This from Cutting For Stone, a novel by Abraham Verghese that I liked very much. It sags quite a bit in the second half and I don’t totally understand the choices the author made about which moments to expand and which to collapse or leave off-stage. But I found the characters in the first half so well and tightly drawn, and the story line was propulsive enough to carry me through the duller parts. I also really admired the way that he wove the story of Ethiopia into the fabric of the narrative. Not overwrought or thick with exposition, but also not at all secondary. The turmoil, politics and even geopolitics play decisive roles in key plot turns, but the book never stops being about the individual characters and their complicated entwinements.
The excerpt below got me thinking about the American health care system, and the yawning gap between the most elite medical centers and the most marginalized ones. For all our endless discourse about how broken everything is, we never really look at that disparity head-on, nor talk much to the folks on the down-side of it:
“The poorest in America are the sickest. Poor people can’t afford preventive care or insurance. The poor don’t see doctors. They show up at our doorstep when things are advanced.”
“Who pays for all this, then?” I asked.
“The government pays with Medicaid and Medicare from your taxes.”
“How come we can afford a helicopter and a helipad if we’re so poor?” The bull’s-eye atop the newer four-story part of Our Lady, with the blue flashing perimeter lights and the shiny helicopter that came and went, seemed incongruous for our setting.
“Salah, you don’t know abut our claim to fame? Our number one industry? Sometimes I forget you just got off the road. Man, that helipad was paid for by hospitals that are the opposite of ours. The helicopter is really theirs not ours. Rich hospitals. Taking care of the wealthy, the insured. Even if some of them take care of the poor, they have a big university or a university private practice to underwrite their costs. That kind of taking care of the poor is noble.”
“And our kind of taking care?”
“Shameful. The work of untouchables. Those rich hospitals up and dow the East Coat got together and paid for our helipad so they can fly here. Why? Ischemia time! You see, what we have here in our neighborhood is an abundance of guns, ABMs, ALMs - Angry Black Males, Angry Latin Males, and actually angry males of all stripes. Not to mention jealous females. The man on the street is more likely to carry a gun than a pen. Bang! Bang! Chitty! Chetty! And so we wind up with too many GPO patients - good for parts only. Young, otherwise healthy, but brain dead. Pristine hearts, livers and whatnot. Under warranty to keep going long after your pecker droops. Great organs. Great for transplant. Transplants which we can’t do. But we can keep them alive till the vultures get here.They get the organ and run. Next time you hear the whup-whup-whup-whup, don’t think helicopter blades. Think pays, moola, dinero! Heart transplant costs what, half a million dollars? Kidneys a hundred thousand or more?”
“That’s how much they pay us?”
“Us? They don’t pay us a fucking cent! That’s how much they make. They come, cut, and take, show us the middle finger and ride off in their whirlybird leaving us on our camels.”