An Education

Today is October 1st which means two very important things in my life. Number 1: My favorite month has just begun and the leaves are changing colors which made my walk to work this morning extremely enjoyable. The calendar is already full of fall activities and outings. Also, my house is decorated for Halloween (thanks lyss), so again, October is starting out on the right foot.

Number 2: Today, is the beginning of the new fiscal year which means many things for many people, but I'll just focus on how it affects my reality on this Tuesday. At Bread of Healing, we are starting to get our patients signed up for insurance under the Affordable Care Act. We have two full-time staff people newly trained and poised to begin this process when the clinic opens in half an hour. I entered the office today to a flurry of "Happy insurance day!" and physicians with smiles plastered on their faces. A sense of hope is palpable amongst all our staff and many of our patients. We have flyers and power points and other educational material ready to hand out as the questions come flooding in today. In light of recent events in Congress, I imagine that today will be FULL of questions, concern, confusion, hope, excitement, promise, the list goes on and on. Many of the most vulnerable in our midst will gain some form of a safety net starting today if things go as previously planned. There is much to discuss, and be excited about...but for me there is much more to learn.

As the day begins, I am stuck on a conversation that I had with a patient yesterday. It was nearing the end of the day and he was waiting to see a doctor, so I sat down in the room with him to chat for awhile. We talked about what's happening in the news as we usually do, and he started telling me about the information session he went to about the new insurance exchanges in Wisconsin. I sat and listened for awhile, before I realized that I knew VERY little about what he was telling me. His monthly income qualifies him to sign up for the exchanges with co-pays, and he was expressing some frustration about the lack of information he was given about just how much he would have to pay, and how everything would really work. I tried my best to contribute to the conversation, but I was really lost. The questions came flooding in:

"So Abbey, explain this to me, they want me to give up my free care here and buy into something that half of the government doesn't even agree with or face some kind of a tax penalty? Does that seem fair to you?"

"How much is this actually gonna cost me?"

"Is it true that my premium will cost me more because I live in Milwaukee county where there is more trauma like gun shots and gang violence? Are they really gonna tell all the poor people in this city that they should pay more than those people in the suburbs?"

And lastly, "Why aren't you answering me? You don't know?"
Bingo. I don't know. I'm a well-educated healthcare professional who is struggling just as much as my patients to understand these changes. Here's a tip to all of you Seattle U nursing students- ask your professors why this is never talked about in school. We are taught how to work in a system without ever being taught how the system works. We discharge patients all the time without a thought as to where they might be getting their medications when the ones we send them home with run out. Here I was expected to know how to help someone understand their reality and I really just didn't know.

Yesterday, I was very humbled by the fact that I am not that well-equipped for today. I don't have all the answers. In fact, many of my patients have been educating me in the past few weeks. Granted I have spent loads of time reading and trying to understand everything myself, but still anticipate today will be full of:  "I'm sorry (insert name here) I wish that I had a better answer for you."

As classes get going this week in Seattle, I am left to reflect on the reality of my education. What I learned in a classroom is a foundation for many things that I do during the day, but has still left me extremely unprepared for the reality in which most of my patients live and receive healthcare. I will work very hard today to teach and serve to the best of my abilities while acknowledging that constant nagging feeling that reminds me that I still have so much to learn and be taught. I sit full of hope as the clinic chatters with change today.

Happy October 1st. I hope we all learn something from the events of today and remember the people whose voices aren't heard in the decisions of many who are trusted to represent them.