La pobreza

Sometimes I don't think about the fact that all of my patients are poor.  I don't know if I've just become desensitized to having people tell me their total income is $800/month, or if it's because people tend to get somewhat dressed up to go to the doctor.  Regardless, last night while I was interpreting for one of our doctors, the living situation of many of our Hispanic patients really hit me.  This is only one example, and although each individual is different, I think it gives a good picture of the home and work conditions that make it hard to provide helpful medical treatment.

A Nicaraguan woman who I've been trying to get in touch with for the past few weeks finally showed up.  Her and her husband just moved and changed their cell phone numbers.  (Side note: This is pretty standard, but I usually end up calling every number the patient had ever listed and ask people if they know where said patient is. However, in this case, even when I got in touch with the couple's friends, no one seemed to know their new contact information.)  The woman, who I'll call "A", presented with severe lower back pain.  She proceeded to explain to me that she had come in August and was given 2 meds, but that her and her husband couldn't afford them.  When the couple finally got work and could afford the meds, "A" was working such strange shifts that she was afraid of messing up the pill schedule.  She goes to work at 5am, but she can't eat that early.  One of the meds was supposed to be taken an hour before eating, but her break was at 9 and that was when she would eat breakfast (and she said she couldn't take the pill an hour earlier amidst working).  Long story short: she never took the medicine she was prescribed.  The doctor kind of rolled his eyes; after all, this is noncompliance.  "A" then continued explaining that she used to sleep on some sort of "cushion" on the floor.  However, now she sleeps on a blow-up mattress.  The other night, she tried to get up to go to the bathroom, but her lower back hurt so badly that she ended up literally crawling out of bed.  The next night, her husband pumped more air into the mattress so that it was a little firmer, and she said she felt a little bit better when she woke up in the morning.  Additionally, though, her feet swell when she's working and become quite painful by the time she leaves to go home.  The doctor said that she should try to alternate sitting and standing at work, and "A" looked bewildered.  She works at a label-making factory, so she works 12-hour shifts on her feet with two short breaks.  The doctor suggested that she wear compression stalkings (yeah, try explaining what those are in Spanish...) and that she put her feet up after work.  He wrote her two new prescriptions of anti-inflammatory meds (from the $4 list) that she could take with food twice a day, and told her to make sure the mattress she sleeps on is as firm as possible.

The doctor was very nice.  "A" and her husband are extremely sweet, so I guess it'd be hard not to be nice.  But when I left the room, I couldn't help but wonder if the doctor had ever slept on the floor.  As I lay down in my very comfortable bed last night, I tried to bring myself back to service trips where I've slept on the floor of a soup kitchen or YMCA gym for just a week at a time.  I remembered the lower back pain as if it were yesterday, and then I tried to imagine doing that for years on end.  That, coupled with 12 hour shifts working at a factory, coupled with struggling financially, made me feel depressed even thinking about it.