freedom. a tribute to cindy

It was one of those hot and dry summer days in Kansas City. It was about mid-day.  I adjusted my necktie and walked into our small humble conference room in my newly built Direct Primary Care office to meet a potential new member. This was a “meet and greet”. I was a young physician who just started on a new journey to bring change to our health care system. 
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You see, I had been an employed hospital medicine physician for 5 years prior to this moment and I had come to realize that primary care was in dire need for a real make over. It is the foundation of our health care, the gatekeeper, the seed that if planted just right and is cared for, it can blossom into something special with good health outcomes.  

I had seen enough. I had set out to eliminate financial barriers, system barriers, and communication barriers that were in the way of providing good primary care services. The current health care system rewards “sick” and “reactive” care. When the truth is that primary care can handle 80-90% of your health care needs and PREVENT downstream costs and illnesses. We need to flip the current paradigm of specialists first with primary care for cough and colds, to PRIMARY CARE, THEN specialists if they are needed. And if they are needed, let's get their help and then have them leave the party. Crowded parties are messy, loud, confusing, and we can barely hear each other talk!  

As I entered the conference room, I was met by a sweet young woman who was dressed in a full sleeve shirt and jeans on this scorching summer day. I was immediately intrigued and curious. I smiled and greeted her as I usually do with these “meet and greet” meetings.  
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After a few pleasantries and small talk, she said, “I heard about your practice from my nutritionist after I was complaining about how I feel like a pinball in our health care system. No one is giving me answers to my questions.”  

I nodded my head. Many people in sales and other professions can relate to how her statement initiated a response in my head instantly. All the things you say and the stories you share in your marketing strategy come forward in your brain itching to spill out of your mouth. My brain was screaming, “I know! I have heard this a million times! This is why I am here!”  

But, I stayed calm and nodded.  

She then went on to roll back her sleeves. It felt like it was in slow motion, because the rash that was living underneath that shirt was so red and angry that although my eyes widened, I made sure my mouth stayed closed.  

I was speechless. 

This rash went up to her neck and she told me it even covered her legs and back. It was remarkable. I assured her I would give her the best care I can and review the work up she had completed. After a little more questioning and back and forth, she was satisfied and signed up for our services.  

​Over the next few weeks, I was able to review her case in detail. It turns out, she had a skin biopsy done, but somehow there was no action taken based on that biopsy because the conversation stopped. She did not have health insurance. The treatment would cost too much so everything halted at that moment.  

I presented this case and the biopsy results to another dermatologist using a Telemedicine service that is FREE for our patients to see if the treatment I was considering for her would be reasonable. The medication I wanted to use was much more affordable cash price and I could dispense it at our office for her. The dermatologist agreed and we started the treatment.  

​After a few weeks on the treatment, her RASH DISAPPEARED! She wore short sleeve shirts again and flip flops. She was ecstatic.  

Primary Care wins! 

After about a year or so, she had a cough that would not go away. She was feeling ill and short of breath. She continued to smoke cigarettes, so we ordered a chest x-ray to look. She had been treated with the usual steroids and inhalers with the occasional antibiotic. The x-ray showed a spot that was concerning. The cost of the xray was $35. Knowing she did not have health insurance, I discussed with her about getting a CT scan of her chest. This would be around $300 cash price. We decided to move forward with it and get the CT scan.  

Within the next day she had her CT scan and by this time, she was more breathless. I reviewed her CT scan and sat back in my chair a second time...speechless.  

There were lesions that looked concerning for cancer everywhere in her lungs. Lymph nodes were also enlarged, suggesting possible spread of the cancer.  

So, here you have someone who has no health insurance and facing something that may potentially harm her and make her bankrupt in a matter of days.  

I called the Oncologist and Pulmonologist at the hospital. I then called the case manager at the hospital to review the case and see if we can get her qualified for Medicaid. Then, I called the ER physician to explain our master plan. We needed to admit her to the hospital to get all the necessary imaging completed and a biopsy, while we get her breathing better. However, we also wanted to assure she would qualify for Medicaid given our concern for cancer. It is with this game plan I finally called Cindy and said, we have to go to the ER and my team is ready to give you the best care possible.  

Later, that evening, I drove to the hospital after I finished seeing my patients at the office. By this time, the Oncologist and the Pulmonologist had met with her, CT of her Abdomen and Pelvis were completed, breathings treatments had started, and other treatments were occurring at the same time.  

Her ER room was full of family members. I could feel each of their eyes fixated on me as I passed through the curtains to enter her room. I was greeted by her smile that even surpassed the oxygen mask she had on. She was feeling better already. I answered multiple questions from her family and laid out a potential hospital course that would soon follow.  

After a few days, she was discharged from the hospital and started the merry go round of seeing specialists. Her Medicaid was APPROVED because of our master plan and coordination.  

​Soon she came to my office to catch up and she wanted to see me before she started chemotherapy. I took her back to the same conference room where we had first met. This time, it was a “meet and greet” for her cancer.  

I projected her CT scan on the screen and the latest guidelines regarding her cancer treatment on a large TV screen. I showed her the enemy. I said, “This is what is causing you to be short of breath.” She started to cry and said, “You are the first one to show me the CT scan and explain why we are discussing these chemotherapy agents.”  

Her prognosis was about 6 months with stage 4 cancer.  

After 3 years, she continued to play with her grand kids and was breathing better after chemotherapy and radiation treatments.  

Through this entire course, I told her to enjoy each day and think positive. Meanwhile, myself and her specialists will worry about what is ahead of us. That is our duty. Her job was to enjoy each day to the fullest and stay positive. Simple recipe for longevity. It worked.  

Cindy was a person who always wanted to be informed and be in charge the best she could. Her definition of quality of life was based on independence and maximizing time with her grandkids.  

I understood this not when I met her for the first time in that conference room. I still didn’t get it after several visits. But after years of walking this journey of life together, I learned a little more about her each time we visited. This is the beauty and value of primary care. Each visit, we learn. Each visit we get to understand one another a little better. Ultimately, a beautiful relationship is born.  

What finally took Cindy’s life was not the cancer itself. It was worsening kidney failure because of the toxicity related to her chemotherapy. She had to decide whether or not she wanted to move forward with dialysis. I spoke with her and her family the night before she passed. Together, we reviewed her options. I listened to her as she cried and shared her frustration with the sudden onset of this kidney failure.  

Then there was silence. I waited to say anything and allowed her words to sink in. We both knew what Cindy would decide. No dialysis. She was exhausted and pursued hospice care. Her last words to me that night were, “Dr Ahmed, you will never know how much I appreciate you.”  

​Her daughter laid with her in her hospital bed that night. That is how Cindy passed. She was surrounded by family and held by her daughter. In peace.  

This is our WHY. Freedom from 3rd parties getting in between patient care and making people feel as if their insurance is in charge of their health care. You are in charge, and we have a team ready to help.  
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 Happy 4th of July. Stay blessed.  
Dr Ahmed