As a family physician, I've rarely heard someone tell me how I could make better life choices -- everyone knows that I was the one studying for the MCAT while my friends partied. But when I went public about my family's reliance on SNAP/EBT (food stamps), I suddenly found that a large number of people thought I was incapable of making good decisions.
Back in January 2013, I was just a couple years out of residency and my life was planned. My husband and I had always prioritized my career, so the next steps seemed obvious. My husband would stay home with our kids, an infant and a toddler at the time, while I worked to pay off my student loans and the mortgage on the small fixer-upper we'd bought when I was in medical school. I was still trying to get in the rhythm of parenting two kids while working in a busy family medicine office when I noticed that something was terribly wrong.
I went to a colleague and nonchalantly said, "So...ever since yesterday, whenever I reach for something, I miss."
She looked confused.
I demonstrated by trying to reach for a door knob, with my hand landing too far to the right.
"Robin!" she exclaimed. "You could be having a stroke!"
Our office manager drove me to the ER and asked if I thought it was just stress. I told her that I didn't know. But on some level, I knew. It was definitely more than just stress. The friendly emergency physician did his usual cheerful sing-song set of questions. The nurse got me a warm blanket. I was taken back for imaging.
When the CT was done and I was being wheeled out of the room, I glanced back to where the tech sat and saw my scan. There were several spots on my right cerebellum. I tried to remember something about hypodensities versus hyperdensities, but it all swam together. Did the spots mean something acute? Chronic?
In my little ER bay, my husband had arrived with our kids. The baby reached eagerly for me. She didn't care that I was a tangle of cords and lines. The toddler hung back anxiously, not sure what to do. The emergency physician returned. This time he was calm and quiet. He was followed by two nurses and a student. They filed in and he sat down on the stool.
"S#@&," I thought. "He's got an entourage and he's sitting down."
I don't remember how he prefaced what he was going to say. My stomach sank in anticipation of bad news -- when else does an ER doc sit down?
Out of the haze of words, I heard him say "vertebral artery dissection and cerebellar strokes."
"Oh thank heavens!" I exclaimed. "It's strokes. Then I can start getting better."
Everyone in the room looked startled; I still remember the expression on each of their faces so clearly.
"It could have been something that would get worse," I explained. "But a stroke is something to recover from."
Immediately after I got home from the hospital, my husband and I discussed next steps. I needed help with moving around, and I certainly couldn't care for the kids by myself. Some people suggested that we should put our kids in government-subsidized child care so that my husband could get a job. But I'm sure anyone who has sacrificed to make it through medical training will understand that the priority is always to get back to the career.
Luckily, we figured out a way that I could get back to work on a limited basis, with the support of my husband and SNAP to make sure we could make ends meet. I had just opened a direct primary care micro-practice and had fewer than a dozen patients. My plan had been to continue in my old job simultaneously for another year, but given the circumstances, we decided my best option was to focus on my own practice, which could work around my recovery. I was cognitively adept and could still care for patients; typing patient notes and the physical exam portion of the appointment just took a little longer since I was still re-learning to do everything. Every morning, my husband would help me down our front steps, drive me to work, and get me settled. I could catnap between patients and he would bring me home at lunchtime to rest and then take me to any appointments in the afternoon. Resigning from my old job was hard on so many levels, but I couldn't even drive to work safely, much less work a regular schedule.
Initially, I was only able to work for an hour at a time because I fatigued so quickly. That meant I couldn't manage more than about 8 hours a week at first. Given our limited income, SNAP was absolutely life-saving. But with the help of an excellent care team and my wonderful husband, I was able to gradually increase my hours, and about 18 months later we were able to get off food stamps.
Given the fact that SNAP literally saved my career and my family at one point in my life, you can imagine my dismay when I read that for specific beneficiaries as part of the debt ceiling agreement.
Most situations that cause someone to end up on SNAP are complicated. It's usually a mix of bad luck and a broken system. While most working-age SNAP recipients do work, of participants are in families with children, and over one-third are in households with older adults or people with disabilities. Many of those who are of working age are in unstable and low-paying jobs. An increasing number of SNAP recipients are but can't make ends meet because of the shockingly low pay they receive. Often, their options are limited due to transportation issues or family responsibilities. Flexibility in work-hour requirements gives people the ability to seek better opportunities or otherwise do what they can to improve their situation.
Even before the expanded requirements, SNAP already incentivized people to get jobs and already had significant work requirements in place. In fact, it's that increasing work requirements doesn't actually increase work, it just increases hunger. People are already doing the best they can, and putting more barriers in place for specific populations will only do more harm than good.
As physicians, we know our advice to patients to eat a particular diet for their health condition is at least as important as medication, and often more so. Caring for our most vulnerable by making sure they have food to eat should be a non-partisan issue. So why is the government making access to food even more challenging?
Robin Dickinson, MD, is a family physician, who returned to practice for 7 years after her strokes. She is now adjunct faculty at Rocky Vista University and the creator of , which teaches kids how their bodies work and prepares budding physicians from elementary age.