What We Pay For First

A rebonded head of hair, an exam moved for a family gathering, and the prescription nobody budgets for

After the consultation, the first thing she asked was how much.

That is a fair question, and I do not mind it. Medicine costs money. A mother who brings her son to the clinic has every right to know what the visit will cost and what the pharmacy will ask from her after. So I told her the fee, and I told her the prices of the medicines I had written.

She said she did not have the money for those. Could she buy the generic ones instead, the cheaper ones?

Generics are not the problem. Many of them work perfectly well, and a doctor should be glad to write them when a family truly needs them.

The problem was what I could see from my side of the desk.

Her hair was rebonded. Every nail was painted. Her make-up was thick and carefully done. And while I was writing, she talked about her travels.

It is not about her hair

I want to be careful here, because this is not a post about how women should look. A salon visit is not a sin. Neither is a trip.

It is about order. What gets paid for first, and what is left for whatever comes after.

The same thing, with time instead of money

A medical student once asked me for a special schedule for her exam. The exam already had a date. On that date, her family was having a gathering, and she wanted another day to take it.

Family gatherings matter. I am a mother, and I know what it costs to miss one. But she is training to be a doctor. In the years ahead she will miss birthdays, reunions and Christmas dinners for patients who did not get to choose the day they got sick. An exam is the smallest of those choices. It is also where the habit starts.

There is also the rest of the class to think about. A schedule is set for everyone. Moving it for one student means another exam to write, another proctor, another room, all so that one family's calendar can come first.

Priorities are not only about pesos. They are about what you protect when two things fall on the same day.

The louder one

Another patient, an adult, came in carrying an expensive bag and an expensive wallet, with an expensive watch on her wrist. She talked about the big hotels she had stayed in and the food she had eaten there, loudly enough that everyone in the waiting area heard. She had the attention of the whole room.

Then came the prescription. She read what was written, saw how much it would cost, and went quiet.

She said she did not have money.

The room was the same room. The bag was the same bag. Only the voice had changed.

What illness does to a budget

Illness does not wait for payday.

It comes on a Tuesday night as a fever that will not break. It comes as a lump someone finally mentions, or a parent who slips in the bathroom. It does not check first whether you have just booked a flight.

And when it comes, it is expensive in a way that very little else in ordinary life is. Laboratory tests. Admission. Medicines that must be taken every day, not just once. A family that has set nothing aside ends up borrowing, or buying less than what was prescribed, or stopping the medicine halfway because the bottle ran out before the money came in.

Any doctor in practice will recognize that last one. Antibiotics stopped on the fourth day because the patient felt better and the money was needed elsewhere. Blood pressure medicine taken only "when I feel something." These are not people who do not care. They are people who reached the end of a budget that was spent before they walked in.

So, the order

Not a lecture, exactly. Just the order I would put things in, if someone asked me.

Needs first. Food, rent, tuition, electricity, water. The things that keep a household standing.

Then something set aside. Every month, even if it is small. For the fever, the fall, the test the doctor orders. A few hundred pesos a month, kept in an envelope or an account nobody touches, becomes a consultation and a week of medicines by the time it is needed. PhilHealth helps, but it does not cover everything, and HMO cards have limits that people discover only when they are already admitted.

Then the wants. The salon, the bag, the hotel. Enjoy them. But you will enjoy them more knowing the medicine money is already there, waiting, untouched.

I do not doubt that the mother with the painted nails loves her son. She brought him in. She asked the right questions. She had simply paid for the other things first. Or she realized late that being a mother entails a lot of sacrifice.

The quality of the medicine shouldn't be compromised. The medicine should never be the thing that waits. Always prioritize.