The workdays flow by, often inundated with faxes, emails, patient visits, charts, labs, and other flotsam and jetsam. Sometimes it seems we're all simply buzzing with the energy of staying on top of our patients' care. I currently "care manage" 84 people, many of whom have extremely complex medical conditions and comorbidities. Their poverty and relative level of disempowerment only adds to frequent feelings of desperation (both on my part and theirs). That desperationis not always quiet, but it can be profound for both patient and provider.
Reading recently about the lack of infrastructure for the care of people with AIDS in Africa, I'm astounded by the lack of awareness our patients have of their relative fortune vis-a-vis their healthcare. We have access to every medication on the market for which our patients pay absolutely nothing. We have complete and unfettered access to the most cutting-edge blood tests, including genotyping which elucidates for us the exact mutations of virus replicating in our patients' bodies at any given time. Doctors in Africa probably only dream of testing genotypes, let alone having the vast armada of medications needed to work around such mutations once they're revealed.
However, even as we note that our patients are blessed with the availability of care and medications, we also must bear in mind that such blessings are indeed relative, and even here in Amerika---"the land of milk and honey"---poverty and powerlessness serve to undermine our patients' ability to fend for themselves and take their healthcare into their own hands. We must also examine our own patrician attitudes which may only serve to perpetuate their dependence and seeming lack of will, disempowering them even as we feel righteous in our work with the poor and disenfranchised.
That said, it's just that when I see those dying souls in Africa bereaved for lack of access to life-saving medications, I can feel justifiably disgusted that my patient may simply fail to call the pharmacy for a refill, or worse yet, simply not take his medications as they gather dust on his dresser. No one can live inside the mind of another. No one can know the processes which bring a person to a certain frame of mind, a certain way of being. Past traumas and indignities are suffered only by the individual, and my white, middle-class priviledged self can never truly understand the plight of another.
Luckily for us all, the dawn brings each of us a new opportunity. For my patients, it might be an opportunity for empowerment and self-actualization and self-care. For me, the provider, it might be a new perspective, or perhaps a newly discovered well of patience and humility. It is all so complex, this being human. And when one attempts to help others in this complex and multidimensional world, one's emotional, class, and cultural baggage also comes along for the ride.
May the dawn bring us all a new chance, and the ability to seize the day in unprecedented and life-affirming ways.