Pharmacy: House of Pain/Hurry Up and Wait Saturday, Dec 5 2009 

Once inside the Clinic building, the misery continues. The pharmacy is located just inside the entrance. It’s ground zero for another crucial aspect of the health care crisis: the price of medicine.

The pharmacy is full of hostages to the pharmaceutical industry. Refugees of the drug war.  

Everyday I scurry past the hostages and refugees to get to my office on the second floor. They are clumped together in a tiny waiting area, sitting on long, hard benches or standing and pacing anxiously and above all waiting, waiting, waiting  and waiting for the medicine that allows them to function like normal human beings. That allows them to be “compliant” with doctors prescriptive orders. To keep the sugar between 70 and 100, the good cholesterol good and the bad good, blood pressure low, voices in the head tolerable, virus undetectable, heart ticking, pulse clicking and pain bearable.

Pandemonium punctuated by an automated voice in English and Spanish call out numbers: “Attendiendo cliente numero 233.” If  your number is flashing in bright red on the small black screen you’ve won the medication lottery. A brown paper bag full of plastic bottles of pills is the prize. Hallelujah, thank you drug lord Jesus! 

The hostages and refugees come from every corner of the globe. There are tall, proud Mexican campesinos with gold teeth wearing scruffy cowboy boots and sombreros made of straw standing next to diminutive Indian women in diaphanous, swirling saris – wrists completely encircled with gold bracelets. African women’s heads are swathed in colorful cloth and women from the Middle East don black hijabs. Along side them are indigenous prisoners of big PhRMA, some of the poorest people in Cook County, USA: Black and white, whose lives and clothes are hand-to-mouth and second-hand.

The procurement of a month’s worth of medication is a harrowing, error-prone, daylong proposition. A machine dispenses numbers like the deli counter in a grocery store that patients must get in order to simply drop off a prescription. To pick it up another number has to be secured. The waits are legendary and can rival the ER. Patients inhabit the rows of benches across from the pharmacy windows where  pharm techs can be seen briskly dispensing precious pills and liquids. Hundreds of eyes and ears are trained on seeing and hearing the magic number. Shit out of luck if you fall asleep, aren’t paying attention or are confused and your number calls and blinks and you miss it.    

Medicine is a gift and there are no guarantees.

Arguments and anger at the dispensing windows. Signs are posted proclaiming  rudeness to staff will not be tolerated and ejection from the pharmacy will result. One day a furious and feisty old woman leaning on a cane was throwing down on two burly, armed police officers. She wouldn’t move away from the cashier’s window until the pharmacy manager was called. 

Patients plead and beg staff to give them their medicine. Prescription snafus (usually the fault of doctors) or lack of co-pays, trigger yet more rage and belligerence – on both sides of the glass window.

Because hell hath no fury like a patient in need of medication.

Drug company profits are astounding and depend on the desperate desperation and daily pandemonium at the Pharmacy where there is an astounding dearth of dignity and enough unnecessary pain and suffering to fill an ocean – or two.

Resident Poem Saturday, Oct 31 2009 

No battle lines

No septal hematoma

No septal deviation

No discharge

No epistaxis

Welcome to The Oupatient Clinic Saturday, Oct 17 2009 

I’ve transferred to a full-time position in the outpatient  clinic. It’s across the street from the new hospital and right next to the old hospital. Sandwiched in between old and new, the building is a ghost of the past that promises a future to patients that enter it.

There is abundant evidence of both human misery and mitigation of human misery on all four floors of the clinic.  

The clinic experience” starts outside of the building. Dozens of patients, many homeless, are just hanging out in front. It’s part freak show, part party, part circus, part the only place to be.  As I walk into the building I smell, see and hear: mentally ill patients responding to internal voices only; angry exchanges between patients in physical pain; a chorus of crying children and parents who warn “Shut up or I’ll whup your butt”); patients hocking cigarettes (they call out  “loose square” – it costs anywhere from 50 to 75 cents for one cigarette), t-shirts, lighters, bags of peanuts, chocolate bars (the seller pitches the candy to women claiming it’s “Pretty ladies day”); people pleading and yelling into cell phones; a county worker cries out “medication refills” and hands half-sheets to interested patients with step-by-step instuctions on how to get  medication by mail.

The air is full and thick with clouds of metastatic smoke.   

The people speak a patois unique to the downtrodden and marginalized. Half sentences, grammatically incorrect word choices, slang sounds slurred spoken and stitched together utterances originate in drug-addled, battered brains and flap past broken teeth bloody, gingivied gums and busted crusted, spittle-laced lips.   

Patients stagger, wobble instead of walk, damaged and disabled arms and legs jerk intermittently and at weird asymmetric angles from broken and battered bodies bent over wooden canes or crutches, dented and dirty aluminium walkers with worn and torn faux leather seats. Patients are pushed roughly in beat up wheelchairs by bitter, burned out relatives. Bloody bandages on necks, patches on eyes weeping watery discharge, dirty plaster casts, nostrils plugged with plastic canula tethered to portable oxygen tanks, swollen pregnant teen bellies. 

The poundage is astounding. I have never seen more obese people in one place in my entire life. These heavy weights don’t hide the fat and flab. Just the opposite. Elephantine women with butts as big as hot air balloons wear made-in-China tight stretchy, neon lime and silver pants that serve only to accentuate all that stretch-marked flesh. The men are massive, gigantesco and positively waddle under the weight. It’s like walking through the land of the giants.   

Health workers in short white and long gray lab coats with picture ID necklaces swiftly enter and exit the building oblivious to it all, a singular goal of treating this roiling sea of humanity.

There is a stern elderly, demented man in front of the clinic almost every day and has been for years. He has matted gray-white, filthy knots of dread locks that poke out all over his head. He wears blue sweat pants and a thick, soiled blue coat. The man stays off to himself and talks to no one. Occasionally I’ve heard him go off on insane swearing tirades, repeating over and over again, “Fucking bitch.” Years ago, social workers staged an intervention to get the patient evaluated for medication and housing. It failed miserably. And so like a mostly silent sentinel, he watches over the clinic entrance every day. A no smiles, no handshake version of a Wal-Mart greeter.

Like the undead zombies in Michael Jackson’s video, Thriller, all roads for the medically indigent and uninsured lead to the clinic.

Welcome to my world.

Trauma Observation #21 Resident Poem Friday, Aug 21 2009 

Open Globe, Left Eye

Stromal Scarring

1 o’clock Limbus

Vitreous Prolapse

Conjunctiva

Chemotic

Flat Retina

Disorganized Interior Segment

Fundus

Prolapse Intraocular Contents

Possible Enucleation  Left Eye

Trauma Observation #20: Easter in the ER – 16 hours Monday, Apr 13 2009 

How crazy am I? I agreed to work the morning and evening shift: 16 hours in the ER.

8am  A knock on the social work office door. 2 women in the hallway. The back story: They brought their sister here from East St. Louis. The patient has ovarian cancer and the doctor said she has less than 6 months to live. The sisters don’t believe it and want another opinion. They tell me the sister is uninsured and ask can she get a medical card in Illinois. What will be the discharge plan? Are there resources? I answer the questions.

I check the computer for the medical story. The patient is 41 and has advanced cervical cancer, not ovarian. No woman should get cervical cancer in the United States, a simple pap test and death is avoided. This diagnosis always astounds me. Only poor, uninsured women get cervical CA. The cancer has metastasized. Surgery is not an option. Maybe chemo. Not good.

8:30 Call from Blue Team. They have a guy with head and body lice and are going to shower him. His clothes have to be thrown out. Can I find some clothes for him?

9:00 My co-worker working up on the units wants to buy me a cup of tea. We go to the cafeteria and drink tea and chat.

9:42 Call from trauma ICU. A patient is going to have a peg placed and will be ready to be transferred to Oak Forest Hospital early next week. The team wants to make sure he can still go to Oak Forest. I offer to leave a voice mail for the social worker on that unit. I check the patient’s medical record to see if she has seen him. 33 year-old man. Multiple gun shots to the head. He never regained consciousness. Gray matter was extruding from the brain.

 The resident’s note:

Intubated no sedation, no eye opening, pupils 4mm not reactive, doll’s eye sign absent, weak gag present to deep oropharyngeal stimulus, no spontaneous movement, no movement to noxious stimulus, overall prognosis is poor.

The social worker’s note:

SW met with patient’s sister to provide emotional support. The sister stated her brother would want to stay on earth, even if in a nursing home in his present condition.

11:34 Page from labor and delivery. A patient’s baby died. No money for a funeral or burial. Staff ask me to come to the unit and talk with mom and dad.

11:45 Call from trauma. The nurse asks me to meet with a patient who is an alcoholic and give him a “pep talk.” I meet with him and he tells me he’s a Viet Nam veteran. He started drinking heavily when he was over there because he was afraid much of the time. When he returned to Chicago the fear didn’t end. In the past, the patient received treatment for alcohol abuse at the VA. He tells me he’s going to go back for more treatment. Great idea I say. One day at a time.

1:pm  Saw a patient who needed transportation home. He was assaulted by fists in the face and by a brick that was smashed in his left eye. He had surgery on the eye and was wearing a fox shield (fancy word for an eye patch.) He looked like a pirate.   

2:30 Peds trauma resident calls. An iron gate fell on a child, breaking his clavicle. Per the peds protocol that says every injured child must be seen by social work, I am asked to come and interview patient and family. Except not right now because the child’s mother has just passed out. They’re going to work her up.

3:30 I have the office door open and I hear a loud, raging argument emanating from around the corner in the ER waiting area. A woman is shouting, “Fuck-you, go ahead and try to arrest me, I’ll fuckin’ have you arrested What he be saying to me? Fuck you.” It went on like that for about 5 minutes.

3:45 My co-worker comes down to my office for a break and we swap patient stories. She’s catching hell up on the units, I’m catching it in the ER.

5:30 Domestic violence victim, 32 years old, with 2 children in the big, big city of Chicago from a small, small town in rural Illinois. I went into the exam room and the kids are out of control and mom was screaming at them to sit still. One is 8, the other 10 and they have both been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD.) They can’t sit still because they are not medicated. Mom bursts into tears and chokes out, “I can’t do this.”  There isn’t another person in the entire hospital that is more stressed out than she is at this moment. The room is so full of tension if feels like it could blow up. For about 30 seconds I just stand there in stunned silence trying to think of something to say. 

It’s impossible to have an uninterrupted conversation. She grabs the children roughly by the arms and legs, yells at them again and forces them to sit on the floor. They immediately start moving the minute she turns her attention back to me. They touch everything in the exam room. Again, she breaks down into tears. Even a 2 parent family would have difficulty controlling these children. I recommend she ignore some of their behavior and tell her she that she is going to get through this; it’s only temporary. I also suggest she always bring things –  electronic games, books, crayons and paper  – to keep the kids occupied whenever they go anywhere. 

Next stop is the peds ER to see a pediatrician/psychiatrist so the kids can get their medication. In that ER there is a special enclosed waiting area for children filled with books, games and a TV. I know mom will finally get a break from the 2 little ADD maniacs.

They are going to a domestic violence shelter tonight; they’ve already been in 2 other ones. I tell mom to have the nurse page me when the kids are finished with the doctor and I will call the Department of Human Services (DHS) for them.  

6:30 I walk back to my office through the red team. Behind a curtain a patient is throwing up as loud as a bomb and with great difficulty. He starts coughing out chunks of something. No one moves to help him. The sound is so disgusting I sprint out of out of the room as fast as I can.

7:15 I duck into the chapel for a moment of silence. I stare up at the lighted circle on the ceiling.

8:00 I’m out at the vital signs desk seeing patients when a heavyset young woman starts going off, complaining about having to wait over 4 hours. She starts shouting, “Fuck y’all, I’m leaving.” She points to my co-worker behind the counter and calls her a fat bitch. The patient is escalating and telling everyone in the waiting area to go fuck themselves. The police officers just stand back and watch her. She yells at her friend to get up, it’s time to go. She keeps repeating as she walks out, “Fuck y’all, I’m leaving, fuck y’all.”

8:30 DV mom and ADD kids are finally all medicated and ready to go. I bring them to my office and call DHS to pick them up. The kids start to have at it in the office: slamming down the keys on the computer keyboard, pressing the buttons on the copy machine, diving under the desks, spinning like a top in the chairs. Mom yells to stop. They don’t. They knock over the trash bucket and she bursts in to tears. Then I say in a stern voice, “You have to stop and you have to calm down, your mother is crying and upset, you have to listen to her, you are hurting her feelings.”  They stop and apologize to her. Is that some social work or what? We gather up their things and walk toward the waiting area for families. I leave them there and trudge back to my office with foreboding and relief.

9:00 – 10:00 Write notes on patients in electronic medical record. Eat leftovers for dinner. Surf internet. I read online that 3 of the Somali pirates holding the captain of a cargo ship hostage are shot in the head by snipers and killed.    

11:00 Home, helluva Easter in the ER.

Trauma Observation #19 Still Life: Newborn and leg-cuff Saturday, Apr 11 2009 

I got a page to talk to a young woman who had given birth to a baby a few days ago and now had to go back to prison. The nurse told me everything was ready for discharge except who would be coming to get the newborn. I looked in the patient’s medical record and found the number for her boyfriend, the father of the baby. I called and a woman answered. She said he wasn’t home and she didn’t know when he would be back. She thought he might be out buying cigarettes. Hmm, out buying cigarettes and his newborn is waiting to be picked up…. In any case, she said her son wouldn’t be able to come and get the baby for 2 days because he had to work.  Oh really, you think we’re running a newborn hotel at Stroger hospital, I wanted to say?

I got on the elevator and headed to OB/GYN to see the mom. I hate these cases because the criminal injustice system always wins. Young, drug addicted mothers will be punished.   

It was around 8:30 pm. At night the halls in the wards appear to be extra long, the lights too bright, and there is few staff around. It’s creepy in the way that horror and psycho movies depict hospitals. I’m afraid that some maniac will grab me from behind and drag me into a dark room and rape and stab me to death. No one will hear my screams….

I talk briefly with the patient’s nurse and she gives me a heads up that mom is angry and uncooperative. In front of the patient’s  room are 2 police officers from the Department of Corrections (DOC) talking  loudly, laughing, and eating  greasy bags of Burger King french fries.

I walk into the patient’s room and the newborn son is lying on her chest. He’s in delta sleep and doesn’t move. I sit at the end of the bed in a chair and see her leg is locked to the bed by a metal leg-cuff. Then I glance over at baby and see the plastic cuff on his impossibly tiny, chicken-wing leg. It has a light that blinks green. One cuff imprisons, the other secures.

Mom starts crying – tears spill down her blue patient gown. Her red-rimmed eyes have only seen 22 years of life and I know instinctively it’s been a hellish and mostly unhappy 22 years. She said her boyfriend is trying to find childcare, but because the baby was born a few weeks early, nothing is in place. Mom said dad definitely wanted to take the baby home, but really, it didn’t look that way at all. He hadn’t even been to the hospital to visit the infant. 

Mom reveals that she has another child, a three year old living with her boyfriend’s mother (the woman I had already spoken to.) She starts to tell me her story and it’s impossible to follow. So many patients are incapable of telling in chronological order and with clarity, what the issue is. We call them “poor historians.”  It’s equal parts not remembering, lying, and clumsily weaving together a tale to include important details and leaving out important details. Moments of shame, embarrassment, humiliation and sometimes flashes of anger accompany the account. Then she quietly mentions the crack. She was pregnant, using crack and left the treatment program. She reveals the police arrested her for “child endangerment,” meaning, I think, her using crack was putting her child at risk. Oh shit, here we go, this has Child Protective Services (CPS) written all over it. The story got so convoluted and crazy I gave up and decided to just focus on what was going to happen within the next couple of minutes: the baby was going to be taken away from her by the nurse with back up from the DOC police officers and then she was going back to prison.  

There is a phone next to the bed and I suggest she call dad. She dials the number, someone picks up and then hangs up. She calls again, same thing happens. I call the number using my hospital issue cell phone and boyfriend’s mom answers. I ask her again is anyone coming to get this baby and if so, they have to meet with me and the doctor. She said he’s not coming to the hospital and not only that, she doesn’t believe the child is her son’s. She spews out, “That woman has sex with a lot men, she’s a slut.” Grandmother is not willing to take care of another child, especially if it’s not her blood. Okay. I couldn’t believe I was having this conversation with this woman in front of the woman who just had a baby and was crying her eyes out. I didn’t tell the patient everything that was said –  that would have sent her over the edge – only that grandma wasn’t willing to take care of another child. More 22 year-old tears.

Newborn wakes up. He is an Anne Geddes photo. He is wrinkly, crinkly, all creases and criminally cute and I want to hold and squeeze him. I almost ask but in the nick of time realize every moment mom has with her son in her arms is precious.

I tell her that if dad doesn’t come to pick up the baby we will have to call CPS and they’ll take temporary custody. She starts crying and howling, no she blurts out, that’s not going to happen! She shouts that her son is not going into foster care, she knows how horrible that is, she was a foster child. Mom states she was abused in her foster home. And there it is, the cycle completed. I try to assure her that the case worker will come to the prison to talk with her and help her keep and parent this child. She’s having none of it and I realize nothing I can say will assuage or erase the fear she has that her son will end up like her.

As I leave the unit, I see there are 2 more officers from the DOC – that makes 4. They are snapping on latex gloves and moving down the hallway like a pack of animals, toward the patient’s room.

Trauma Observation #18 The Lost Poles Monday, Mar 23 2009 

With regularity we see middle-aged Polish men in the ER. Chicago has one of the largest groups of Poles outside of Poland. They come to America like all immigrants: to work. These guys are the backbone of the construction industry and their bones and backs end up broken. Many drink a lot, too. So because of the drinking and working an insane amount of hours for years on end, these men have lost wives, girlfriends, children. They end up with no support system, no one who cares about what happens to them. They speak survival English only:  hello, good-bye, yes, no, thank-you, help. When they no longer have strong backs and hands to work and thus money under the table to keep a roof over their heads, they are cast out onto the dirty boulevards of homelessness.      

The polish patient I’ll never forget was 57. He had diabetes, high blood pressure, CAD. He was sweating, weak and used a walker. He spoke no English. He hobbled into the ER with sugars off the charts. Homeless. My supervisor had assessed him and called the Department of Human Services (DHS)  to pick him up. Then a polish interpreter explained to the man that a van would take him to a shelter. Hours later DHS arrived and the workers told me that no shelter would take him because he had too many medical issues and needed to be in a nursing home. I explained the patient didn’t meet the medical criteria to get into a nursing home. A patient has to have skilled nursing care needs, not “custodial” needs. Plus, he was undocumented and nursing homes by law do not have to accept and do not accept undocumented patients. You see, they won’t get paid for providing care and that is their number one priority: a payer source for the profits. Period. But who was the staff at DHS to be telling us in the ER  the patient should be in a nursing home? We are the medical professionals, not them! They wouldn’t take him. I called and talked with the supervisor and he assured me the next time DHS came out they would take the patient to a shelter. I got the patient on the waiting list for Inter-Faith House, the only residential shelter in the entire city for the homeless with short-term medical problems. They simply don’t have enough beds to accommodate all the homeless that need a place to recuperate from illness, broken legs, minor wounds and minor surgeries. Even though my Polish guy didn’t fit Inter-Faith House criteria, I got him on the waiting list anyway, hoping they would make an exception. He was a patient falling through the criteria cracks, just an old man with a walker suffering from chronic medical conditions controlled by medication.  

Next day the Polish guy was sitting in the ER, right where he was the night before. He was sweating and had a pasty pallor. I called an interpreter to find out what happened. DHS wouldn’t take him to a shelter, again. The patient said he was uncomfortable sitting in the chair all night, needed to wash and change his clothes. Even though I don’t understand a word of Polish, the desperation in the mans voice and eyes made me both sad and angry. I said I was sorry hoping he would understand at least the word sorry. I got on the phone and starting yelling at DHS. They were steadfast in their refusal to transport him to a shelter because of his medical issues. I was told again it was my problem and to find a “placement” for him, an impossible task given his undocumented and indigent status. So I started climbing the chain of command at DHS. I called my supervisor for back up. We were promised again by a different person at DHS that the he would be picked up. But the next day when I arrived to work and checked the ER waiting area, there he was, his third day in the ER. Now I started talking with the director of my department about calling the media. He said no, no yet and got on the phone to DHS. He knew some of the higher ups.

He was there the following day, sitting with his metal walker in front of him like a gate defining his space and blocking anyone who tried to get near him.  His fourth day of living, if you can call it living, in the ER. This is not happening I thought to myself. I felt the full burden of finding this patient a place to go and I was failing miserably. No one was helping me. No one wants to house this man.

The patient looked and smelled awful, who wouldn’t living in an ER waiting room with no access to the basics of daily living, with the exception of food. I gave him something to eat everyday. Now my concern was this guy was going to stroke out, have a heart attack, or go into a diabetic come in the ER because of the enormous stress he was under. He said through the interpreter he couldn’t take it anymore, the ER was too loud, crowded, he couldn’t wash himself or sleep. The interpreter took me aside and expressed concern about his mental health.

I headed back to the social work office thinking that today the County ER was going to be on the 6 o’clock news. The lead story: Homeless Polish man living in ER for 4 days goes into diabetic coma, dies. Back in the office the phone rang. It was a woman from a Polish church that ran a shelter. They finally had a bed for my guy! I arranged for a medicar to take him to there. Poof, just like that he was gone.

I have asked these patients if they want to return to Poland given the fact that their lives in the United States are so hard. They can’t speak English, they are homeless, there is no family or money. There is no American dream anymore. Not one has ever said they wanted to go back.

Trauma Observation #17/ Medical Records Monday, Feb 23 2009 

I don’t need a Kindle, I’ve  got computerized medical records to read. They’re some of the most interesting “books” I’ve ever read. They are a series of notes by individuals who practice different medical arts: medical social workers, nurses, PT/OT, doctors, surgeons, respiratory therapists, nutrition. We are all writing in the chart analyzing, assessing, planning, discussing, documenting, discharging  a persons medical life.

 There are different screens in the patients electronic medical record. There is one that simply lists in a descending row a short description/diagnosis of what the medical problem was that brought the person to the hospital. To me they are poems that tell a story and leave a trail. Below are the words I found in one patient’s electronic medical record.

med refill

blood in urine

defibrillator malfunction

sob (short of breath, not son of a bitch)

chest pains

rectal bleeding

dizziness

epistaxsis

left side numbness

rectal bleeding

testicular swelling

chest discomfort

sob

scrotal swelling

palpitations

med refill

swollen testicles

Trauma Observation #16 Death by Denying Dental Care/Necrotizing Fasciitis Friday, Feb 13 2009 

I got a call from ICU to help identify a patient. He was dying and the doctors needed to get in touch with the family ASAP. I was nervous as I rode the elevator up to the floor. The man was  hooked up to every machine invented. Big blue and white tubes going in and out of every orifice, veins impaled with IV’s galore, hyperventilating machines, heart monitors beeping and beating out time,  flashing screens full of green lines, zig zagging peaks and troughs, the surveillance of all bodily functions.  And I looked at his swollen and sweaty face and saw death.

The nurse told me to enter the room I’d have to gown up, wash my hands, and wear gloves. I didn’t like putting on all the gear, it felt creepy and there were killer germs everywhere and I needed to be on guard. Then the residents came over to talk to me. They explained what happened in voices that betrayed fear, awe, disgust, and disbelief. The patient had an abscessed tooth and they surmised that he hadn’t gone to see a dentist until the infection was out of control. The pain must have been excruciating. He saw a dentist and then went to a  hospital ER  and got a prescription for antibiotics filled.  But it was too late. The infection had spread: it was necrotizing fasciitis, the dreaded flesh eating bacteria.  Actually, that’s a misnomer. The bacteria doesn’t eat flesh, it pumps out mega amounts of toxins and exotoxins that destroy tissue and organs.  The doctors were gobsmacked and said this isn’t supposed to happen, this guy shouldn’t be in this room dying, he should have been diagnosed and treated immediately. They didn’t expect the patient to make it through the night because the bacteria had invaded major organs and one by one they were shutting down.  Domino effect.  The super, duper antibiotics – vanc, clinda – that were being pumped into him weren’t doing a damn thing.  The two of them just shook their heads. For a moment we all stood around the door to the patient’s room in  an awkward silence. And I thought: this guy is going to die tonight, alone, if I don’t hurry up and find someone and tell them to get here, STAT!

I had to go through his belongings, find the wallet, or even better, a cell phone with preprogramed numbers. I lifted the bulky plastic bag out of the closet. I gingerly  took a pair of pants out of the bag. They were filthy dirty, the kind of dirt that is so embedded in the fabric that it will never wash out. Pants that are worn over and over and over again, over years – poverty pants. I could see the outline of  a wallet bulging from the back pocket and slipped it out. It was a  beat up old piece of brown leather that had been well sat on.  There was no money, not even a penny. No credit cards. I fished out a few business cards. With my gloved hands, I reached back into the bag and and pulled out a shirt, socks, muddy boots, a black leather coat.  I saw the bottles of antibiotics. They were full of pills.  No cell phone. Drats!

And then I felt sick to my stomach and scared. I stood there and thought, what am I doing? I was violating the patient’s privacy, a nosy parker, touching his personal belongings, rifling through his things without his permission.

I started calling the numbers on my hospital issued cell phone. I left short, cryptic voice mails designed to create fear and panic and thus, quick call backs.  A few minutes later the phone rang. The caller didn’t know the patient. Another person rang and said he’d call someone who might be able to help. Phone rang again, the woman said the patient was an acquaintance but she knew his pastor and would have him to call me. Pastor called and said he was on his way. Whew, the patient wouldn’t die alone after all and who better to be with him than his pastor.

I found out the next day the patient “expired.” The health care system killed him. He was a poor man, no medical or dental insurance.  And because he had no access to a dentist, and dental care is expensive, and dentists don’t like to, and by law don’t have to see uninsured patients, he died. If he had been able to see a dentist and got diagnosed and treated  right away he might be alive. He’s not the first and and he won’t be the last to die this way. Deamonte Driver, a 12 year old boy from Baltimore, died because his tooth infection spread to his brain. The Washington Post ran a story with this headline: For Want of a Dentist. I have another headline, it’s more accurate: Death by Denying Dental Care.

I found out too, that the pastor never came. The patient died alone.

Trauma Observation #15 Transamerica/A Blessing Sunday, Feb 1 2009 

I had my first transgendered patient. He was a she, but he was doing she poorly. The patient looked like a man trying hard to be a woman, but in no way pulling it off. The voice, the facial stubble, the clothes said male. I suspect the patient couldn’t afford to take hormones and was poor. I ended up being right on both counts. The patient was elderly, tall and skinny with long, greasy, gray unkempt hair. She was new to Chicago having just recently arrived from California. California is a much better place to be transgendered. San Francisco practically invented transgender and hippie; she was a bit of both. Midwest, not so much. She had come to Chicago to live with a friend and start a Church for the transgendered. She called herself a Reverend. The plans fell through and she was asked to leave her friends apartment. Homeless and still wanting to open a church for the transgendered. She had both savvy and schizophrenia. My job was to find her another shelter. She had been at  Pacific Garden Mission but didn’t feel accepted or safe there. We talked for a few minutes about how difficult it was to be transgendered in America. She thanked me for not judging her and trying to help. I called a gay organization and was told to send her to a shelter on the North Side, stay on the North Side they cautioned me. I brought her to my office and she called a relative in California to let them know she was okay. I could tell from the conversation it was a person who really cared and understood her.

Later that evening I found a note the patient left for me on my computer keyboard. It was written in cursive and said, “Hello, I would like to offer you something, the only thing I have to give.  A blessing for you, a person who has helped me. Father above, I ask you to bless this woman. May she have all she needs in life; good health, wisdom, abundance and understanding. May she be blessed with her hearts innermost desires. Watch over her lord Jesus. We ask in your name. Reverend.”

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