Many Patients Don't Survive End-Stage Poverty - NYT op-ed - no paywall
https://www.nytimes.com/2024/04/11/opinion/doctor-safety-net-hospital.html?unlocked_article_code=1.kE0.YcGb.hjj9hDFyIM9B&smid=em-share*******
He has an easy smile, blue eyes and a life-threatening bone infection in one arm. Grateful for treatment, he jokes with the medical intern each morning. A friend, a fellow doctor, is supervising the man’s care. We both work as internists at a public hospital in the medical safety net, a loose term for institutions that disproportionately serve patients on Medicaid or without insurance. You could describe the safety net in another way, too, as a place that holds up a mirror to our nation.
What is reflected can be difficult to face. It’s this: After learning that antibiotics aren’t eradicating his infection and amputation is the only chance for cure, the man withdraws, says barely a word to the intern. When she asks what he’s thinking, his reply is so tentative that she has to prompt him to repeat himself. Now with a clear voice, he tells her that if his arm must be amputated, he doesn’t want to live. She doesn’t understand what it’s like to survive on the streets, he continues. With a disability, he’ll be a target — robbed, assaulted. He’d rather die, unless, he says later, someone can find him a permanent apartment. In that case, he’ll proceed with the amputation.
The psychiatrists evaluate him. He’s not suicidal. His reasoning is logical. The social workers search for rooms, but in San Francisco far more people need long-term rehousing than the available units can accommodate. That the medical care the patient is receiving exceeds the cost of a year’s rent makes no practical difference. Eventually, the palliative care doctors see him. He transitions to hospice and dies.
A death certificate would say he died of sepsis from a bone infection, but my friend and I have a term for the illness that killed him: end-stage poverty. We needed to coin a phrase because so many of our patients die of the same thing….
*****What is the saying …. The measure of a society is how they treat their most vulnerable …..
= new reply since forum marked as read
It is alive and well among the moderately wealthy and the upper middle class, and it can often be found at even lower levels than that.
For example, when Habitat for Humanity wanted to build homes in my town, who objected? Middle class and upper middle class folks who lived in the neighborhood where Habitat wanted to build, that's who. Property values are EVERYTHING around here, and people are suspicious of anything they fear might possibly affect theirs, regardless of who would be helped or how badly they may need that help. I was horrified to see how strenuously people objected to allowing Habitat to build in their nice, but definitely not particularly upscale neighborhood. It was textbook NIMBY.
The uber wealthy would probably fight something like that, too, but they are insulated from this kind of thing. No one is going to try to build a Habitat house in their neighborhoods, because no one except them can afford to buy land there. Those in the socioeconomic strata that are comfortably off, but without a lot to spare, are the ones affected by this kind of thing, and they will fight it tooth and nail.
A big part of the problem is that many people see helping the needy as a zero sum game and fear that any help given to others will mean something taken away from them. These are the people who keep voting in Republicans year after year, because they know that's the party that isn't going to try to help anybody. It doesn't occur to them that Republicans are also going to do things that will be bad for them. 
In case you're wondering, Habitat did eventually build some homes here, not in the neighborhood where they initially tried, but another one where, I assume, the homeowners didn't object as much.
K and R but I can find no appropriate words. 
