As a senior in high school, I went on a mission trip to Mexico to play with kids and build a house. My classmates were happily kicking around the soccer ball and drilling nails into a framework, but I remember watching all those kids running around barefoot in a field with rusty nails, and thinking that what they really needed was tetanus vaccinations. It was my first real glimpse into poverty, and gave me a sense of purpose for my future life as a physician.
Fast forward six years. I am now a third year medical student stationed in the central valley of California, my task to learn medicine while providing services to the underserved and poverty-stricken population here. What I've observed is a lot different than what I expected. I had thought that my time here would be a similar experience to that time in Mexico- working hard to provide something good for a family who would otherwise go without, and the people would recognize the service and be thankful. Instead what I've seen is two types of poverty. One is heartbreaking, one is frustrating.
Probably the worst representation of poverty that I've seen here is the car washes to raise money to bury a dead family member. The whole family sets up in a parking lot and depends on the money they raise to pay for the funeral. I can't imagine this grief; that you would be mourning your loved one while soaping a stranger's tires to earn money for a burial. Families of dying patients don't come to the hospital because they are picking fruit and will not make wages without a full day's work. Sometimes they die before their family gets there. Moms with babies, broken down on the side of the road. Parents that don't bring their kids to the doctor for fear of deportation. A man with six black widow bites on his back, from a day of grape picking (they fall out of the vineyards down the workers' shirts) who didn't come in for treatment until his shift was over. Families that share one apartment, one car, one social security number. This poverty is heartbreaking and deeply compels me to do the one thing I am able to do: provide compassionate and quality medicine.
And then there are the people that I tend to think of as selectively poor. A man who cannot "afford" his $4 prescription from Walmart, yet has a four pack per day smoking habit. People that demand that the doctor sign a disability form so they don't have to go back to work. Parents who use food stamps in front of me in line and then put their groceries in the back of their Cadillac Escalade with 26" spinner rims. A 17 year old with four kids whose frame of reference and way of life is to live on a government check. The woman at the clinic who is on MediCal, pays nothing for the $500 IUD I just put in her, and walks out chatting on her iPhone with a Coach bag slung over her shoulder.
I had expected my work here, even though I was in school, to be rewarding. And sometimes it is. But more often than not, I am confused by a population that drives a nicer car than I do to the swap meet on thursday morning, while I go to work. Some of my patients are appreciative of the care they have received, and motivated to make changes in their own health. Most of the time, however, the patients treat me like it is my duty and honor to serve them, and demand a lot in return for nothing. What I'm left with is a genuine desire to help those in need, with a disillusionment of needy people. I feel like my work here matters, but only to a few. I am tired of trying to make changes in people's health who only want Vicodin and a disability form signed by the doctor. I enjoyed working in practices where bills were paid by private insurance; where the patients asked thoughtful questions, were polite to me, and seemed committed to maintaining a healthy lifestyle.
I don't like myself for wanting to work with those above the poverty line. It seems like a failure, like I wasn't good enough of a person to reach out to those in need. But what I've experienced is that you give and give to people who are not invested in their own health and it is an unfulfilling experience for all involved. The truth is, public clinics have a hard time retaining doctors; they come for a few years (possibly for loan repayment) and then move on to a better life. I want to be a doctor who is excited about what I'm doing, who feels like my work has a purpose. I thought the greatest purpose of all would be in serving those who would otherwise not receive quality healthcare, but instead I'm left wondering what might be a better fit for me. In the end, all people need healthcare, everyone gets sick. It's just that some have better access to care than others. I am not content settling only in a comfortable practice with patients that pay their bills on time, but maybe there is a balance between this and the community health center. I'd love to have a practice that is a good fit for me and volunteer for Doctors Without Borders. Is this enough? I don't know. A comfortable, wrapped up ending to this post? There isn't one. Somewhere between my sense of morality, guilt, and desire for an enjoyable practice I'll have to figure out how and where I should practice medicine.