My last admission on my last call day of the year; only one patient stands between me and freedom. Freedom from the endless calls. Freedom from self-doubt and anxiety. Freedom.

She sits propped up in the ER bed, her husband dutifully by her side with encyclopedic knowledge of her long medical history. She is visibly weakened by the daily fight, yet her smile remains radiantly defiant as if to announce: “I’m still winning, y’all.” Freedom.

The words “cancer” and “metastatic” are long familiar to this loving couple, hopeful for what lies ahead. He dotes on her sharp memory and quick wit; her brain was always a sanctuary from this unholy battle. Freedom.

Until today.

I kneel at her bed to reveal the imaging findings. We discuss how this new brain mass likely caused her to suddenly lose grip of her favorite coffee mug this morning. We outline the planned course of action, together.

“Alright, honey. Let’s get to it then.” Everyone is on the same page, and her resolve strengthens my feeble confidence.

Before I leave to start the cascade in motion, we have to talk about her code status: what to do in the event her heart or lungs fail.

“Fail.” I tread delicately through this landmine of loaded questions, but even a roadmap fashioned from of years of similar conversations isn’t enough: her eyes well with tears in the silence between answers. I know she is playing out the frantic scene in her head already.

But she was not crying from her advancing illness. She was not crying for her new weakness. She was not crying at the prospect of cardiopulmonary resuscitation and life support.

Her words pierce through streaking tears: “I want you to do everything, but I don’t think my insurance will pay for all of that now.”

She was crying because she lived through years of “No” before experiencing life with medical insurance, but now was terrified at the uncertainty of what lies ahead. A woman who spent her entire life fighting: for her community and civil rights, for affordable housing, for something beyond herself, through chemotherapy and radiation and ER visits and the deluge and now this. Her indomitable strength felled by the country she adores.

Land of the free, home of the afraid.

Moazzum Bajwa is a family medicine resident.

Image credit: Shutterstock.com