Nick Hakes
In 2020, I suffered an ischemic and hemorrhagic stroke due to an undiscovered brain tumor the size of a golf ball. Emergency surgery saved my life but left half my skull missing. When I awoke in the intensive care unit, I could not remember my birthday. I could not identify a football despite having played my entire life. I could not smile evenly, not that I wanted to. My strokes ravaged me—body, mind, and bank account.
Nick Hakes
For the next six months, my life became a loop. I awoke at 4:30am, injected 15 medications, and then walked an hour to the clinic because I was not allowed to drive. After two hours in physical, occupational, and speech therapy, I walked an hour back and went to class. All that before working three jobs in the evening to pay my medical bills. Each bill that arrived felt heavier than it should, as though it carried not just paper but also judgment. I began to understand that recovery is both physical and financial, and that survival itself can cost everything.
Before I became a stroke survivor, I was a farmer. From stopping the mower to splinting a cardinal’s broken leg to dropping everything when smoke rose from my neighbor’s barn, I owe my core value of service before self to my rural upbringing. That compass carried me to the county hospital in Akron, Ohio, where, after negotiating one day to prove myself, I earned a summer position with orthopedic surgery. I registered, roomed, and transported patients, most of them indigent. I saw poverty etched into bodies: untreated ulcers that became amputations; chronic pain endured in silence; illnesses that stole health, wages, and hope. Those moments taught me that suffering has a cost beyond the medical, a cost that can last a lifetime.
Drawn to the “anyone, anything, anytime” ethos of emergency medicine, I began unofficially volunteering in the emergency department after every shift. I worked with orthopedics until 4:30pm, ate dinner in the cafeteria, and worked in the emergency department from 5pm to 8am before eating breakfast and repeating. I slept in the on-call beds and showered in the locker room. My journey to medicine was underway.
I learned that the trauma team, with the same urgency that I ran to my neighbor’s burning barn, helps the victims of tragedies. Trauma can affect anyone: young or old, vigorous or frail, privileged or disenfranchised. The shooting victim receives the same quality of care as the gunman. Inspired by the trauma team’s impartiality, I started assisting the trauma team full-time. The first patient I saw die was a stroke victim whose parents had been murdered a week earlier, days before their 50th wedding anniversary. By giving me a flower made from book pages that was meant for the celebration’s centerpieces, she taught me that the goal is not to live forever but to create something that will. She motivated me to establish a stroke awareness program for the city of Akron. The program, now operating at the county level, educates hundreds of thousands per year and reinforces that education is prevention—prevention not only of strokes but also of the financial crises that too often follow.
When I became a patient myself, I refused to ask for help until a week after my strokes. When my brother arrived and I recognized him but failed to recall his name, I realized I was a burning barn. I could not care for others unless I first cared for myself. The costs of therapy and medication nearly broke me, and I knew many patients had less resources than I did. I began to see financial wellness as inseparable from clinical care.
Medicine rarely teaches physicians to navigate this dimension of healing. Recognizing the gap, I began sharing what I had learned with my medical school classmates. I explained deductibles, copayments, coinsurance, and how to read explanation of benefits statements. I even formed a financial education committee to weave these lessons into the curriculum. Their enthusiastic response affirmed what I had come to believe: financial literacy is preventive medicine, and physicians ought to play a role in delivering it.
Determined to build a system where financial health is valued alongside physical health, I took a leave of absence from medical school to attend business school at the University of Cambridge. I can still picture the lecture hall where we modeled hospital budgets and traced the flow of funds through a health system. At first, the spreadsheets felt cold. Then I realized that every row and column represented patients and their families. Each exercise became a way to imagine a system that treats patients equitably, optimizing care delivery while protecting them from financial devastation. I learned how to redesign patient flow to shorten waits, how to leverage supply chain strategies to allocate hospital beds more effectively, and how payment models shape which patients receive which treatments and when.
My business education did more than sharpen my skills; it restored my sense of agency. For the first time since my stroke, I felt I could build a system where others would not experience the fear I did, the fear that survival might mean the loss of financial security.
Cambridge taught me to think at the systems level, but my mission remains grounded at the bedside. I intend to practice emergency medicine, addressing my patients’ physical and financial questions alike, because true patient-centered care demands we heal the body and protect the livelihood. I believe that “do no harm” must also mean preventing economic harm, as physical and financial health are inextricably linked. Because of this, I will go beyond the trauma bay to design and implement health policy that promotes financial accessibility and sustainability.
Financial literacy, I have come to realize, is preventive medicine. It preserves dignity, protects recovery, and keeps patients from becoming casualties of the very system meant to heal them. By integrating my clinical experience with business and policy expertise, I will help more patients than I could ever treat myself. This is how I will create a future where healthcare is truly accessible and affordable.