Honest Patient Honest Dollar

In this business of medicine we are typically hurried along in our patient care duties by unseen forces, such as adminstrators, who enforce expectations of speed. The underlying impetus for this is institutional income, of course. It's not an intransparent truth. When, at your annual check up, your doc or PA seems to be speaking in half sentences and glancing at the door, it's likely because this professional is under pressure to see more patients per hour.

However, in a location where I work currently, there is no money to be made per patient. It's just the way the money flows from one hand to the other within the government. So the need for speed is due to patient flow, not administrative hand wringing over a keyboard. We still go fast. But it's because the patients show up fast.

Yesterday, for instance, I was asked to go quickly by a patient with multiple problems because, she explained, her sheep were being stalked by a coyote lately. She could only be here a little while.

Intrigued by this sincere concern, I asked why this was a problem now. I guess that's the ER person in me; the question of immediacy is ingrained. She informed me that her best sheep dog has gotten too old to take good care of the herd, and the three new puppies aren't trained well enough to the task. Plus, her mother is too old to shoot the shotgun straight anymore. So, would I please hurry. She can't afford to lose any more lambs.

Accordingly, I hustled with a quick step that no email from a hospital CFO had ever put in my Nikes before. I imagined the coyote checking the dirt trail for her old pick up, then peering at the lambs, then back at the trail.....

And before long I had her exam done, her meds refilled, and our requisite chat about the exam, plan, and medications completed. I watched her perfect black braid trail down her back as she left the room, and I wished her lambs well in my mind.

A More Lighthearted Look...

If you read that August 18 post and think we only export angst here, this video from the Funny or Die people shows that dark humor is also offered from where power and prejudice reside in tandem in the governor's office:

http://www.funnyordie.com/embed/ccf82db57e

Meanwhile, here in the Navajo Nation, the days are shortening and the temperature is dropping. It's still August. I have my beloved winter beanie on - the one with the colorful border trim. It's like a basic bean and rice dish; no matter where I go in the world, it seems to fit in ok. Or at least I think it does.

Just to be reminded that I'm still in Arizona (if the occasional internet news isn't enough; there's no TV), a 3 yr old boy was bitten by a rattlesnake this week. He was whisked in by his frantic mother when she realized what had happened. I saw a swollen, slightly bloody foot, and thought it might by a bite from a small dog. I was wrong.

The entire lower extremity began to swell and darken with an alarming speed, and the child was inconsolable. As many reading this will know, the key is to keep the patient still and calm. So he was back boarded and sent traveling in the waiting ambulance the 50 miles to Chinle, where there is anti venom. An RN went with the paramedics for further support. By that time his foot and leg were so swollen it was difficult to see his toes; he had apparently received a large dose of venom.

From the Chinle Hospital, he was medevaced to Phoenix Children's ICU, where his definitive care proceeded. Rattlesnake bites break down the components of the blood's clotting factors, and his were indeed breaking down. It's as if you ingested rat poison, or all your granfather's coumadin at one sitting. The labs supported that ominous knowledge about this snake. Ongoing messages we are learning is that his condition is stabilizing.

In the Navajo tradition, rattlesnakes are not to be killed. Instead, they are asked to leave. I do hope by the time this family returns home there has been a ceremony to encourage their herpetologic visitors to move on.

The deluge of overnight rain has ended with the gray sun's meek arrival. My morning run will be muddy. On mornings like this, every being will leave their paw prints for me to see.





 

Not Just Any America

I returned to the United States from working in a small space in Kurdistan, and from being off leash in Istanbul. Indeed I did. I kissed my dog, hugged my friends. I went to Haiti to do what Peacework Medical does so well there.

And upon my return I repeated the activities listed above with my dog and friends.

Then I decided to earn a paycheck again, and ventured to do this in the United States. But this would not be in just any American enclave. This place where I would warm my stethoscope would be the very sinus node of our country. For those who avoided cardiac anatomy, I'm alluding to where a heartbeat begins.

Specifically, I'm working in the Navajo Nation. Without argument, where America thrived in spirit and culture before it had this name. Before we had names, and lumbered in on horses and carts with too many things to name in one sitting.

There is a distinct irony to be working among our native population here in Arizona.  Frequently needing an interpretor to communicate with my patients, who speak the indigenous Navajo language, and being witness to an ancient culture, reminds me that I'm a newcomer to this land. Times like these I feel like a foreignor in the United States. I remind myself I'm in Arizona at least once daily.  It's an intriguing juxtaposition of time, place, and circumstance.

The irony exists in that our governor is currently wielding all the power of her office to deny certain other newcomers to our land any benefits of human decency, dignity, and opportunity. She has essentially blocked the federal "Dream Act" in its practical application here. It exists by law; it's just been skeletalized in how you could actually use it. For instance, now you can't get a driver's license if you're a part of this effort...she was able to unilaterally block this and other parts that make it impossible to follow through on the Act itself.  Vindictive and petty.

This is the treatment for people who never walked into the U.S. on their own; their parents brought them in as children. It wasn't their choice to arrive, but it has been their choice to learn English, engage in the culture, and become a part of what is now known as the Dream Act. Simply put, to continue their education and/or serve in the military. Reasonable goals for any young person who would contribute to the land we all share and call our  home.

So while the governor appears to have had relatives who may have escaped a potato famine, or been in a nearby country who may have shared a potato as they were departing for the New World, she herself forgets that we were not here first. And we were not particularly welcomed with open arms either.

This fluke of circumstance that has hoisted her to the top of the heap is fleeting, and her bias toward those in positions of less power in society is stunning. We should behave more like guests, and perhaps this should begin with respect for all constituents: the powerful, the powerless, for those who have been here since her family was planting seeds on European soil, and for those just learning to dream the American Dream.

But you might not seize this big picture of the value of inclusiveness and attention to history when your education  extends to a community college certificate, as hers does. And the legislature she oversees overwhelmingly matches her at this level of higher learning. It's true: fewer than half of this state's lawmakers have bachalaureate degrees, something that could help with pondering the world beyond the lines drawn around your district. I can't make this stuff up.

If I did, it would be duplicitous, and I would need the authority of, say, congress to get away with that. And less of a conscience, perhaps like the men and women in the downtown Phoenix halls of Congress deciding to abrupt the futures of motivated young people. The very ones who want to legally go to college and explore beyond the Arizona counties they were born in.

They could make Arizona a better place for all of us someday, with ideas and innovative drive consistantly shown by immigrants in this land. Or they could be relegated to become short sighted, poorly educated citizens with dead end jobs. Education and opportunity make the difference. Divisiveness breeds hate. How can a governor willfully perpetuate a heirarchy among our citizens, and create a place where there is discrimination for its own?