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In Medical Trenches, Feelings Run Deep : Reform: Clinton's speech evokes emotions of frustration, anger, fear and hope among the professionals. Some worry about their own futures.


It is momentarily quiet in the emergency room of Houston's Hermann Hospital. Paramedics who serve the med-evac helicopter are watching President Clinton on television and sharing Gummi Bears and chocolate candy with a group of nurses. Here, in one of the grittiest bunkers of the health care delivery system, the foot soldiers are tired and skeptical.

"He's going to solve all our problems with that credit card," whoops paramedic Norman Williamson.

In the intensive care unit of Denver General Hospital, nurse Sharon Wilbert pauses beside a television set at the end of her 12-hour shift. On a nearby bed, a 45-year-old man lies comatose, his shriveled body pierced by 17 intravenous tubes. The President's words move Wilbert to express the strung-out exasperation those who live too close to chronic illness sometimes feel:

"I hope we'll see a change in what we'll do for patients who don't take care of themselves. We see gastrointestinal bleeders month after month who go home and drink a quart of gin a day until they're back in here. Why should taxpayers have to pay for that?"

Whatever it meant to others, Clinton's health care speech Wednesday night struck those who work in the trenches of medicine with unique--often personal--force. It brought to the surface feelings of frustration, anger, fear and hope. In some, the President's speech sparked thoughts about their own futures. In others, thoughts of the terrible social and ethical issues that lie beneath the surface of modern medicine.

Worlds away from the well-honed responses of policy analysts and professional spokesmen, their reactions spoke volumes about the challenge facing both Washington and the nation.

For all their cynicism, the nurses and paramedics in the Hermann Hospital ER have friends or relatives who have been burned by their insurance coverage. Paramedic Williamson's father-in-law pays $700 a month for private insurance that only covers catastrophic illnesses. "He has hypertension, but the insurance doesn't pay for treatment," Williamson says. "You have to admit there's a problem with the system."

A telephone begins to ring in the dispatcher's office of Life Flight, the hospital's helicopter trauma unit. Clinton is momentarily forgotten. A 24-year-old man has flipped over the handlebars of his mountain bike on a darkened trail in nearby Memorial Park.

Within minutes, a helicopter arrives and the man is laid on an examining table, conscious but dazed, sucking oxygen through a mask. His long hair is clotted with sweat and dirt. He appears frightened.

A doctor runs a pin across the soles of his feet; there is no response.

Later, Dr. Dennis Bartasis, 40, the emergency room physician on duty, thinks about the case and what the President has said about costs and universal care. Bills for the helicopter flight and the emergency room care alone may exceed $10,000.

"A single guy, this young--I doubt that he's insured," he says. "We're already doing what Clinton wants us to do. This is reality. This is what we've been talking about, brought to life."


At Denver General Hospital, it is not the first time the 45-year-old chronic alcoholic has been in intensive care. It probably will be the last, but his family wants everything possible done to prolong his life. The cost of this stay already exceeds $70,000; it is expected to climb higher.

Fewer than 15% of the 110,000 patients seen last year at Denver General, which is largely supported by county funds, Medicaid and Medicare, had private insurance. This patient is no exception.

Respiratory therapist Dan Burst, standing near the television set in his green garb, agrees with nurse Wilbert.

Beyond waste and inefficiency, the nation has to make some wrenching choices about things Clinton did not bring up. One of them is rationing.

"There's a huge gray ethical area that needs to be confronted," says Burst.


Dr. Cornel J. Lupu's examining room is fast filling up. His wife, Jan, who serves as his receptionist and office manager, gently reminds him that three patients are waiting. But Lupu, a Miami internist who specializes in geriatrics, wants to talk.

"The President is a great orator," says Lupu, a native of Romania who came to this country when he was 18. "There's no question that the health system needs revamping. Whether the cure is worse than the disease, we can't tell at this point."

A solo practitioner for the last 15 years, Lupu has resisted joining an HMO. "I'm very proud of what I'm doing," he says, but he fears "my days are numbered."

He sighs. "We doctors have managed to put ourselves in such a terrible public relations position. Everything we say can be considered as self-serving. The fact is that primary care physicians work very hard and make very little money."

"I think we're going towards gigantic clinics that will offer efficient medical care but very little personal touch in a K mart type of atmosphere. I'm not optimistic about my survival in this environment."


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