Recommendations

I recommend tummy time to increase abdominal muscles for the 7 month old struggling to sit upright. But apparently it is hard to find space for the luxury of tummy time when you live in a 400 sq ft. mobile unit on an orchard, the floor scattered with dirt and pesticides, dragged in from the field.

I recommend taking the insulin and Metformin we prescribed to the 60 year old diabetic with an A1c of 11.7. But apparently when you cannot read, cannot afford medications and cannot figure out which medicines are which in your sac full of expensive drugs, it becomes less feasible to be compliant.

I recommend some common anxiety and depression treatments, but apparently when both your parents just died in Mexico within days of each other and you cannot afford to go there for a funeral, you cannot afford to buy caskets, and instead of getting to say goodbye, you are stuck in overcast Oregon, it’s easier said than done.

I recommend not shoplifting for your $100 per day ($3,000 month, math whiz) heroin habit. But apparently when your Dad is a meth addict, your Mom is an alcoholic and you really, really, really like the heroin in your veins, it’s tough to keep your hands off the merchandise.

It’s one thing when recommendations fall on deaf ears. If you really don’t care what I say, then fine. Sign here and bring the next one back to room 19. You like the potato chips and TV more than exercise. I get that. Say hi to your pannus for me.

But what kills me is the recommendations that the patient soaks up like a sponge. They desire change. They want the best for themselves or for their children. The ears are not deaf. The instructions flow in and register in the brain. But something stops them from being able to follow through. Enter life’s circumstances. Some would call it an excuse, and perhaps that is true in some cases. But when was the last time you lived as a migrant farm worker? When was the last time your parents died and you could not afford to bury them? When was the last time you couldn’t afford a $4 Wal-Mart medicine? When was the last time you had to steal to pay for a habit that you know is killing you? The sadness in this clinic abounds, though I realize it is not confined to this place or this population.

Trying each day to show up and put myself in the patient’s shoes has been an exercise in futility. I will never know what some of these people have been through. All I can do is show up and listen. And recommend. And then listen some more. And count my blessings: supportive family, adequate shelter, functioning pancreas, and only a very minor caffeine addiction.