Heart of a Lion, Hands of a Woman: What Women Neurosurgeons Do
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Monday, April 18, 2011

Fingernails and Insurance

She came into my office with the usual complaints-neck and arm pain, back and leg pain.  All started after the car accident more than 10 years ago.  As the story unfolded I took my notes but my attention was drawn to her fingernails.  What struck me was how perfect they looked-luciously long, groomed, and painted.  These were obviously well tended nails-the kind that take an hour to create-with the latest technology for fillers/lengtheners and the like.  I have sat next to women in various nail salons who were receiving such nails and was struck by both the time and cost associated with this-not to mention the frequency of required treatments to maintain.  For some reason, on this patient, these perfect nails struck me in an unpleasant way.
This was a woman who otherwise seemed to care little for herself.  She was sloppily dressed and not only overweight but clearly out of shape and unhealthy.  When she removed her shoes during the examination, her socks were more gray than their original white.  In addition, her history as she related included numerous times when she opted not to have insurance because she didn't want to pay her "portion" or when she opted out of recommended care because she couldn't afford the required co-payments.
Fast forward, and before me sat a woman now with a chronic pain syndrome-out of work for more than 6  years as a result and thus statistically unlikely to EVER return to gainful employment.
And yet her fingernails were perfect...
Hard as I try, I can't put myself in this woman's shoes.  I can't say for sure that she made poor choices about her limited funds.  It may be that the only thing she does for a "treat" just for herself is her nails.  Perhaps even this was a first-a special occasion and not something done regularly.  Undoubtedly there are many possibilities that perhaps I can't even imagine.
I just know I was struck by the dichotomy-the willingness to devote significant amounts of resources to her hands while neglecting a whole spectrum of healthy living activities, some of which require little or no money at all.  It did raise the question in my mind about the balance between societal and personal responsibility, especially when it comes to health and utilization of those precious resources.  In the coming years, perhaps these questions will be an increasing component of the discussions about health care insurance, Medicare, and reform.


  1. "I can't say for sure that she made poor choices about her limited funds"

    I think you should have advised her to revise her priorities, being your patient for years, allows you as I think to be informal with her

  2. I agree with you. Difficult to understand.

  3. Agreed, I think it's difficult to reconcile personal feelings when you see such a dichotomy. I always try to give the benefit of the doubt and remember I am not there to judge. Still it does go through your mind.