Tomorrow, we may fail you: Vignettes of pre-existing conditions

Today, I cleaned the laceration above your eye from where he punched you with a closed fist. As I was stitching up the gaping wound with two layers of sutures, I told you that the scar would fade into the line of your eyebrow. I helped you apply your foundation on your neck to cover the bruising from where he strangled you. I monitored you for any swelling of your airway. I wrote down the names of the local battered women’s shelters and hotlines and slipped the paper in your shoe. I offered to call the police for you no fewer than ten times. I told you how I feared the next time you would not be discharged home. Today, I tended to your superficial wounds. Tomorrow, when your wounds are move severe or when the deeper wounds appear, we may fail you.

Today, you came to me alone after passing out while working part-time at the local movie theater. You are a college student, and your family is hundreds of miles away. No one was with you when I explained that your bloodwork was concerning for cancer. I’m not sure you truly heard me when I explained you would need to stay in the hospital for a blood transfusion and bone marrow transplant. You asked for a note to excuse you from your physics final tomorrow. That may be the only note I can write on your behalf. Today, I was able to suspect a diagnosis and set up life-saving treatment. Tomorrow, when you are in remission but develop secondary heart failure from toxic chemotherapy, we may fail you.

Today, I reviewed with you the dietary considerations for having Type 2 diabetes. It turns out, you already knew everything I was telling you. I assumed you didn’t, since you came to the emergency room with a blood sugar of >500 and blurred vision and dizziness. You told me that your insulin and supplies cost more than $1,000 per month. As a senior retired person, your income is fixed so you’ve had to “get creative.” When I asked you to explain, you tell me how you do your best to make one week’s worth of insulin last the whole month. You’re still giving yourself some insulin, most of the time, but less than what you’re supposed to. You ask me, “isn’t it better than not at all?” Today, I was able to have the social worker provide a voucher for a month’s worth of insulin in supplies. Tomorrow, when your blood sugar gets so high from rationing your meds, and you become unresponsive, we may fail you.

Today, I had you undress and place your clothing items in separate paper bags. I took cotton-tipped swabs of your mouth, private areas, and that mark on your shoulder where he tried to bite you. I scraped underneath your fingernails and pulled hairs from your head and your private area. I took photos of all the bruising, cuts, and wounds that kept bleeding. I gave you medications to prevent pregnancy and prevent transmission of HIV. I apologized that this happened to you, and told you this was not your fault. I let you shower, as if it would help wash away your shame or vulnerability. Today, I comforted you, and safely dressed you in clean clothes. Tomorrow, I will testify for you and other victims of sexual assault. But when you are afraid to go to sleep in fear of the haunting flashbacks, we may fail you.

Today, I changed your diaper and combed your hair. I sang nursery rhymes to you, and fed you scrambled eggs and avocado. I read you our favorite book, On The Night You Were Born, and I told you I loved you at least fifty times. I tucked you into bed, kissing you one last time for the night, again telling you that you are one of the loves of my life. Today, I was your mother. And I will spend all of my tomorrows fighting so that no one ever fails you.

Amanda Guarniere is nurse practitioner and writer. She can be reached at Amanda’s Great Idea.

Image credit: Shutterstock.com

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