeping. I had a routine of setting an alarm clock for the next time I had to take meds, drinking water or eating something (I still had peanut butter and bread), and falling asleep.

My Aftermath

Eventually, I improved and vowed to not be in that position ever again. When I found work again in another month or so, it was at an office that promised health insurance. For the next two to three years, I sometimes had health insurance for a month or two at a time, but my undiagnosed depression led to a lot of instances where I’d call in sick and eventually employers either let me go or made it difficult enough to work there that I found a new job myself just so they don’t have to pay unemployment for letting me go. I was most definitely not in a good place.

This hasn’t been a concern of mine for well over a decade now. Through good fortune, networking, God’s grace, and hard work, I’ve managed to get my act together for the most part. I still have not-great days or weeks where I’m depressed for much of that time–I’m having one right now, in fact–but on the whole I’ve been healthier and happier in my thirties and now at forty that I ever was in my teens and twenties.

What I Tell my Children about Poor People

I have very good health insurance now and am able to afford to pay an ER fee when needed for myself or family members, but I know there are just as many people out there today in the same situation I was in twenty years ago. I wish we could find a good answer for these people–yes, some of them are poor because of their own bad decisions, but many others get caught in a downward spiral that began before their birth and they haven’t found the inner strength or assistance to get the help needed to improve their lives.

I wish I had the answers. Sometimes, my children ask my why people are poor, and I have to think about what kind of answer I can give to them that points to the nuance involved in all of the societal, economic, mental health, and addiction issues that complicate that question. It would be easier if I could just say something like “because they made bad choices” or “because someone hurt them” but that’s too low-resolution of an attempt, even for my seven year old. What I instead say is “there are lots of reasons why people are poor, and there are a lot of smart people trying to figure out ways to fix the problem, but you and I just need to try and offer a little kindness to people who are struggling”.

On my best days, I can say this right after we’ve given a few bucks, a bottle of cold water, and a pack of crackers, but other times I don’t have anything to give and my heart hardens a bit because I’ve let myself run out of things to give and I don’t want to think about how I’ve not fully done my part to help the suffering human being that God put before me that day.

The Overwhelming Necessity of Action

How do we fix this problem? I know I can’t solve that issue at the end of an already-long blog post. Strong social safety nets tend to work well in other countries, but there are many who are critical they will cause more problems than they solve.

New grassroots initiatives like UBI also promise a better path, but I’m worried about how people in fragile circumstances can be victimized by that system as well. I spent a couple of years preparing income tax returns and have seen how children are bartered to be used as dependents for a maximized tax refund. I’ve known many excellent foster parents, but I’ve also known horrible foster parents who view their foster children as little investments without emotional needs. What happens when pimps start collecting UBI for each of their “girls”, controlling this as they control all else in their lives.

On the other end are all of the potential evils of unrestrained free markets deciding all charity and social nets should be private and church-supported. In theory, I would find myself closest to this view, but in practice I don’t think we’d do a very good job of it these days.

We have 50 states with very different types of leadership and ideas; what I’d like to see is to have several states test out each of these potential solutions so we can start to work out the bugs. Let’s let California go fully NHS with health care and let Texas go 100% private and see who does a better job taking care of the poor and neglected. Anything would be better than spending more money on less care that we do right now with our bastardized, worst-of-both-worlds approach.

  1. At least I’m assuming it was Confucius since Naval Ravikant said so. I really should look that up. “Trust, but verify.”

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