I have learned that patients seek health care services at free clinics for a myriad of reasons and some are atypical. There were specific populations I expected to see: the uninsured, underinsured, undocumented, and those without access to transportation. Yet there were other populations I was more surprised to see, namely patients who had insurance but preferred their experiences at free clinics.
A scalpel, a corpse — / His beard is neat, his eyes are / Empty. Gloves hide clammy hands / Afraid of what awaits beneath
Each morning, Mr. E had a new concern — too hot, too cold, too dizzy, too stiff. He was admitted for what seemed to be a straightforward heart failure exacerbation, but his echocardiography showed severe hypertrophy in both sides of his heart that the cardiologists described as “concerning for infiltrative cardiomyopathy.” For me, this was intriguing; as a fourth-year medical student with only one year of clinical training under my belt, the autoimmune diseases I’ve come across in actual practice have been few and far between. Mr. E, however, seemed completely uninterested whenever I brought up the amyloidosis they had found on nuclear imaging.
Unmotivated to study, I dedicated myself to researching the virus as well as its epidemiological, social and economical impact on our communities. Adjusting to life in quarantine was frustrating, and I felt like I was watching the world turn upside down. However, researching the pandemic felt much more relevant than trying to use all these anatomy apps to fill in gaps created by a lack of practical hands-on learning.
Until recently, vulnerability meant weakness, allowing oneself to fall behind without a chance for recovery. Courage, on the other hand, had the opposite meaning: betting all my chips on prevailing at any cost.
Mrs. H’s story is just one of millions of Americans who have become victims of structural violence and suffered from the social determinants of health. With a clearer understanding of the complex factors that contribute to patients’ health outcomes, I now aim to reunite the erroneously separated domains of medicine and social sciences.
High potassium? / How did this happen so fast? / Secret burrito.
Sameera was an Iraqi refugee who had recently arrived from Tijuana, Mexico. She fled violence from what seemed like every corner of the globe, starting with Iraq, then to Yemen, Brazil, Mexico, and now to a small, bare and cold cell somewhere in southern California.
Today, my grandparents are older than Saul was when distanced from his family. Now during the coronavirus pandemic, they too are isolated. This time it’s not because they are the fomites, but because I might be. Those big enveloping hugs that grandma lives for and kisses from grandpa will likely become a thing of the past.
Our patients deserve to have their battles acknowledged. That means believing your patients when they implore, “I am trying” and appreciating that we may encounter people at different phases of recovery.
“There’s a great neuro exam in room 5147,” my resident said as I dropped my bag in the call room. “Why don’t you go check it out?” I clutched my reflex hammer in one hand and googled the components of a neuro exam with the other as I headed towards the stairwell.
When I was told I had a mass in my chest, I was shocked. Like most people who are told that they have cancer, I was blindsided. But it was even more shocking because I had been going to multiple doctors over a period of six months complaining of pain in my chest, right arm, and right shoulder.