I recently read an article where Rudy Giuliani said that America has the best healthcare system in the world.

A very vindictive part of me kind of wishes he was uninsured, gets diagnosed with rectal cancer, gets charged $23,000 for the CT scan used to diagnose it, and that be the end of his options.

Of course I don’t really want that, but I want him to know how it feels. Because I saw a patient last Saturday at clinic that is going through just that. Here is how I would write the History of Present Illness:

A 55-year-old Mien man presents to clinic today with a diagnosis of rectal cancer. He wants to inquire about medications to treat his cancer. The patient is uninsured, but is paying out-of-pocket to the UC Davis Medical Center for the CT Scan used to diagnose his cancer. He has had rectal bleeding since July 2009, but delayed seeking medical treatment because of his insurance status. He was finally diagnosed in December 2010 when he was admitted to the UC Davis Emergency Department. The patient complains of rectal bleeding every time he has a bowel movement (3-5 times/day) and even when he isn’t having a bowel movement. The patient used to be a farmer, but is currently unemployed because his condition prevents him from working.

This man has had cancer for 19 months at least without any treatment. This is the saddest case I have seen yet in clinic. What can a dinky little student-run clinic do for him? (I love our clinic, but it is dinky). Not much. We did a physical exam, and I saw the bleeding for myself. It seriously looked like he was on his period, but out of his rectum. We drew blood to test if the cancer has metastasized to his liver, and to test other markers I don’t really understand.

But besides the lab tests, the most important thing we could do was to be his advocate. So our medical director wrote a letter advocating that he should receive Medicare despite his age. As of right now, I’m hopeful that he will qualify for Medicare. Thus, I’m hopeful about his prognosis. He is supposed to return to clinic this Saturday, and I really hope he returns with good news. Because right now, I’m very optimistic. But if Medicare rejects him…I don’t know how I will handle it.

So this is my story as a medical student. This is my story about why our nation’s healthcare system is so fucked up. I don’t have a nation-wide solution to the problem. But at least for California, WE NEED SINGLE PAYER!!!!!!!!