:: to the teeth ::    thoughts on social justice, medicine, race, hope and beats

"Another world is not only possible, she is on her way.
On a quiet day, I can hear her breathing." :: Arundhati Roy ::

"The most common way people give up their power is by thinking they don't have any." :: Alice Walker ::
Thursday, October 27, 2005  

Case Study

33 year old woman, spanish speaking, undocumented, great sense of humor calls early in the day. she works until 6:30pm washing cars so she's glad we are open until 7pm. She complains of right sided numbness and tingling, both arm and leg, for two days which is now beginning to improve.

Later in the day, at the clinic, she presents as a jovial, slightly overwieght, intelligent woman, single mom with a six year old child. Her concern is clear - "am i having a stroke?" she starts by telling me that she felt so bad the day before she went to the public hospital ER. After 7 hours waiting, 6pm-1am, feeling worse, she went home "to die." of course she didn't die and after a thorough physical exam, reassuringly normal vital signs, a normal family history, and no strong risk factors, it was clear her symptoms were of a myofascial pain symdrome, not vascular disease.

I let her know she was lucky that she left the ER. they probably would have done too many blood tests, a CT scan of her head, EKG and charged her $1-2 thousand for the workup. as a single mom washing cars all day, the last thing she needs is a bill for 3-4 months of her yearly income.

So we talked about her job and it turns out she just transferred two weeks earlier to a busier location where she doesn't even have a break of 15 minutes for lunch. she drinks sodas all day for energy and downs an occasional greasy burrito. at home she doesn't have enough energy to make dinner so they do fast food. no time for stretching, for basic exercise, for play or dance. it's an untenable existance, an impossible paradox. the human body cannot sustain such rigor and stress for more than a few months before symptoms arise and eventual serious illness.

not many options available. probably the only two important things i did were to reassure her she wasn't going to die from a stroke and to acknowledge her stressors (legitimize and humanize her experience of suffering as wrong). i tried recommending she and her car wash colleagues try to organize for a break or at least create a coverage system for each other, she didn't think it would be possible. i recommended massage as a vluable investment and offered her an appointment with our awesome massage therapist volunteer, Jennifer. (she's been massaging our patients for a few months now, every wednesday. it's a beautiful gift of hers to our patients. for many, it's the first massage experience in their lives, the first times they have let themselves physically relax, release stress, and enjoy the touch of a therapist. Thanks Jennifer!!).

There is a story in this story that needs to be a driving force for health care reform. the way we practice medicine on uninsured patients is detrimental to their health. our protocols, our fear and lawsuit driven testing strategies shift huge cost onto these tired, ill individuals, those least able to suck it up. this happens with so many myofascial pain syndromes, from headaches to neck pain to chest pain to unilateral weakness, etc. the cost of the ER visit would pay for 1 years worth of appropriate massage/exercise, physical therapy, time off work, etc. and the ER visit doesn't even diagnose this kind of pain after all the tests since many docs don' touch their patients. this leaves the patient with the large bill, no education, no emphasis on healthy lifestyle modifications... how did we go so wrong? maybe it's just my local environment. i'll hope that's it.

posted by andru | 10/27/2005 07:04:00 PM | |


The unfortunate woman you describe finds herself in a predicament largely produced by her own choices over many years. A few: choice of having children, choice of mate, is she married? More immediate choices: type of work, place of work, any job training or education? In short, she is not just a victim, she has had a huge input to her current outcome.

# posted by Blogger narnius : 11/29/2005 11:37 AM  

That is so true. The choices we make help carve out the paths we walk in this life, give or take other forces at work, and regardless of whether one is a single mother or not, working 40 to 80 hours a week, having no time to do anything but work and pay the bills, it is a choice that has to be made. And we're the ones to make it. Blaming the system is only taking the responsibility off ourselves and though it is true that our current healthcare system is so flawed, it is no reason to remove the blame, or some of the blame and responsibility, from the individual.

# posted by Anonymous Anonymous : 11/30/2005 8:17 PM  

I am disturbed by the rush to judge and blame by many people to those in difficult situations. Yes, often these situations are the consequence of unwise choices, but often they are merely the result of unfortunate, unforseen or unalterable circumstances. Things can seem rosy and fine, all is right with the world; then unexpectedly, your husband/wife dies... or you are laid off from work... And when it comes to bad choices, who among us has never made one? Unfortunately, the bad choices that end in a hangover and the bad choices that end in a life of poverty do not always look that different, except in hindsight. Society is not improved by deciding who the blame goes to.
Sorry to rant, but I feel that many issues would be better addressed, and many people would be better served, if we could try to identify solutions instead of running to high moral ground and "blaming" or "punishing" people who need help. Finding a way to understand and truly help others, in a timely and preventative manner, would result in a safer, saner, and less expensive place for all of us to live.

# posted by Anonymous Anonymous : 11/30/2005 9:43 PM  

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