A True Story
Money and Medical Care
First the backstory. My French wife Brigitte and I met as students at
the University of New Mexico. She received her first degree from Sorbonne
University in Paris. At UNM she continued her studies in French while I was
working on my third degree in philosophy. We both ended up teaching high school
in San Diego. After a few years of renting we finally got into a
condo. The mortgage was just over $2,000 a month with a condo fee of $500 a
month. (Yeah, that’s crazy, but that's California!) We were living in middle-class poverty, meaning we
lived well but from paycheck to paycheck. It’s a way of life in which you must
live frugally, avoid making mistakes, and don’t get seriously sick.
More
important than our income was our medical insurance. No insurance = no medical
care without going into debt, most commonly via the infamous credit card.
Still, the health insurance provided by our jobs required a $200-$300 monthly payroll deduction.
When we retired we relied on Medicare, which limited our access to medical
treatment. Still, we weren’t without medical care. And my doctor kept me on
when I lost employment insurance coverage. But yearly exams became a conversation
rather than a physical checkup. To have full access to doctors and specialists
expensive supplement plans were necessary.
Other Workers Weren’t so Lucky
The
situation for unemployed workers or part-time workers or those who work for
businesses that don’t provide medical insurance can only be considered desperate.
Just Getting by in America’s
Finest City
We
decided to retire and move to France. Old-age deterioration ended my teaching
career. Brigitte would have liked to teach another four or five years, but we
couldn’t survive on her income and my Social Security. The problem with condo living
are the surprising big fees. For example, the community had to be tented for
termites costing homeowners $4,000 each. After one of the big California
wildfires the condo’s fire insurance demanded wooden shingle be replaced by
composition shingles. That cost each homeowner $8,000.
Being an Academic Rolling Stone
My
retirement is only about $15,00 a month mainly because I spent my twenties and
thirties being a professional student. In the following order acquired an A.A.
degree in philosophy, a BA in philosophy (both in Long Beach, California), an M.A. in
psychology (Portales, New Mexico), an M.A. in English (Canyon, Texas), an M.A.
in philosophy (Albuquerque, New Mexico), and a doctorate in English (Greely,
Colorado). It was a great intellectual odyssey but poor preparation for making a living. My first
full-time teaching job at a private college (San Diego) paid $18,00 a year with no summer vacation. When I left
the college after ten years I was making $28,000 a year. I spent another 13
years at a high school and was making $50,000 a year when I retired. That seems
like a lot of money even to me but it isn’t for a family in San Diego,
California.
Paradise Beckoned
After
Brigitte’s parents died we had to decide to sell their house on the side of a
mountain in a French alpine village or move to France. We couldn’t do both.
Staying in San Diego would require selling the family house. It wasn’t a hard
choice for me. I was sick of San Diego traffic, congestion, and polluted air. I
felt we lived like mice in a maze with all the mice driving cars. As long as I
could boogie board life was bearable, but once I couldn’t boogie board because
of arthritis, I said it’s time for the Great Escape. Brigitte wanted to
continue to teach. She loved her job, but she didn’t want to lose the family
home in France.
Rehabilitating an Old Farm House
The
house was built in 1826 and was used only as a summer house by Brigitte's parents. We arrived in France
with some money from the sale of the bank-owned condo (the outstanding mortgage would require 30 more years of payments). And the condo complex really wasn’t a community. Even after five years we
were mostly a gathering of strangers and a few acquaintances. The money from
the sale of the condo was quickly spent to buy a car and have the house rewired and the windows replaced. It took only one winter for us to realize that the
old windows had to go. I spent the first winter filling leaks around doors and
windows. Still, single pane windows allow heat to escape and welcomed in the cold from outside. There was no
insulation, still isn’t. And we had to rely on electric space heaters, which
were turned on only when someone was in the room. Wood-burning wasn’t an option
because our chimney was declared a fire hazard by an inspector. Repair was
beyond what we could afford so wasn’t an option. In addition, because there is
no gas, all appliances use electricity. Electricity is expensive in France. Unlike
the U.S., France is energy poor thus has to rely on nuclear, hydroelectric, and solar energy for
its electricity. Our electric bill is about 430 Euros a month.
Three Amigos to the Rescue
Also
the stable’s ceiling was threatening to collapse and required reinforcement
with wooden beams. One section of the barn required a concrete floor for the
car; the other section where my books were stored in plastic boxes received a
wooden floor. Three really cool local old timers did all that work for about five
hundred Euros! The barn was without lighting and still is. After buying a lawnmower, cultivator, and snowblower, we were without
money for further improvements. I did what I could. I put in a vegetable garden
and a stone driveway so the car wouldn’t sink in mud when it rained or
snowed as it did repeatedly the first year. But trained in philosophy and
literature I was no handyman. Putting in tree swings for the grand kids was
about my limit.
France
After
couple years Brigitte and I finally settled in. We weren’t rich but made enough
to get by. Most of all we loved France. French society runs like a grandfather
clock. Order comes from within, from the people themselves rather than from the
government. The exception would be automobile, which brings out the worst side of the French personality, but unlike in the U.S. road rage is rare. It’s not
so much that French drivers drive aggressively but think they're race-car
drivers. Not all French drivers, of course, but once they hit the road many suddenly become in a big hurry—impatient, speeding, tailgating, incautiously passing
other cars, etc. Still, aggressive driving is rarely angry. You never see the
highway hatred that erupts in the U.S. And, oddly enough, French motorists tend obey the
laws of the road even when they're in a big hurry. I’ve had tailgaters just itching to pass me when there is
no oncoming traffic but refrains from doing so until they get a broken line.But
put them in a long line in a supermarket and suddenly they become patient as Buddha even when the clerk is having a chatty conversation with a shopper. The
French are most patient with people engaged in conversation even if the two
talkers are blocking the road.
Pastoral France
One
reason I don’t understand speeding through the countryside is that the scenery in France is so
beautiful that it encourages me at least to drive at a leisurely pace. I’ve live
in France for eleven years and still feel like a tourist. The countryside is
filled with fields, pastures, and woods. And along with the people there are
dogs, cats, cows, horses, donkeys, chickens and turkeys, sheep and goats, and
that lovable machine the tractor.
Big C in Paradise
So
we had every reason to look forward to living a pleasant retirement in paradise. But
cancer had a different plan for us. Our family doctor, now retired, was to me a
traditional country doctor. His office was next to his home, and though he took
appointments he also had a “first come first served policy” for morning visits.
We would arrive to find the waiting room filled with about a dozen patients
mostly elderly who greeted new arrivals. There were no numbered tickets.
Everyone pretty much knew who was next in line.
Merkel Cell Carcinoma
The
other thing about the doctor was he would always have me lie down for a quick
physical exam (blood pressure, lungs, stomach, etc.). Next he would ask me a few
questions about how I was doing, with Brigitte serving as translator, before
getting to the reason for my being there. His co-pay for visits was about 7 Euros. We went to him when Brigitte developed a harmless
looking small, pinkish spider-web lesion on her cheek. He didn’t think it was
something to worry about but referred her to a dermatologist in Grenoble. Unlike doctors in the U.S. French primary care
doctors won’t hesitate to refer a patient to a specialist. In the U.S.
insurance companies authorize referrals.
The
dermatologist turned out to be a godsend though the old doctor rather than God
deserved all the credit for sending Brigitte to her. We weren’t expecting a
dire prognosis, but the no-nonsense doctor recognized immediately that the
lesion was a serious threat: Merkel
cell carcinoma. She arranged for Brigitte to see a private surgeon to remove
the lesion and take a biopsy. As it turned out the surgery was extensive
involving opening and cleaning the entire cheek. The surgeon was young, in his
thirties, affable, and truly skilled at his trade. The scar was hardly noticeable. The co-pay was 250 Euros.
The
biopsy confirmed the dermatologist’s diagnosis. This required a more extensive
surgery to remove all the cancer. It was performed at Grenoble Alpes University
Hospital (CHUGA) by a woman doctor who looked like actress Marion Cotillard. It
seems as if half the doctors at the hospital are women. The surgery was just a
part of what would turn out to be a long series of treatments that would involve many
doctors, nurses, technicians, and taxi drivers. But once Brigitte became a
cancer patient there were no more co-pays or taxi fares to pay for. And who was
paying for all this? The unselfish French people represented by the French
government.
Lymphoma and Shingles Join the Attack on Brigitte
Lymphoma
It
would take over a month for Brigitte to begin to recover from the treatments
needed for the Merkel cell carcinoma. There would be more visits to the
hospital and daily home visits by nurses who would clean and rebandage her new cheek made from a skin graft. The wound was purplish and to me horrific looking. I couldn't imagine how it would ever heal, but it did. The operation was totally amazing to me as were the surgeon and her team (The Miracle Workers❤️). After the first visit I left the nurses alone to do their work. I think Brigitte preferred her squeamish husband not to be present. However, during Merkel cell carcinoma treatment it was discovered that
Brigitte also suffered from lymphoma. Apparently this cancer had been hiding out in her for a long while. It would require radiation,
chemotherapy, and immunotherapy. There would be more trips to the hospital for
those treatments provided by devoted caring doctors, technicians, nurses, and
taxi drivers. However, the treatments would depress her immune system, which
would have bad consequences later on.
A General Practitioner Comes to Brigitte's Rescue Again
She had replaced our first family doctor who had retired, the one who sent Brigitte to the specialist who discovered the Merkel Cell Carcinoma that began Brigitte long battle with cancer. Because of her fatigue Brigitte spent most of her time in bed. I would bring her meals, mostly soup and sandwiches and help her to the restroom. It was a most depressing time. Then came the realization that she had entered a period of rapid deterioration. She was so tired, she didn't seem to notice that she was getting worse rather than better. To me she seemed at death's door. I had my daughter contact our new doctor, who contacted CHUGA. They told her that they were swamped with COVID-19 patients and couldn't take another patient. Our doctor told them that they would take Brigitte or else! I don't know what the "or else" was but it worked. Our son-in-law drove up from Grenoble to take Brigitte to the hospital. There wasn't time enough to arrange for a taxi. Besides, he was Brigitte's favorite driver. At CHUGA she was welcomed by masked techs and nurses and taken to an isolation room. She remained in the hospital until her condition was stabilized. There is no doubt in my mind that our new family doctor saved Brigitte's life. And for that she joined my long list of French medical heroes who have worked to keep my wife alive.
Shingles
It
seems that one never fully recovers from cancer because checkups and treatments
can continue for years. In Brigitte’s case there were treatments to boost her
depressed immune system. Yet, in a vulnerable state she was struck by shingles
in a fashion similar to that experienced by the late Senator Dianne Feinstein.
Brigitte lost control of one eye, which made it impossible for her to drive or
read. The latter was especially painful for her since she has been an avid reader all her life, a
book or two at week. When a teenager she read Leo Tolstoy's War & Peace. Shingles (zona in French) put her in the hospital for eight days, where she
was attended to by a legion of nurses, doctors, and interns.
Her Mechanical Valet
Once
at home she continued her intravenous therapy, which required that she remain
attached day and night to a clunky mobile solution holder. She learned to
manage it when to use the restroom and even go downstairs to the kitchen. It
became her constant companion. Brigitte’s determination to survive had already
become heroic to me, but seeing her attached to the device was heartbreaking.
Nurses came daily to check on her and maintain the IV. They too were my heroes.
They kept us from feeling abandoned on the side of a mountain. Months passed.
Eventually, she regained control over her wandering eye and she could once
again read her beloved books and peruse Facebook and reconnect with friends,
though driving remain interdict for a while longer. However, for the rest of her life she would
remain on valacyclovir for her shingles. And this is where I should point out
that for all her medicines related to her cancers and shingles there was no co-pay.
They were free, though not totally free because they were paid by the French people.
Disaster at the Vet’s
After
years of Brigitte’s doing battle with life-threatening illnesses, we thought that once again our life would finally get back to normal.
But a visit to a veterinary said no way. We were taking our nervous wreck of a
border collie for his yearly checkup. At the vet he had a nervous breakdown.
He’s not aggressive, but at a veterinary he goes crazy and snaps at anyone who
touches him. When Brigitte tried to control him, he snapped at her. There was
only a pinprick of blood on her wrist so we thought it would be okay. Four
hours later Brigitte’s arm had swelled to twice its size and was becoming
increasingly painful. It was dark by then and outside a rain storm raged. My
night vision is lousy and lights from other cars are blinding, so I never drive
at night. And at eighty years of age I really don’t have much confidence in my
reflexes when driving at night. I’m a good driver under normal daytime conditions, but conditions weren’t
normal that night. Brigitte said she had to get to the local hospital’s urgent
care about 25 kilometers from us. The small-town urgent care wasn't like the emergency
care facilities of big cities. There was only a nurse and a doctor on board.
Anyway,
we hit the road. To make driving worse, much of the highway had just been resurfaced
and was without a center white line to guide me in the pouring rain and darkness. I felt
trapped in the noir film The Wages of
Fear expecting to drive off the road into the forest or drift into oncoming
traffic. Finally arriving at the hospital we walked to urgent care and rang to be allowed in. We
were welcomed by the nurse. She was calm and friendly and took us to an empty
waiting room. The hospital was like a ghost town. Brigitte too was composed and collected; however, my mood
was bleak after the noir drive to the hospital. For both of us it had been a
long day and eerie night. Seeing Brigitte’s arm suddenly double in size I could
only think the worst. I mean cancer and bacterial infections are the two most
fear medical threats in the minds of most people, including mine.
After
a forty-five minute wait during which the doctor had been treating another patient,
the nurse took Brigitte to the doctor. I stayed behind and never met him, but
Brigitte said he was great. He stuck a probe into her arm to remove what infection he could. He apologized that he didn't use an analgesic for fear that it might contribute
to the spread the infection. Thus, the procedure would be painful, but Brigitte
was a veteran of painful procedures. Afterwards, he gave her a prescription for
antibiotics. He said if there is no improvement after 48 hours Brigitte had to go to CHUGA. We didn't have to wait even 24 hours.
By
that time it was early morning and Brigitte called our daughter. She wanted our
Good Samaritan son-in-law to take her to the pharmacy. She had more confidence in his driving ability than she did in mine. For him it would be a
forty kilometer drive from Grenoble. I said that his coming was unnecessary,
but both Brigitte and our daughter said I was in no condition to be driving
around in town where I might have an octogenarian lapse and run over a
pedestrian. I was grateful to be relieved of duty. The rain had stop and the sun
was rising. Brigitte having been treated and soon to be on antibiotics, I felt better knowing that her condition was finally being treated. So during the drive home I marveled at
the beautiful scenery—fields, pastures, and forests, with mountains powered
with snow. I gave a thought to the artist Winslow Homer whom I had been
studying. “The Sun will not rise without my thanks” he said. That’s how I felt
as I headed for home.
But
that nemesis Mr. Bacteria had other plans for Brigitte. (How strange that there
are 7 types of bacteria in this best of all possible worlds!) The day passed
and the swelling and pain continued. In the predawn morning Brigitte said she
needed to go to the big hospital in Grenoble, also known as le CHU Grenoble Alpes. A taxi would be required. He or she, I forget now, came. They always do wind, rain, snow or sunshine. In good weather or bad, they come. And like the nurses who come to the house, taxi drivers are kindly men and women. They have served as Brigitte's lifeline to CHUGA. We had
to pay the fare—100 Euros—since the taxi hadn’t been prescribed by a physician. It was a fair
price considering the distance is about 50 kilometers, a third of the return
trip was up a mountain, and the price of gas in France is $5.54 per gallon. Brigitte would be four days in the hospital, during that time there would be surgeries,
antibiotics, loving care, and three wonderful meals a day. (You smile but in
France hospital food can be quite tasty.) With her arm in a plastic cast she went to the hospital yesterday and will visit the hospital again today. Apparently there will be a long schedule of treatments until the arm is given the okay by the doctors.
Is this loving care?
Because of CHUGA Brigitte has survived life-threatening cancerous, viral, and bacterial attacks. That is a remarkable shared story that has involved both courage and love. Some
people believe that expressions of love require the emotion. They can, but I
don’t believe emotion is necessary. Expressing tenderness, compassion, and
sensitivity need not require amore. And there are different types
of love. Agape, from Ancient Greek, is
considered by some to be the highest form of love, charity, a disposition to
show kindness or compassion without amore. The philosopher Emmanuel Kant might say it’s love rooted in a love of duty—doing the right thing, doing
good. Agape is often defined as God's love for human beings. That’s a stretch given God’s behavior in the Old
Testament. He destroys cities and has his own people mass murdered and created
a fiery Hell for Buddhists, Taoists, agnostic, secularists, and unbaptized. According to J. D. Vance’s hero Augustine of Hippo unbaptized babies go to hell for eternal punishment. Who would want
such a guy to be the spokesman for one’s religion? And where was the loving
Yahweh during the Holocaust? Six million Jews died and will be sent to Hell according
to that other nightmarish spokesman for the religion Apostle Paul. Personally I
can’t see Jesus being okay with such an idea, given his one and only goal in life was
to save his people the Jews—as Jews, not Christians. Agape isn’t divine. It’s purely human as
illustrated by the man Jesus and the Good Samaritan. I believe Agape is what Brigitte has received and
continues receive at CHUGA, along with other forms of loving care.
Another
form of love is philia or friendship
or good will. I believe that unlike agape there is some emotion involved (and
there’s nothing wrong with having that loving feeling present), though I would
call it fellow-feeling or perhaps brotherly or sisterly love. Some characteristic
or commonality can trigger philia. Brigitte
might remind many medical personal of their mother or grandmother (she’s both).What
is unique here is that it is love not based on a developed friendship. For
example, at the grocery store you have 30 items in your basket and the person
behind you has three. You let him or her go before you not because you feel
sorry for him or her but just because the person is a fellow-human, and the result is a courtesy. If the person is elderly or handicap then sympathy may play a part.
Sympathy alone is not an expression of love, though perhaps sympathy that inspires helpful action is. This does not quite fall in the category of being a Good Samaritan. The need isn’t great
enough. It’s just doing a good deed for a fellow human being, a moment of
spontaneous helpful friendship. Brigitte has often referred to the friendly treatment
she received at CHUGA, such as being welcomed with a smile and kind word.
The Highest Form of Self-Realization
Human
beings seek to realize themselves in endless ways, but the most praiseworthy
and noble form of self-realization as a human being is living a life inspired
and guided by moral principles. That is why the highest praise is given to men
like Buddha and Jesus and women such as the courageous Joan of Arc, Jesus’s loving mother
Mary, and the devoted Ruth the Moabite. There are two categories for moral self-realization. The first comes from the wisdom of
Buddha: avoid thinking and actions that cause suffering. The other is
illustrated by Jesus or Hippocrates: act to alleviate suffering—moral altruism.
Both are praiseworthy as being the highest achievements in life. But the latter
is superior to the former. We expect people not to cause suffering and in
some cases punish them if they do. In addition, to achieve the Buddhist
ideal one needs only to refrain from harming others. It's passive form of
morality. Altruism, on the other hand, always requires action, acting to end or lessen the suffering of another human being (or any other creature for that matter). Médecins Sans Frontières come to mind. There is no greater achievement than to dedicate one's life to end the suffering of others. That is the highest good for self-realization.
The Good Samaritan and Moral Self-Realization
The
parable of the Good Samaritan is the most famous illustration of altruism. He
goes out of his way to help a man who was attacked by evil men. (There are so many
such men in the world today.) In service to God’s law a priest and a Levite
avoid helping the injured man. Here is what the Good Samaritan does:
He
went to [the injured man] and bandaged his wounds, pouring on oil and wine.
Then he put the man on his own donkey, brought him to an inn and took care of
him. The next day he took out two denarii [two days’ wages at the time] and gave them to the innkeeper. “Look
after him,” he said, “and when I return, I will reimburse you for any extra
expense you may have.” (Luke 10:34-35).
This
is not passive morality—which is also good. It’s active morality, which is even
better. Who are the Good Samaritans in Brigitte’s story? First, France’s universal
health care system paid for by the French people. It is a government program in
so far as it is provided by the government, though private of health care also
exist in France. CHUGA is a social institution paid for and operated by French
citizens that is open to the sick and injured, to the rich and poor, and to
those with or without medical insurance. This is why as an institution CHUGA
achieves the highest moral status.
Love: Humanity’s Greatest Achievement
The other Good Samaritans are the doctors, nurses, techs, clerks, and maintenance people who work to serve patients. I think there must be a little bit of Buddha, Hippocrates, Jesus, and the Good Samaritan in people who are drawn to professions that seek to prevent or alleviate human suffering. What have been the great achievements in the human evolution? There have been many such as intellectual reasoning and artistic appreciation and creativity. These are high-level achievements, yet ironically they may not be as profound as the rather basic ability to love, not just other people as recommended by Jesus, but everything as seen the paintings of those great lovers life Winslow Homer, Monet, Cézanne, and Renoir. And what produced those paintings? Love. What inspires the devotion to care for the sick, aged, and injured at CHUGA? Love. So perhaps love does give birth to altruistic morality.
Spiritual Institutions
Spiritual
institutions are not where gods are worship but where loving deeds are
performed. Is CHUGA a spiritual institution? In the moral sense yes, and there
is no other sense. Jesus shows that the spiritual life = the moral life. To
understand this one must focus on his actions, not his words, which are not
trustworthy because they are not his words but the words of writers of the
Gospels. Spirituality is associated with that which is other than the material
or physical. Christians believe spirituality is related to the soul, but there
is no reason to believe that such a substance exists in people. And if it does,
what good is it? If the soul is the source of moral goodness and motivator of
moral actions, then why are there so many evil men in the world? It
doesn’t make sense. Or does the soul serve the selfish desire to live forever?
Morality
isn't material or physical, yet it can motivate actions. And moral people choose to be moral just as evil people choose to be immoral, often choosing
to be evil. Thus according to the role models of Hippocrates, Buddha, and Jesus,
the spiritual life is the moral life. And in all three cases, what is the superlative
moral life? It is a life that refrains from causing suffering (Buddha) and alleviating
suffering (Hippocrates and Jesus). By behaving morally, one’s life is
spiritualized. And there is no greater achievement for human beings. And it is
an achievement available to anyone, no special talent or ability is required,
though certain skills enable a person to more effectively alleviate suffering.
CHUGA Is What Utopia Looks Like
If
CHUGA was a nation it would be a utopia. It is an institution of pure moral
goodness. Such would be a society of Good Samaritans devoted to helping people
in need. There are endless ways to do this: https://dosomething.org/article/community-service-project-ideas
But
the French people do this each and every day by providing hard-earned tax Euros for government programs such as universal
health and public transportation. France is not a utopian society, but that is
its goal, and the fundamental element of a utopian society is caring for
others. Avoiding causing suffer and avoiding ignoring suffering.
The Purpose of this Article
Is to
thank the French people, our primary care physicians, but especially employees at CHUGA for their loving care that has kept my wife alive. And my gratitude is shared by the rest of the family and by Brigitte's many friends and former students.