Friday, August 28, 2009

A Day at LSU Clinic

I was just shy of my tenth birthday. I was standing in the basement, washing doll clothes in the giant laundry sink, rinsing and hanging them on a little clothesline. Off in my childish fantasy land of domesticity (that fantasy SOOO didn't last!), I wrung out each tiny dress. I was pulled out of that fantasy by my mother's scream of "Oh NO." I remember running upstairs to find out what had upset her so. "The President has been shot." I sat with her and the black and white tv flickered the images that are burned into our collective brain. The car, the onlookers sobbing, Jackie climbing over the trunk, the funeral, little John-John's salute, Jackie's veil, the long tailed jackets of his brothers.

I was just about out of eighth grade on June 6, 1968. Robert Kennedy had been shot. By then I knew this was a big, big deal, and I'd already hung my hat on what he was saying. It made sense to me in a way that the grownups around me didn't seem to get. But hell, I was in eighth grade. Maybe they were right and I was wacko. What did I know? I knew for sure that after watching the Vietnam War play out on the nightly news, yes, still in black and white, that the war didn't make sense and that what RFK was saying did, at least to my eighth grade mind. I also knew that it was horrific that such a thing had happened to this family, so soon, so familiarly, so fast. Boom. He was gone.

Now the youngest boy of that generation of Kennedy's is gone too. Yes, he was "SENATOR." Yes, he was "PARTY GUY." Yes, he was the one walking both coffins to the grave, holding the enormous family together, a role he that he had not signed up for and didn't expect, having been the youngest of all the kids. But somehow he was always "Teddy." Not like a Teddy Bear, although he bore a certain resemblance in his later years, but just "Teddy." One writer, forgive my not remembering who, said he was the only one of the boys who actually knew the end was coming. That struck me as profound.

He, who came from a family which could afford the best of healthcare, no matter how dire the circumstances, always, always thought about the little guy and his lack of access to that same healthcare. Now we have townhall meetings and the constant use of the word "socialist/socialized" and people getting laid off in droves, losing their healthcare benefits in the process. People who knew him are saying the one thing he wanted to finish was a quality healthcare bill.

Today I saw amazing things that put it in stark, sharp focus.

Ironically the old Lord and Taylor department store on Poydras, a store full of things, has been turned into an outpatient clinic, full of people. And I really mean FULL of people. My husband broke his arm last week and needed a followup--more xrays and probably a real cast as opposed to the heavy plaster and padding thing he's been lugging around. He had been given a piece of paper saying he had an 8AM appointment, a term I learned is loosely used in this situation. So off we go arriving at 7:30AM. We didn't leave there until nearly 3PM. What I saw in the interim was astonishing, desperate, inspiring and terrifying.

Upon arrival (don't get me started on the parking--which was a constant concern all day) he was sorta checked in. We are told to sit in the chairs to the right of the desk. Various staff members, apparently from different departments of the clinic, come out with hands full of papers shouting numbers and an occasional name--F47, F48, F49, Camille Shaw. People come out of the chairs and are told to follow these people. They do. Mostly. We are told he doesn't have a number yet, that they will call his name. Okay. We wait. We sit. I look. I realize the system of number calling and escorting people to their proper destinations makes sense. It cuts down on endless "Where is. . . .name the department. . ." questions and keeps people moving.

An elderly man, using a walker with a basket filled with his medications and a water bottle puts his walker aside to push the wheelchair that his wife currently occupies. She is wearing a terry cloth dress of sorts, her right leg stuck out at 90 degrees from her body, covered by a towel. He gets her checked in, pushes her out of the line of traffic, leaving his walker over near the check in desk. She says her leg was shattered in a fall last year. It was so shattered that they could only deal with a few of the bone fragments at a time. She currently has about 12 "pins", which are actually rather large diameter rods sticking out of her leg five inches tall, placed there to help the next few fragments mend to the first. No angst, no feeling sorry for herself, it just is.

People are coming and going. All manner of walking-with-crutches wounded and unable-to-walk rollers in old style wheelchairs. (I see a sign saying there is a shuttle from the parking lot next to the Superdome to the clinic for those who are totally immobilized, except on Thursday when there is a Saints game.) So many are by themselves and are walking on casts not meant for walking on. I finally broke them down into the "hardwares" and the "castes"<---yup, I meant that spelling--and their spouses, helpmates, significant others, children, whoever was there to help them if they were lucky enough to have someone like that.

One kid, no older than 23 had what looked like a cookie sheet on steroids, bent like a rain gutter attached to his heavily fiberglassed foot with rods of remarkable geometry coming out of his lower leg, into the upper foot, coming out the back. He's swinging along on his crutches, his pants cut off roughly to accomodate the cast. He was by himself.

In front of us sat a couple. He was wearing a cast, much like my husband's. She sat next to him. Both waited. I hear the man say, "That's it. I need a job with real health insurance so I can see a REAL doctor." She listens, not saying anything. Clearly this man is angry. Angry at his circumstance, angry at being there, angry that these "other" people have, in his opinion, more screws and more teeth loose than he does. He is unlike them. He doesn't belong here.

The check in desk has a line around it. It's the fifth line of its length I've seen. I started counting. They had processed about 500 people, placing them in their appropriate clinics by 11AM. These were the people lucky enough to have an "F" number. Everyone with a "G" number, or folks like us waiting to hear an actual name, had to wait. There were no arguments, no voices raised by either patients or staff. We were lucky enough, lucky being a relative term, to be in a position to see the Price is Right on the monitor above us. A monument to American acquisition in the midst of people who no doubt were dreaming of that $25,000 cash out if only they knew how much that washer/dryer combo cost to the nearest dollar. Whoa, check that! A diamond and sapphire bracelet. Wonder what it's worth? Wonder if it would fit around my cast? No problem, I'd just wear it on the other wrist, or maybe sell it on eBay and pay my rent, or part of it.

The man in front of us says in a voice heavy with judgment, "These people are the dregs," referring to the other patiently waiting patients. One woman had had the temerity to show up in her pajamas, nevermind she was clearly in pain, clearly couldn't put her foot down, clearly couldn't have showered and dressed to suit him in her condition. THAT man was obviously special, superior. These "dregs" were unsuited for civilized society, and besides a great many of them were what he termed, and no doubt some doctors termed, "obese." Outrageous. Truly. It never dawned on this man that the woman in the pajamas, in pain, might have been a brilliant woman, a Rhodes Scholar perhaps, who had unfortunately majored in Anthropology and was now a laid off professor with no health insurance, a house about to be foreclosed on thanks to that ARM they talked her into, and with University cutbacks, no employment prospects in sight. And ya know, maybe she wasn't. Maybe she was a welfare queen, or a trailer trash girl, assaulted at 11, three kids by 18, used to a vicodin and malt liquor cocktail used to ignore all that. Maybe she was. But some of those not "REAL" doctors were gonna take care of her. She was near tears as she sat in those chairs.

We are summoned. We go answer the questions asked and are given a "G" number. We are told to go back to the chairs someone will call us. G15. Please call G15. A woman comes out, she calls G12, G13, G14. (Perhaps we're playing Bingo, I wonder.) Those folks follow along on their crutches, with their hardware sticking willy nilly out of various limbs, with their casts, dirty from walking on them when they should be keeping them up, in wheelchairs, casts perched precariously on the ill fitting leg rests. Another man comes out calling G34, G57, G58, Melissa Washington? No rhyme or reason in the numbers, but maybe we have Bingo. Nope, no G15.

The man in front of us, also still waiting, makes another derogatory comment about the other patients. The woman with him says, "Well unless you're a neurosurgeon, or in some other enormously high paying----" "OH," he says, eyes glinting with a gotcha spark, "You're saying that shitty care is what we deserve if we're not in the right class?? That's classist. That's elitist. I can't believe you sai---" "It might be classist, but that's the reality of the healthcare system. It's not an indictment of the people here, it's an indictment of the sytem," she responds. He doesn't like that answer. "I've noticed a racial component as well," she says, trying to engage him. "Oh yeah? What?" says he, not knowing that I'm listening. "The black folks here seem not at all upset by the wait." "Well, I guess they're used to being treated like shit," he responds.

A little girl in pigtails wearing a perfect Sunday-go-to-meeting sailor dress, much like I wore when I was little, with perfect tiny Mary Janes is holding her mother's hand. Her mother has walked the length and breadth of these halls to keep the little one from being bored. The baby dances holding on to her mother's arm, smiling widely, not seeing color or class or gender--okay maybe gender vaguely, she's barely two. She doesn't care that the guy on Price is Right is trying to act as though he's enthusiastic about a dining set and lawn furniture when the OTHER guy got the showcase with the dune buggies. The lawn furniture guy wins. He proposes to his fiance on Price is Right. Hell, why not. It's not stuff he WANTS but it's STUFF. How cool is that? She says yes, hugs all around, no tears from the folks in the chairs, balancing their casts, their hardware, their anxiety, their circumstances, their aloneness on very precarious edges.

Elderly woman, clearly in pain with a cast on her left leg, in the old timey wheel chair being pushed by her son or grandson, it's hard to gauge the generational gap there. She's trying everything to alleviate the pain, folding the cast over her other leg, putting it on the leg rest that's just a smidge too short, letting it hang down. The son is wearing a tshirt reading, "I only wear this tshirt when I'm a grouch." So much for bucking up Mom! She waits with the rest of us. At first he pushes the wheel chair dutifully, later in the day I see him pulling her around like bricks in a Radio Flyer. So much for compassion. She was, at that point, merely a duty. One he resented. But he didn't say so, he just dragged her around, sullen but blessedly silent.

People with canes helping people with crutches. The escalators of the once fancy department store still run in the distance. The woodwork and trim is still there amidst the cubicle dividers of grey fabric, the signs in large letters pointing the way to the pharmacy, the rest room. Just follow the little arrows on the floor, red for THAT way, green for THIS way. Keep the traffic flowing just like the cars on Poydras Street outside. "Lady, there's a chair over here. You can't sit on the floor."

My husband goes and asks about G15, the ever present deli counter number slip held tightly to the ream of other papers in his hand. Within seconds the wonderous number is called and off we go to XRay and another set of chairs. Jeopardy is on. Best category, Oscar winners. I have it cold. Still no arguing. Still no raised voices. We've all been there for five hours waiting to answer this Final Jeopardy question. We are conservative in our wagers.

An older black man stands near the back wall on a three legged cane. He's struggling. I point out a chair, upset that the younger folks haven't gotten up to offer him a seat. He smiles and says, "Thank you ma'am, but I'm just waiting on someone," and ambles off slowly. A couple of young Turks, in spanking new Timberlands, go past. One wearing only one as the other leg is in a cast up to his thigh. Both wear dreadlocks, obviously brothers, the younger two legged one spurring the other on, "Hey, dog, maybe you should use that THIRD leg you always talking about." The Timberlands still have the tags on. I'm wondering if that's intentional. A white man, plaid shirt, blue baseball cap, cast on left lower arm, explains to a friend that he's cut off his fingers with a table saw. They reattached them, but one didn't take. Now he fears the other one is failing. Later I see him in the chairs, him with a cast on his left arm, patting a guy on the back to encourage him, the other guy's cast is on his right. Fingerless guy was a contractor.

I went out for a cig. The steps outside were another scene from this opera. One guy teeters on his crutches coming down the steps. I tell him to be careful. He says, "You shoulda told me that a WEEK ago before I screwed up this knee that I'd already screwed up and it was healing!" He laughed. He had fallen off a ladder. A white guy, about 40, with paint covered shorts and white paint on his fingernails, wearing a cast on the left arm, bums a cig then starts complaining. They lost his paperwork, these people are assholes, it's outrageous he's spending his entire day here, his eyes are pinned from the Vicodin the "assholes" gave him. I listen to him complain for a bit then say, "You need the help, these people are helping. How can you fault them for doing what you need done?" "Well it should be faster. All this waiting around."

I lost my patience at that point. He was acting like an entitled jackass. Hell, he's a working man, he's white, he believes in justice and duty and has worked hard all his life, why aren't they jumping to just for him? I opened my mouth, never a good thing I've learned. Out comes, "What? You were planning on doing a lot of painting today were ya?" He looked at the ground and the rest of the smokers snickered a little. Welcome to the world, little man. THIS is the current reality. Sorry, truly, about the cast on your arm. Sorry you're worried about the rent. So is everyone else here.

Of all the people I spoke with, patients I mean, all but one were working people with no insurance. The one who was not a working person was a woman in her early 60's who clearly HAD worked for a long time in an office somewhere. None of these people were what some would and did call the "dregs."

Not one patient got nasty, no matter how impatient they were, no matter how frustrated. I was amazed. Many of the staffers helped without eye rolling when asked, all of them worked hard to make sure everyone got where they needed to be. I was and am still amazed by that. No slackers that I saw in the staff. No unfortunate incidents in the chairs. Everyone just trying to get through, trying to get along through the red and green arrows, everyone seeming to understand that their arms, their legs and the system was broken and needed to be fixed.

As I waited for them to put the new cast on the husband's arm, an excruciatingly skinny woman wearing a wig came up to me outside. "Excuse me, ma'am, can you tell me where the Charity pharmacy is?" "Yes, ma'am, in through security and a sharp left." "Thank you." Ten minutes later, she returned. I asked if she had found it. She said yes, thank you. She was clearly a chemo patient, clearly getting toward the end of her fight. She turned and walked her tiny self across the lanes of Poydras and LaSalle, away from what was a department store for them that had, now a haven for them that ain't got. She was alone.

I kept wondering why we have a department store as a clinic when Charity Hospital is sitting there just waiting to be updated, rehab-ed and used? I kept wondering why the "dregs" were somehow thrown into a weird caste system of healthcare? I kept wondering how healthcare workers keep going without completely losing it in frustration. I kept wondering how all these people in pain, physical and psychic, managed to not take it out on the staff or each other. I kept wondering what would happen to the man with no fingers, the old grandmother with the cast, the boy with the rods bigger than my currently well attached fingers (hey really, ya never know when THAT could change). I kept wondering how we'd pay the rent. I kept wondering about the skinny little lady, casting a shadow of strength and courage on Poydras Street. I kept wondering how anyone in their right mind could have an issue with a public option in healthcare. I also finally understood that those opposed were having issues with accepting they ARE the little man, not some master of industry, commerce or trust fund.

I kept wondering if Teddy was looking down saying, "Yeah, THIS is what I was talking about."

7 comments:

Mark Folse said...

F' brilliant slice of the reality of health care.And on a day when many people are probably remembering the rumors of Katrina (thank bog it's not a normal AM radio talk day), a reminder that "those people" mostly suffer in silence.

I think you need to stick this up as a link of Facebook, tweet it, send it out far and wide.

E said...

This is amazing. I am going to spread this around.

E.J. said...

The sad thing is that those against the public option, or any sort of reform for that matter, would still find a (logically incoherent) way of discounting your observations.

That doesn't mean you're allowed to stop writing though. LOL I could be wrong, and this is exactly what the rest of us need to hear to keep from giving up.

Anonymous said...

Wow. What a great write up. It really resonates with me.

Anonymous said...

Everyone in Congress should read this before they get back to work on health care matters. So vivid and heartbreaking.

j. m. said...

Horribly frightening. All we’ve been through since K. & so much stays illogically bad. 4 years. World War 2 was fought during that time. We as a Nation are capable of so much if driven – the Space Race for example. Why can’t this Country get this right? It burns the edges of my heart & continues my disilusionment. I’m so sorry you & your husband had to go through that idiotic abuse of sanity.

Anonymous said...

This was an amazing post.

Thank you so much.