Mr. Jack

Mr. Jack was the parking lot entrance “guard” at the shelter on Friday evenings. He got that job, one of the best ones available, after months of successful participation in the shelter program. Every week when I drove by the lot entrance at around 5pm, he would put his guitar down, wave enthusiastically, pop his head out of the little office, and wish me a blessed day. One day, I decided to walk back to his little office and chat. I learned that he loved music, and was learning to play the guitar from a community volunteer. From then on, we shared our favorite songs, Googled lyrics, and tried to sing together for a few minutes every Friday. This is a song he had worked on for a while and was excited to share.

Feel My Pain

So summer is finally kicking in. After a long and gloomy winter, I was looking forward to nice and bright summer days. The problem is that with summer comes heat, and with heat come my allergies. My arms start itching and bumping up when exposed to 80+ degree weather, and if I don’t cool down fast enough, it starts to spread.

At first, the reaction is mild, almost unnoticeable. But when you’ve seen the ugly side of it, you start to panic as soon as you feel it coming. It just sucks. It is uncomfortable, irritating, unattractive, and sad. At times when the weather is at its best and everyone wants to enjoy the outdoors, my body forces me to be locked in an icebox. Thus, making my favorite season the most painful to live through.

Two summers ago I went to the doctor in search for a solution. He literally prescribed me an air conditioner. Is this for real? In the 21^st century, all a doctor can tell me is to stay cool? This morning, hoping medicine had advanced some, I went to a local pharmacy on my way to work, showed a pharmacist my arm, and asked what she would recommend. After making a very distinctive “that’s nothing” face, she said that “a little hydrocortisone will take care of it.” No, genius. It won’t. I have tried EVERYTHING. Just because it doesn’t seem that bad, it doesn’t mean that it isn’t. Granted I could not blame her because she did not have the full story (and she was not a doctor), I was extremely irritated by her response because that is the response I get from everyone.

The truth is that life goes on for anyone not feeling what you feel. But still, why is it that humans innately don’t give a crap? That unless things look so absolutely terrible, we cannot be moved?  I am guilty of it too. People around me complain about headaches quite often, and as society has taught me, I usually throw a sympathy one-liner and move on because headaches are not a big deal.

Part of our uncaring response has to do with how we express pain. Perhaps we are so focused on what we are feeling that we are incapable of describing it in a way that others can understand and relate to. After all, how would you “describe” a headache? But at the end of the day, it doesn’t matter how the sufferer describes his/her situation. We have all been there in one way or the other, and should be able to recall. So next time someone around you complains about something, even if it does not seem like a major concern to you, put yourself in his or her shoes, and rethink your response.

Finding someone that appears to care is so comforting that the experience alone makes us feel better. I believe we can fight illness by simply caring a little more.

Can I give him mine?

They called me from the Pediatrics Eye Center. Ugh, I thought. I hate it when they prescribe glasses to small children.

Outside my assigned examination room, the doctor, nurse, and social worker were gathered- a little unusual for an ophthalmology appointment. As soon as I arrived, they broke: “She is here, lets do this.” We went inside the room. I saw mom walking back and forth with her 3 month-old baby in arms, dad was sitting on a bench against the wall. The doctor, social worker and myself stood across both of them.

The family was there for an evaluation of baby Joni’s vision. His pediatrician had some concerns that the baby’s eyes were not responding to light and this appointment was to check if that was true, and see what type of surgery would be necessary. A concerning, but overall positive and hopeful visit.

Immediately after walking in, I noticed that Mom looked worried. She spoke some English and was able to gather that something wasn’t right during the examination, when there was no interpreter. She suspected there was bad news, but remained quiet, hanging tight to her baby in prayer. Dad had no idea.

“You have a very healthy, strong boy.” The doctor began. “Unfortunately, the concerns about his vision were correct – he is unable to see. At this point in time, there is nothing we can do about his condition. Your baby is permanently blind.”

I took a deep breath before I started talking, to keep my voice from cracking. As I repeated the doctor’s words in Spanish, mom and dad’s eyes are fixed on me, begging for relief. Painfully, I looked straight back at them with the most compassionate expression I could put together after hearing such shocking news for the first time. As I finished interpreting, mom burst into tears and held even more tightly onto her baby. Dad turned red and looked down, holding back. Baby Joni was awake, his eyes wide-open, looking as happy as any child his age.

The doctor kept on talking, trying to convey some hope and explain that this was not the end, that the baby was otherwise healthy and would be able to develop normally; that he would “see” the world in different ways.

But the family was not listening. They were dazed, not knowing what to do, what to think, what to expect.

At some point, the doctor asked: “do you have any questions for me, about your baby’s eyes?”

Dad, a robust man who had been quiet the entire time, suffering in silence, burst:

“Can I give him mine?!”

Tears finally started rushing down, tears everyone in the room had been able to control until this point. There was a brief moment of silence as the doctor tried to find the least painful way to answer his question. I took another deep breath:

“No, you can’t…”

So you DIDN'T want your tubes tied?

Not too long ago, I was called to the Mother-Baby unit. Mrs. Gonzalez had given birth to a healthy boy and required post-c-section instructions before going home.

We began as usual, asking how the patient is feeling, and giving a summary of the patient’s current state. We talked about her incision and the steps to take to avoid infection or hurting herself. No bending over, no heavy lifting, lots of rest, blah blah blah. It was actually a pleasant interpretation – c-section was smooth, baby is healthy, tubes were tied, mom can go home. Until…

“What do you mean my tubes were tied?”

Oh oh – the nurse looks at me in shock as I repeat the patient’s words in English.

In very simple terms, the nurse explains this is a semi-permanent procedure to prevent future pregnancies. Conveniently, it is offered to women scheduled to have a c-section since doctors are going to “be in the area” already. The nurse emphasizes that consent is required for this to be performed and that the patient signed it before the surgery.

Mrs. Gonzalez, still in disbelief, says in Spanish: “so you are saying I cannot have any more children?” The nurse rushed out the room to get a doctor.

Minutes later, a doctor the patient had never seen before came in with the nurse. While fully aware of the situation, he looked fresh and calm… a little too casual for the occasion. A defense mechanism, I would say.

“So, how are you feeling? I understand you have some questions for me!” He says energetically.

“The nurse is telling me I cannot have any more babies because of a surgery. I don’t understand…” The patient said worriedly, hoping the nurse had confused her with a different patient.

The doctor’s tone became sober and his smile disappeared as he explained to Mrs. Gonzalez that she did get her tubes tied, that her insurance would not cover its retraction, and that even if it were to be reversed, there was no guarantee she could have a baby again. As I finished repeating his words in Spanish, the woman broke into tears. Having just delivered her second baby, she looked forward to having three more, as is accustomed in her culture.  “Por qué, por qué?” she sobbed. “Why, why?” I asked the doctor. The doctor apologized and slowly drifted out of the room.

Under what circumstances did Mrs. Gonzalez sign the consent form? Who explained the procedure to her? Did someone confirm she understood? Did the medical interpreter screw up? Did the surgeon? The anesthesiologist? The residents? The nurses?

At this point, it is not about who to blame, but about recognizing that there is a gap that goes beyond the language barrier. Being in a hospital and not understanding the language of your providers is a huge risk despite the availability of medical interpreters. Some providers would rather not wait for the interpreter to arrive, others choose to practice the little foreign language that they know, others prefer not to waste time waiting for the interpreter and “wing it” by speaking louder/slower English with a touch of improvised sign language.

Communication between Limited English Proficient patients and health care providers is a real challenge, with real consequences to people’s lives. This is just one of the several “misunderstandings” that take place on a daily basis. And just as they are in the hospital, the patients remain voiceless about these injustices when they go home. What rights do they have anyway?

Please, Just Give Me Some Water...

I was supervising the medical interpreters that day. It was early in the morning, and the first call came from the Emergency Department – they needed a Spanish Interpreter ASAP.

The interpreter and I ran to room 36, expecting to see it full of clinical staff given the urgency of the requester. Instead, we found a Hispanic man in his 30s, lying in bed, suffocating. He had difficulty breathing despite the oxygen going thru his nose, and moved from side to side, desperately changing positions, complaining about how exhausted and thirsty he felt. His lips were completely white from dehydration, his skin pale, and his look confused and powerless: why is no one trying to help me?

When we walked into the room, he was alone. By protocol, the interpreter should not be alone with the patient, so we were supposed to leave. But it was impossible, his eyes cried for help, or company at least. A few seconds later, a nurse walked in very calmly and injected something in his IV without saying a word.

“I am thirsty, I am so thirsty. Please give me some water” the patient panted.  The interpreter relayed the message to the nurse, who responded: “The doctor said you cannot have any water. You are very very sick, OK?” as if her condescending baby talk would make the patient understand English. The interpreter relayed the message to the patient, who continued his struggle to breathe.

The patient had dangerously high levels of blood glucose. His diabetes was out of control and he was actually pretty close to dying. We spent about three hours in that room, waiting for a space to open up in the ICU so that Mr. Jesus could get the care he needed. The entire time, he pleaded for water, but no one gave him a single drop…

Once in the ICU, he asked for water once again, and a kind doctor ordered a nurse to wet a sponge and rub it on his lips. If he drank water, he might vomit and make his already delicate state worse. His hydration needed to be directly through the IV.

When Mr. Jesus felt the sponge on his lips, his eyes widened and his lips almost smiled. His problem was solved! He impatiently bit the tiny sponge and squeezed it with his lips, trying to suck out the minimal amount of water in it. A profoundly sad scene, his joy for a few drops of water after hours of begging for it.

This experience made me realize the huge discrepancy between health care providers’ approach to illness, and the perception of the patient experiencing it. Providers usually concern themselves with the biological dictates of disease, a mechanic view of the broken human body that needs to be fixed. Patients, on the other hand, experience the consequences of such brokenness, which should be reduced with mechanical fixing, but may also require another level of attention and care.

In Mr. Jesus’s case, yes, he was in a very critical condition and needed his internal body to be fixed. Hence all the IV medication, the oxygen, blood tests, etc. But what Mr. Jesus was complaining about was not how much his blood glucose levels hurt – he could not feel that directly. His primary concern was thirst, a thirst that was making him delirious and could be appeased with a few drops of water in a sponge, with no significant risk to his health.

I am not saying that the medical team should have stopped everything taking place to give the man some water. But I do believe that health care providers need to be aware of what patients experience and not ignore those concerns. The three hours we spent in the Emergency Department would have been entirely different for Jesus if only someone in that department had listened to him, had some compassion, and given him a drop of water to reduce his suffering.

Biologically speaking, the feeling of thirst and exhaustion is connected with the high blood glucose level and blood pressure. If those “bigger concerns” are addressed, technically the lesser ones (like the thirst) should decrease eventually. But why not try to empathize with the patient and do what is possible to make his experience of illness a little less terrible?

Professionals in the medical field need compassion, not just knowledge. There is a big difference between fixing a patient and caring for one.

When I Thought Was a Huslter

I just got back from a fabulous work trip with my fabulous boss. We drove to a beach town in North Carolina, for about 5.5 hours each way for a 2-hour-long meeting. The meeting was quite successful and the ride rather enjoyable. Beyond lacking sensitivity on my bottom due to sitting in a car for so long, I couldn’t complain…

However, on the way back to my house (now alone in my car), I started feeling tired, and thinking about the work ahead of me despite it being Friday. I have another work assignment out of town that will take all weekend and for which I have to wake up tomorrow at 5am. I also have an avalanche of time-sensitive emails that I need to respond to, and a load of responsibilities that only gets heavier the more time I spend out of the office.  As any dramatic young lady would, I took pity on myself and started thinking about how all I do is work and study and work some more. Such is the life of a hustler.

On my way home at 9:30pm, I passed by the local Hispanic supermarket to pick up my cousin Ronny from work. He got in the car and immediately started to tell me about this new guy that started working with him today. “He is Dominican, just moved to North Carolina from Florida. He had a car accident there, got laid off his job, has two children to raise, and his mother recently passed away. Man, he is having a hard time! He did not even have money to buy water today. I heard the manager is only letting him work this week, but I hope he can stay. Some people have it so rough…”

My cousin’s story shook me up and down and all around. Here I am, complaining about a fun trip to the beach and having too much work at a job that I love. Exhausted from all the hustling, heading home in my new car, to spend time with my loving family, and go to bed in my air-conditioned room. Real rough.  

Next time I get even remotely close to feeling sorry for myself, I hope I can think of this guy. Not for the purpose of comparison, or realizing “how good I have it.” But for inspiration, as despite his pain, burden, and hardship, the man tirelessly strives for success. “He was so energetic! Kept finishing the jobs really quickly and asking me what to do next. When he was telling me his story, he said ‘I will do any job, I will clean human shit if I have to. I need to support my family. I hope they let me stay…”

On our way back home, we saw Jose walking to his place – fast pace, long strides. In a hurry to get home, and out the empty and crime-ridden streets. I hope they let him stay.

Hunger is Real

I just got back from my grandparent’s house, located in a “not so fancy” part of Santo Domingo called Barrio Los Frailes II. This is the place, same town, same house, where I was born and grew up to become the beautiful young lady that I am today (wink).

My family’s house is one of the oldest and nicest in the town, probably because we are one of the few people who travel and work abroad. My grandparents retired to Santo Domingo after over 20 years of living in the US, working ungodly hours in sweatshops, babysitting, pushing delivery carts in supermarkets for a tip, spreading flyers, cleaning college dorms and houses, etc. Without knowing more than a few words in English (which is still true today) they worked hard, and struggled more than I could ever imagine, judging from their stories. Together, they made enough money to raise their 4 children, and take them to the US where they could also earn a more decent living than they could at home even as [not well-connected] professionals.

Now that their faces are wrinkled and arthritis is kicking in, they are back home, living peacefully in the same house they built together in their 30’s, and raising chickens for fun. “It gets boring, sometimes, that’s why we play dominoes and I kill his chickens for lunch while he prays” says my grandma about my overly-protective-of-chickens grandfather.

Coming to visit every now and then, I have come to realize that not everyone in Los Frailes had the same luck. Hanging out with my grandmother on the front porch, we talked about Marina, a now old lady that took care of me while my mother left to “try out” the US. Her husband died, she has no job, and all of her 3 children along with their spouses and grandchildren depend on her. My grandma normally saves Marina a portion of lunch, which she takes home to eat peacefully every day (meaning, to share with the 10+ people waiting for her at home). 

“It’s incredible!,” my grandma expresses angrily. “That’s why she is so skinny… her children are so old, yet don’t make an effort to take care of themselves.” It amazes me too.

“A lot of people are hungry in this town. See the people next door? They eat whatever they can find around 11am, and their mother cooks at 4pm, that way they don’t have to make dinner,” says my grandma sadly. These “people next door,” are good family friends, people who I knew from when I was little, people who came to my birthday parties, people who I thought were like me…  “normal.” 

“My lady, you are one of the only families in this town that eats three times a day,” says Marino, the guy from the grocery store across our house.

Realizing this was a shock. Hunger is real, necessity is real, and it happens to real people, people we know, people we care about, people that matter. But the thing is, all people matter, even those that we don’t know.

Hunger is not just something happening somewhere in Africa, it’s something happening everywhere, to people we may or may not now.

The question is…what can we do? My grandma saves Marina lunch, my dad gives Raul (the Haitian doorman) dinner when he is home, a friend of mine takes his leftovers to go, and gives to the first rando that comes around, you…? 

I hope that one day ending world hunger will no longer be a concern, however until then, we can all play a small part affecting those nearest to us.

My grandparents playing dominoes 

My grandpa's chickens