A middle-aged man lies on a gurney. Anxious. Work boots. Blue jeans.  Stained white shirt. Rough hands.

“Hi! I’m your doctor. What brings you to the emergency room?”

The patient looks at me, puzzled. He’s Spanish speaking. It’s the middle of the night, and I’d rather not use the translator line. We start in broken English – then I reach for the phone to call the language line.

He collapsed at work, and his employer required him to be evaluated. It’s not his first time. He tells me he suffers from seizures. I take a look at his chart. He’s been seen for the same presentation multiple times before. He has a treatment plant – a single anti-epileptic drug. He hasn’t been taking them. Correction: he has, but only 30 days at a time. I start to dive into his social history to figure out his barriers.  He’s hesitant to share. He has children. He has a wife. He’s vague about his work, although I suspect he works in construction. He’s reluctant to share where he lives.  Or how long he has been in the USA.

I look up his demographic profile on the EMR and find his insurance to be blank. A bit perplexed, I enlist the help of the social worker. I have other patients in the waiting room needing to be seen, and this process is taking too long.

I’m informed by the social worker that my patient is undocumented. Puzzled, I ask her what that has to do with his medical care. She tells me he cannot apply for Medicaid without risk of deportation. This patient has a chronic disease, easily treated with a pill – without them, he is a hazard at work. Without work, he cannot provide for his family. It’s an all too familiar cycle. What can I offer this patient? A prescription voucher?  That will last 30 days.  I feel defeated.

We, as residents, entered medicine motivated and eager to learn patient care. In reality, I spend the majority of my days sitting at a computer thoroughly documenting in patients’ charts to meet the increasingly stringent documentation requirements of the perpetually shifting mandates. We are not trained to face the daunting political, social, and economic forces that threaten the health of uninsured, and in my patient’s case, undocumented populations. I find myself focusing on these system failures and lose sight of my greater purpose. This was my first time coming to that realization, but it has not been my last.

Zachary Wikerd is an internal medicine physician.

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