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Naisohn Arfai, 33, Philadelphia

I started in mid-July. I was a resident here, so I'm not entirely new to the system, but I'm new as an attending physician. You feel like you're at the front lines in emergency medicine. It's both rewarding and very painful at the same time. I feel like I've seen more people coming in in the past half-year telling me they can't afford their blood-pressure medicines. They haven't been able to see a doctor for a while. They used to have a doctor, but they're not covered anymore.

They come in when they've reached a point of desperation. They could be having a stroke or a heart attack or kidney failure. But more commonly what we see is people who are coming in with recurrent headaches. They feel lethargy. They feel like they're having blurred vision, headaches. Sometimes they have some mild chest pain or difficulty breathing. They come in, and they say, "I know my blood pressure's high. These are the kind of symptoms I get." It's frustrating, because you know you can remedy it temporarily, but in the long run, how can I be sure that these people are going to be seen by a physician after they leave?

There are times when people will come in and they'll need a chest X-ray, but they'll ask, "Well, how much is this going to cost me? How much is a CT scan going to cost me?" Oftentimes I don't see these people again. I don't get to see what happens after they leave the ER.

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