Last week, I woke up disabled. Not “differently abled” or some such nonsense, but with something important that out of the blue didn’t work any more. This is the penalty you pay for living, sometimes, and I’m lucky in that it’s likely that I’ll have a pretty good return of function (although any time me or one of my colleagues tells you that “you may have some permanent residual disability”, we’re not just hedging our bets). It’s going to be a while, though, and it’s going to involve some work and pain on my part, and I may have to learn to do some things differently. Through the week, I alternated between depression and determination, as I came to terms with what was ahead of me.
This morning, my medical profession and my nation are waking up disabled. No accident, this, but rather the designed and deliberate outcome of the work of people who wish us harm. Ignorant breakers, no more acquainted with the mysteries of medicine than they are with the intricacies of fair play or the strictures of ethical constraints. But just as with my own condition, this imposed disability does not change who we are. The idiots have spoken. They have elevated payment above practice, wheeled and dealed their way to a Devil’s bargain, and missed everything important about caring for the ill and the well in the process. So be it.
So tomorrow I begin my part of our national rehabilitation. Some things may be harder than before, because parts of the system – payment, reimbursement, rules, common sense – are now broken or gone. Some things I may have to do differently. Government panels, for example, do a terrible job of evaluating evidence and recommending practice. We are to be blessed with an abundance of poorly-informed government panels to supplement the ones we already endure. I will have to simultaneously fend off their advice while finding new and better ways to evaluate evidence on my own. Payment will be denied for services I find necessary. So I will have to find still more ways to serve without that payment. Political panels will want to tell me what to say to patients. I will have to tune that out and speak truth.
Most of what I deal with for the next several years will be colored and constrained by the damage done tonight, and it may be hard to stand up straight and practice. So I will learn to walk with a limp.
There is a limit, of course, to the amount of damage that a profession or a nation can withstand. It is possible that, armed with this latest weapon, the fools and demagogues who created this atrocity will use it to hack away at the principles of the profession until we achieve Soviet-level life span and health metrics. Part of the extra burden of our new disability is that we have to take the axe away from the madmen. Elections are coming, and we all have a job to do.
In the end, however, it is simply this: I didn’t get into this job because I cared all that much about reimbursement, insurance, lifestyle, or even common sense. I did it because I was called to do it, and because I have been lucky beyond belief. Much so have I been lucky beyond all reason to be born in this nation, and to have been placed where I can do some good in a hard time.
As the sun set both literally and figuratively last night, it was a time of crippling. In the morning, it is time to begin the work that will transcend it.