From Sara Paul, who directs a Hickory heart failure clinic and is pursuing her doctoral degree in nursing practice at Duke University:

Nathan was fired from his job, and in a roundabout way, I am responsible.

Nathan is a 39-year-old African American man who has heart failure from an unknown cause, and I am the nurse practitioner taking care of him. Even though he feels pretty well and is basically without symptoms, he was fired from his job four months ago because I would not write a letter stating that he has absolutely no activity restrictions on his job.

The fact is that lifting, pulling or pushing heavy objects puts a strain on his heart and he needs to avoid those activities. Nathan's job is supervisory and does not require strenuous activity but his company would not allow him to continue with these physical restrictions. So, despite being a loyal employee in a management position for 12 years, they let him go. And with his job, so went his health insurance.

Nathan's employer probably foresaw health costs rising over the years as Nathan's heart weakened, even though this might be avoided with appropriate medications or cardiac devices such as a pacemaker. We'll never know because Nathan can no longer afford regular doctor visits or his medications, much less expensive devices.

So, even though Nathan feels fine and wants to contribute to society, he is now unemployed. To look at him, you would have no idea his heart is so sick. He has no amputated limb, no seizure activity, no stutter in his speech. When he applied for disability, he was denied because, technically, he can still work. But who will hire him? Once he discloses his illness, he is no longer a candidate for the job.

As someone working in the health care system, I know many are like Nathan in facing this dreadful situation, in which the loss of a job equals the loss of health care benefits. It's something I've seen too often.

When people complain that President Obama should hold off on health care reform until he gets the economy under control, I wish they would stop a moment and think about people like Nathan. I agree with Obama that it's difficult to fix the economy without also addressing health care. But even beyond economics, it's past time for us to do right by Americans who want to work and can still contribute to our country.

Health care should not be tied to a job; it should be portable and travel with us wherever we go. We insure every car on the road; don't our citizens deserve the same?

I've thought about Nathan a lot since I refused to write the letter he wanted stating he has absolutely no restrictions on his job. I've wondered if I actually served his interests by refusing to overlook that something terrible could have happened to him if he lifted a heavy object. I might have been blamed if that happened, at least by my own conscience.

As a medical professional, I have to be true to what is right and best for my patients, even in difficult situations like this one. I wish our health care system would step up to show similar responsibility and do what is right for all of the patients in our country, regardless of their employment status.

I hope the Obama administration and Congress will not wait to fix that system, which is badly broken. As someone who sees it up close, I know there are countless Nathans here in North Carolina and across the country. They deserve better from us.