She’s a Foot Soldier in America’s Losing War With Chronic Disease

Sam Runyon navigated to the house by memory as she reviewed her patient’s file, a “problem list” of medications and chronic diseases that went on for several pages. Sam, a 45-year-old nurse, had already seen Cora Perkins survive two types of cancer. During previous appointments, she had found Cora’s arms turning blue from diabetes, or her ankles swollen from congestive heart failure, or her stomach cramping from hunger with no fresh food left in the house. It had been a week since Sam’s last visit, and she wondered if anyone had come or gone through the front door since.

She knocked, but nobody answered. She walked across the porch to a hole in the window and called into the house. “Cora, honey? Are you OK?” A light flickered inside. A dog began to bark. Sam pushed open the door and walked into the living room, where she found Cora wrapped under a blanket.

“Sam. Thank God you’re here,” said Cora, 64. She tried to stand, but she lost her balance and sat back down in a recliner.

“It looks like you’re wobbly this morning,” Sam said. “Are you feeling really bad or just normal bad?”

It was the same question she asked her patients dozens of times each week as she made home visits across West Virginia, traveling from one impending emergency to the next in a country where feeling bad had become the new normal. All 31 patients in her caseload for the Williamson Health and Wellness Center were under 65 years old, and yet each had at least one of the chronic diseases that had become endemic in the United States over the last two decades: death rates up 25 percent nationally from diabetes, 40 percent from liver disease, 60 percent from kidney disease, 80 percent from hypertension and more than 95 percent from obesity, according to data from the Centers for Disease Control and Prevention.