I couldn’t help but smile when I saw his name on my patient list. I thought, “There must be more than one ______ ________ in the world, but certainly not in this area”. I checked the records, and sure enough, it was him. I won’t use his real name here, as he has a right to his privacy, so I’ll use the pseudonym “Bob”.
I got to know Bob when I was a very young man - both emotionally and chronologically – and we worked together as guides for a whitewater rafting outfitter. He was, I thought until this week, much older than me. It’s funny how years and distance can actually make you seem closer to people, at least in age, than you once were.
His face had not changed much, though it was perhaps a bit more weathered. I couldn’t help but think this was the first time I had seen him without a cigarette in his mouth, sunglasses on his face, and completely sober. The lifestyle of a rafting guide can be as variable as the personality of each individual, but for a large number, it involves excessive alcohol consumption, heavy smoking (tobacco as well as marijuana) and telling stories that are upwards of 10-20% true.
Some guides are college kids who need seasonal work and don’t want to spend four months away from school flipping burgers at fast food joints. Many are near migrant workers, following the transient seasonal work from the rivers to the mountains, working winters as ski instructors or patrollers. These would be the ones who may or may not have dropped out of college, or just have not found or accepted what society has to offer them. Bob embodied the latter group.
I have long since given up the life of a guide – spending more than I earned in the company bar, chain smoking and trying desperately (and mostly unsuccessfully) to convince attractive women customers that a fling with a grungy, unshaven man who sported a tan that outlined a lifejacket on his upper body was a good idea. But back then, I thought guys like Bob were the ones who had it together: they had no permanent homes, no wives or children (that they knew of), few bills and worked “real jobs” sporadically at best. At the ripe old age of 20, it was my bohemian dream to follow in their footsteps.
Alas, time moves forward and most of us grow up and become adults – or at least more emotionally mature – and move closer to the center of society. That is, we find regular work, satisfying personal relationships and become more main stream. Bob never did though. He still hangs on to much of the old lifestyle - it has been too hard for him to give it up. He still makes his annual or bi-annual pilgrimage to the canyon so he can row the greatest river in North America; still has no wife or kids (that he knows of); still does not have a “regular” job as it would interfere with his play time; and still smokes like he’s sponsored by Philip Morris.
As a result of his own choices, he is one of our millions of uninsured in America. Not that he minds, or that he wants more from the health care system than he is willing to pay for out of his own pocket. He had a blocked coronary artery several years ago that required the placement of a stent and he paid for it himself – eventually. He now takes bottles of nitroglycerin with him on his canyon trips, because as he told me, “you never know and it’s a long ways away from anywhere”.
The cardiologist in our office who saw him told me Bob needed to stop smoking and make some significant changes if he was going to have a shot at growing old. I told the cardiologist that Bob would do no such thing – it’s just not who he is.
Bob would rather die relatively young doing what he enjoys and without regrets than stop being himself and live longer. He has followed the “live fast, die young and leave a good looking corpse” philosophy to the letter, except that he has made it farther than he likely ever thought he would. He has managed to outlive many of our old comrades and friends despite maintaining the lifestyle. Too many of the people we knew died young as a result of poor choices and bad luck.
I don’t know where people like Bob fit into the health care debate because he’s such a rarity: he’s non-compliant for the most part, but does not hold anyone but himself responsible for his problems. He throws off the curve, if you will. People like Bob will not buy health insurance (even if forced at gunpoint) because they just don’t see a need. He’s self sustaining and uses only the services he needs when he needs them. And he pays for it himself. He’s not our typical member of society by a long shot.
He’s Peter Pan – but older now and all too vulnerable to those things that affect mere mortals. And even though it’s for different reasons now, he still has my respect.