Surviving

Sometimes I think about all the patients I see who have dead children. Some from an act of violence, some from a disease; lives full of tragedy. Recently, a woman came to our clinic as a new patient. She brought with her a box full of her medical records. She was petite and pretty with short light brown hair. She looked her age at 45 years old but she's had more tragedy than anyone should be expected to survive.

She begins her story, listing the horrible things in her life with the same emotion given to reading a shopping list. "I have hepatitis C. I think I got that a long time ago when I experimented with drugs and now I have cirrhoses of the liver."  She stops looking at the papers in her box long enough to say, "Oh and I've been treated for PTSD". "What's your PTSD from?" She continues her list, licking the tip of her index finger and sorting through her papers."One of my daughters was murdered by a boyfriend. I watched another daughter's husband being murdered in my house..." 

I turn away from my computer and look at her, in horror. I lean against the wall to sturdy myself for more. She goes on, "I was stabbed in my back by my ex-husband and then when he and I were in the car one time, he reached over and punched me in the face so many times that I've had 8 facial reconstruction surgeries. Now my ex is in prison for molesting his new wife's daughter." She smiles sometimes but never cries. The only words I could muster up were, "Oh my God." I am not only struck by the things she tells but by the emotional detachment with which she tells it. She's busy finding the papers she needs to show the doctor. She's busy surviving. 

Suburbia Verses Inner-City

Yesterday, I was sitting outside a coffee shop in my quiet suburban neighborhood, when suddenly an overweight woman wearing an apron ran out of her ice cream shop, yelling and pointing at a young man who was running away from the scene. "He stole the tip jar!", she yelled. "Does anyone have a cell phone?! Someone, call the police!". Within one minute two police cars arrived and as I watched them get out, hands over their guns, I couldn't help but laugh. Has working at my clinic jaded me? All this police activity for someone who stole a tip jar from the ice cream shop. I tried to imagine a frantic phone call to the police station near my clinic about a stolen tip jar. I could see the officer answering the phone and then looking at it with a quizzical face, shaking his head at the idea that someone would bother the police for this, then hanging up. 

Today, I was busy assisting with a procedure on a patient when there was a little action outside the clinic. The security guard told me he was standing in our parking lot and was watching and listening to two men argue. All of a sudden, one of them pulled out a gun and shot it, missing the person with whom he was arguing. I'm assuming he meant to miss since they were in such close proximity. As he was telling me the story, one of the doctors asked what happened. When he told her, she very casually  said, "Oh, is that what I heard." And then continued working at her desk. 

Our security guard's only weapon is his walkie-talkie. His company hasn't even provided him with a cell phone. So he stayed outside to keep witnessing, and asked a patient to go in the clinic and call the police. He then called his boss and told him he really thinks he needs a cell phone. Gee, ya think?

 

Spinning Out of Control

The patient population at the clinic can be very difficult and I am realizing the layers upon layers of poverty. Their lives have been teetering on the edge, in some cases, since they were born. Many patients are demanding and rude and their volatility has been getting more explosive recently. With so many job losses, budget cuts, and reduced resources, the nurses have become a verbal punching bag. It is common these days, for patients to interact with me in a disrespectful and uncivil manner. My stomach is often tied in knots as we interact. I have written about the hardships and the sadness I see. Here is an example of another way poverty expresses itself. While this patient also faces hardships and sadness, she is so angry and hostile that she makes it impossible for me to advocate or have compassion for her:

A patient is refused a prescription until she makes another appointment with her doctor. She yells so loudly at me, that I hold the phone a foot away from my ear. "WHY THE HELL CAN'T I HAVE THIS?! WHO DO YOU THINK YOU ARE?!" This goes on and on until she finally demands, "LET ME TALK TO THAT NURSE THAT DON'T TALK TOO GOOD ENGLISH!" I can't help myself. I reply, "You want to talk to the nurse that don't talk too good english?" "YEAH! PUT 'ER ON! NOW!" I manage to calmly tell her that she's being rude and disrespectful and if she doesn't calm down I will need to hang up the phone. She doesn't calm down so I warn her that I am hanging up and then do. 

Poverty's cycle; how it starts, how it presents itself, and how it continues, is a wheel that spins out of control. It tries to drag others in to gain momentum. It's complex and it's ugly and it needs to be stopped in its tracks.