Clinic Vignettes February 11, 2006

a 37yo man presented with signs and syptoms of stroke, right arm weakness, right leg heaviness and a slight change in speech. this is very unusual in young people. the first day he presented last week, i was totally confused and didn't put the story together until after he left. he had a few other complaints and i didn't pick up on the leg and speech changes until his second visit. the first night after he left, i was thinking alot about him and started getting more and more concerned. we spoke by phone the next day and my suspicions were confirmed with deeper questioning. he had symptoms for almost two weeks so he was well outside the 3 hour time period to try to do anything about a stroke urgently but it never makes you happy as a doctor when you miss something important. back in my clinic at his second visit, we did a thorough review of systems and picked up a bleeding tendency and a smoking history as the only two risk factors i could find.

so here ends clinical medicine and now starts this mans journey into the perpetually painful world of trying to get healthcare when uninsured for a complicated illness. turns out this man is undocumented. he was trying to be responsible and was a few weeks ago from his work insurance kicking in... with the urgency of the situation, we can't wait a few weeks to i had no choice but to send him to the public hospital ER for an immediate workup which will no doubt nail this man with a pre-existing condition prohibiting his imminent insurance from taking effect. this man has bigger worries, but this financial piece is going to be a painful thorn in his side. he has lost significant function of his left hand and will no longer be able to do the construction work that was supporting him and his family. and he will not be eligible for disability as a non-citizen. now for all you people reading this who immediately think - "well, so what, why doesn't he just go back to his own country," let me run a few ideas by you.

immigrants make up the majority of this country, every one of us, except for the "First People's," also known as Native Americans, are immigrants. so who is calling who illegal. secondly, many Mexicans in particular have made the southwest their home for thousands of years, crossing what is now a border as naturally as any of us would cross a state line. many Mexicans are Indigenous and have historical roots long predating the formation of the United States of America. That's just a little reminder of whose land we stand on, and a brief history lesson. Now fast forward to the present moment where we live in the comfortable illusion that this country is Ours. Even in that case, it cannot be denied that "illegal" immigration is a huge part of what makes this nation so great. our fields, restaurants, contruction sites, music, culture, house cleaning, etc are fueled by the continual influx of illegal immigrants, people drawn to this land by the hunger in their bellies and the very real promise of businesses and people who demand their cheap labor. if you are sitting there on your couch having some stiff opinion about people you don't know, about economics you don't understand, then please, turn off teh computer, do some traveling, learn a second language, study macro-economics and history, and then, let's talk.

(By the way, i got a call from the family after two days in the hospital, this man didn't have a stroke, he had cancer of the brain. they found four separate lesions in his head. the family is awaiting the biopsy results at this moment.)

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a 28yo man comes to the clinic with right sided eye pain and redness for three days. he does landscaping and was out in the wind when a bunch of dirt got in his eye. on flourosceine/woods lamp exam he had a large corneal scratch and a piece of dirt, small, sticking into his cornea. the dirt wouldn't come out with irrigation. luckily i had purchased a Nikon slit lamp which is a microscope for examining the surface of the eye. it's a really cool tool. i picked it up for $150 used from a local eye doctor who had a newer electronic one. they usually run for about $5000 or more. with the slit lamp and some courage, i was able to remove the speck of dirt saving this guy a visit to the ER for a cost of $500-2000. a note for other docs starting up clinics - you can make your own woods lamp for about $10 instead of $300. just buy a regular bulb lamp, portable is best, and use a "black light" bulb. works great. we wound up charging the man $50 for the visit and procedure. he left very happy and promised to use his safety glasses next time.

andru