You Get What You Need

What will the future of health care in Western New York look like?

In the following four stories, an interwoven cast of patients and health care providers - Barry Glover, Miranda Trimble, Don Castle, Laura Castle Clark, Felicia Johnson, Tony Tomasello and Anita Wallace - interact with each other on a single day in 2018, Friday, June 22, to be exact. The date is the same in each story but each Friday has been reached along a different path, with distinctly different outcomes for all involved.

The Story

The recession of 2009 made cutting health care costs a priority for the 2010 Congress:

  • In WNY, health facilities and providers merged to form more efficient delivery systems.
  • Now medicine focused on prevention and education, with classes on nutrition, exercise, smoking, and substance abuse.
  • Most people took part, though sign-up rates were lower for the mentally ill, the poor, and those mistrustful of government "systems." Therefore, many families remained vulnerable.

77 percent of community conversation participants said they would like to see WNY health care head in this direction

Positioned on his back, wearing a crisp paper gown, Don Castle kept his eyes on the flat panel monitor beside his gurney.

He asked himself once again why he couldn't have waited a year or two for this procedure. "Even if your father hadn't died of colon cancer," Dr. Tony Tomasello had said during his first office visit, "this could save your life. The more colon screening I do, the less surgery I have to do."

Castle had read the magazine articles, had been happy to get a break on his insurance premium for being part of his employer's physical fitness program. And he had tried to eat a balanced diet-but the pizza in Buffalo was just so good.

"This is so much less invasive than the old way," the doctor said, moving the imaging wand over Castle's abdomen. "By the way, how's your daughter?"

"Still pregnant," Castle said. "She's got diabetes and already had one miscarriage. But this time she's getting really good prenatal care and she monitors her blood sugar seven or eight times a day. She has an appointment for a Caesarean next week."

"Where's it being done?"

"At the hospital right across the street from here. Laura and Mike live down in Holland," Castle explained. "But she used the internet to find the best doctors for high risk pregnancies, and they're here in Buffalo. Thirty plus miles is a long haul when you have her problems, so they decided to schedule her delivery."

"See these small pockets right here?" the doctor said. "Diverticulosis."

Castle swallowed. "Is it serious?"

"It's a normal part of aging. Just stick to a balanced diet with fruits and vegetables and drink lots of fluids."

"Getting old is no fun," Castle said.

Dr. Tomasello laughed. "You sound like my mother, or how she did before her mild dementia set in." He sighed. "She was okay at home with us until she fell. Now she has to go into a nursing home. At her age, with her confusion, nobody will approve a hip replacement or rehabilitation."

Castle said, "They straightened out Medicare and Medicaid, according to my wife."

"She's right. More preventive screening, more flu vaccines, stable funding agreements between federal and state governments." Dr. Tomasello shifted the wand again. "Almost done...So what is it your wife does, Mr. Castle?"

"She's the financial officer at Autumn Valley Nursing Home."

"Really? That's on our list of homes to visit."

"A nice place," Castle said. "They take good care of their residents."

"Glad to hear it." Dr. Tomasello patted his arm. "You'll be happy to know you're clean and healthy, not a polyp in sight. You can wait another four years before your next procedure. Because of your father, I recommend a screening for any siblings you might have."

"My brother didn't sign up for this coverage," Castle said. "He's one of those guys who never trust the government. Now, thanks to his wife's lung cancer, he may lose his house."

"The system's not perfect," the doctor said, "but it beats losing everything." He was quiet a moment, then said, "Hey, my nurse and I have a little bet about your lunch plans..."

"I treat myself to steak once a month," Castle said. "Today's the day."

Twenty minutes later, as Castle was leaving the doctor's office, his cell phone buzzed on his hip.

"Don," his wife said when he answered, "Laura's water broke. She's on her way to the hospital out there."

"Call her doctor here," Castle said. "Maybe he can get online for a virtual surgery link. Then go outside and wait. I'm on my way."

As he closed his phone, the steak he had dreamt of for a week began to recede from his mind's eye.