Without insurance, John has been unable to get surgery or even help managing the pain. When he collapses or suffers particularly excruciating headaches, Esther rushes him to the emergency room of one hospital or another, but an E.R. can’t do much for him. One hospital has told them not to come back unless he gets insurance, they say.

Esther used up her family leave time to look after her new husband. “Then I went back to work, and he fell several times,” she said. “I told my boss that I had to quit. Taking care of John was more important than building someone else’s house.”

That meant that the couple had no income  and no insurance for anyone in the family, including the children. Neighbors have helped, and a community program has paid the rent so that they are not homeless. But bills are piling up, and John and Esther don’t know how they will cope.

The doctors warn that pressure from the growth could lead a major blood vessel nearby to burst, killing him. “They tell me I’m a time bomb,” John said. With a touch of bitterness, he adds, “It sort of feels as if they’re playing for time to see if it bursts, to save them from doing anything.”

I’m not a physician, and I certainly can’t speak to the medical issues here. But I have examined John’s medical records, and they appear to confirm his story.

John says the principal obstacle to treatment appears to be simply his lack of insurance. In August, he qualified for an Oregon Medicaid program, but he hasn’t been able to find a doctor who will accept him as a patient for surgery, apparently because the reimbursements are so low. Doctors tell him that his condition is operable  but that they can’t accept him without conventional insurance. He is increasingly frustrated as he watches his family crushed by the burden of his illness.