The complaint was constipation. In the exam room, a quiet girl stood in a too big johnny, her eyes staring down at the floor. The 13-year-old was here with her “aunt.” Like over 50,000 children before her, she’d made the fifteen hundred mile plus journey from El Salvador to escape the violence of government and gang fighting, perhaps not knowing Mara Salvatrucha and the other gangs hung out only a few blocks away from the health center.
Her heart and lungs sounded fine, and her abdomen was soft with good bowel sounds. An inspection of her backside revealed sheets of condyloma cascading over her perineum and obstructing her rectum. In the cramped room with the community health worker we discussed additional testing, the need for referrals to the hospital, and future follow up. The rape and abuse of this child and these children as they make their perilous journey to a “better life” was just an unspoken given to be addressed in time. I could feel my cell phone vibrate in my white coat as I washed my hands and walked back to my computer.
I clicked on her medical record as I glanced at my wife’s daily reminders and queries: Who in my family was coming to Christmas dinner, could I pick up the appetizers I wanted, and had I talked to our daughter about harassment and personal boundaries, the current topic of our progressive society. I slipped the phone back into my pocket. I typed out referrals to pediatric/general Surgery and pediatric infectious disease and sent them into the cloud of seamless care. I called upstairs to our pediatric department the old-fashioned way and plugged her in for a new patient appointment.
As I typed my note, I thought about what family meant to those who had the strength and courage to leave everything they know behind for the “dream” of something better. I thought about boundaries: intimate, personal, work, government and how they could mean everything or nothing depending on who held the power. And I thought about stuffed mushroom caps and hot artichoke dip and visions of sugar plums.
In the bipolar world we navigate daily, thankfulness is our lifeline. This year (and every day) I’m thankful for the community health workers who will do more for my patients and this young girl as they guide her through the complexities of the health care “system” than I ever will. I’m thankful for the MAs, nurses, techs, administrative staff and physicians on the other end of my clicks who will coordinate, care and support her through her journey of treatment and recovery.
And I’m thankful for a hospital president who despite every economic driver, political incentive and government cutback to stop, continues to put community and compassion in our mission.
Jeffrey Collins is an urgent care physician and chief medical officer, MD Now.
Image credit: Shutterstock.com