the upside of my experience

I have been so down on all things Gallup these days, I have decided to purposefully write about some positives. I have Otis with me. But wait, is that a positive? Well, I have learned to do more stuff around the house and have made some good friends at Home Depot. And just having a Home Depot is a positive. Last time I was here, there wasn't so much as a Safeway. My apartment is growing on me. We are close to the kid's athletics fields so we get to absorb that energy when we hear them out there practicing. I have a grand view for sunsets and sunrises. Okay, one little positive/negative about the complex. I have befriended a Navajo gent by the name of Andrew (well, Richard was his given name, but somehow it got changed recently). Andrew is about 50ish, clearly either developmentally delayed or the victim of severe head injuries, or likely both. We have been talking everyday as he waits for the bus to take him to his activity center. He taught me how to do needlepoint. His sister hates me. Because I am white. She has never spoken to me, but throws me looks that could kill, and when she is around, Andrew ignores me. He tells me she gets really mad if he talks to me. Or the Bolivian pediatrician that was here for awhile. But he is obviously so lonely.  Well, 4 days ago I showed him my finished needlepoint masterpiece from a pattern he gave me that is meant to frame a picture. I framed a picture of Andrew in it. I haven't seen him since. I think his sister is locking him in the apartment because he was talking to me, that evil white woman who gave up her entire summer at home to come care for the Navajo, whose ancestors were happily drinking beer in Bavaria whilst other European settlers were doing awful things things to Native Americans. I don't understand why it is okay for some people to be racist.

On the medical side of things, the clinic seems to be settling down. I am still that doctor that doesn't follow rules that make no sense, but there are more docs suddenly around and all are questioning the same things I have, and some change is in the air. We still see anyone who walks in, but we aren't being pushed to get them out the door at 4:30 or else. And today, when we had a young girl brought in unresponsive from the middle school, it was me they asked to see the patient first. We have a new Navajo NP and a locums from the DR that just finished residency. Ha, we now have 3 of us to do what I have been doing all by my lonesome!!

I went to my first Pow wow during the recent inter tribal Indian Ceremonial last weekend. Uh, it was actually the weekend before. My how time flies. What struck me about this was that here were tribes from NM, AZ, SD, and other places. They all have their own take on creation and God and other things. But here they were, all in beautiful regalia, dancing with and for each other, for the sheer joy of expressing themselves via dance and drums. Well, okay, there was a small cash prize given to those judged by Native peers to be the best dancers, but lots of folks were just dancing to dance. And I thought to myself, so many people right now are dying because of their interpretation of religion and God and creation. Maybe we should all eat some fry bread, smoke a pipe, and dance a little. Just  a thought.

today I learned how to run coaxial cable

As with most blogs, after a while folks stop reading, but I am also using this as a diary of my thoughts whilst here, so if you happen to read this post it may be a little disconnected a la free form thinking but it helps me remember what happened here in the land of the Navajo.

Today I came home to the curtains I hung to keep otis from destroying more Venetian blinds on the floor. An umbrella was ripped up in the living room. He tried to scratch thru the door to my bedroom. And he pulled the cable for the tv clean out of the wall. So we made our weekly trip to home depot to get the fix ins for cable repair and I jerry rigged something that will get us thru the final 3 wks here and it seems to be working! Today's Otis antics were brought to me by the handymen that were working next door on a flooded apt. They think it's cute to say hi to him thru the closed window, not realizing that it drives him nuts.

Earlier this week, after a particularly interesting day where I was referred to as a Godsend (now that's a first), more on that later, I was driving home and saw a cute Golden running down the road. I said to myself, gee that dog looks a lot like Otis, which is good, because it was Otis. As I drove past the apartment complex to pick him I saw my curtains blowing out the window, and a mangled screen laying in the bushes. And Otis running down the street. I think it was the thunder that day that sent him on his journey. So I have learned to repair screens and cable tv this week.

Work. Ah work. My last post was rather depressing. But unfortunately it was also realistic. It turns out that Tohatchi Health Clinic has had a great deal of difficulty recruiting and keeping docs. I can see why. While I enjoy so many aspects of caring for the Navajo, there is so much I don't understand. Like, why do they expect me to understand their idea of time, but they don't understand that I can't see 10 patients all at once? And how do a few women with a chip on their shoulders gain so much power in the organization? Okay, I know the answer to that. It's the government. When someone fails at one job, promote them to get them out of there.

Let me cite some examples to illustrate why this is a hard place to work. Reader beware, this is clinical.

We are supposed to see anyone and everyone who walks in the door. Graeat in theory. But a lot of folks walk thru the door w/complaints that most of us would not even think of going to the doctor for, thereby utilizing time that could be spent on the other folks who stay at home until they can't breathe before coming in. Case in point: I was recently busily trying to convince a nice Navajo woman that a stuffy nose for 12 hours probably doesn't warrant antibiotics whilst another patient was sitting in the waiting room with a trimalleolar ankle fracture (3 breaks in 1 ankle). And then, whilst trying to fashion a splint out of available material for said ankle fracture, I was being harassed by the receptionist of sorts to get up off the floor covered with plaster dust I had created during the creation of a wonderful if i do say so myself splint. Why? not to protect my clothes from plaster, you silly. She  wanted to go home (it was 4:30 after all), but I needed to stop taking care of the patient, go to a computer and complete my note before she could leave. So can you just take care of the important stuff doc???

On the day before I left to come home for a week, which was wonderful I might add, I was seeing the last patient of the day. She was put in the room at 4;20. Somehow I was supposed to see her and get done and out of there in 10 minutes. How do you do that? Especially when her main concern was that she had slept with someone 3 months ago, without the benefit of a condom, who clearly had syphillis by her description. And they weren't just sleeping. When I examined her she had a problem that I wont describe in detail, but suffice it to say she had number 2 coming out of the wrong place. She had been wondering why it was so hard to stay clean. So you don't just see that and walk out of the room. After a little bit of discussion, I come out of the room, at 4:45, and all the clinic lights are off and everyone is gone. I am still seeing a patient that someone decided needed to be seen, but she is not important enough for anyone to stay until she is adequately cared for. Even the med student shadowing me that day said " really?"

When I returned I was determined to put that behind me and carry on without pissing anyone off (by, ummmmm, taking care of patients???). Foiled again. On day 2 after my return a man in his early 50s came in looking like, as we say in medicine, shit. He was having a heart attack before our very eyes. I called the local er and explained what was going on, whilst resuscitating this poor man, and we both agreed the best course of action would be to fly him directly to albuquerque to the heart hospital. I called the cardiologist there and he agreed. So I asked the paramedics to direct the helicopter to the nearest landing site. They did, the patient flew to ABQ, and he survived. the feedback I got? I broke policy. I didn't waste time by sending him via land ambulance to Gallup, who would then have sent him to ABQ. I am a bad girl.

POLICY. FUCKING GODDAM POLICY. Does no one here care about the patients???????? We are supposed to open the flood gates at 8 am, but if that lazy ass white girl doctor isn't done by 4:30 she has probably been sitting on her ass eating bonbons all day. But now I must rest. More later.

the down side of my adventure

Sitting here is SFO(just got the usual we are delayed and we don't know for how long) and can’t get wi fi connection. Just like my apartment in Gallup. So I am going to have an Irish coffee at the Buena Vista and try creating this blog in Word and put in on my blog later.This trip home couldn’t come at a better time. I have been in the Navajo Nation in general and the IHS in particular long enough to be bothered by the many warts I see now. The honeymoon is definitely over. Although I still am glad to have had this experience, I doubt that I will be back. Much to Dr. Mock’s disappointment. He says he likes how I stir things up and wants me to stay forever.

The negatives of the Navajo Nation. The main thing that bothers me is the trash. A people that supposedly takes pride in Mother Earth certainly doesn’t take care of her very well. There is trash everywhere. Broken bottles, mainly of vodka, plastic cups from the many Sonics and McDonalds, and empty beer cans decorate the landscape in as much abundance as the cacti and wildflowers.

Yes, there are stumbling drunks, in great abundance at the first of the month, but they are benign. Sad, but benign. They talk and laugh with you, occasionally hit you up for money, but are not aggressive and don’t litter the street corners with cardboard signs and themselves. I am amazed at how much they move. Walking everywhere. Up to the plasma center, across to the liquor store, back to town, and often end up at the hospital where they can get a meal and a bed while waiting to be seen in the ER for their daily visit.

And that is my segue into the Indian Health Service. This is Medicaid gone really, terribly wrong. Not in that services are not available. To the contrary.  Everyone comes to the doctor or dentist as often as possible. 20 yr olds have charts as thick as most octogenarians in the private world. Wake up with a stuffy nose? Go the clinic. Don’t like what they say(usually that antibiotics are not needed), go to a different clinic in another town. Still don’t get what you want , go to the ER, where they are so busy seeing non-emergent patients that they are likely to cave in and give you the antibiotics you are demanding. And guess what? You get better in a few days. So take a trip back to the original clinic to complain that the white lady doctor doesn’t like Navajo people and wouldn’t give you the antibiotics that the Navajo PA in the ER did and see how much better you are already. Of course, you would have been better by now anyhow, but now you get to make the rounds again to get treatment for the yeast infection caused by the unnecessary antibiotics. And all this unnecessary care is totally free of charge.

Make an appointment to see the doctor? Never. That, too , is seen as the white man not understanding the Navajo culture. Time isn’t a big thing. Unless you can’t see all at once the 10 patients that all walk in at 8:30, demanding to be seen for either inconsequential or very complex problems that really require a lot of thought and maybe some time, and someone has to wait an hour. Then you get the stern glance at the watch, the “ how long are you here” question, and the shake of the head cuz no doctors stay here longer than 30 days. Kind of reminds me of the days when Chrissy was looking for a husband. 

I am considered the walk in doctor. Which means I don’t have any scheduled appointments. At all. Some days I see 24 patients and some days I see 5. Great use of my time. The IPC (stands for improved patient care, haha) docs are the full time, permanent docs. While I am running around handling lacerations, chest pain, fractures, and a lot of nothing wrong, but while I’m here visits, they are leisurely walking from room to room, seeing only scheduled patients, half of whom don’t show up.  Anyone who walks in, with any complaint, gets to sit in the waiting room until I can get to them. Even if their own doctor is in that day. Even if they just saw said patient the day before and made changes in their meds. I get to jump in the middle of the stream and try to figure out what happened during the 2 hospitalizations they have had in the last 2 weeks, one of which was at another IHS hospital. (Oh, did I mention that none of the medical record systems in the IHS talk to each other? They all use the same EHR but they don’t communicate with each other.)

BUT, here’s the killer. I have to see anyone and everyone AND be absolutely done by the bewitching hour of 4:30. Then everyone, and I do mean everyone, leaves or at least clocks out. Yesterday, I got in to see my last patient at 4:20. She had issues that happened a year ago, but she was in the eye clinic anyway so thought she’d check in for a medical appointment. I came out of the room at 4:35 to find the clinic empty. Looked like the morning after. Lights off, nurses gone. I needed to do a pregnancy test and some blood work to evaluate the inevitable “oh, by the way” complaint, so I went to the lab. The lab tech was there, but clearly informed me that it was “10 to 5” clearly implicating that  the lab was closed. So I did the tests and drew the blood and got it ready for them to process all while she sat there and watched.  And when I turn in my time sheet, they will give me grief for having put in “overtime.”

During our morning “huddle” I have tried to make suggestions that maybe patients could be triaged by one of the 3 RNs we have floating around everyday (in addition to 3- 4 assistants and a few health techs to walk patients to the rooms), and the less urgent folks could be asked to make appointments, but I am told it basically that it is a treaty right for native americans to get health care when and where they want. It doesn’t seem to matter that this is less quality health care than it could be as I really can’t take the time to go over everything with one patient when I know there are 10 more waiting. Then I get the eye roll, there goes the white girl again look. And you should see the looks I get when I say that I am fine staying late to make sure patients are cared for, but it would be nice if a few of the support staff stayed as well, since I don’t know the system………

Yep, I am ready for a trip to the chicken coop and some hugs from my son and hubbie.