Financial First Friday: Medical Debt as a Spiritual Journey
by Mary E. Johnson, Chaplain Emerita
In recent years National Public Radio (NPR) has aired a series of audio stories about people who have been financially ruined by unanticipated crises of health. One story described a cancer doctor who lost her young husband (1). She now writes about the “financial toxicity” of medical debt. Another NPR program told the story of a woman who incurred a mental health crisis while trying to survive her husband’s suicide and the deaths of both of her elderly parents. Her own crisis resulted in a $21,634 hospital bill (2). A third story involved a young man whose emergent admission to an out-of-network hospital resulted in crushing medical debt (3).
Unfortunately, stories of financial ruin resulting from loss of health are all too common. Although the circumstances are personal, the burden is universal. Imagine dealing with physical pain, loss of function, threatened independence, generalized vulnerability while wondering if you can feed your family, afford your medication, or keep your house.
As a hospital chaplain I sat with many patients who were experiencing financial ruin. “Jim” was a 4th-generation farmer who was working hard to hang onto his family’s farm. He never knew if he would still be on his land by season’s end from one year to the next. I met Jim after his sleeve became entangled in the power takeoff mechanism of his tractor. He had removed the safety cover to save time. Now he was hospitalized with a mutilating injury that could result in loss of limb. Even in the midst of tremendous physical pain Jim was kicking himself for his “carelessness.” He had gambled in an effort to get ahead, to save time and he lost. He was now plagued with worries about who would feed his cattle, who would cut the hay, who would pay the bills.
Jim wasn’t the only farmer shouldering worries of financial ruin. The everyday stress of running a small family farm is sometimes enough to compromise health: unending workdays; unpredictable commodity markets; management of mounting operational debt. Many of my farmer-patients had suffered heart attacks. Their ability to successfully complete programs of cardiac rehabilitation was compromised by the ongoing stress of being a farmer.
One day I was called to visit a patient who was receiving chemotherapy for a gynecologic cancer. I had met her some weeks before in the hospital as she recovered from surgery. She wanted to speak with me about how she could reduce her stress and channel as much of her energy as possible into healing. She explained that she wasn’t bothered by her cancer problem or the likelihood that it would shorten her life. She was bothered by a storm of confusing medical bills, many of which contained errors, and by the hours and hours she spent on the phone each day with her insurance company. She said that her faith had allowed her to rely on God and reach a place of serenity about her diagnosis and prognosis. But she explained that her faith was apparently not up to the task of helping her with fears of financial disaster.
How does one cope with the burden of financial worry in the midst of serious health issues? I know this is a practical question that has practical answers. But I am going to take a slight detour at this point and respond as a chaplain would respond.
In 1983 Ken Mitchell and Herbert Anderson, two pastoral counselors, wrote a book entitled, All Our Losses, All Our Griefs: Resources for Pastoral Care (4). One of the unique contributions the authors made to the pastoral care literature was their description of the concept of loss. They were among the first to differentiate losses: the loss of a loved one; the loss of function; the loss of purpose, etc.
Mitchel and Anderson describe one type of loss that is particularly relevant to our discussion of financial stress stemming from serious health problems: intrapsychic loss – the loss of the way we thought things would be; the loss of the dream; the loss of an emotionally-important image of the self.
For many, dreams of the future do not include instability, vulnerability or failure. And yet these experiences are common, especially in the setting of health crises. The experience of intrapsychic loss raises existential questions, challenging our assumptions about how the Universe works, about how God works, about how prayer works, and about our place in all of it.
Existential questions are not signs of weakness or lack of faith. Some people are ashamed of their existential questions for fear that they indicate a weak faith. In fact, it takes a tremendous amount of faith, strength and courage to ponder these questions. Existential questions don’t ever really seem to get answered – they get lived with. They are signs of a living, vibrant faith.
If you are experiencing intrapsychic loss you might consider speaking with someone. Sometimes sharing your experience, especially in the context of financial stress related to loss of health, can unburden you. Speaking of your deepest concerns with one trusted person – someone who can handle your questions, someone who is not compelled to provide answers, someone you don’t have to protect and someone with whom you can be completely honest – can provide great relief and allow you to take another step. And sometimes one more step is enough for now.
- “Widowed Early, a Cancer Doctor Writes About Medical Debt” (NPR, 8/10/17)
- “A Woman’s Grief Led to a Mental Health Crisis…” (NPR 10/31/19)
- “A $41,212 Surgery Bill Compounded a Patient’s Appendicitis Pain” (NPR 1/29/20)
- Mitchell, K., Anderson, H., All Our Losses, All Our Griefs: A Resource for Pastoral Care. (Westminster Press, 1983)