Friday, November 21, 2008

un-American values

I saw a bumper sticker on the back of someone's car that read:

Because we can't all be on welfare

The word 'REPUBLICAN' was very large. It wasn't until I got up close that I could see 'Because we can't all be on welfare'

When I first saw it, I gasped in horror. Then I thought maybe it's tongue and cheek; perhaps my denial that someone could be that mean-spirited and have such little insight. But since the words under REPUBLICAN were very small and could only be seen when I was right behind this car, I decided it was not tongue and cheek, but rather a dangerous and hateful person driving that car. I say dangerous because to have such little empathy is dangerous. It keeps the poor, poor and that helps to foster inequality.

You would think this kind of sticker might be on an expensive car but it wasn't. It was on an older mid-sized American car. What un-American values on an American car.

Thursday, November 20, 2008

Cycle of Poverty (2)

She was crying so hard on the phone I could hardly understand her. She hasn't slept for days and here is why:

She was checked into the hospital at the beginning of the week to have some tests run since her stroke last month. This overweight 47 year old also has diabetes and high blood pressure. While she was in the hospital, her 14 year old son was admitted to the hospital. His bolts and screws that hold his leg together after he was hit by a drunk driver while crossing the street a few years ago, had become so infected that he became septic and almost died. So she checked herself out of the hospital to be with him.

Her 16 year old son was assaulted by 4 men and when he was able to get away, they decided they weren't done with him yet so he then became the victim of a drive by shooting. He was not actually hit by any bullets but he's so afraid they will kill him, he won't go to school. I'm guessing he's part of a gang but I didn't ask her.

Her husband decided he'd had enough of this and so he up and left the family this week. She's had terrible financial problems for a long time and today her car was repossessed.

I assured her I would get a doctor to write a prescription to help her sleep and told her I'd call her right back. In the 10 minutes it took me to call her back, she received a letter in the mail from her neurologist saying her tests for Lupus had come back positive.

After much coaxing, I was able to make an appointment for her to see our Social Worker.

I feel sorry for this woman and can't imagine living her life. She is part of the wheel that spins out of control. And now I think the real victims here are her 4 boys. They live in poverty and in fear. They have no father and their mother may not live much longer. I shudder to imagine their day to day life. I try not to think about what their house looks like, what they eat, what they can't buy, and if anyone ever said "I love you" to them. I wonder what will happen to them and to their children in this cycle of poverty.

Friday, November 14, 2008

Dangerous Budget Cuts

There's a pharmacy near the clinic where I work that has been a God send for our patients. Here are the criteria someone has to have to fill a prescription there: you have to be a patient at our clinic or another of two clinics it serves, have either no insurance at all or using medical coupons. Patients get their medications there at cost plus a small dispensing fee. So it's possible for someone to get their blood pressure medications and their diabetes medication for less than $10 a month. (Even this amount of money is difficult for some of our patients). They also have interpreters on staff. It's subsidized by the county and it's supposed to close at the end of the year because of budget cuts.

I happened to speak to a pharmacist there and she told me the county and city officials have said they don't feel there is a need anymore for this kind of pharmacy. I knew I had to do something. I called the city council office and asked what I could do to try and stop this pharmacy from being closed. I was told I could write a letter and directed me where to send my letter. She told me there will be a final budget hearing on November 24 so it's important they hear from me immediately.

I decided I had a mission. I sent an email to all the staff at these clinics regarding this and then sent my letter. Here is my letter with the name of the clinic and pharmacy left blank:

I work as a Registered Nurse at the X Clinic. I know the X Pharmacy is due to close very soon. This letter is in support of the X Pharmacy.

Our clinic serves the poorest of the poor in our city and this pharmacy has been an invaluable resource for our patients. Here's an example of why this pharmacy is so important:

I saw a patient the other day who stopped taking his diabetes medication and his blood pressure medication because he couldn't afford them. His blood pressure was 170/112 at the visit. He told me he had to make a decision to pay his rent and buy food for his family or buy his medications. He didn't know about the X Pharmacy where he could buy his medications at cost plus a handling fee. He told me he would even have a hard time affording it there but at least he would manage. This patient is just one of so many examples of patients whose lives would be put in danger if this pharmacy was closed.

We also have so many patients who need the interpreter service only they can offer.

I know your job is not easy; trying to figure out the budget for the next year. Please do not forget about the poor in this county. With such hard economic times I think there will be even more need for this pharmacy where our patients can buy their medications at a reduced cost.
Thank you for your consideration.

By the end of my workday today, a total of 6 staff from our clinic had sent a letter. I'll be working on getting even more letters sent. I don't know if these letters will change their probably already made up minds but I do believe it is our responsibility to do what we can to speak loudly for those whose voices are not strong.

Wednesday, November 5, 2008

The day after...

I went to work today, sure we'd all be talking about last night. I was busting at the seams; still clapping and cheering. Alas, it was business as usual. How could that be? My life has changed. I felt like I just had a baby and no one noticed. Oh, they're just young and don't know how hard we've worked to get to last night. I told myself that to quite my emotional swell. But the patients...why didn't they say anything? Their lives will change. Don't they know that? Our social worker noticed. We hugged for a moment and then he left to pick up free baby clothes from a donation site. I want to bask in it. I want to talk endlessly about the future.

HELLLLOOO AMERICA!! We are going to ROCK this world!!

What an amazing night it was. Getting together with friends, eating and drinking Champagne, clapping, cheering, crying. Seeing Jesse Jackson weep, watching people in NY and Chicago fall to the ground with joy and relief, and listening to John Lewis who sounded stunned. I think he was having a hard time even talking. When he worked so hard during the civil rights movement, he probably couldn't even imagine this night would come. The young people and people of color will forever have their say.

And now---

It IS a beautiful morning indeed...

I feel like dancing in the streets...

And then I want to lie beneath a shady tree and think about how much I love my country...

Saturday, November 1, 2008

The cycle of poverty...

uneducated, poor, demanding, distrustful. I talk to a patient on the phone and she yells at me. I tell her if she doesn't stop yelling at me I will need to hang up the phone. She says, "I'm not yelling. Believe me, you'd know if I was yelling". I tell her I think she is yelling at me and she needs to stop. She calms down, and proceeds to tell me she will be at the clinic in a few minutes and has to be seen right away. I tell her there may be a 2 hour wait because she doesn't have an appointment. She hangs the phone up on me and comes to the clinic anyway. I bring her back to a clinic room and do my assessment. Her lip is swollen and she thinks she was bitten by a spider. She spent the last two nights in an abandoned van. She's African American. She has fake two inch purple fingernails. She tells me she must be out of the clinic in 20 minutes because she needs to pick up her 8 year old son who will be waiting for her outside the YMCA. I beg one of our doctors to see her ahead of other patients because her son will think he was abandoned. They are homeless. 

A Cambodian man comes to the clinic with his 14 year old son. They do not have an appointment as he rushed him there from school. He tells me his son was sent home from school because he's sick. I do my assessment. He has a slight fever of 99.5 degrees and a sore throat. I do a throat culture and it's negative for Strep. I tell them it's probably just a virus and he should feel better in a few days. The man, who was difficult to understand because his english is poor, acts as though his son is dying. He tells me he wants me to give him medicine so he can get better. He asks me how he got sick. He asks me if 110 degree fever is a lot. I fax in a prescription for some Tylenol and he feels like I'm helping his son. He has no understanding of illness.

I talk to a patient on the phone who needs more percocet because she's on a wait list to have her tooth pulled. She says when she went to the community health clinic dentist, he couldn't get her numb so she's on the wait list at the county hospital to have her tooth pulled with general anesthesia. She's been on the list for 3 months. I tell her I'll call the hospital and see how much longer they think she'll have to wait. Surely it couldn't be much longer. When I call the clinic in the hospital, I'm told she probably has another 9 months to wait.

I call a patient and ask if this is Charlene. She says, "Who's this?" This actually happens a lot. I wonder if they think I'm a bill collector. I asked someone one time why she asked me that question. She said, "I don't wanna talk to anyone I don't haveta."

I see an 8 year old boy for a well-child check. He comes in with his mother and older sister. They're all eating Big Macs and fries in the clinic room. The boy has fat cheeks and a fat body and weighs a whopping 110 pounds. The mother tells me she's a little concerned about his weight and wonders why he's so overweight. I look at the boy eating his french fries. I look at the mom with her long fake fingernails and wonder how she'll clean all the food out of them. I can't help it. I start laughing. After I compose myself, I start talking to her about nutrition. She doesn't know what a "protein" is. I give some examples and the 8 year old says, "You mean like Chicken Nuggets?" The mother tells me when she was growing up, her mother would give her fried sandwich meat and a soda for breakfast. I set them up to see our nutritionist. 

Thursday, October 30, 2008

Vile Fox News

I went to the gym when I got home and got there just in time to watch the nightly news. With my headset plugged in, I watched and listened to Brian Williams interview Obama about the criteria by which he will pick a Supreme Court Justice. He sounded so beautifully articulate and knowledgeable. Afterall, he really IS a Constitutional scholar. In contrast, McInsane's running mate doesn't know what the role of the VP is as written in the constitution. Nor did McInsane's chief advisor when asked by Chris Matthews on Hardball. She said, "I'm NOT a constitutional scholar" using a tone of voice that sounded like she was offended to even be expected to know the answer to this 9th grade civics question. To my right of this TV screen was another screen with the Fox (fair and balanced news) channel. I didn't hear anything they were saying as I was listening to Obama but they kept flashing "BREAKING NEWS". And there was Ann Coulter who must have come out of hiding since she had the nerve to say such mean things to and about Elizabeth Edwards. Their breaking news was showing videos of Rashid Khalidi, the professor and supposed "mouthpiece" of the PLO, followed by William Ayers, followed by Reverend Wright with Obama's face, color darkened in the background. How vile, how desperate, how stomach turning. This is all they have to try and win-lies and fear. It was hard to even look at. 

I see that McInsane and Sarah Palin are now palling around with Joe the unlicensed plumber. Yes, Joe. You're just like everyone else; trying now for a book deal and even a country western recording contract. Unbelievable. 

Wednesday, October 29, 2008

Another person on our staff got her car broken into today. It happens almost weekly. I've been lucky so far.

Poverty and a bad healthcare system

Some stories from my patients today: I saw a new patient to our clinic who is Spanish speaking. She came to the clinic with two of her three sons. Her oldest son, who's in the 9th grade interpreted for her. He's a very good-looking, sweet kid and was attentive to his mother's problems. He told me he goes to the high school about two blocks from my clinic which is considered the roughest high school in the city. It's known for it's gang activity. On occasion, I go to the Starbucks near this school right around the time school lets out. There's often 5 or 6 police cars with, well, two police in each car so that means I've sometimes seen 10-12 police officers getting coffee at the same time I'm there. I've often thought it's a shame I'm not into men in police uniforms. BTW, this doesn't include the police cars already parked at the school. I asked this young man if it's true about all the gang activity there and he said, "Oh yeah!" I told him I hoped he doesn't get involved with any of that. He assured me he doesn't and his mother, who was able to understand some of this conversation said in her broken English, "I tell him all the time not to get involved with that." I couldn't help thinking once again how lucky my kids are that they didn't go to a school like this. How lucky I am that I never worried about them joining a gang or being around gang activity. It just wasn't a part of their reality. How can kids learn in this kind of environment? I always ask new patients if they have smoke detectors. He told they have one but it's not working. He then started telling me all about the things that aren't working in their apartment but the apartment manager won't fix them. I expressed my sympathy and I also know this is typical of the poor who live in sub-standard housing. I asked him if he has plans of going to college and he said he does. His mother said, "I hope he will go." I left the room to get something and when I came back he asked me if I'd heard the story of the girl who was stabbed to death with a screwdriver and then thrown in the lake. I told him I hadn't because I don't watch local news. He told me she was his friend. He said she was a "gang-banger" and someone from another gang killed her. After I expressed my shock, I asked him how he was doing with all this. He said, "Oh fine. I mean she wasn't a really good friend of mine." Was he minimizing this because he's just a 9th grade boy who doesn't want to show his feelings or has his environment desensitized him. I'm guessing it's a little of both. The mother, who didn't go past 6th grade in Mexico has a smart and good kid who has a lot to say. I can tell he wants his life to be different. I have high hopes for him.

I talked to a patient on the phone who needs more pain medication. He's supposed to have surgery on his arm and shoulder but he can't afford to take the time off work. He's a maintenance worker. The surgeon told him he'll need to take 3 months off work after surgery. He told me he's been trying to save enough money to do this and thinks in a few months he might be able. In the meantime, he takes narcotics for his pain and keeps working with a bad arm and shoulder. 

A nurse in my clinic told me that last year around this time right before I started working there she heard gunshots outside the clinic. She got down on her hands and knees and crawled away from the window. Police were there soon after. I said, "Oh great. No one told me this story when I interviewed." The truth is, I would have taken the job anyway.

I was overhead paged to come to the front right before we closed. This usually means someone is having chest pain. So I swung on my stethoscope, ready for the job. When I got there, a medical assistant was helping a man up after he'd fallen because he was so weak. His girlfriend brought him. He'd never been to the clinic before. He'd been sick for 5 days with vomiting and dehydration. He looked confused but was able to tell me his name and where he was. I told them he was much too sick for us and he needs to go to the ER. I wanted to call for an ambulance but his girlfriend wouldn't let me because he doesn't have insurance. I gave them the address to the county hospital and hoped his body systems didn't completely shut down before they got there.

Monday, October 27, 2008

All in the name of Allah

We have a lot of Somali patients at our clinic. There's a baseline of post traumatic stress disorder (PTSD) since they've come here after the civil war in the early 1990's that happened in Somalia. I've heard stories from patients that I can't even imagine. These stories include mothers being separated from their children, the sound of bombs going off, and life in refugee camps. Not long ago, a patient came into the clinic dressed in her Somali attire as they all are. She told a story, through an interpreter, about how she was hit by a bomb and she still has shrapnel in her head and face. She lost her ear and hearing in one ear and was paralyzed on one side of her face so her mouth was drooping. She had six surgeries already and was considering having another but then decided not to. She had a meek voice and said, "I know I'm not beautiful but this is what I look like now." I said, "I think you're a beautiful woman and you've been through so much. You're strong and beautiful." She thanked me and then said, "Well, Allah had plans for me and I know he knows what he's doing." When I left the room I wanted to cry. How could she explain her ruined life by saying Allah had plans for her? And then I thought about her country destroying itself. If you haven't read the book, "Infidel", it's a must read.

Saturday, October 25, 2008

Do I eat or take my medicine?

My first blog post! I feel like I have to have the perfect entry for this momentous occasion and finally decided to just write:

There was an article in the NY Times the other day about how some financially poor people are opting out of buying their medicine because they need to make choices. These are choices no one should have to make: do I eat and pay my rent this month or do I buy my medicine. I see this often in the clinic where I work. Just the other day, I was seeing a patient who came in just to have me put his medications in his pill box and to talk to me about them. When I took his blood pressure it was 190/110. For anyone who doesn't already know this, that's high. He is also a diabetic, although not on insulin. When I asked him if he'd been taking his blood pressure medications and his medications for his diabetes, he said he'd skipped them this month because he couldn't afford them. I reminded him of a pharmacy our clinic uses which gives patients many medications for only $4 but he said he couldn't afford that. He very sadly told me he's been out of work for a long time. When I asked him what he used to do (he's only 59 years old) he told me he used to work in construction. Then he said, "I send my resume out all the time but no one wants me now. I'm too old." I just listened to him and looked at his sad face, once again feeling angry and frustrated that we are a country of the haves and have nots. I reminded him to vote, got him some samples of some of his medications to last him for at least a little while, and arranged for him to meet with our eligibility worker so he didn't need to pay for that visit.