The Ambulance that Never Came: When Being Human Isn't Enough

Our eldest son's rickshaw driver died this morning as he was taking my son to school.  Minutes before, the driver had pulled off the road, stopped, walked to the side of the road--presumably to relieve himself (so that my son averted his eyes)--and when he looked back again, the rickshaw driver was on the ground having a seizure.  He did all that he could do to help him.  My son's phone was dead so he flagged down help on the nearby road.  Someone else called for an ambulance, and, in the process, mentioned that the man was a rickshaw driver.  And so...the ambulance never came.  While they were waiting and waiting for the ambulance that never came, my son talked to the dying man--the man who'd taken him between home and school every school day for nearly two years--and did his best to comfort him as he came out of the seizure, moaning in pain, into an altered state of consciousness.  He never completely regained consciousness. When it became clear that no ambulance was ever coming, my son persuaded a by-stander who'd stopped, to drive the rickshaw driver--in the backseat of the car--and him--my son--to the nearest hospital.  The rickshaw driver died on the way and so was dead on arrival at the hospital.

My son worried that things might have turned out differently if his phone had been working.  Would he have been able to persuade the ambulance to come if they had known that he--my son--would pay the bill?   Would the driver have survived if my son had not waited so long on the ambulance that never came?  Would he have survived if my son had persuaded someone to provide car transport earlier?  There are a hundred what-if's.

It's clear that the rickshaw driver didn't die from the seizure itself, but from something else--perhaps from a massive heart attack, a torn aorta, a massive stroke, or a burst aneurysm?  Almost certainly, the seizure was secondary to that other primary event; it was the catastrophic primary event that killed so quickly.  I'm not trying to play doctor.  My point is simply that the primary event--whatever it was--was so catastrophic that the driver likely wouldn't have survived anyway.  Rich man or poor man.  Ambulance or no ambulance.  And so my son's feelings of guilt are likely misplaced.  There's probably nothing that my son could have done to ensure a better outcome--one in which his driver survived.  And my son did all he could do to help and comfort his dying friend.  Death is never easy.   "Love is watching someone die."  and staying with them, helping them know as they take their final breaths that they are not alone.  Whether those final breaths happen in a hospital setting, in an ambulance, along the side of the road, or in a stranger's car on the way to the hospital.

The fact that no ambulance ever came....and the likely reason the ambulance never came, is disturbing.  And it points up a troubling phenomenon that should make us all feel sad, angry, and guilty, wherever we live--whether that be in India, the US, or any number of countries around the world.  And that troubling phenomenon is both the inequity and the hit and miss nature of critical health care.

 The kind of medical care we get or don't get is not a function of our being a human being, infinitely valuable because we're a part of the family of man, but instead is a function of where we live, who we are or aren't, how much money we or someone else is or isn't willing to provide to enable our care (whether through directly paying the medical bills or through health insurance), and finally, how invested, persistent, brave, and persuasive--even ingeniously persuasive--those around us are (whether our loved ones, customers, acquaintances, or community members) in securing medical care for us when we need it.  And we shouldn't kid ourselves about our dependence on the others around us and on the critical importance of their judgments, persistence, ingenuity, etc.  It is simply true that when we need medical care the most, we are the most unlikely to be a condition in which we can secure it for ourselves.  We must depend on others to help us.

The truth is this:

• Where we live shouldn't matter, but it does.
• Who we are shouldn't matter, but it does.
• How much money we or those who care about us have shouldn't matter, but it does.
• The ability of those who care for us to advocate for us shouldn't matter, but it does.
• And of course, dumb luck shouldn't also matter, but it does

The death of my son's rickshaw driver is all the more ironic and disturbing because the man had been complaining to my son about his chest hurting for at least a month.  My son--a struggling student himself--had given his friend the money to go see a doctor and get his health concerns checked out.  Which he did--though he didn't give my son the details about what the doctor said or did or the treatments he was offered or given.  The question, of course, is, did the fact of who this man was and wasn't, affect both the quantity and quality of the health care he was or wasn't given?  Did a rickshaw driver get the same care and consideration and health care that an upper middle class or rich businessman, doctor, or government official--or the hundreds of medical tourists to India--in the same position would have gotten?   Were tests, medication to control high blood pressure, a stint, by-pass surgery, or cholesterol-lowering drugs suggested, offered, or given?  There is, of course, no way to know at this point.  And of course, there's no way to know if any of it would any of it have made any difference at all anyway.

But when an ambulance won't pick up a man because he's deemed not worth the effort, it does make one wonder about both the quantity and quality of health care he received when he sought it out when he was still alive...

Ironically, my son's experience today is eerily familiar in some respects to the plot of an Indian movie my husband and I watched a few months ago.  I.D. is an indie film (available on Netflix) by Director Karmal KM.  It premiered at the Busan International Film Festival in Busan, South Korea in 2012.  In the film, a relatively rich young woman tries to secure medical help for a painter who collapses in her friend's apartment.  The ambulance won't pick him up.  She flags down a car and persuades the driver to take her and the unconscious man to the hospital.   They won't treat him unless someone pays for his care.  And so she must secure his medical care by paying for it herself.  Ultimately the man dies, whereupon she embarks on a mission to find the man's family and to notify them of his death.  Which is exactly what my son spent most of the rest of his day doing.  My son returned to the scene of his driver's death, and looking through the rickshaw, found the driver's papers and ID, and then proceeded, with the help of his landlady--to try to find the dead rickshaw driver's family and notify them of his death.  In the film, the young woman's quest leads her to return to the morgue to take a photo of the dead man, and then to try to track down how the man came to be painting in her friend's apartment.  The trail is surprisingly hard for her to follow as information on the man is scarce, the numbers in his phone no longer in working order, and the trail hard to follow.  She scours local labor pool sites, following lead after vague lead, and ultimately ends up in the city's slums walking through shanties, discovering world upon world previously unknown to her.  It is a film about the have's and the have not's.

The film posits that radically different worlds coexist side by side in a city--worlds that connect only as the more well-off hire the less well-off to do the jobs they need done.  And then fail to fully comprehend the latter's humanity and treat them accordingly.  Even down to the incomprehensible idea that ambulances only come to help some people, but not others.  The movie is ultimately about the divide between economic classes.  And the resulting disparities in health care.  The most disturbing thing about this movie is that it looks full in the face, the blind eye that health care systems turn to whole segments of the population.

Though set in India, this movie's searing commentary is relevant to many countries in the world--including the United States.  It's relevant in all countries where there's a wide gulf between the lifestyle and privileges of the relatively wealthy and the lives and struggles of the working poor as they attempt to eke out a living.  

The working poor is the "other half" of the population; the people on whom the city depends to get the things done that need done.  And the movie's  commentary is relevant in all countries of the world where this wide gulf results in some people receiving the best of health care while others receive something else--inadequate or neglectful health care.  Where ambulances, hospitals, and doctors will help only some patients and not others.  The film makes painfully clear just how some are left out in the cold, unable to access the medical care that those living beside them take for granted.

Today, my son came face to face with this reality when he watched a his driver die while waiting for the ambulance that never came.  As we contemplate this story it's an occasion for all of us to question our world and the way it works--or fails to work--for some of us while working well for others of us.