Louisville Magazine is Louisville's city magazine, covering Louisville people, lifestyles, politics, sports, restaurants, entertainment and homes. Includes a monthly calendar of events.
Issue link: https://loumag.epubxp.com/i/853426
LOUISVILLE MAGAZINE 8.17 75 into a silver charm. It sits inches from the mechanical valve that clicks — tick, tick, tick — to keep her heart functioning normally. When it's quiet, like when she lies in bed at night, she can hear it — tick, tick, tick. "I call it my Rolex," she says. "I want to hear it. Because I'm here." Imburgia says that when a patient needs surgery, he works with hospitals (often calling administration personally) to get it covered. It's tricky. "No one is hanging up a sign saying send me all your uninsured," he says. "And yet it's in all of their mission statements. ey say they are there to serve the community. at drives me crazy. And I understand. ey need to make money to survive." Imburgia says that when an unin- sured patient arrives at a hospital, the first thing the hospital will want to do is enroll them in insurance, even if it's just a temporary Medicaid card. It may not always be the best route. "e reimbursement is never going to be enough" to cover the cost, he says. With- out insurance, medical supply companies often donate equipment (like mechanical valves) to needy patients. And the uninsured can qualify for some indigent-care programs that often reimburse at a better rate than Medicaid. In the morning I spent with Imburgia, he guards personal details well, save for one. One of four children, he was quite close with his father, Anthony Joseph Imburgia, known lovingly as "Papa Tony." Over the years, the Sicilian patriarch, who owned an electronics corporation, would often listen to his son's frustration with medicine. As a young doctor, he wanted to help more people, give more time, but he had young children and was already putting in long hours. "He always used to say, 'You're young. You have a young family. Your time will come,'" Imburgia says. "And the time came." His wife Sandy says some of their friends won- der why her husband won't just gleefully scoop up retirement like most men his age. Quite the opposite, she says. After a few hours at Have a Heart, he's giddy. "He's like, 'Oh, my God, it was great. We did so good today,'" she says. "In fact, this morning he got mad at me because it's 7:15 and I'm not ready to go." She laughs, then her voice drops soft and low, loving and proud. "He'll die with his stethoscope around his neck. He'll never stop doing this." e clinic will total 14 patients this Saturday, a little under the average. Imburgia will suspect a faulty pacemaker in an older woman from Ghana. He will inform a Cuban immigrant that his heart muscle appears damaged from a recent heart attack, and he will prescribe medicine and a follow-up appointment. Imburgia and Have a Heart's board of directors have decided that, for the clinic to remain sustainable, they will have to start seeing paying patients soon. But with the future of Obamacare up in the air, with the possibility of millions of people losing health insur- ance, Imburgia says it's hard to know when to "flip the switch" and find a balance between paying and non-paying patients. "We won't turn anyone away," Imburgia says. "It would be nice to know what's going to happen." One of the last patients Imburgia will see today is a 49-year-old woman with light-brown skin and freckles that stretch cheekbone to cheekbone. Lately, she has been experiencing crippling fatigue. She manages a Rally's and works 10- or 11-hour days, often clock- ing out at 2 or 3 in the morning. She lives with her 29-year-old epileptic son. "I'm always tired," she tells Imburgia, sighing. "I think I do need more exercise. I walked yesterday and it felt great." She recently wound up in the ER with shortness of breath and chest pain. No evidence of a heart attack, but a doctor recommended she undergo a nuclear stress test, a procedure that involves taking images of the heart pumping while at rest and while stressed. e test can expose areas of low blood flow or dam- aged heart muscle. Imburgia's eyes squint a bit, as if questioning the recommendation. e patient doesn't have consistent chest tightness or other troubling symptoms. She does have high blood pressure. And he wonders whether perhaps the medication may be to blame for her fatigue. "You have insurance?" he asks. "No," she replies. "So the test they want you to get, if charity care doesn't pay for it (at the hospital), it can cost $3,000." e woman loudly gulps. Her eyes widen and bulge. She already owes a couple thousand dollars to the ER for her recent visit. "And I'm just not sure you need it," Imburgia says. (Have a Heart cannot do nuclear stress tests on site.) He writes her a prescription for different blood-pres- sure medication and advises her to cancel the nuclear stress test scheduled for the following Monday. "Do you have a blood-pressure cuff?" Imburgia asks. "Yes," she says. "Promise me you'll call me and let me know you're feeling better," he says, reaching out his hand for a handshake that lingers as he speaks to her, looking at her directly in the eyes. "So you're gonna call me in a few weeks?" he reiterates. She nods. If she doesn't feel better, Imburgia will proceed with a stress test. "Don't go until I call you and tell you it's free," he says, still clutching her hand. "Because I really do believe that if you don't qualify for charity care, you'll pay." "at will put me into cardiac arrest for real," the woman jokes, smiling. Imburgia laughs as he lets go of her hand and walks out to see his next patient. This patient may never find a specialist willing to see him. He may tumble out of the healthcare system until popping back up in an ER in critical condition.