Wednesday, June 17, 2009

Some of the details

(For travel in Asia, go to 11/2008-1/2009 & see link below right; backpacking: Grand Canyon 4-7-2009, Winds 9-12-2008, Maroon Bells 7-21-2008, Bandelier 5-23-2008, Big Bend 3-12-2008)

Sorry no photos. The storm last week fried my computer and some other things at the same time. As I wrote in the intro to this journal, I hope when I get old(er) someone will read these to me and I can remember some of the details of how life was.

How life is: I’m writing today sitting in the front room where all the books and many of the artifacts are (thangkas, images, betel gear, textiles, photos, etc.). It’s about the rainiest day I can remember, in the US, anyway. Electricity is still off. Leslie tells me it rained most of last night, while I slept.

David has my car and Nora picked me up to go to the clinic. When we got there, there was water in the pharmacy, work area and rooms 4 & 5. Soon it started raining again. I mopped for awhile, and then the 1st patient was ready and I started working my way quickly through the 2nd and 3rd and on and the water was rising despite several people (the usual type crew – children of two of the promatoras, several students, a volunteer) bailing and mopping and then the electric went out, but then came back in a few minutes. We were sloshing through water about an inch deep in the pharmacy and hallway and now exam rooms 2, 3, 4, and 5 and someone pointed out when we had power we were in some degree of danger of shock. Of course. So we closed the clinic, finished getting meds together for the last patients and Aaron and his students finished with the Burmese people in the hallway.

(Every time there is a big rain the water comes up through the floor into the clinic. We’re in the basement of a 104 year old church (it’s beautiful) and the drainage system doesn’t work very well. For several years we had “sewer gas” in the clinic in the mornings. That wasn’t very pleasant. Now the gas is gone, but the water is still an issue. It’s always interesting.)

So we piled into Nora’s little red car – Nora, me, Julio, Fabi, and Roxana – and started to my house. Columbia flooded and cars stalled in water up to their windows. Same for Gaston, Swiss, and not as bad on Live Oak and when Nora started slowing as the water deepened I’m saying, “Don’t stop, don’t stop.” (You say stop, I say go. You say why. I say I don’t know.) We got to my house and everybody dashed in through sheets of rain and there we were, more or less all piled up in the front room except now Leslie was there and that’s good.

Making me crazy: a few days ago someone asked me for help with psych meds (probably Symbyax or lithium SR) for a homeless person with bipolar. I told him we’re short on these meds and in fact, are switching some of our patients from more effective to less effective because we’re running out and cannot afford to buy them. I also told him that since the person he was advocating for is homeless, he could get care and meds from Parkland or from the Homes (homeless healthcare) van that actually comes to the Stewpot, where the man in need of meds is often found. And I also told him that we only care for people who cannot get services from Parkland and that our energy and resources are finite: if we care for Parkland-eligible patients, we won’t be able to serve those people with nowhere else to turn.

After this conversation he and I and others heard a talk from a well-known physician, including a brief discussion of the shortage of meds for poor people world-wide.

After the talk, the man who had approached me for meds again approached me to say that the patient’s doctor would call me – well, he says, the doctor won’t have time to call, but someone else will (assuming, I guess, that I have time to talk). I again explained our situation and my friend Shirin (who works with the Homes team one day/week) explained about services for homeless people. At some point I kind of lost it and said with some degree of passion, “We’re fuckin’ dyin’ out here, man.” That kind of closed it down, but what can I say.

Starts with a B: my first patient of the day was a woman asking that we help her with meds from an unusual set of Rxs and no distinctive set of signs and symptoms and no papers indicating a diagnosis. She had no money and had been sick with no meds for more than a month. Her diagnosis started with a B and we finally got it: brucellosis! Yes, she said, that’s it.

That’s interesting. Less than 100 cases/year in the US every year and here she was with scripts for 6 meds. We did the best we could, substituting TMP/SMX for rifampin and extending the course of treatment from 2 weeks (what was up with that!) to 6 weeks. So she didn’t get the optimum medications, but at least treatment is now for the proper length of time.

Ballin’ that jack: 52 year old man, complaining of elbow pain. Denies injury. Works digging with a shovel and pick; runs a jackhammer. Oh, right, a jackhammer. I gave him the strongest NSAID we have and some ideas re other measures, but I’m not very optimistic. So I’m making a point of really looking whenever I see someone running a jackhammer in the hot Texas sun and thinking about a 52 year old man doing that and no options. No other jobs out there. Just that. Grateful for it.

I been ballin’ a shiny black steel jack hammer
Been chippin’ up rocks for the great highway.

Doctor say I better stop ballin’ that jack.
If I live 5 years gonna bust my back, yes I will.

I hadn’t seen her in awhile: a woman came in with her two children. She used to come to the clinic and help, read to children and so on. Last time I saw her, her sister-in-law had beaten her up and she was traumatized a little physically and a lot mentally and spiritually. She moved and now was back 4 or 6 years later and her daughter, 5 or 6 years old then is now 10 or 11 and is like a Mexican Valley Girl, with all her gear and clothes and make-up and what not and still a sweet and innocent smile.

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