3am

3:30 AM It’s 3:30 AM and I am dozing lightly. The weather abruptly shot up from cold and rainy to almost 90° yesterday and I haven’t gotten around to installing the air conditioner yet, so the room is a little too warm to be really comfortable. The cats are agitated because I had to take away all of their food at midnight because Connor‘s biopsy is tomorrow. It hasn’t been long enough for them to be actually hungry, but rescue cats feel more secure just knowing that there is some food available and they don’t like the deviation from their routine. I’ve been having a lot of headaches lately and tonight is no exception. All that combined meant that I was not deeply asleep when a text message came into my phone. My clients generally know better than to contact me in the middle of the night unless something is really wrong so I grabbed the phone to see what was going on. "I’m heading to the hospital," JJ wrote. He had spent the week dealing with increasing stomach pain and nausea and was trying to hold out for his G.I. appointment. "The symptoms have become unbearable he wrote," JJ is very anxious about hospitals so I knew it must be bad if he was actually going. "If you don’t hear from me, save my cat" he wrote. "She doesn’t have access to that much water." I’ve been through enough client and other emergencies to know that this is a little bit extreme. It’s rare that you have to break through a door to save anyone. "If you have to stay, we’ll take care of her," I write back. "We'll come get your keys. What’s your address?" Past experience has taught me to get necessary information while someone is conscious and accessible. "Which Mount Sinai?" I added. "Manhattan," he said. "Which one?" I asked. Mount Sinai has taken over a number of hospitals in Manhattan. I recognize the address he sends me. I’ve gotten to be kind of an expert when it comes to hospitals. I can look at an incoming phone call and recognize which hospital it’s coming from just by the number. He’s headed to the main Mount Sinai on the Upper East side. All my Mount Sinai doctors call it the Mothership. I’ve had surgery there three times. I tell him they’re good. That much self disclosure I’ll do to reassure him, but I don’t specify the kinds of surgery. "I cried getting ready. I really don't want to do this. I just wanted to get better," "I know," I tell him, "but sometimes things get beyond that point." "I couldn’t sleep or eat comfortably," he said. "That’s definitely time to get help," I assured him. There was a pause in the messages so I went to get some seltzer. The next message was after he arrived at the hospital. "I wish this equipment didn’t look so intimidating," he said. "It’s just hardware." I tried to shift his perspective a little. "At least I got a nurse who agreed to take blood from my hand. I’m still so panicky," he said. "Medical stuff makes you anxious," I reminded him."Plus sometimes this is the way the body tries to tell us that something is wrong." I hope once he gets meds for the pain and nausea they will also lighten up the anxiety. "She gave me medicine for nausea just now. I feel so much better." "They sound very efficient," I say. A high school friend of mine who became an emergency doctor once told me the best time to go to the ER is very early in the morning because by then they have mostly finished with the rush of night patients so JJ picked the best time to go in. "Mount Sinai is amazing he says," and I know he’s comparing it with the crappy under-resourced hospitals in the Bronx where he lives. At New Alt, we have an unofficial policy of encouraging people to get to hospitals in Manhattan if at all possible because the quality of care in facilities that serve wealthier people is like night and day. "I'd love to move at this point, but my program only exists in the Bronx, and I owe Con Ed $800 in back payments so can't move but from now on, when I can choose, I'll go to Mt. Sinai bc it's like primitive af in the Bronx," he writes. He had hit the nail on the head. The concentration of low income housing, and other programs in the Bronx keeps my clients trapped. If they are too sick to make it to Manhattan, they are stuck with low quality healthcare. This has happened a number of times to my client with AIDS who sometimes waits too long and then winds up in an ambulance situation and can only get to his local hospital, which has a D rating for patient safety. It’s so crappy there that more than once he has waited until he was a little better then went against medical advice and left and took himself to NYU. "She even told me what medicine she was giving me and everything. So professional." I tried to tap down the rage that rises in me at the idea that something so basic is a new experience for him. When people talk about the higher mortality rates in low income communities and among people of color, they often talk about things like drug use, cigarette smoking, diet, and other behavioral factors. Focusing on these things is essentially, putting all the blame on the people without acknowledging that the system that provides them with lower quality care is itself boosting morbidity, and mortality rates. They talk about people not complying with care in an accusatory way, but if care means navigating a confusing, incompetent disrespectful, and often literally dirty system, it’s no wonder that people are reluctant to engage with it. As I lie here, thinking about the injustice of the healthcare system, the sun comes up and the birds go crazy with their chirping. The cats have resigned themselves that there will be no food forthcoming, and settled back down into their sleeping spots. I don’t know if I’ll have a chance to get back to sleep before I have to get up to take Connor, but I know this virtual handholding is important. Even for me with all of my healthcare experience, it can be kind of crappy to be alone in the hospital. I pulled up the New York Times crossword puzzle and start filling it in. One clue is "alternative to masc in gay dating." I guess they’re getting into pride month like everyone else. By now it’s 5:45am. I haven’t heard from the client for half an hour. I’m hoping that medicated and more comfortable, he fell asleep. I have to be up at 7am anyway so I give Connor some extra snuggles. He’s going to have a hard day. He hates the carrier and he yells the whole time he’s in there. Then he’s going to be at the vet and have to go through this procedure. He’ll spend the day there and then I pick him up after work. When Kate S was alive, I would drop the cats off and she would pick them up when they were done. Now that it’s just me they’re like children of working parents stuck at daycare until I can get there to pick them up.