The Need for Healing

In 2018, healthcare economists estimated that the cost of illness and premature death due to racial disparities nationwide was at least $421 billion every year.¹ It costs taxpayers money to allow preventable suffering. It would save money to do it right.² Why don’t we?

Stalin supposedly once said that “one death is a tragedy; a million deaths is a statistic.” As a health outcomes researcher, I know the statistics. As a family doc serving low-income and uninsured people, I know the tragedies. Cervical cancer, for example, is rarely seen at advanced stages in white, well-educated, well-insured patients. Once the Pap smear was widely adopted, cervical cancer went from being a leading cause of death for younger women to being a preventable, treatable condition.

One evening, I was called to the emergency department to see one of my patients who was having profuse vaginal bleeding. She was from the dirt-poor enclave of Stuckey Still, once an old turpentine work camp outside of Groveland. The emergency physician thought she might bleed to death. She had been previously diagnosed with cervical cancer and treated with radiation implants by a specialist in Orlando. Perhaps because our patient didn’t have good insurance, the GYN oncologist refused to have her transferred to the larger specialty hospital. “I don’t really have anything else to do for her,” he said blithely. “Just pack her with gauze and maybe get her some hospice care.”

I examined her gently. With a lighted speculum, I tried to see past the blood that was pouring out. A normal cervix looks a bit like the tip of a nose, pink and round with a small hole at the center. Instead, I saw what appeared to be a huge white rotting cauliflower mass where her cervix should be. Blood was leaking from multiple sites. What the hell could I do? I’m not a surgeon, and none of the specialists wanted to help me.

I ordered blood transfusions to replace the blood she was losing so quickly. I packed sterile gauze up against the bleeding cancer. I kept packing until the vaginal canal was full of bloody gauze, hoping that the pressure would stanch the bleeding.

I spoke gently with my patient. “You know what’s going on?”

She nodded. “I got the cancer last year and they put the radiation seeds in me. But they said it was pretty far gone. I never had the Pap smear. Never really went to doctors at all....”

I paused to let the wave of grief and sadness pass over me. “The specialists, they say....” I stumbled for words.

“I know,” she said, trying to comfort me more than I was comforting her.

I felt inadequate and powerless and sad. “I’ve done everything I know how to do. We’ll keep you here tonight and see if we can get the bleeding to stop.” We both knew how this would end if we couldn’t.

She expressed her faith in God and her sense of peace, whatever the outcome might be. My faith was a lot less adequate. We held hands for a bit, as I tried to give her my spirit and my compassion, even as she gave me her strength.

The next morning (a few hours later really), I came back to the hospital to check on her. The bleeding had stopped. Her blood count had stabilized with the transfusions. Later that day, we changed the packing. With old clots of blood came pieces of the mass, the cancer that was trying to kill her. She was having a late response to the radiation. The cancer was dying more quickly than the patient. “Tissue necrosis with hemorrhage due to erosion into a blood vessel,” I wrote in the chart. But in my soul, I know it was a miracle. Can’t it be both?

I came to understand that beyond each individual, the community was also my patient. I was practicing the specialty of community health,³ and my community was ailing. It had a sick, abusive, dysfunctional history, largely based on race and poverty. I was trying to make a sick, dysfunctional healthcare system work for the uninsured and for the poor, for people of color and for immigrants.

The patients all needed healing, but so did the community. And the longer I worked there, the more I needed healing too.

George Rust, MD, MPH, is a professor at the Florida State University (FSU) College of Medicine and codirector of the FSU Center for Medicine and Public Health Policy and Practice. His previous positions include serving as public health medical director for six counties in Florida and as the founding director of the National Center for Primary Care at Morehouse School of Medicine. In 2017, he won the American College of Preventive Medicine’s President’s Award for Contributions to Health Equity. This article is excerpted and adapted from Healing in a Changing America: Doctoring in a Nation of Needless Suffering © 2025 Johns Hopkins University Press. Reprinted with permission of Johns Hopkins University Press.

Endnotes

1. T. LaVeist et al., “The Economic Burden of Racial, Ethnic, and Educational Health Inequities in the US,” JAMA 329, no. 19 (May 16, 2023): 1682–92; and National Institutes of Health, “NIH-Funded Study Highlights the Financial Toll of Health Disparities in the United States,” US Department of Health and Human Services, May 16, 2023, nih.gov/news-events/news-releases/nih-funded-study-highlights-financial-toll-health-disparities-united-states.

2. Public Citizen, “FACT CHECK: Medicare for All Would Save the U.S. Trillions; Public Option Would Leave Millions Uninsured, Not Garner Savings,” February 21, 2020, citizen.org/news/fact-check-medicare-for-all-would-save-the-u-s-trillions-public-option-would-leave-millions-uninsured-not-garner-savings.

3. Institute of Medicine, Community Oriented Primary Care: A Practical Assessment: Volume I: The Committee Report (National Academies Press, 1984), ncbi.nlm.nih.gov/books/NBK217635.

[Illustration By Jesse Zhang]