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“This is a mess,” cardiologist Nancy J. Davenport declares as she examines the abominably bloated legs of Jerone Browner-El, who sits angled on a stool in an arrangement at Washington Hospital Centermost attractive afflicted and angry.

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“You’re like the bustling beginning doughboy, baby,” Davenport adds gently, scanning the account of medicines the 56-year-old Northeast Washington citizen is declared to be taking. The drugs are declared to ascendancy his claret pressure, rein in his diabetes and bank up his abominably continued heart. Because his kidneys are failing, his anxiety are so bloated he can almost being them into bendable shoes that resemble bedchamber slippers. His claret burden is alarmingly high.

Davenport zeroes in on that first, allurement Browner-El whether he is demography the hypertension medicines she gave him. Sometimes, he replies, scowling. His wife bound interjects, acceptable Davenport, who has been her doctor for several years, that her bedmate is mad at her for authoritative him go to the doctor.

“We are a mess,” she says to Davenport. “You’re the reason, forth with God’s grace, that I’m actuality today,” she adds. This time, she tells Davenport, it is her bedmate who needs help.

So do a growing cardinal of low-income Washington breadth ociation who are adverse an astute curtailment of doctors, decidedly specialists, accommodating to amut them.

In the District, an estimated 15 percent of the citizenry has no bloom allowance and one in three ociation receives bloom allowances from a analysis of government programs. Those covered by Medicaid, the government affairs for the poor and disabled, are added clumsy to acquisition doctors accommodating to affliction for them because of the program’s low agreement rate. The aforementioned botheration affects the accoutrements enrolled in the D.C. Healthcare Alliance, a arrangement of doctors and hospitals launched six years ago, two years afore the city’s alone accessible hospital, D.C. General, was closed.

“It’s absolutely adamantine for bodies afterwards able bloom allowance to get cardiovascular care,” said Paul Ginsburg, an economist who directs the Centermost for Studying Bloom System Change, a nonprofit Washington antite tank.

“Doctors who action pro bono [services] or discounted fees are few and far between,” said Carolyn Gardner, ambador of the Washington Chargeless Clinic. Finding specialists charcoal a huge claiming for her staff, she said. For patients with affection problems, the dispensary relies on the casework of a abandoned cardiologist who comes to the Mount Pleasant dispensary already a month. Frequently, she said, her agents has to “get on the buzz and beg, borrow and steal” to access accessories for patients with added specialists.

Aftereffect affliction is capital for cardiac patients because affection problems tend to be abiding and generally action in affiliation with diabetes, hypertension and lung ailments. Numerous studies accept begin that bodies who accept alone anecdotal analysis for these problems tend to ache from causeless affliction and abortive death.

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Because patients generally delay months to see a specialist, abounding wind up in crisis in as emergency rooms. Doctors there are appropriate to booty affliction of them during a crisis, but not to accommodate the continuing affliction that adeptness antite a recurrence.

Davenport, one of the Washington area’s few changeable interventional cardiologists — affection specialists with avant-garde training who accomplish angioplasty and added invasive procedures — is an exception. Although she sees about 100 patients per anniversary in her own arrangement in aerial Northwest, two Saays a ages she holds a cardiology dispensary for beneath flush patients, abounding of whom who alive in medically under-served areas of the District.

Using an arrangement adopted from addition cardiologist and with abetment from medical acceptance from Georgetown, area Davenport teaches, she dispenses admonition and advance and gives abroad ample quanies of chargeless biologic samples in bogus arcade accoutrements she brings from home. She arranges for tests and aftereffect affliction for her growing agenda of accustomed patients, as able-bodied as a abiding beck of new ones, some referred by added doctors or hospitals or their accompany or relatives. A boyhood of patients are homeless; others alive as far abroad as Calvert County.

A few patients access afterwards an arrangement and are apparent anyway. The majority are enrolled in Medicaid or the D.C. Healthcare Alliance, which covers poor bodies who don’t authorize for Medicaid.

Abounding of the 20 or so patients who about appearance up for the Saay dispensary — auto drivers, convalescent biologic addicts, auberge workers, above prisoners and the aged — would be absurd to see a affection specialist alfresco an emergency room. Best accept a austere cardiovascular problem, sometimes several of them. A hasty cardinal are in their forties and accept survived at atomic one above achievement or affection attack.

Unlike best affection specialists, “Nancy has an admissible policy,” said Tom Norin, the ambador of her ample practice, which follows about 3,000 patients.

While abounding physicians abuse paltry allowance reimburts and accuse they charge ignment harder to atone for ascent abuse allowance costs, Davenport, who is board-certified in centralized medicine, cardiovascular diseases and interventional cardiology, shows no absorption in the banking aspects of medicine.

“The accuracy is that she’s the atomic absorbed of any physician I’ve anytime met in authoritative money,” Norin added. “I accept to actually hunt her bottomward to get her to allocution about it.”

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Norin said the clinic, at which he sometimes volunteers, was started added than a decade ago by a above accomplice of Davenport’s; her new accessory Getu Assefa sometimes helps out. Echocardiography artisan John Galvin additionally donates his time on a few Saays during the year, uming tests that amount about $600 anniversary on dispensary patients.

Davenport, who adores talking about cardiology, is abundant beneath accessible about herself. She looks afraid aback asked why she continues to accomplish a dispensary that adds to her biggy workload. In barter for borrowing the hospital centermost arrangement of cardiologist H. Brandis Marsh and dispensing his ample backing of samples to her patients, Davenport makes circuit for him every weekend.

“I feel responsible,” she says simply. Aback asked to elaborate, she observes that abounding dispensary patients would be clumsy or afraid to biking to her office.

A Full Schedule

Davenport has a acerb faculty of humor, great activity and a direct, calm address that befits a nurse, which was the aboriginal of her three careers. Now 59 and a grandmother, she larboard a tenured captain in nursing at American University to access George Washington University Academy of Anesthetic at 35. She’d already becoming a doctorate in cardiac analysis at GWU and formed for two years as a postdoctoral adolescent in a lab at the National Insutes of Bloom (NIH).

At the time she entered medical school, Davenport and her bedmate had four adolescent sons, and her bedmate was establishing his career as a Washington litigator specializing in circuitous artefact accountability cases. Their daughter, now 17, was built-in during Davenport’s address at Georgetown.

Davenport grew up in a medical family: Her mother was a istant and her ancestor was a arresting Chicago surgeon. She said she absitively to go to medical academy because she was anno that a physician’s signature was appropriate for accepted claret draws at NIH. “I absitively I wasn’t activity to be the basal being on the totem pole,” she said.

Her convenance is amid in the flush Foxhall Square medical architecture on New Mexico Avenue NW. She commonly works 90-hour weeks, shuttling amid Sibley Hospital, Suburban Hospital and Washington Hospital Center, sometimes blockage up until 4 a.m. uming cardiac catheterizations on patients who’ve had affection attacks.

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Davenport displays none of the cachet alertness accepted amid activating specialists: She tidies up the ay apartment and empties the debris afterwards her dispensary is over and afresh absolved out to the cat-and-mouse allowance to apologize to a accommodating who had been cat-and-mouse 30 account to see her. She doesn’t own a corpuscle buzz or PDA or use e-mail.

“Nancy is a first-rate being in all respects,” said Marsh, the cardiologist whose arrangement she borrows. “She knows her cardiology, she pays attention, she follows up and she seems to adore the affectionate of claimed accord with her patients that was the accurate affair about anesthetic aback I started. Nancy is never too active to do article for addition else.”

Accessible Door, Chargeless Admission

Afore she met Davenport in the emergency allowance of Washington Hospital Centermost six years ago, Carolyn Browner-El said doctors abroad had minimized her complaints of chest pains and beatific her home with nitroglycerin.

Davenport, she said, was different. She performed several tests and again did a cardiac catheterization, chargeless that Browner-El had a anemic affection because of cardiomyopathy, a action that affects the heart’s pumping ability. Now 49, she became one of Davenport’s patients and her affection botheration improved.

“Dr. Davenport gave me a dieting of medicines that counterbalanced my heart, and now I see her already a year,” said Browner-El, who said her ancestors ets is about $1,200 per month. She is now disturbing with a added austere problem: Her alarmist is declining and she needs a transplant. But aback she and her bedmate came to the dispensary aftermost month, Davenport was added afraid about Jerone.

Davenport tells the brace she will alarm addition branch specialist–the fourth she has contacted on his behalf– to ask if he will see Browner-El. She gives him a aftereffect appointment, reminds him to booty his claret burden anesthetic and asks if he needs a adver for a chargeless home claret burden cuff.

As she active for the abutting patient, one of two pagers abrupt to her white covering emits a acute beep. The emergency allowance at Georgetown has a 40-year-old woman who may charge a cardiac catheterization. Davenport tells Georgetown to accelerate the accommodating to the hospital centermost and she’ll see the woman afterwards her dispensary closes about 2 p.m. — and afore she active to Suburban Hospital to accomplish circuit there.

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Weekend Activity

Two Saays later, Davenport is in the dispensary by 9 a.m. Usually her daughter, Gina, serves as the receptionist, but this time it is her husband, Jim, who is cutting jeans, a T-shirt and active shoes.

Robert Dent, the aboriginal of the day’s 20 patients, arrives 15 account aboriginal for his appointment. At 56, he has survived a near-fatal affection advance and a beneath austere one, as able-bodied as a claret clot. He has bogus achievement and knee replacements, wears a pacemaker and has undergone anaplasty on his shoulder. Retired on absolute disability, he takes anesthetic for aerial claret pressure, animated cholesterol, and affection and lung problems.

He met Davenport in 2003, aback he was taken by medevac to Washington Hospital Centermost from Fort Washington Hospital abreast his home in Prince George’s County. She performed angioplasty, but the avenue after bankrupt up and aftermost year he had his additional affection attack. Davenport performed a additional angioplasty, this time aculated with low-dose radiation to aculate the avenue open. So far, it seems to be working, and Dent says he is anxiously demography his medications.

“That’s my babe appropriate there,” Dent says, animated broadly as Davenport greets him with her commonly animated “Hi, sweetie.”

Dent, who is abased on Medicaid, said he decidedly appreciates the samples of the seven drugs Davenport gives him. Already he had to pay for them, and he recalled “I couldn’t get them all, because they would accept eaten up all my [$500] account check.”

Davenport congratulates her abutting patient, a 47-year-old above auberge laundry worker, on his accustomed claret burden and abnegation from drugs. Davenport met the man a year beforehand while he was spending three months in the hospital convalescent from a achievement he said was induced by his able cocaine habit. The man is so admiring about his claret burden that he asks “Miss Davenport” to address the numbers on a allotment of cardboard so he can appearance his mother.

She declines to accord a D.C. cab driver, who has apparent up afterwards an appointment, added Viagra samples forth with his added medications because she suspects he may be affairs them. “One a day for claimed use, okay, but 10? Come on,” she says later. “He’s not accepting any more.”

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Davenport says that while smoking, biologic use, high-fat diets, alcoholism and added bad habits are accepted amid her patients, she doesn’t address them, ertive it would be counterproductive.

But she admits to casual frustration. A few months ago she had a allocution with a accommodating whose diffuse account of life-threatening medical problems is affronted by her aberrant obesity. Davenport acquainted she’d gotten through until she absolved by the Blimpie restaurant in the hospital antechamber an hour after and spotted the woman tucking into an adjustment of french fries.

One Step Forward . . .

Jerone Browner-El is back, attractive abundant added alert than two weeks earlier. He tells Davenport that the nephrologist she begin for him tweaked his medicines in the achievement of alienated dialysis and clarification the 30 pounds of aqueous that accept aculated in his legs.

Davenport tells him she is animated to see that his claret burden is lower than aftermost time, and he replies, attractive somewhat sheepish, that he is demography his pills.

Aback the doctor asks about his wife, Browner-El tells Davenport that doctors at addition hospital accept told Carolyn there is annihilation added they can do to amut her declining liver.

“They may not be able to get her a [new] liver, but addition can booty affliction of her,” Davenport says. “And if they won’t, you accord me a alarm and I’ll poll some of my GI [gastroenterology] buddies and see if they’ll booty her.” ยท

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