Women in the Bronx get sick.
Pregnant women in the Bronx get really sick.
The patients of the Bronx live in a hard place that has some of the poorest zip codes in the United States. And if there’s anything I’ve learned from my medical training as a fellow at Montefiore — and now as an attending in maternal-fetal medicine — it’s that poverty can make you sick, not just theoretically, or mentally, or figuratively. I’m speaking about real, clinical, dangerous illnesses.
Theories exist about discrepancies in health outcomes: One is that underserved communities lack resources, so that small health problems are not addressed until they are large and dangerous. But the outcomes that we see cannot entirely be explained by delays. Many of us have come to believe that the everyday stresses have caused these discrepancies. The new theory is that the hundreds and thousands of tiny stressors on any one person, cumulative across a day, across a week, across a year, will damage the human body.
I don’t know why this is true. I can just tell you that from my four years taking care of patients here, it’s the truth.
I hate this about the Bronx. And I love this about the Bronx.
I hate this about the Bronx because I don’t want to see a young woman with metastatic breast cancer in early pregnancy. I don’t want to mourn after telling a teenage girl that her water has broken at 19 weeks gestation, and that we cannot save her pregnancy. I don’t want to be at a “routine” visit in our clinic, listening to the lungs of a woman who had a baby one week before, and realize that she is in cardiac failure and needs to go to the hospital, and probably to the intensive care unit, while she weeps about who will take care of the baby. All of these things are too, too hard.
I’ve taken care of all of these women. All of these women, and more. Many get through their hard time with us and get better; some do not.
But in the face of difficulty, I also have to love this about the Bronx, even as I hate it. The truth is that taking care of these patients has given me an education that I don’t think a doctor can get in many other places. Now, when I see that postpartum patient in heart failure, it’s not the first — or sadly, even the second or third time that I’ve dealt with this rare complication. That’s tragic, but it also means that now I know a lot and know, now, the right medical thing to do, and the right medicines to start thinking about. And I know, now, who are the right people to call, and how to help this woman with the other parts of her life so that she can be in the right place to heal.
And so, one by one, the women of the Bronx have taught me to be the right doctor for the women of the Bronx. And that is something that I can love.
Eve Karkowsky is an obstetrician-gynecologist at Montefiore Medical Center.