— a chapter from the Neurosurgery wards by Dr Nitin Jagdhane

He arrived the way many stories begin in South Chicago—sirens first, name later.

It had all happened in one violent blur. He was stabbed in the back and, in the chaos of trying to get away, he fell and struck his head.

By the time he reached us, he had fresh wounds from the stabbing, a head injury from the fall, blood in his hair, and a look that mixed confusion with a very specific kind of worry that had nothing to do with his own body.

He was living in unstable housing, one rent payment away from losing his room, and he kept asking about his two dogs at home—the only “family” he felt he really had nearby.

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As part of the standard trauma protocol, we obtained a CT scan of his head. It showed what we expected from the fall.

But tucked quietly inside the images was something older, slower, and more treacherous: a cerebral cavernous malformation with signs of prior bleeding, discovered purely by accident.

The radiologist called it an incidental finding. Incidental only in the way fate often is—unexpected, but able to change everything.

For the moment, he was alive.
For the moment, his dogs were alone.

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In the emergency department, some things still work the way they should. He came by ambulance. He was examined, scanned, stabilized. No one asked for an insurance card before they stopped the bleeding and closed his wounds.

By law, under Emergency Medical Treatment & Labor Act (EMTALA), any person who comes to an emergency department must receive stabilizing treatment regardless of their ability to pay.

At its most humane, the American system still remembers how to do this much.

But cavernomas do not care about legal definitions of “stabilized.” They do not respect discharge plans.

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His immediate trauma would heal. The cavernoma, however, played by different rules. It needed elective neurosurgery—careful planning, an operating room, post‑operative care, follow‑up scans. None of that falls under the emergency safety net.

With that single shift—from “emergency” to “elective”—you could feel the ground move under him. No insurance. Medicaid not yet approved. No savings. And his mind was back in his small room on the South Side: 

Will my landlord throw my things out if I stay here too long?
Who is feeding my dogs?
Are they scratching at a door no one will open?

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At one point, his fear for his dogs pushed him close to signing himself out against medical advice.

From the hospital’s point of view, it was madness: a man fresh from a stabbing, a fall, and a newly discovered brain lesion, ready to leave because two animals might be alone at home.

From his point of view, it was simple. The hospital would go on without him; his dogs would not.

Eventually, after several tense conversations, the team negotiated with him and with the system. The hospital granted him a brief leave of absence for a couple of hours.

He went home, saw his dogs, made sure there was food and water, spoke to the landlord, checked that his world was still physically there—and then, just as he had promised, he came back.

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His reality now is strangely suspended.

He will likely remain in the hospital not only because of medicine, but because of money. He needs to stay until his Medicaid is approved, then undergo brain surgery for the cavernoma, and then spend another week or two recovering enough to walk out safely.

It is safer for his brain, but it also traps his life: housing, work, and the two living beings who depend on him all hang in the balance.

This is one of the quietest cruelties of how we deliver healthcare today. The lesion is operable. The patient, as the system currently sees him, is not “payable.”

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Where he comes from, this story is not rare.

South Chicago is not a place without hospitals. It is a place where emergencies are handled swiftly, but the long road of recovery is riddled with gaps. The patterns repeat: heavy exposure to violence and trauma, patchy insurance, late or absent primary care, emergency rooms as default clinics, unstable housing—rooms rented month to month, arrangements that can disappear with one missed payment.

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For him, being admitted did not simply mean IVs and CT scans. It meant he might lose his room if he stayed too long. It meant wondering if his dogs would be taken in by a neighbor or left to fend for themselves. Nurses and social workers began making calls—not just to clinics, but to community organizations and pet‑support charities that sometimes arrange emergency foster care for the animals of hospitalized owners.

The medical chart did not show it, but a large part of the struggle was to treat the brain without letting the rest of his fragile life unravel.

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On paper, the rules sound simple. A person comes to the emergency department, gets screened, and if there is an emergency medical condition, the hospital must stabilize them regardless of insurance or ability to pay.

Once that condition is no longer “unstable,” however, the obligations soften. The safety net thins.

The cavernoma does not care that the law now considers him stabilized. It can bleed again whenever it wants.

The rent, unlike the hemorrhage, comes on schedule.

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In India, where I trained and worked before coming to the United States, the story would look different—but not as different as we might wish.

There, the barriers loom in other forms: cost at the point of care, distance to a functioning hospital, and deep social inequality that shapes who feels entitled to walk through the door in the first place.

Long before “universal health coverage” became a buzzword, Dr Bhimrao Ambedkar argued that dignity, security, and access to essential services—including health—should be treated as fundamental rights, not favors for the privileged few.

He understood that who gets sick, who gets treated, and who is pushed aside is not a random pattern etched by fate; it reflects deliberate choices in how a state and a society are built.

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In India, you might see a poor patient bargain for a reduced fee, lean on a charitable trust, or find a bed in a crowded public ward.

In the United States, the surgeon may be entirely willing and technically able to help, but the mesh of insurance rules, income thresholds, and billing codes can still say no.

India struggles with scarcity of resources.
America struggles with scarcity of access.

They are different faces on the same coin. Left uncorrected, both lead to the same destinations: delayed care, preventable disability, and deaths that did not need to happen.

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American medicine lives with a kind of split personality.

On one side, we have precision imaging, robotic arms in the operating room, advanced ICUs, molecular treatments—things that would have sounded like science fiction not long ago.

On the other side, we have a young man with a surgically curable brain lesion who might never reach the operating theatre because he fell into the wrong category at the wrong time, with the wrong insurance status attached to his name.

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When I think about this, Bob Dylan’s album The Times They Are A‑Changin’  comes to mind—a warning to institutions that the world beneath them was shifting, that they could not stand forever in the doorway pretending nothing had changed. Our scanners and tools have changed beyond recognition.

The deeper question at the hospital door has not: who is allowed to cross from rescue to recovery, and who is turned back with a bill or a denial letter?

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Underneath this single story lies something else that matters to me as a neurosurgeon and as an educator: explaining what a cavernoma actually is.

A brain cavernoma, or cerebral cavernous malformation, is a cluster of abnormal, thin‑walled blood vessels inside the brain or spinal cord. Rather than one smooth channel like a normal artery or vein, it forms a small bunch of blood‑filled “caves,” with little or no normal brain tissue inside.

On MRI, it often has a characteristic look—doctors sometimes describe it as “popcorn” or “mulberry‑like,” with different shades inside representing old and new blood and a dark rim caused by iron from past bleeding.

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Some cavernomas sit quietly and are discovered by accident, like his, when a scan is done for another reason.

Others make themselves known through seizures, sudden or worsening headaches, weakness or numbness, balance problems, or changes in vision, speech, or memory, depending on where they sit in the brain.

CT can show bleeding if a recent hemorrhage has occurred, but MRI is the workhorse: it lets us see the lesion clearly and, with special sequences sensitive to blood products, can reveal even small or multiple cavernomas.

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Not every cavernoma needs surgery. Some can be watched with regular scans and clinical follow‑up.

The decision to operate depends on whether it has bled, how often, where it is located, and what symptoms it is causing. A lesion deep in the brainstem carries different risks from one sitting near the surface of the non‑eloquent cortex.

In his case, the cavernoma had already bled and lived in a location where another hemorrhage could leave him with permanent neurological damage.

That is why we were pushing to keep him in the hospital, to move his Medicaid application forward, and to get him to surgery as soon as it could be done safely and ethically.

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Behind scenes like this, there are often quiet efforts that never make it into the chart but matter just as much as the operation. Early Medicaid applications initiated while the patient is still in bed. Social workers calling housing agencies and legal clinics. Nurses printing out forms and helping patients fill them in despite language barriers, fatigue, or pain.

For some people, survival is not just about stopping the bleed; it is about not losing their bed, their job, or their last thread of social support while they heal.

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There are also more hidden supports that occasionally appear—safety‑net hospitals, charity care funds, local groups that help with rent, food, or even temporary foster care for pets. They are patchy, often under‑resourced, and dependent on where you happen to fall ill. But when they are present and when someone on the inside is persistent enough to connect the dots, they can turn a theoretical right to care into a real operation, a real discharge, and a real chance at getting back to life.

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For this young man, all these strands are now tangled together.

A stab wound. A fall. A brain lesion.
Two dogs pacing in a small apartment.
A landlord counting days.
A Medicaid application waiting in a queue.
A neurosurgical plan that depends as much on paperwork and policy as it does on scalpels and sutures.

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I have stood in crowded government hospitals in India and high‑tech centers in the United States. The language changes. The machines grow more sophisticated. The billing codes multiply and creep into every corner of the chart.

But the moral question that haunted Dr Ambedkar in his own time still hangs over ours: is access to health and basic security something you enjoy only if you are born or placed in the right group, or is it a non‑negotiable part of being human in a modern society? Dylan’s restless challenge to institutions—adapt, or be judged by history—echoes each time we watch a system work flawlessly for some and brutally for others.

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In the end, the case forces me to return to a simple, uncomfortable question.

Do we treat healthcare as a privilege that depends on paperwork, employment, and eligibility categories—or as a right that follows from our shared humanity?

Until the answer shifts from the first to the second, and until that shift shows up not in speeches but in the lives of patients like him, people will continue to bleed into the gaps between what medicine can do and what society allows it to do.

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He is still in that bed as I write this.

Waiting for an insurance approval that may come tomorrow or next week.
Waiting for an operating room slot that depends on forms he has never seen.
Waiting for a future that does not end in another siren‑filled ride.

His cavernoma has no opinion on any of this. It will either bleed again or it will not. It does not read Medicaid guidelines. It does not calculate rent. It does not know that two dogs are pacing circles in a small room, unaware that their world depends on paperwork moving through distant offices.

The lesion will do what lesions do.

The rest—the housing, the dogs, the surgery date, the question of whether care follows need or follows coverage—is up to us.

And in that gap between biology and bureaucracy, between what we can heal and what we allow ourselves to heal, lies the story not just of one young man in South Chicago, but of the systems we build, the values we choose, and the quiet, everyday violence of calling some lives more worthy of saving than others.

Dr. Nitin Jagdhane
Your Trusted Neurosurgeon