[soft music]
- Where you grow up makes a difference.
We often think, is it your genetics
that gives you diabetes and hypertension,
or is it your zip code?
And really, it's about where you grow up,
not being able to get to the doctor's office,
so your transportation,
your housing, your heat.
Having money allows you to eat more healthy foods.
Who takes your insurance?
- Martin Luther King made a famous statement
that is commonly referred to today:
"Of all forms of inequality,
injustice in health care is the most inhumane."
- The Cleveland Clinic provides tools
to help equalize the care that our patients get
in order to decrease health disparity.
- Ready for this? - Yeah.
- How much you think it is today?
- Well, it shouldn't be too bad.
- Just need a little drop. - Mm-hmm.
[laughter]
- Carl had diabetes-- wow, it was--
I don't know--early 2000s, he discovered he had diabetes.
It's very strong in his family.
She died of diabetes? - Yeah.
- Your mom--wait, she did too. - She was on dialysis also, you know.
- Oh, my God, look at you and Marshall.
I hope Marshall doesn't inherit diabetes.
- Yeah, me either.
- Carl was a perfect example of the potential hazards
of being diabetic.
He had a small cut on his foot.
That went on to become a very severe infection
that resulted in him losing all of his toes.
How's your wife these days?
- She good.
She nursed that little nub back together. - [laughs]
So you tell me if this hurts you any, please.
Because the infection was so severe,
that area would not heal up.
He underwent a series of skin flaps
in attempt to get that area to heal up.
- Looks like it's ready.
- Carl recognizes the impact
that a full limb amputation would have on his life.
- Well, I can tell there's some skin over it that's--
wasn't there before.
- He's lived with it for two years,
the threat of an amputation
and thinking about how it would dramatically change
his ability to function.
- If I change it late at night,
then I won't worry about it until I get home from work.
Wrap that there.
Just kind of cushion it.
- She do a good job of wrapping me.
So I really prefer her to wrap it 'cause she--
this her foot.
Yeah, it's definitely her foot, you know.
- He's fortunate enough to have a supportive wife
who has cared for his wound for two years.
She's essentially been a day-to-day nurse.
She's very involved in his care.
- Then I put this stocking over it
to go all the way up his leg, like, just kind of rub his leg, good.
- The surgery we're planning to perform on Carl
is endovascular revascularization.
You can see the outline, that hypopigmented area.
We're opening up blood vessels using a combination of balloons or stents.
There's a window maybe right there.
We push the blood vessel open.
Can I have a turner, please?
That restores blood flow to the foot in this instance.
Oxygen is the lifeblood of any area of the body
and very important in this area, wound healing.
[monitor beeping]
We know that there's some implicit physician bias
in taking care of patients.
African Americans are less likely to have this limb salvage attempt,
more likely to undergo what we call primary amputation.
That is no attempt at diagnosing and performing the appropriate tests
and then going on to attempt some type of revascularization.
- The Cleveland Clinic is an oasis.
It really sits in the middle of a lot of under-resourced areas.
And anything that's shiny and bright
might bring fear to the people that we are reaching out to
and that we want to serve.
- Cancer has been a big dinger in my family.
I turned 40 July 10th.
I've always wanted to get a mammogram done.
One of my aunts passed and one of my cousins just recently passed
from first-stage breast cancer.
Now my mom passed Friday.
So, you know, we're...
[sighs heavily]
We're going through a big storm right now.
- Is this your first time here? - Yes, indeed.
- So it should be fine. Just about 20 minutes.
Little nervous? - Yeah, sort of.
- Nothing to be nervous about. You're in good hands.
- All righty.
- We know, for certain diseases of the new era,
20th, 21st century, such as cancer,
our best chance to defeat a cancer is through early detection.
And we cannot emphasize that enough.
- This is your very first mammogram, correct?
- Yes. - Relax this arm down.
- And that is really an advantage of having a large health-care system
in an immediate neighborhood,
that we can provide an entire scope of treatment,
from early detection to cure.
- So I have the results.
This is the first mammogram you ever had, right?
- Yes.
- Okay.
Looks like they're seeing some cysts,
so we need to take some extra pictures.
Okay.
So even if we are seeing something normal,
we just want to make sure that's the case.
- Okay.
Just a couple more minutes.
- Come on in. - [sighs]
- Reach across and hold on to that bar.
That's good. We're gonna do one more angle.
Hold really still.
- I told myself today that if I did have cancer,
I'll do whatever I have to do, you know,
to take care of myself,
because at first, I was scared, and I said, "No, I'm not going.
Whatever happen happens,"
to be honest. - Oh, I'm so glad you came back.
- But now I'm like, "Okay, girl, get your butt..."
- That's right. - "To that hospital
and see what's going in with you."
So no matter what the results are today...
- We'll be together.
- Absolutely. - All right.
- We're doing a lot behind the scenes.
We have navigators in the Fairfax area,
people that are from the community
that can help you get to different appointments,
and pretty soon, you're able to do it on your own.
You might need some help-- like, who doesn't need help--
but once you get used to some of these things,
you can be empowered on your own to seek help for yourself.
And for me, it's so important that women are educating women
and that they tell others.
- So I just have one more to find, and then we should be done.
Okay, these just look like benign cysts to me.
- Oh. - You're gonna be just fine.
We always recommend that you continue breast self-exams,
come back with any new problems anytime.
- All righty. Thank you. - Okay?
Yeah. - Thanks so much.
- Uh-huh.
- Whew.
- Particularly for women of color,
I think, so often, they feel marginalized,
that they aren't listened to,
that they're dismissed.
If you can have a positive impact,
a positive office visit,
it just makes their whole future health-care experience
that much more important.
- See you in six months? - Yes, indeed.
- And if you need anything in the meantime, okay...
- I definitely will. - All right, take care.
- You as well. - See you.
- Should we go out this way?
- I mean, you know, I had the dialysis twice this week.
But the two dialyses in a row,
I don't know where I got all that energy from.
[laughs]
- I know. - I feel pretty good, huh?
- For a patient like Carl that's gone through this for two years,
about to lose his leg,
he has modified his behavior and done all that we've asked of him.
That's why I'm pulling for him so much to get through this
and for us to have a successful outcome.
- So, bae, how you been feeling after the surgery?
- I get around pretty good. [laughs]
I slipped the other day and hit my knee, remember.
- 'Cause your balance has been off. - Yeah.
- Well, this is gonna help you get it all back.
Ta-da. - Ooh.
- Doesn't my chicken look good?
- I was always taught that we should live so vibrantly
and be almost like a light bulb, that we shine brightly and then we die,
instead of having a life of you're healthy, then you're sick,
then you're not well, then you're sick
and it just goes on and on and your life just sort of dribbles away.
- Mmm, mmm.
- A toast to a perfect healing. - Mm-hmm.
- We're all gonna die of something,
but I think the public health argument is quality of life
so that people really live a vibrant life.