If obtaining healthcare is difficult for America's citizens, imagine how it must be for those who are here from another country. Living in a border state, I knew I would be seeing patients who are in this country illegally. What I did not realize one year ago, is how many of these patients I would see, how sick most of them are, and the fact that their diversity is no different than that of other populations. Here are some examples:
Recently I delivered a premature infant to a couple who have been as attentive to this baby and their other two children as any parents I have ever seen. The baby is a little girl. Her brothers are 8 and 14 years old. Both parents were employed at the time labor began, the mom with a cleaning service, the dad in construction. The father of the baby apologizes every time he sees me that he is not present more but there are two days during the week where the pediatricians tell me he is always there with his family. Both of the brothers are clean, bright, and polite to everyone. Always well behaved, they seem to do as they are told and wait patiently for their parents to speak with the physicians.
A few nights ago I admitted a lady who is about my age. Her adult daughter was with her to translate. This woman does not speak any English but through the daughter I find out that she has been in two other hospitals in our city. I am sure one reason she has not received follow up for her medical condition is fear of deportation. I am also sure the reason she does not go back to her own country for treatment is the fact that she may not be able to re-enter this one. Her family is here and they are natural born citizens.
A 17 year old I have been seeing for two months delivered her baby a few days ago. He has a heart problem. The baby will need specialized treatment for sometime. This young mother is a candidate for Medicaid, as is the baby but it remains to be seen if they will get it. I have helped her fill out all the required paper work - twice. She has had minimal schooling. She is a citizen. Her parents are not. The father of the baby, who is 20, seems to be her support system. He has money to spend but no steady job. This concerns me. She needs contraception. The baby is going to need a great deal of care.
This is the very tip of an iceberg. I do not know how the social workers do this work. My work at least is interspersed with the working poor, many of whom get social services such as Medicaid and WIC. There are also the women who left their midwives to get pain medication during labor, and patients just like the ones I use to see in private practice. These women have health insurance, jobs, and families. They are simply at the big hospital due to complications with their pregnany or problems with their baby.
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Musings of a physician in private practice for 24 years, now teaching in a residency program and working as an ob-gyn hospitalist in a large metropolitan hospital.
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The Local MD
Having now been a physician in private practice for twenty-one years, twenty-six days and about an hour and twenty minutes, it occurs to me that I have become what in medical school was often a derogatory term, the local MD.The presentation on rounds often went something like: "This 45 year old Caucasian male was seen last week by his LMD, and diagnosed with a viral upper respiratory infection..." At that point everyone knew that the LMD had missed the diagnosis. Otherwise the poor patient would not have ended up in a tertiary medical center with three consulting specialist, a fellow, a resident and four medical students at his bedside.What we, the medical students, the resident, the fellow and even the attending hospital physicians did not realize is that we would never know John Smith as well as the LMD. We would never speak to his wife using her first name. We would never be able to recall the names of all his children and know where they were in the world. We would never remember his favorite hobby let alone joke with him about it. Nor would we shed a heart felt tear when we gave him the diagnosis of the aggressive small cell carcinoma of the lung that had landed him in our midst and would kill him in less than three months despite our aggressive treatment that was the best medical science has to offer.At that point in my life I was very proud to be even the lowest ranking person on the team that was on the cutting edge of the diagnosis and the treatment of the gravest of conditions that plagued mankind. I felt so very lucky that I was being initiated in to this sacred fraternity. That I would soon be able to write "MD" after my name. I am still proud of my vocation yet I believe there is a wisdom that has only come with those twenty-years of practice.Today I realize what people want most of their physician is that he or she is someone who cares.Yes, we all want "everything medical science has to offer." Yet, what most of patients need is someone who will listen with their heart as well as with their head. Physician eyes are important, not only for seeing signs of disease in the body but for making contact with the patient's eyes where we are often allowed to see into their soul. All of the technology in the world will not replace a warm clasp of the hand or sitting at the bedside to share a few moments of the day along with the test results.So, I have created this blog. In large part it is a place for me to put my feelings. My hope is that at least some of these posts will resonate with others out there. Not just physicians, but others in caregiving vocations and even those for whom we care. If we are not here for each other then why are we here?
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