During my residency at Keesler Air Force Base, I took for granted that the care our patients received was not influenced by their social or financial well-being. The military health care system is a single-payer, equal-access health care system. Beneficiaries are of all different racial and socioeconomic backgrounds and ranks and receive comprehensive care without significant copayments, deductibles, or enrollment fees. As a result of access, disparities in several cancer outcomes are significantly reduced or eliminated altogether.^1-4 When I entered a civilian fellowship in hematology and oncology in downtown Washington DC, I quickly learned that such care should not be taken for granted.

One of my first patients was a 60-year-old Hispanic male who presented with severe pancytopenia, including a hemoglobin of 2 g/dL, and was found to have very-high-risk myelofibrosis. He had invasive fungal sinusitis from prolonged neutropenia and was transfusion dependent. In caring for him, I got to know him on a personal level. He was born in Mexico into a rough neighborhood with family members involved in gangs and corruption. As an adolescent, he endured a near-fatal stab to his chest that was home-treated, leaving behind a scar that served as a reminder of the struggles he faced to survive. He rejected his family and this lifestyle and, as an adult, immigrated to the United States for a better life. He traded his life in Mexico for a peaceful life in a small town where he could make an honest living as an auto mechanic but, as a result, struggled financially. He had felt ill for a long period of time but delayed seeking medical care so that he could continue working to pay his bills. Despite enduring a life-threatening illness and being saddled by poverty, a difficult past, and absent family support, the patient sitting in front of me was mild mannered and always expressed tremendous gratitude for the care we provided him.

The only curative treatment of his disease was an allogeneic stem-cell transplant, and without one he had only a couple months to live. The first step was to find a donor, which was problematic; matched related donors are our first preference, and he was completely estranged from his family. After reluctantly reaching out to his siblings in Mexico, we were disappointed to learn that they were unwilling to undergo human leukocyte antigen (HLA) typing or to serve as his donor. I remembered that he had a 21-year-old son enlisted in the Navy who was stationed across the country. Since haplo-transplants were becoming increasingly used, we sent an HLA kit to his son and found out he was a match. Now the next step was to find a facility to perform the transplantation. This was tricky, as transplantation costs at least $200,000, and there are significant copays, even for those with good health care insurance. In addition, patients must be able to afford housing near the transplanting facility for at least a month and have reliable transportation and adequate caregiver support. The gravity of this challenge soaked in as I looked at my patient in front of me. He was thin, worn from years of physical labor and hardship, and wore an old cotton T-shirt, faded jeans, and dilapidated sneakers. He lived in rural America, nowhere near any major medical centers. He drove an old pick-up truck that regularly broke down. He could not afford the gas required to drive to DC to his appointments or the time away from work.

We reached out to multiple transplantation centers, which all listed the financial and caregiver requirements that my patient would never be able to fulfill. We then reached out to the National Institutes of Health (NIH), which doesn’t require patients to have health care insurance or to make copayments, thus eliminating financial barriers to care. The NIH was willing to perform the transplantation under a clinical trial, but only if he had a caregiver and could live in the vicinity after his transplantation. How was he going to afford living in Bethesda, one of the most expensive cities in the country, and find a caregiver? It was beginning to feel hopeless. My attending physicians and nurses at my hospital were not surprised, having regularly witnessed health care disparities over the years. While they found it very rewarding to care for underserved patients, they were frustrated by the hurdles created by a system that often fails our most vulnerable patients and as a result had become hardened. Everyone had accepted that the patient would die soon.

I couldn’t believe the life of a man who had already overcome so much would now come to an end, not because of a lack of a curative treatment option but because of inequity. The situation reminded me of my own upbringing in rural Texas from a broken home. I lacked the resources and support needed to reach opportunities that were not easily accessible to people from my background. On my own, I had no shot at being where I am if it weren’t for the Air Force supporting me through college and medical school and giving me a better life. The Air Force looked past my background and gave me a second chance. Why couldn’t our health care system look past my patient’s background and give him the chance to live? Why couldn’t his son have a fighting chance to keep his father?

I had an idea but knew it was a stretch. Maybe if the Navy reassigned the patient’s son to the local area, he could be his donor, caregiver, and support system. We described the situation to his son, who loved his father and was willing to do anything he could but was only an E-2, a junior enlisted member at the bottom of the military ranks, without any money or connections. What incentive did the US Navy have to support this? We knew we were asking a lot, but my attending and I wrote a letter to the son’s command laying out our request. Days went by, then one week, and then another. As the stress of uncertainly began to build, my patient started falling apart physically and emotionally. Right when we thought we had lost him completely, his son notified us that the Navy approved our request! We were deeply elated that our hard work was successful in breaking the barriers of inequity and, selfishly, were relieved that we didn’t have to carry the burden of helplessly watching this kind-spirited man die alone of a treatable disease. Duly transferred, the son relocated to the area, and my patient got his transplant. Now nearly 4 years later, he is alive and doing well.

One of the most rewarding moments of my first year as a new attending was when the son sought me out to express gratitude for helping his father. It reminded me why I went into medicine and oncology: to give second chances to some of the most unfortunate people who were dealt a bad hand. This isn’t just limited to their cancer and comorbidities. My patient was from a demographic that faces systemic barriers to access. But by looking past this and advocating for him as an individual who deserves the same chance as well-to-do patients, we were able to break through these barriers. My patient got a second chance thanks to the NIH being a system that gives some of the poorest patients the opportunity to enroll in clinical trials and to the US Navy’s willingness to look past its member’s rank and allow a son to give his father the gift of life. It was not the right insurance coverage or personal wealth that saved my patient. It was humanity.