Friday, January 23, 2009

If opposites could have attracted

She's 20 years old. She's been through more than anyone should have to go through in their entire lifetime and she is surviving so far. She was beaten and sexually abused by her father while he was drunk and high on street drugs. Her mother was too drunk and high on drugs that she never came to her defense. She was in three foster homes and homeless. She's the only one in her family to finish high school. She's the only one in her family not to use drugs or alcohol. She thinks she's bipolar because she gets mad at her girlfriend for things she knows she shouldn't be mad about and then feels so bad, that she apologizes. She thinks she's bipolar because both her parents are and her mother, who is "shacking up with some dude" and still high on drugs told her she is.

I told her she needs to be evaluated by a psychiatrist to determine if she's bipolar. I told her anyone who has experienced as much as she has would have mood swings and deep feelings. I told her she's an absolutely amazing person and a survivor. I promised her we'd help her get the help she needs.

She came to the clinic with adoption paperwork that needed to be filled out. The paperwork needs to be signed by a doctor saying she doesn't have any mental illness, and she is basically a healthy person. She's in the process of adopting a 7 month old baby that has been in her foster care since he was 4 months. This baby will need a bone marrow transplant as soon as the adoption goes through. She's hoping to move the process along so she and her husband can help save his life.

Her husband works with homeless youth and she used to be the director of a food bank. They've cared for a total of 14 foster babies in their home. She got these babies from women who would come to the food bank and couldn't care for their babies. She didn't have them long enough to get very attached, except for one baby. This baby lived with them for 9 months and was finally sent to live with her grandmother. "This baby will always be my baby", she says. She and her husband have also adopted their nephew. She says because of state budget cuts financial help will be cut off for people like her who adopt very medically challenging babies. She and her husband have no medical insurance. I told her she has a beautiful big heart.

I wish this first patient, born into a family full of hate had had a guardian angel like this woman, so full of love.

Friday, January 16, 2009

A Woman's Choice

She's 20 years old and has been feeling tired, with an upset stomach so she decided to see a doctor. When the medical assistant found out the date of her last menstrual period, she did a pregnancy test. It was positive. I walked in the clinic room to give her the news. She was a very beautiful African American young woman with many fancy light brown braids down her back. I sat down to tell her and when I did, she didn't express much emotion. I asked her what she wanted to do. She began talking to me, never looking at me, as though I was sitting at another place in the room. "I already had an abortion and it was a horrible experience. There's no way I'm going to have another one". I asked her to tell me what happened. She told the wall across from her that it hurt and she didn't think they took very good care of her. I told her I could give her names of very good places that would make sure it didn't hurt and would take good care of her.

She began to tell me about her dreams of going to college in the fall. She wants to be a medical assistant but now doesn't know if she can do it. She started telling me in a young, whiny voice how tired she is and wants a note to let her employer know why she keeps putting her head down on the desk. I was struck by the immaturity of this, the need for a note from her doctor, like she's still in high school and needs an excuse because she has the flu. She's about to cross that bridge to adulthood too soon, I thought.

I asked her if the father will be involved. She doesn't think so. I told her she will have to put her life on hold. I told her if she thinks she's tired now just wait for the baby. I told her that having a baby is a beautiful thing when someone is ready but if she's not ready, then this isn't the right time. I felt angry inside that she didn't think about using birth control. I realized how much I didn't want her to have this baby. I saw in front of me, yet another young woman in poverty have so little chance to change her life. I saw another African American baby growing up without a father. I saw the cycle of poverty going on for another generation. And I saw myself being judgmental of her decision.

I left the room and came back in with some phone numbers for her to call if she changes her mind. It was then she told me she doesn't feel good, morally, about having another abortion. Then it hit me. I'm pro-choice and that means I believe it is HER choice to make, not mine. It's important this woman make the decision that will make her feel like she did something right. It's her belief system that has ruled her decision; a belief that she feels at her core. But as I sit here, I am thinking about the future of this mother and baby, stuck in poverty, stuck in a prison so difficult to escape.

Friday, January 9, 2009

One of the lucky ones

Her skin was dull and pale. She had dark circles under her eyes. Her hair was blond, or at least that's what she wanted people to think. It was dry, like straw. She's been staying with her friend for the last three months. After living on the street for four years, a friend found her and told her to "come home". She feels safer than she's felt in a long time. She tells me how comfortable she feels talking to me because I'm wearing jeans, not scrubs or a uniform.

"Where did you actually sleep when you were on the street", I asked. "Sometimes in a shelter. But mostly I'd just keep walking until I couldn't anymore and then I'd just lay down and go to sleep". I sold my body for four years. But I'm done now and I want to start taking care of myself". She pulled up her sleeves to show about 30 scars on each arm where a "trick" had burned her with a cigarette. She's been raped, held at gunpoint, and incarcerated for prostitution. She told me so many bad things happened to her while she was on the street and it's taken her three months to start sorting through some of it. I told her how proud she should be of herself, how it's never too late to start over. Never too late to start taking care of herself.

The homeless are so vulnerable. Women and children on the streets, especially so. So far, she is one of the lucky ones. She is off the streets for now.

Wednesday, January 7, 2009

Pharmacy update

It was announced today that our group of clinics bought the pharmacy! What a relief for our patients. What a relief for my heart.

Sunday, January 4, 2009

And now for something completely different...

I want to pay tribute to musicians who died this year. Maybe you do too. Take a listen:

Creepy-crawlies on a homeless man

It's been a long time since I've written. So many stories, so much snow, so little time.

Our nurse practitioner came to me yesterday in a panic because she couldn't figure out a way to get a homeless man some medication to get rid of his scabies. He obviously can't afford any medication. I reminded her that our clinic can write off the cost of a medication through the public health pharmacy I've written about. (An update on the pharmacy to come). I've seen scabies quite a few times in our clinic. Scabies is a parasite that burrows under the skin and causes severe itching. Burrow markings and scratch marks can usually be seen. I've never actually seen the parasite as they are as small as the head of a pin and they hide. I've read it's possible to see 3 or 4 on somebody.

The NP told me there were so many scabies on this man and she'd never seen anything like it. She asked me to come and look. When I went into the clinic room, I saw a man who looked to be in his 70's but was 52 years old. He wore a blue knit cap, a flannel shirt with a T-shirt underneath. His jeans were stained with urine. His face was very red, perhaps from drinking but I don't know. He was asked to open his flannel shirt to expose his T-shirt. There on his shirt on his chest were literally hundreds of scabies parasites, crawling all around. He rolled up his sleeve and his arms were bleeding from his scratching. He thinks he was infected from a mission shelter he stayed in when it was very cold.

I apologized to him that the pharmacy he need to use was closed until Monday, two days from then. I assured him the medication would be ready for him to get on Monday morning. I couldn't even Imagine having to wait two days in his state but his response was, "Ok, That's all right. I can wait". He demanded nothing, expected nothing. I told him it was very important to wash his clothes in hot water and dry them on a high heat. (He really should throw his clothes away but it's all he has). I instructed him how to use this cream all over his body and told him he must put on clean clothes afterward. I asked him if he has access to any other clothes. He told me he has a friend he stays with every once in a while who could give him some clothes. I reminded him of the protocol again before he left that he needs to follow but wondered if he could really follow it. Would anyone actually let him into their house? Can he wash his clothes? Can he find clean clothes? Can he follow the medication instructions?

As I was pondering these questions, I made sure our clinic room was disinfected, and made sure the chair he was sitting on in the lobby was disinfected. And I said out loud once again, "We don't treat our poor very well".