September 5, 2017

Peanut butter and tokens

My patient turned her head away from me, her affect flattened from the last time we had spoken. I asked if she was ready to leave, and told her she was being discharged so she could seek a place to stay through the local shelter intake. "It doesn't matter when I get there. I'll have to sleep on a chair. I'll be back here tomorrow." Her eyes were doleful as she looked at me, then rolled over toward the window. Our conversation was over.

All week we had been fighting and working with social work to make this patient's discharge a possibility. She no longer had any medical reason for remaining in the hospital; now, it was just the looming forces of homelessness, mental illness, and desperation that kept her on the antepartum service. She had been living with a neighbor of sorts, but her possessions were abandoned outside when she came into the hospital. She had a transit pass before, but it had been lost. We gave her tokens. She had a glucometer before, with test strips, but that had been abandoned with her belongings at the neighbor's home. We found an extra glucometer in a desk drawer at our clinic and ordered more test strips and lancets. The fact remained, though: she had nowhere to go.

What does it mean to discharge a patient who is homeless? There is a sense of futility, a bitter aftertaste of cruelty when you sign an order that spits a patient back out into the world with no place to lay her head. There can be no joy in your voice when you tell the patient that she "gets to go home," because you know the phrase is meaningless - worse, it is hurtful.

My patient has another issue as well - she is diabetic, on insulin. I write a letter on letterhead, cosigned by my fellow resident and by our attending, that explains that she is pregnant and diabetic and desperately needs a place to stay and consistent meals in order to be healthy. I knew the food in the shelter would not be satisfactory - likely carbohydrate heavy and inappropriate for a diabetic pregnant woman. I almost left the hospital to run to the store, a few blocks away, to buy her a large jar of peanut butter. I wanted desperately to do anything to keep her healthy and safe without having to hold her in the hospital.

Her words resonated with me - a promise that she would return, with any possible complaint, to be seen in triage and possibly admitted again. She knew, and I knew, that her fetus might have another deceleration requiring further monitoring. It would be easy for her to be readmitted.

I was not surprised when she called the Labor floor the next morning, while I was on call. Neither one of us stated the obvious while I asked about contractions, or leaking fluid, or if the baby was moving appropriately. She told me she was contracting frequently, and I had no choice: I told her to come back for evaluation. When she got to the triage unit, we put her on the monitor and she fell fast asleep: finally in a quiet place, with a bed, and a chance to rest.

January 22, 2017

When our children tell our story

There are some who will say that lacing up your tennis shoes and setting out, sign in hand, to gather and celebrate the common values you hold dear does nothing. There are some who will say that it is a waste of time, an exercise in futility, all talk and no action. There are some who will question whether your goals are unified, whether your protest will even be heard.

To those people, I say: your arguments hold no weight with me.

I find myself craving the Hamilton soundtrack more than ever these days. It was an addiction even before the election, but now many of the songs seem to speak exactly to how I feel about where we go from here.

"I'm just like my country, I'm young, scrappy, and hungry and I am not throwing away my shot!"

"When you're living on your knees you rise up / Tell your brother that he's gotta rise up / Tell your sister that she's gotta rise up"

"I may not live to see our glory / But I will gladly join the fight. / And when our children tell our story / They'll tell the story of tonight / ... / Raise a glass to Freedom / Something they can never take away."

In times like these, when it is apparent that the administration will not be on our side, does not have the interests of the country at heart, and cares only about undoing the work of the previous administration - in times like these, I find it a balm for my weary soul to soak in the energy and passion and commitment that carried our founding fathers through a revolution and the birth of a nation.

So when I strode out my front door and down the street to the Women's March on Philadelphia, in solidarity with my sisters and brothers who marched all across the United States - and, in fact, across the world - it was not with the intention that the march itself would cause change. No one expects a large gathering of people to simply create change. Instead, I sought solace, and community, and an invigoration of my spirit. I sought to re-commit myself bearing witness to the travesties that are to come regarding health care (not just women's healthcare, though I fear greatly for the impact of this administration on that in particular), for the willful ignorance of critical issues like climate change facing our nation, for the attempts at rolling back civil liberties, for the attacks on women's bodies and autonomy and equality that are certain to happen. We cannot have a sexual predator in the White House without an implicit statement that women's lives do not matter to this administration. He has said it himself, on multiple occasions: he has no respect for women; he thinks our bodies are his playthings, that we exist for his pleasure alone.

I marched today to say that I do not accept this as status quo. I will not go gently into the good night of this administration. I will fervently oppose any attempts to return to an imaginary America from 50 or 100 years ago. I marched not just for myself, but for my mother, my cousins, my aunts, my friends, my coworkers, my patients. I marched not just for women but for men, too, because inequality and misogyny hurt men and women both. I marched so that when my future children ask what it was like when the 45th president was inaugurated, I can tell them where I stood. I marched to declare that I will not aid or abet the immoral dismantling of health care and human rights in this country. If there is a stand to take - here is the line I have drawn. Cross it and feel the wrath of myself and millions of women who joined across the nation to say that we demand satisfaction.

Make America great again? America's already pretty great. Maybe we should just try not to muck it up any further.