Take, for example, our transplant center’s requirement for three people to make up a support team. No one can survive the physical and emotional toll of transplant without assistance, especially in the first year. But not everyone is lucky enough to have people who can commit to helping with medications and appointments. Will we choose not to list someone whose family members live in a different state? How about a patient who would be an ideal candidate but simply lives an isolated existence?
And even if a patient is approved for a transplant, the process — like any protracted hospital stay — can bring with it unanticipated out-of-pocket expense. While the procedure itself and required medications are typically covered by private insurance or Medicaid, patients who live far from a transplant center and need to drive back and forth for appointments might have to incur the cost of an overnight stay just to be seen by their doctors. Even the simple act of parking at a hospital can cost hundreds of dollars each month, a largely unseen drain on patients and families who are already struggling simply to exist.
Even as we prepare for this next wave, my 61-year-old patient and his family continue to wait. Standing at his bedside, I am struck by the reality that if his son had not pushed for him to be transferred to a hospital that would consider him a potential transplant candidate, if we did not have access to the machine that could make it possible to reach that goal, he surely would have died.
Maybe he still will, his family’s grief only protracted. He is just at the start, and we cannot yet know whether he will even make it to transplant, nor what will happen if he does. But he has a chance.
When Dr. Nirmal Sharma, the medical director of transplant at my hospital, first talks to patients and families like this one, he asks them to imagine themselves at the base of a mountain.
“If we look up at the mountain, we grow overwhelmed and feel that we are going to fail,” he tells them. “So we don’t worry about the peak. We focus on the individual steps. There is still no guarantee. But we’re going to attempt. That’s all we can do.”
Daniela J. Lamas, a contributing Opinion writer, is a pulmonary and critical-care physician at Brigham and Women’s Hospital in Boston.
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