Archive for December, 2005
Mom and dad look weary and frightened as dad holds their 2 month old daughter in his arms.
mom: “Doctor, how will this meningitis affect our child?”
dad: “will she have brain damage?”
you did the right thing by bringing your baby in early, I say. I explain to them that meningitis is an infection of the fluid surrounding the brain and spinal cord, that the treatment consists of antibiotics in case of bacterial cause, and that there are varying prognoses for an infant with meningitis. I address their concerns, try to calm them. They need some reassurance—their eyes are bloodshot, they have not slept for the past 2 days with their worries and baby’s fevers.
mom: “You know, doctor, this is our first child together…”
dad, finishing her sentence: “and we want to provide her with the best opportunities in america, all the opportunities we couldn’t have. We worked so hard in the phillipines… to come here and start from scratch, just so that we could build a beautiful life for our children.”
mom and dad hold back tears. I am reminded of parents’ ultimate love for their children, the immense sacrifices that immigrants make for their childrens’ futures, and what my own parents felt about the opportunities they wanted to provide for me. At that moment, three thousand miles away from my parents, I missed them more than I have in my seven months in this new city.
I hear the nurse ask, Señora, on a scale of one to ten, do you have pain today?
I shudder and walk into the room.
Buenos dias Señora.
How is it that you have ten out of ten pain and still walk and breathe and live I wonder?
This damn JCAHO requirement that we assess pain in our patients will be the death of us I mutter. Don’t these people understand that the ambulatory arena is not the same as a post-op suite or a surgery ward?
Our administrators don’t care—just do it. It’s required.
We don’t really care what it means, is what I think they are really saying.
Well Señora, tell me about your pain. Where does it hurt?
It hurts all over.
Where does it hurt the most?
When does it hurt the most?
All the time.
Does anything ever make it better?
I am quiet and she becomes uncomfortable.
In more than a familiar routine, I ask about her sleep, her memory, her appetite, her weight.
I find that once she had energy, that she was full of life and full of dreams.
That she would struggle to make a better life, if not for her then for her children. I find that her life has been falling apart. That each dream has slowly been eroding, a gentle and almost unnoticeable erosion of the strength that has driven her and in turn her family.
I come to understand the hardships she has endured and see the scars on her soul that have come from the injuries and the indifference her children have endured and the hopelessness that has resulted from her inability to protect them.
I translate the suffering into guilt and grief. She has not been able to give them the things they wanted, but she has worked so hard. She has not given them as much of herself as she feels they might have needed.
Yes, this strong and proud woman is in pain. The pain is centuries old and has settled in her soul. There is no knife that can cut it out, there are no pills that can heal. I hand her a tissue as she begins to cry, but she doesn’t need one. There are no tears. They ran out about the same time that her dreams began to die. All that is left is the shudder from her soul… and I become lost in the pain in her eyes.
I regroup. Her heart, her lungs, her abdomen, her muscles—things seem to be in working order. I smile as I think of bottling justice and giving her three tablespoons a day. Taken with hope for a better world—a place where people care for and about one another.
I smile and touch her gently. I think we can help I whisper. Take these once a day. When can you come back?
How is it that you can have ten out of ten pain señora, and still walk and breathe and live I wonder? As I walk into the next room I glance at the chart—ten out of ten pain…
This is an exciting project for us as we attempt to find our voice and contribute to the dialogue on health and the practice of Medicine in underserved communities.
We have developed a simple vision for the future of health care: that there is equal access to evidence based health care, that we address the many social needs that contribute to both health and illness and that we provide a strong focus on prevention and education strategies.
While our vision is not complex, translating it will require persistence and dedication. It will involve reengineering how health care is delivered, empowering self care and addressing risky health behavior. It will also involve focusing medical education in a somewhat different manner than occurs presently. In addition, the notion that health care can only be addressed in the hospital or office needs to be dispelled; in fact self-care strategies can not only be taught in the office but can equally be taught in community settings with measurable effectiveness.
Our journey as a program has evolved from an effort to meet the needs of our most vulnerable communities while attempting to meet the educational and social needs of the physicians we train to go into these locations. Our evolution will never be completed as long as these communities continue to have unmet needs and overwhelming challenges—this will require at least several lifetimes of diligent work to accomplish.
We would like to elaborate on how we are attempting to address the changes that we see as necessary to reform our health system. In addition, we would like to share the perspectives we have developed from working in the trenches with our most vulnerable patients and their communities; our frustrations, our inspirations and the everyday human condition we encounter.