Lines

I had a busy weekend last weekend. On Saturday, I went to Mexico with a group called the Flying Samaritans. It began back in the day with a few doctors flying down to Mexico to provide medical care for free. Now it has grown to several chapters of the group at different schools, and UC Irvine School of Medicine now has its own chapter. We should be called the Driving Samaritans, because we get up early in the morning and drive down to a place south of Tijuana. Last weekend it was so cold it was snowing both in San Diego and Mexico, so we didn't have that many patients. Probably the really sick ones stayed home in bed. Nonetheless, we were there for several hours, without time for lunch. I was so underdressed that I shook and chattered all day and nearly caught a cold myself.

Our first patient was a young guy who looked about college age. He'd been in a car accident a few years ago, busted a few ribs and got intubated while in the hospital. They left him intubated too long though, and it damaged his vocal cords, so now he can't talk. What's worse, they gave him a stoma, which is a hole in your throat that you breathe in and out of. It functionally replaces your mouth and nostrils, bypassing the blockage might be in your windpipe below your mouth/nose but above your throat. In his case, it was inflammation and scar tissue. He had nasty scar tissue all around his external neck too, from surgeries to repair the damage to his vocal cords. All this I found out from his mother, who accompanied him to the clinic and did the talking for him. So why did he come to see us last weekend? Apparently, he came for the first time to the clinic during the last trip down there, before I had joined the group. The tissue around his stoma had gotten so infected and was oozing so much pus that it was clogging his only breathing hole. If his stoma ever gets completely clogged, that is the end of the road for him. He doesn't have any other way to breathe except that little hole. So all he really needed was antibiotics to keep his stoma free of infections. But where he lives, he can't get antibiotics. He cleans his stoma with a cloth and water, and that's all he can do. My classmate Randy was down there last month, and he said that the patient had improved vastly with the antibiotics they gave him. Indeed, he looked well-built and healthy, not sickly. He even had a nicely shaven little stylish beard, like the ones I see on college-age guys here all the time. He just seemed like a normal guy. He didn't have fancy clothes, but they were clean and he wore them well. I know that sounds weird, but maybe it was the feeling I got that although he was seeking help, he didn't project helplessness. He had impeccable manners. When I brought a chair over to the exam room for his mother and him, he wouldn't allow me to stand. He silently insisted with his gestures that he would stand, so that his mother and I could sit, even though he was the patient. While the rest of us talked about his condition, he made appropriate gestures, participating even through his silence, and closed off his stoma with his hand at one point to ask me how many languages I spoke. He certainly did not play the pitiful part of a helpless patient.

We couldn't do anything for him. We had brought a family medicine doctor and a pediatrician, obviously neither of whom could perform correctional surgery on this guy, particularly not in a clinic without electricity or water, with just our cardboard box of ibuprofen, antibiotic ointments and blood pressure cuffs. But I could see that both the mother and the patient were here because we offered some kind of hope for him. We had brought doctors, after all, and doctors are supposed to be able to help. I felt impotent and frustrated. There are so many lines all around us: monetary ones, linguistic ones, and geographical ones. This dude lives just a few miles from the U.S.-Mexico border. If he was on this side of that line, his current state would probably be very much different. We talked about "papers," because it turned out he has "papers." That represented a surprising ray of hope, that he could legally come to the U.S. for treatment if he had to. But the line he cannot cross is not geographical, it's financial.

In the midst of all the anti-immigrant sentiment whose flames were fanned and made into a nice, roaring fire by Republicans for the November elections, I kept thinking about a student that Darron told me about. My trip to the clinic made me think of him again. Darron asked his class one day what they thought of people who didn't want them to come here from Mexico because it was illegal. This student, Darron told me, paused for a moment, then replied, "What would you do?" Seriously, what would any of us do if we were hungry just a few miles away from the Land Where People Die of Overnutrition? I don't think it should be a mystery to anyone. Particularly anyone who's been a parent should understand the motivation for anyone to give the very best opportunities to their children to be healthy, happy, and better off than themselves.

So that was just my first trip down there. It's depressing. Even when I've gone on vacation trips there before, I've never been able to completely enjoy myself in Mexico because of the povery. But I want to keep going. If bringing this dude antibiotic ointment will keep his stoma from getting infected, then we did something, however small. Many of the other folks, all they need for treatment are simple things. I heard there was a lecturer that went to Africa somewhere, and conditions are so bad there that all they need to make vast improvements to the health of the village as a whole is multivitamins. Multivitamins. Such simple cures for maladies that aren't medical mysteries, and yet people are still dying from them because we have lines. I'm not sure how I'll handle it if God forbid, I ever go back and hear that my patient died of suffocation, caused by a simple infection. I know that drawing lines is human nature, and this is the way things always have been. I'm not disillusioned into thinking that I can change human nature, but that doesn't mean I have to like it. For every person I see like the young guy with the stoma, I'm sure there are millions of other sad stories like it. Some days, being a doctor just doesn't seem like enough. What good does it do to know what someone is dying of if you don't have the means to treat it? Then all that medical knowledge is simply trivia to sit around and talk about while you watch people die.