Been There Done That (Leffersbee #1) - Hope Ellis Page 0,123

social determinants of health. I can coach and teach a patient and their doctor to have the most open, collaborative conversation possible. But what happens outside that clinic door has such a huge effect on what ultimately happens to that patient and their health.”

“Like what? Give me an example.”

“The other day, we had a lady come in, fresh from a surgery to remove a lump from her breast. The doc wants to explain a test he’s recommending that will take a closer look at the pathology of her tumor to help determine if chemo will be helpful for her or not in the long run. The conversation goes well. The doc really digs in, probes to try to understand why she’s objecting to this really important test. You know what the issue is?”

“What?”

“She has insurance, but she’s under-insured. When she ranks all the financial needs in her household, that test comes in last. She’s gotta think about the roof she can’t afford to replace, the income she’s lost as a result of not working during her treatment, the fact that the financial assistance she’s gotten to keep her afloat during treatment is so miniscule it barely scratches the surface of what she needs. So, when a doc comes to her and proposes a test that will leave her with an astronomical out-of-pocket expense, what decision do you think she makes? Even after she’s had a great conversation with her doctor about all the risks and benefits, and how this test can improve her outcome after identifying the best treatment option?”

I let out a sigh, pained by the anguish I heard in her voice, and the fact that another human being would be placed in such a heart-rending position, with so much already at stake.

“That’s terrible, Z. I’m sorry. You’re right. Those barriers do need to be addressed, and they do have a direct relationship on folks’ health outcomes. Are you thinking that you, your research and training, don’t matter in light of that?”

“No, it’s just that the world needs so much more. What I’m doing isn’t enough.”

I weighed my words carefully. “I don’t want you to just think about what the world needs. I want you to think about what you want. You got into the work you do now to address a problem you learned about during your mother’s cancer diagnosis.”

Her chest lifted against mine. “Yeah.”

“My team told me about another grant you got to improve communication between patients and doctors when they talk about pain and opioid use.”

She started to pull away. I held firm.

“You were thinking about my mom. Weren’t you?”

Her words were muffled against me. “It’s a well-documented disparity in care. There’s ample evidence demonstrating African-American patients are undertreated for pain—”

“Zora.”

“Yes.” Her sigh hissed out into the open air. I pulled the quilt over us.

“I’m sure that’s true. But I’m willing to bet that’s not all that motivated you to explore that topic.”

“It’s not a bad thing.” There was no mistaking her defensive tone. “To be inspired by the people, the problems you see around you—”

“It is when you’re not motivated by what genuinely excites you anymore. What makes your soul sing. Then, baby—” I captured her chin. “Then you end up feeling like you’re living for everybody else. Like you do now. Your mother said it to you, and I’ll add to her voice. Take your time. Find that thing that excites you. Even if it leads you to a different path, don’t be scared. Maybe the way you’re looking at it, the way I’ve been looking at my own goals, is wrong. Maybe the journey isn’t linear. Maybe the real deal is we never really find all the parts to ourselves, not wholly and completely, without a good deal of continued searching. Maybe life’s just a meandering path we keep chasing in pursuit of learning all our selves. We’re both still learning, growing, changing, and our paths may change to reflect that. I want you to know though,” I pressed a kiss to her forehead, “I’m with you for this journey. I’m not going anywhere. I’ll be with you every step of the way.”

Her fingers pressed into my back. When she spoke, her words were lost to the wind.

“What’s that, baby?”

“I’m scared.”

I laughed, wrapped my arms around her. “Why? Have you met you? I’m excited. I’m gonna buy us pith helmets for this journey. I can’t wait to see where we end up.”

“What if I don’t know who I am without my job? Without