Friday, May 25, 2007

Navajeros

Today at the day laborers’ clinic I took care of a patient with multiple stab wounds; he had been discharged from University Hospital last Saturday with a prescription for antibiotics and the good wishes of his healthcare providers. The bandages packing his wounds had been there almost a week; no one at the hospital told him he needed to have them changed regularly or he would risk major infection. Much less, they didn’t tell him where he could have gone to get that kind of treatment, or how to do it himself if, under likely circumstances, he wasn’t able to be seen in one of the understaffed primary care clinics serving low-income people in post-Katrina New Orleans.

Hearing that story, I felt so naïve. Even though I experience the healthcare system here on a daily basis, and even though I take care of so many low-income uninsured patients who get discharged from hospitals without follow-up, I still couldn’t believe what this patient was telling me. The doctors at University Hospital know better than that, I kept telling myself. Many of those folks are friends and colleagues of mine, people who have put in so much heart and soul and dedication into providing high-quality care for people in a healthcare system whose infrastructure is completely shattered. Many more have worked just as diligently to patch together some beginnings of a free or affordable follow-up system so that patients like these have places to go when they get out of the hospital. Really? I thought. Them? What does that mean for the rest of the city?

Two of us ended up changing this patient’s packing as he sat on an upended milk crate under a tree in the middle of a neutral ground where he and many of his friends and compañeros waited for work. We did our best to keep things as clean as possible, while the wind blew graying dust and long-empty Pepsi cans around our feet. The whole time the other volunteer was gently holding our patient as he squirmed in pain; a visiting doctor from Michigan kept coming over to inspect our careful work while about nine other workers gaped from a few feet away, craning their necks from behind the tree. “Whoa! Look how deep they are! Come see!” they kept yelling while I repeated my requests for privacy, inserting clean gauze into these wide-open spaces in his chest, deeper than my fingers, wider than my knuckles, close enough to the heart that I expected to touch it, beating strongly against my hand.

It’s a miracle this man is alive, I kept thinking. He deserves more than this: this medical care he just happened upon on his walk to work, the tree, the pigeons, the milk crates we sat on, the burned-out buildings on the right and left of us, the audience, that swirling dust all around us. He thanked us so much at the end I almost cried, not out of sadness but anger. Even in this totally messed-up system, this didn’t need to happen.

“I bet if he spoke English they would’ve talked with him about going someplace for follow-up,” my roommate said when I told her the story.

Probably.

But I don’t know that for sure, and I don’t know which is worse: that this person would have gotten better medical care if they were a native English speaker (which is a violation of the Civil Rights Act, by the way, which healthcare centers in the state of Louisiana, just like everywhere else in this country, get federal funding to enforce), or that maybe it just didn’t matter: that maybe things were so crazy at University that day that nobody had the time to make sure this patient got discharged properly without falling through the cracks.

I think the worst part of this situation was not that I felt let down by people I look up to and trust to be conscious about providing amazing healthcare even in insane circumstances, it was the realization—not new, not earth-shattering, but still hard and sad and frustrating-- that it actually had very little to do with them, that there are so many factors that make this patient’s situation happen anyway, despite the best efforts of so many committed individuals. That we can have all the good people we want doing all the amazing things we want in the world, and we still ultimately need infrastructure. We need a system that acts in people’s best interests. We need for our lives not to depend upon the whims or compassion of good people; we need a society that takes responsibility for its people in a much more concrete way.

All day I did my best not to feel cynical about this situation because I know that's not going to make anything better. But it was hard, I tell you, driving away after clinic was over, all the workers waving at us from the neutral ground, the gray sky hanging over us, heavy, like concrete that wasn't going anywhere anytime soon.

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