Wednesday, October 29, 2008

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.

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