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Please note:   To protect patient privacy, I have altered the demographic information, but these stories and circumstances are all too real.

I would like to go to Washington, DC and meet with all the politicians who want to cut ever larger holes in the social safety net.   I want to invite them to spend a day with me.   I want them sit down and face the people I care for at the local mission clinic where I am volunteer nursing.

A twenty-two year old female who works two part time jobs, one at a convenience store and the other at a fast food restaurant presents with an adenoid cyst that is the size of a golf ball that totally occludes her airway if she lies down.  This patient has been sleeping sitting up for a month.  I made the calls trying to line up a surgical consult and was told  by the state’s flagship  charity hospital  that she would have to bring $250 with her before she could be evaluated and given any care.   She has no way to get $250.  We get busy and try to find another solution to this problem.

A thirty-five year old male presents with a severe respiratory infection.  He has worked off shore for 15 years and has a wife and two young children.  While at home, he joined the men of his church in repairing the roof of an elderly church member.  He fell from the roof.  His ankle was broken and bones were poking though his skin.  He has had two surgeries, and needs another.  Since he couldn’t work, he lost his job and his health insurance.  His family is trying to live off $200 per week his wife makes working at the Sonic.    He needs to see a doctor to get his respiratory infection cleared up because he has to go under anesthesia for another surgery to continue repair of his ankle.  A federally funded vocational rehabilitation program is paying for his ankle surgery, but won’t cover the care of a respiratory infection.

A forty year old female presents with ankles so grotesquely swollen she can hardly walk.  She works at a convenience store, where she never had benefits, and recently had her hours cut.  She fixes hair for friends to make extra money when she can.  Every bit of energy and effort she can muster has been focused on getting money to keep her daughter (who works weekends) in college.  She couldn’t get in to see her usual doctor, because she owed money from her last visit.  She can’t see the doctor, therefore she can’t get a prescription for refills for her routine meds.  She has been off her blood pressure and diabetes medicine for 6 weeks.   I wonder at how much damage the untreated blood pressure and diabetes has done.

A fifty six year old man collapses at the front door of the clinic.   He was released from the hospital two days before, having suffered a STROKE.  He has limited grip in both hands and his stamina is compromised to the point that he can walk only a few steps without resting.   He is suffering with the worse case of gout I have ever seen.  He works as a dairy hand.  His employer provides a very modest house for him and pays him $200 per week to milk cows twice per day seven days per week.   The hospital sent him home with a dozen prescriptions he cannot afford.  This man is worried sick about the hospital bill he has incurred.  He’s worried that he since he can’t dairy anymore, he and his family will be put out of their home.  

A nineteen year old female presents for clearance for a minimum wage job working at the local chicken processing plant.  The chicken plant doctor asked her if her hands ever got cold.  She told him that they did occasionally in cold weather.  He told her that she’d have to find another doctor to clear her to work in the chilly environment of the chicken plant.  She comes to our clinic as she can’t afford to pay to see another doctor.  She is anxious and worried.  She needs this chicken plant job to be able to stay in school at the local junior college.

A thirty-three year old unemployed registered nurse presents for care on a thyroid condition.  She’s been out of work two months.  When the patient census dropped at the facility  where she was contracted to work  (70 miles away) , the facility cut loose all the contract nurses.  Prior to that, she was driving 110 miles to another city to work.   Imagine driving 110 miles before a twelve hour nursing shift and driving 110 miles after a twelve hour nursing shift four days per week.  

A fifty year old man presents with shortness of breath, leg pain, and weakness.  He is emaciated.  Since an auto accident the year before, he has been recovering from hip and shoulder surgery.  He is unable to work and has been denied any state funded assistance.  His heart rate and rhythm is irregular from starvation.

A thirty year old female presents with a tangerine sized boil on the back of her neck.   She works as a bookkeeper at a local body shop where her employer discontinued her health benefits three months before and cut her down to 20 hours per week a month ago. Her husband drives a route delivering chips and snacks and his route has been cut.   She is in tremendous pain and like almost all my other patients has tried every home remedy and over the counter treatment available.    She’s made one trip to the local ER where she was given an ineffective treatment, and is worried because she knows she’ll never be able to pay the ER bill.

A forty-seven year old man who is self-employed in a lawn care business, presents with complaints of severe fatigue.  A cursory exam immediately indicates he is in kidney failure.  As we are trying to get him to the hospital he is begging to just be given a prescription.  He protests that he has too many bills to miss a day’s work.  His wife is at home caring for their mentally retarded/physically handicapped child AND his own mother who has had a stroke.   This man has been pushing himself so long and so hard, he won’t even acknowledge how seriously ill he is.

A forty-nine year old female presents with her left hand swollen up the size of Popeye’s.  She works as a cashier and says she has to ask her customers to pick up the heavier items, because she can’t lift them over the scanner.  She got a hangnail on her thumbnail and it has become infected.  Her usual doctor won’t see her again until she pays her bill. Her usual doctor has treated her with two rounds of antibiotics that did not work.    It appears that she has osteomyelitis and she will have to have surgical debridement.   Her prognosis is not good. It is likely that she will lose her thumb.

This is real life.  These are real people who are suffering and struggling right here in the United States.  

Every day at the mission clinic, I have patients whose eyes fill with tears. They break down and cry while I am taking their vital signs and getting their history.  They apologize for coming to the clinic.  They apologize for being sick.  They apologize for being unemployed or being underemployed.  They apologize for being uninsured.  They apologize for needing help.    It is a crime and a shame that here in the United States of America that sick people feel ashamed and feel they must apologize for needing medical care.  

I want the politicians to sit beside me and face my patients.  I want them to see and hear the suffering and anguish that l see.  I want them to see these very real people who are working as hard as they possibly can and doing every right thing they know to do.  

Then I want the politicians to tell my patients that health care is a privilege that they are not entitled to have.  I want them to tell my patients, face to face, that they don’t count and that they don’t matter.   I want them to tell my patients face to face that it’s just too bad and too sad.    

Every time politicians vote for tax breaks for corporations and millionaires, and every time they vote to slash spending or public health or unemployment, or Medicaid or Medicare, they are saying that my patients don’t matter and that my patients don’t count.  They are denying my patients human dignity and compassion.    I am so weary of the tough talk and posturing that goes on with the politicians.  I know that we can correct the unemployment and health care issues in this country.  I know it can be done.  I believe there are people who just do NOT want it to be done.  

A caring presence, a hug, a Kleenex, a thorough assessment and a prescription from the  $4 list seem so damn inadequate most days, but I am doing my best.  Are the politicians really doing their best?  

Originally posted to dhcallahan on Thu Dec 22, 2011 at 10:50 AM PST.

Also republished by Community Spotlight.

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