Clinic.

I love the free clinic. Where else would someone let a know-nothing like me give shots, do sutures, and take ultrasounds? It's a fantastic experience, often exhilarating, but yesterday was somewhat less than splendid. There were people that were really sick, and felt they didn't have the resources to deal with it. We saw a few people with very concerning cardiovascular problems, but none more so than a volunteer firefighter I'll call Russ.

Russ was apologetic to be using the free clinic, but needed a work release signed by a physician and just couldn't afford to go anywhere else. His eyes were warm, but distant, heavy with a thousand other things on his mind. His shirt was riddled with holes, as were his socks, although he did his best to quickly hide the holes from our sight. In a soft but urgent tone, he confessed to me that he was short of breath often, and experienced regular pain in his left arm. He was embarrassed to admit what he considered to be weaknesses, and didn't want to be where he was in life. Broke, sick, and nothing to show for his hard-earned 40-some years. But he needed a physical so he could work.

It took me a second or two to process what I heard when I put the stethoscope to his chest. I remained calm and stoic, and passed the stethoscope back to the doctor. I stepped back, and played the sound I had just heard over and over in my head. It was not the steady lub dub, lub dub that you intimately know and feel within your own chest. It was the sound of five pairs of tennis shoes tumbling around and around inside a dryer. No rhyme, no reason, no rhythm: atrial fibrillation. His heart no longer knew how and when to pump, and in that condition, he would die in seconds, minutes, or months. Russ was a time-bomb. I wouldn't bet ten dollars that he would make it down the stairs and I wouldn't bet five that he would make it through the week.

When he asked how to fix it, the doctor replied without hesitation to go to the hospital immediately. To both of our surprise, Russ politely declined and asked to just get his work release signed so he could get back to work. Of course, that was an impossibility. Russ could not work, he was going to die any second if he didn't get to a hospital. That didn't matter. He was scared, but simply could not afford a trip to the hospital, he had to provide for his parents. The doctor pressed him, you can't provide for your parents if you're dead. Russ asked if he could just get the tests run at the hospital then come back to the free clinic for medication and treatment. However, the drugs to treat atrial fibrillation must be given under observation because they can be unpredictable. No, the only place for Russ was the hospital. And he wouldn't go.

The doctor and I both of course wanted to help him, tried to explain that since he truly had no money, they couldn't refuse him and probably wouldn't charge him. Russ felt that was dishonest. The doctor gave him the name of a social worker. Russ didn't call. We both wished that we could treat him at the free clinic. The doctor had the knowledge but not the tools, and I had neither.

Lesson learned: I can only do my best to give people the resources, suggestions, and medicine that they need. What they do with that knowledge is out of my hands.