Rescued from the middle

Angel Leon and Dedra Blalock
Electrophysiologist Angel Leon and cardiology nurse Dedra Blalock have been caring for Rick Shields for years and have watched his sad journey as his disease progressed, robbing him of energy needed to run his small business. 

 

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When Rick Shields was in his early 30s, he started having heart palpitations and dizziness.

Sounds like Uncle Jess, said his concerned mother. Her brother, always healthy, had died suddenly one day. Shields’ local doctor referred him to the arrhythmia center at Emory University Hospital Midtown (EUHM). The diagnosis was arrhythmogenic right ventricular dysplasia (ARVD), a rare form of heart disease, often familial, in which one of the heart chambers progressively becomes replaced by fat and fibrous tissue. ARVD made Shield’s heart less able to pump blood efficiently, causing abnormal heart rhythms and increasing the risk of sudden cardiac death (the reason some young athletes die at their physical peak).

There is no cure for the progressive disease, but there are ways to help control the dangerous arrhythmias. For more than 20 years, Shields has been through most of them at EUHM: Drugs, ablations (in which electrodes placed in the heart conduct radiofrequency waves to kill clusters of cells causing the irregular rhythms), and an implantable defibrillator that detects an arrhythmia and sends a mild shock to stop it.

Incredible care, incredibly complex, continuously ongoing, and, consequently, incredibly expensive. Last year Shields had yet another ablation, at a cost of some $30,000. Replacing defibrillator batteries alone over time has cost at least $50,000. As his disease progressed, his reaction to the defibrillator changed from mild shock to a feeling of “being kicked in the chest by a mule.” More recalibrations followed, and more charges built up.

EUHM clinicians see a lot of patients like Shields who are caught in the middle. A small dairy farmer, Shields had always made a decent living, doing what he loved, producing something his neighbors prized. For a while, he even had health insurance. This year it was gone, as were his savings and his ability to take care of the dairy by himself. Unmarried, without siblings, he had no one to help him. Too young for Medicare, he was ineligible for Medicaid since he owned land, a house, a barn, and some cows. A proud man, he told the hospital none of that. He only asked if it were possible to pay his bill in installments, at least until he could sell something, meaning everything. He didn’t say it, but it was clear that even if the bills were eventually paid, Shields would be left almost destitute. So, as the medical team at EUHM adjusted his defibrillator, the financial team had his charges declared charity care, allowing him more time to work through the situation.

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