Hand Holding

Boy you are really holding these folks' hand aren’t you?!?

I spent most of yesterday evening in the Baylor ER with Lorenzo and his mom, he needed his catheter changed and something told me to hang out just to ensure everyone behaved. Lorenzo is in a vegetative state and his mother speaks no English.
She came to this country a few months ago when she learned of Lorenzo’s horrible accident and that he was in Baylor’s ICU in a coma.

Lorenzo had car trouble on highway 635 in April and tried to cross the 3 lanes to get to help, he never made it. A car hit him, in some versions of the story I’ve heard he was hit twice. Anyway, he broke several bones but his main issue then and now is the traumatic injury to his brain, an injury that will very likely never heal.

Lorenzo is 24 and has been in the US for 4 years. He came here to earn money for himself and his family. He was successful in creating a life here in Dallas, sending money ‘home’ and taking English classes. He worked cleaning offices. He had a Mexican girl here for awhile but because he was working so much they didn’t work out but remained friends. As a matter of fact she, her husband and one year old son all plan on living together as soon as they can find a place. They can probably only afford a one bedroom for the 7 of them. (Lorenzo, his sister, his brother, his mom, his friend, her husband, and their baby boy)

I think the law is that there can only be 4 heartbeats in a one bedroom apartment. Whoever rents to them will probably just take their deposit then evict them.

Lorenzo is an ‘illegal’, as are his mother and sister and brother who soon followed their mother to support. I’m not sure of his friend’s status or that of her husband but let’s assume they are ‘illegal’ also (I prefer the term 'undocumented' but I'm borrowing 'illegal' for this post). I think the baby might be the only 'legal' one in the group. Lorenzo’s dad remains on their small farm in Mexico, his mom gets to talk to him every two weeks or so for about 5 minutes.

Dr. Walton and I were at their furnished apartment yesterday afternoon to change his catheter and check on him. Baylor put them up there because he was reasonably stable, his mom could take care of him, and it is much cheaper there than in ICU.
They’ve got 2 weeks before they have to pay $40 per day for 2 more, after that they have to leave.

We had no clue how long his catheter had been in, they should only be used for about a month before they’re changed, and since he’s been out of Baylor for about 2 weeks Dr. Walton thought we should change it. After some slight tugging it wouldn’t really budge so he had to be transported across the street to the ER so they could have a look. I showed up about 10 minutes after Lorenzo and his mom arrived. The ambulance took them. There I met Patricia, a wonderful woman who works with us to help look after patients, especially difficult cases like this. By they way Patricia let me know that when Lorenzo's mom first called 911 and the ambulance showed up they refused to transport him because it wasn’t a “life or death” emergency. The second 911 call produced a group that would transport them.
When we arrived Lorenzo was actually in a room, he didn’t even have to wait.

Lorenzo has no insurance and no money, Project Access enables him to get care. This is a program set up by Dr. Walton a few years back that enables poor folk to see Docs who volunteer their time and services.

Anyway, the ER doc arrived and asked the familiar “What is going on today?” question. I gave him an update and he monkeyed with the cath a bit. Still wouldn’t budge. After some additional work it finally came out and they were able to insert a new one. All of this really didn’t take much time, only about 3 hours as it was approaching 7pm at this point. I was glad I was there to give the Doc context on the case however Lorenzo needed meds and a ride ‘home’, to the temporary apartment Baylor has set him up in across the street.
How often does someone need an ambulance ride from the ER? Anyway there didn’t seem to be a clear process for this. Patricia and I asked the Case Worker on duty who directed us to Social Work, who directed back to the Case Worker on duty. Hmmm….. 7pm is shift change and I wasn’t really sure who was supposed to be doing what. I did know that Lorenzo needed a ride across the street. Patricia, through her connections, was able to talk to a Social Worker who called CareFlight. A large, ‘take charge’ lady showed up promptly and threw Lorenzo on the gurney. She had no problems with this and my job was to stay out of her way. OK cool.

Lorenzo had his ride, but what about his meds?

Doc wanted to treat him for a Urinary Tract Infection (UTI) just in case. Made sense to me, but where does he get the antibiotics? His moms had never been to a pharmacy, he was discharged with about a months worth of meds, and I’m kinda glad she didn’t understand English at this stage because the conversation probably would’ve worried her even more than she must’ve been already. Ms. CareFlight looked like she was ready to go anyway so I told Lorenzo’s moms to go on ahead with them and I’d stop by on my way out.
The Social Worker informed us she could waive the fee for his antibiotics and that someone would need to come back to the 24 hour pharmacy around 10pm to pick them up. Cool.
“Where is the Pharmacy?”, I asked. “Got a map?”

The Social Worker had one back at her office and escorted Patricia and I there to pick one up. She gave me a very cryptic block diagram ‘map’ and highlighted Pharmacy. I told her I didn’t know where this was and doubted any of the 7 folks at Lorenzo’s crib would know either. She gave me another more detailed map I could make sense of,

Boy you are really holding these folks' hand aren’t you?!?, she commented.

I was a bit taken aback by this comment, she also had made the comment about the apartment limits. Anyone who knows me knows I’m not in the habit of hand holding anyone, however I was just making sure this family had a good chance at least of getting what they needed. I don’t think that is hand holding but this does illuminate some very serious pitfalls faced by so many, documented and otherwise, in getting health care they really need. As I was heading to their apartment I was thinking about all the links in the chain necessary to solve Lorenzo’s fairly simple issue of needing his catheter changed. He had to get from ‘home’ to the ER, register/sign-in, get his cath changed, get back ‘home’, get his meds ordered, then have them picked up. All done with the support of a very caring mom whose life was turned upside down a few months ago when her son was hit by a car.

I think the social worker was wrong, that’s not hand holding. That’s just taking care of folks.