Public Charge
A young mother, Elena, brings her 7-month old daughter to the emergency department. She is distraught. Siomara is her first child and she has had a fever for the past 3 days. Elena left El Salvador 3 months ago seeking safety and a better life in the United States for her new family. In addition to losing the comforts and familiarity of home, she lost the invaluable experience and guidance of Siomara’s grandmother - a parent and grandparent to dozens.
I assign myself to a new patient that appears on the trackboard, 7 month-old with fever. The usual wheels are turning as I walk into the room. The listed language preference is Spanish so the interpreter joins me. The child looks great, smiling and cooing as I intermingle tickles and pokes with my abdominal exam. Ears, check. Nose, check. Skin, check. Throat...there we go, telltale marks pointing to a viral illness - she’ll be fine in a few days.
I share the good news and my usual speech about viruses and encourage the mother to follow up with her pediatrician. She doesn’t have one yet so we talk a little more about the tarjeta dorada - a vestigial label for the local healthcare system for under- and uninsured patients. I head back to my workstation to take a look at the trackboard.
Elena picked up Siomara and tried to find her way out of the emergency center. She felt only marginally better. She was certain that Siomara would have a fever again once the medicine wore off - they’d both face another sleepless night.
She knew Siomara needed a pediatrician, but this visit alone had already consumed nearly all of their emergency funds. Their asylum hearing was months away but they’d heard that making use of assistance programs could result in denial - returning to El Salvador was not an option.
She caught a glimpse of the interpreter in the hall and asked her to grab the doctor for one last question.
I saw the interpreter flagging me down, the mother of the kid with a fever wanted to talk to me. I consider the options, probably a last-ditch appeal for antibiotics.
Instead, she asked about the out-of-pocket cost for a primary care visit. I admitted I was unsure but asked why.
“Because we can’t use any public services,” she said.
“Of course, she’s exactly who these services are for,” I replied.
She described her situation. The interpreter paused longer than usual between translations. I understood why as her tragic story was relayed in fragments - tears welling up on both of our eyes as the mother stood: strong, holding her now-sleeping daughter in her arms.
We collectively concluded that we didn’t quite know what to do but recommended a discussion with the social worker and business offices for more information.
She thanked us, thanked us, and headed down the hallway.
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Dr. Fadial’s Bio Below
Dr. Tom Fadial
Dr. Fadial is an assistant professor of emergency medicine at McGovern Medical School in Houston. As the educational technology and innovation officer there, he develops unique educational tools, including algorithms that can be found at https://ddxof.com. His other medical education projects can be found at http://fadial.com.
