Come July 1, however, Maryland will expand access to Medicaid by an estimated 40,000 to 45,000 people. It will add more parents, children and workers to the rolls by allowing a family of three making $20,500, for example, to enroll. The limit is now $7,000 a year.
In Maryland, the law requires that hospitals be reimbursed for uncompensated care. But doctors are still running businesses and can't always take on cases like Smith's. Her St. Joseph's surgeon, Dr. Maen Farha, takes that into account but feels a duty to find a way to treat patients like Smith who come to him without options.
"When it comes to somebody who's sick or has a serious condition ... we just treat them," Farha said. "It's not an elective situation. This is a serious situation that has to be taken care of."
Smith can no longer work. She has lost her stake in her Gwynn Oak hair salon. But she has the support of her friends and even her estranged husband, who has accompanied her to appointments and is the actual holder of that American Express card. Smith's only credit is at Macy's.
The medical journey for Smith, who is also an aspiring actress who appeared on The Wire as an exotic dancer who died of an overdose, didn't end when doctors agreed to treat her. Her tumor now encompasses nearly all of her breast, and two different courses of chemotherapy failed to significantly shrink it.
On Monday, Farha will perform a mastectomy and remove Smith's lymph nodes. He hopes he won't have to take out muscles, too. It will depend on how large the tumor has grown. The surgery will be followed by more chemo and radiation. It will be months before doctors will know whether Smith will be cured.
She almost didn't get this far. She almost gave up, until her husband reminded her that their daughter needs two parents.
Smith and her 10-month-old daughter have moved out of the family's Pikesville home and now live with Smith's mother in Columbia, sleeping each night cuddled up on a pullout couch. "I tell myself every morning when I wake up, I'm going to pull through this," she said. "But you never know."
stephanie.desmon@baltsun.com
