A patient falls through gaps in safety net

Katy stood across from me in pain, shifting from her right foot to her left. She took a breath and her face changed -- a funny wrinkle crossed it, the kind that you see sometimes just before someone keels over.

My office is tiny, and in a step I was around the desk and next to her, eyeing places for her to land if she went down. The ratty couch so close to the desk that your knees nearly touch it suddenly looked pretty good. Then, by force of will, she managed to iron that wrinkle smooth.

This happens to me a couple of times a week -- someone walks into my office or calls on the phone with a minor medical problem. Usually they want reassurance that they don’t need to go to the emergency room. But once in a while, it’s more serious. A guy with indigestion ends up having his appendix out; a woman needing a prescription refill has an artificial hip teeming with bacteria and almost dies.

Katy is a healthy 24-year-old, but she danced a little when I pressed her stomach. The pain in her belly had been growing and now felt like fire in her lower pelvis. She wasn’t getting any better, and she was getting scared.

So was I. See, I wasn’t in the ER or even in a medical office. I was in the heart of the San Fernando Valley, at the famous movie studio where they make that TV show about an emergency room. I write medical dialogue and do story work for the show, so I have an office there.

Because I was off the clock as a doctor, if Katy had a ruptured ectopic pregnancy or a fallopian tube full of pus, all I could do for her was dial 911 and wait for the paramedics.

“What about your doctor? A gynecologist?” I asked, just like one of our TV doctors. The answers unfolded like a television story. She’d had a doctor years before, back East, but she’d come to California after college, following her dream to be a director. She got a great job at the studio but when the show stopped filming for the summer hiatus, she’d been laid off -- and her health coverage was canceled. Even though she had recently returned to work, her health insurance wouldn’t resume for a month or so. Medically, she was as alone as the mumbling guy in rags, pushing a shopping cart down Pico at 3 a.m. After a week of frustrating phone calls and increasing pain, she had come to me. She thought I would understand.

She was right. I did. My wife’s company had recently informed us that she didn’t qualify for another year of employer-based health insurance, and, with both of us on that plan, we were scrambling to find an alternative.

I wondered what my patients at UCLA would think if they knew their doctor was about to be uninsured. Like much of the public, they think I’m a millionaire who plays golf and drives a Mercedes. I drive a Buick Regal, like the one Tiger Woods sells on TV -- and that’s about as close as I get to golf.

Both Katy and I appeared to have fallen through the cracks, which seems to be part of the new world of gainful employment. At the studio, I’m an independent contractor; at UCLA, I’m a part-time clinical faculty member who doesn’t work enough hours to get medical benefits. For years, I’ve been covered by my wife’s insurance. But her company, like many others, has been backing slowly away from the cost of the miracle that we call medical care -- and each year, it’s become harder for her to qualify for coverage.

The recent strikes over health-care benefits may feel like something new, but the water has been rising for a long time and now has reached higher ground and a more vocal group of people. I’m probably not the first doctor, and I’ll bet I’m not the last, who is looking down and seeing the river rising around his knees.

Doctors try mightily to identify with their patients, and occasionally medical schools make poor, dopey students wear patient gowns and spend a day in a hospital bed in the hope that this will somehow inspire a cosmic bond between a 28-year-old kid from the suburbs and an IV drug user with a rectal abscess. It usually takes longer, when we doctors get old enough to start having back pain and tumors and heart attacks; by then, the largest part of our careers is over and another opportunity for preventive care is long gone.

I looked at Katy and wondered if we doctors would be more courageous as advocates for universal care if more of us knew what it was like to be out in the cold. An hour later, a few phone calls had Katy set to go to the emergency room of a county hospital.

And my wife had found out that our insurance was OK after all -- some misunderstanding. But as I tossed Katy into the safety net, I wondered how long before this system collapses and the net is really gone, leaving most of us walking a tightrope, a step at a time, all alone -- wishing that we’d stood together and bought our milk, clothes, cars and groceries from companies that believed in more than the bottom line and profits at any cost.

That night I lay awake in bed for a long time, listening to the city make that low, roaring sound. I wondered whether -- on some future lonely night -- I would recall closed emergency rooms and hospitals and wish I had fought a bit harder.

Mark Morocco is an emergency medicine doctor at UCLA Medical Center. He is

also a staff writer and medical supervisor for “ER,” and a consultant for

“Third Watch.”