She could have been me. About my age, my size, with hands that showed her use of them, I could have been her. Neither of us caused our health misfortune and we will never be able to escape it. Her chronic illness is severe, like mine, but we differ in one crucial feature. I have medical insurance, she doesn’t.

As a family physician, I have worked for over 25 years in many of Wyoming’s towns, staffing emergency rooms, delivering babies, attending to those in hospitals and those dying at home. I am from Wyoming, educated mostly in Wyoming and have worked primarily as a “fee for service” doctor in Wyoming. That all changed for me with my diagnosis of terminal cancer.

For the last four and one-half years, I have had the fortune of being on the receiving end of health care services too. Seeing it from the patient’s perspective, financially living it. Believe me when I tell you, we are all vulnerable and what separates us from having access to necessary health care can be as arbitrary as our gender, race, profession, marital status, and age. In Wyoming, it can also be as random as the town where one lives.

The Equality State has very few municipalities with a free or charitable clinic. Fortune exists in Powell, Jackson, Sheridan, and Laramie. Should one live in Pinedale or Gillette, Evanston or Riverton, “it’s time for those bootstraps” and like a unicorn, “medical bootstraps” live in our imagination only. Health care access and outcomes shouldn’t be determined by zip code and yet, in Wyoming and the greater US, they are.

Three years ago in December, I began to volunteer at the Downtown Clinic.

I entered the most unconventional healthcare environment, that was chaotic and fueled with seemingly endless optimism and generosity. I expected to find staff overcome with futility, despair, and judgment. Instead, what was a former auto repair shop had morphed into a comprehensive outpatient clinic/pharmacy, bedazzled with solar panels and hope. For the last twenty years, “problem solvers” and “can-do” folks, mostly women, created and continuously staff the Downtown Clinic. And why not? Who better to notice and respond to their sisters?

Wyoming’s women know that women and children make up the preponderance of Wyoming’s financially impoverished. No matter skin color or primary language, women in Wyoming have to make their dollars spend farther.

Wyoming’s women make 68 cents for every 100 cents a man in Wyoming makes, and are less apt to have health care, disability, and retirement benefits.

This includes my own professional group, women physicians. Equal education and equal skill do not get compensated equally in Wyoming, despite our 150 years of “equality”. Why wouldn’t women be more inclined to see and reply to the chronic realities for us?

So it is at the Downtown Clinic. Our clientele is primarily women and employed. Single and married parents that clean homes, staff shops, wait tables in restaurants, provide house-keeping services in hotels, and take care of our youngest and oldest. The collective responsibilities and stresses born by this group are massive. We also care for men and currently have a number of kind and selfless male volunteers who regularly offer their services to our community and our organization.

Before 2008, health misfortune was the leading cause of personal bankruptcy. Understanding history’s tendency to repeat and rhyme, medical illness (and the resultant bills) are once again the primary cause of the personal financial collapse in the US. One cancer or heart attack, an unavoidable accident or job without benefits, and you could need the services of the Downtown Clinic.

For twenty years now, the Downtown Clinic has believed that “Everyone matters, Everyone deserves care and Everyone can help”. The volunteers at the Clinic have transformed these words into service. Contributing to a system that is dynamic, well run, and filled with humanity is exactly the distraction I needed to contend with my medical conundrum. One overdue medical insurance payment and I might switch from giver to recipient of Downtown Clinic services. I could be her. You could become either of us.

With the wisdom and love that informs this season, please consider contributing time, talent or financial support to the Downtown Clinic.

With Gratitude,

Grace Gosar

Grace Gosar is the MD/co-medical director of the Downtown Clinic.

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