Posted on 06/22/2017 3:04:02 AM PDT by 2ndDivisionVet
“¡Queremos ayudarle!” I shout. I’m trying to reassure my restless patient in the medical intensive care unit that we want to help.
Nurses tie his flailing arms and legs to the bed rails. He is only several hours from his last drink, meaning worse agitation is to come as his alcohol withdrawal progresses. The nurses strategize out loud, but the English that fills the room is incomprehensible to him.
Within minutes, security guards arrive. The patient's eyes bulge when he sees their dark blue uniforms and the intercoms strapped to their shoulders. This, I realize, could easily seem like his worst nightmare: checking himself into the emergency room, only to be deported back to Mexico.
Our inattention to this patient's immigration status shames me into the corner of his room, as I think of the many hurdles he and other undocumented immigrants overcame just to be at the hospital.
The fastest evolving of these hurdles is the fear resulting from strengthened deportation laws, including President Trump’s executive order in January. Among its stipulations, the order mandated the hiring of 5,000 additional border patrol agents and expanded criteria for expedited removal of undocumented immigrants. Studies of similar policies in states like California and Arizona have shown that fear of deportation is linked to decreased utilization of medical care.
Undocumented immigrants’ fear of seeking medical attention is not simply a moral dilemma for doctors, who have sworn by the Hippocratic Oath to take care of patients anywhere. It’s an issue of concern to all Americans. If undocumented immigrants were to stop seeking preventive care at public and nonprofit clinics out of fear of deportation, the financial toll on taxpayers could escalate. Already, the annual cost of health care for the nation’s 11 million undocumented immigrants is $4.3 billion. Most of this expenditure comes from frequent emergency room visits, where complications from chronic disease that has been left untreated occur.
Another major hurdle is the lack of health insurance. Forty-two percent of undocumented adults have no health insurance, and half have no regular health care provider at all. And because of an unfamiliarity with how medicine is practiced, the hospital experience easily can be defined by uncertainty and fear about what will happen next.
When my patient was initially admitted to the hospital, that fear made obtaining information I needed from him a challenge. I tried asking him the routine questions that help guide treatment. But his responses were limited.
“¿Dónde vive?” I’d inquired. He said he lived somewhere nearby.
“¿Cómo llegó al hospital?” Friends brought him here. But he would not tell me exactly who or the best way to contact them.
“¿Tiene familia aquí?” No. All his family lives in Mexico.
I explained that nothing he said here could be legally used against him. Medical centers have long been considered a sanctuary from immigration enforcement. Along with schools and places of worship, they are what the Department of Homeland Security calls "sensitive locations," places where deportation enforcement should generally be avoided.
This brief explanation appeared to put him at ease. He opened up and provided me with phone numbers of his family in Mexico. Hours later, when he was in the full throes of alcohol withdrawal — strapped to the hospital bed with security assistance and later even medically sedated — we used the information he shared to contact his sister and help her obtain an emergency visa to see him. Following intensive therapy for severe pancreatitis, he left the hospital in a stable condition after only a month.
I often think back to his eyes bulging in fear and ask myself how we treated this patient differently because of his undocumented status.
Simply recognizing him as undocumented was a first step; his medical chart specified he had no insurance and the only identification he had was the Mexican passport in the pocket of jeans. These were subtle clues to guide the gentle tone of our discussion. Communicating in his preferred language, Spanish, informed him of what was happening at all times.
What engaged him the most, though, was the reminder of his protection against deportation within the hospital. Given the trajectory of changes in our national policy, that may not be possible in a year — or even a few months. Such a policy change would counteract the apolitical spirit of beneficence in medicine.
But at least for now, being mindful of undocumented immigrants conveys that we want to help, que queremos ayudarle.
For crying out loud. I find it harder to tie my shoes during the Trump era.
Funny, they don’t ask ONCE how he or his family are going to pay for his medical care...
Patch em up, ship em out.
Simple.
Don’t blame Trump. He is just trying to fix the mess Obama, Clinton and two Bushes helped create
I wonder how much taxpayer money was spent to treat this illegal alien alcoholic who has a condition often brought on by alcoholism. And how long it will be before he drinks himself into this condition again.
Why are we not billing Mexico for his treatment?
Why was he not sent back to Mexico right out of the hospital?
At a time when the left is pushing us towards “single-payer” i.e. rationed health care, is there any rationale for treating this guy when health care for citizens is in danger of being rationed?
The physician who wrote this piece seems to be of the opinion that all patients must be treated, regardless. I guess she is unaware of the triage principle, where scarce resources are used for those patients most likely to recover.
Note that triage is not the same as rationing. Rationing is where treatment is withheld because someone judges that the patient’s utility to society is not worth the cost of treatment, and has nothing to do with the patient’s likelihood of recovery. Triage is based on the likelihood of recovery.
Poor undocumented alien, er, drunk alien. Where did he get the money to get the booze? How did he get to the ER? Who knew he needed to get there?
My heart bleeds for the ER doc. Just bleeds torrents. How many white Americans, elderly, living in the ghettos and under bridges in this country need health care, tooth care, clothing, etc?
It is so easy to go from sufficiency to abject poverty. Much too easy in the USA. This drunk alien would do better in Mexico where he might find work and be able to get medical care if only at a minimalist level.
Nope. Not once. I personally saw an illegal alien in a coma from AIDS spend 6 weeks on a vent in the ICU before he died. ONE PATIENT. I heard the cost was $250,000 a week. The hospital tried to hire a jet to fly him back to Mexico to “be with his family”. Mexico wouldn’t take him.
Sounds like they just found a quick way to save $4.3 billion dollars a year.
I call BS. There is NO ICU in a US hospital that ties any patient to a hospital bed ever. A drunk going through DTs is given lots of sedation to deal with restlessness. That’s assuming that the hospital doesn’t have a psych ward. If they have a psych ward that’s where the drinks are taken
This is a load of crap made up by someone with an agenda
She is also a liar
“...the many hurdles he and other undocumented immigrants overcame just to be at the hospital.”
You mean “the many laws ignored”. Immigrate legally, no problems at the hospital..
He got a free month in the hospital, would have cost the rest of us thousands.
“Funny, they don’t ask ONCE how he or his family are going to pay for his medical care...”
an American without insurance, but the identical medical condition would have been given the bums rush out the door in a day or two, with the subsequent $25k owed on the account turned over to debt collectors to hound the poor SOB for the rest of his life.
Forty-two percent of undocumented adults have no health insurance
And the other 58% have free Obama care, which we were told would never happen. So much B.S. in this story it smells like a stockyard.
Mz Haghighat,
remove the dunce cap from your head at once. We will not be shamed. The patient is in our country illegally. His sickness seems to be the fact he drinks far too much. It is not YOUR fault he knows no English - The fault lies with him.
Your faux sympathy campaign will no longer work on this American. Fed up with having illegals take from less fortunate Americans on a daily basis. Cry us a river, take a swim or go sailing when done crying.
LOL - the name, High Hat?
Since you like to virtue signal your oath, compassion, and foreign language skills, Doctor - here’s a new one for you to embrace. “Pro Bono”.
“...worse agitation is to come as his alcohol withdrawal progresses.”
An alcoholic illegal immigrant with no health insurance and I am suppose to care because he is afraid he will be deported.
I could only hope he is afraid, each and every day.
I could only hope he is afraid enough to make the trip back across the border where I am sure he will be welcomed and be given free medical care (that last part requires a /s).
The patient is an alcoholic foreign national, here illegally, who hasn't bothered to learn the host country's language - and we're supposed to care about his emotional state while giving him free health care?
Dump him back across the border and let his home country care for him.
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