(The following essay was written several years ago, inspired by a patient affected by another senseless murder. Identifying information was changed. )
“They killed my brother this evening! You cain’t send me home!” Ashana insists. Her right forearm flicks up and down rapidly at her side. “I’m not safe! I might hurt myself!”
19 year old Ashana refuses to leave the triage hospital bed. A few hours ago, an ambulance brought her to our unit. She is due to give birth to her second baby in a month or so. We determined that she and her unborn child are healthy. She’s not in labor and is medically cleared to go home.
“Why would you hurt yourself?” I ask, resting one palm upon her denim covered shoulder.
“I might do something. I don’t trust myself now.” Her fingers click as her right arm absent-mindedly flails, alternately thumping the mattress below and swatting her own ripe abdomen. She turns her head side to side. “No, no, I have to stay here!” She stops moving for a moment. “I don’t know what I’ll do if you send me away. I’m upset. The cops, they don’t do nothing. It ain’t right! He just be walking down the street, someone shot him from a car and drove away. Ain’t nobody seen nothing and my brother be dead. I need to stay here. I’m afraid I might hurt myself or do something to hurt my baby!”
Ashana agrees to wait a few minutes for me, while I negotiate on her behalf.
I find Sean, with furrowed eyebrows, walking down the hall.
“Are you available for a non-urgent consultation?” I ask, approaching my obstetrician partner for the night.
After Sean nods for me to talk, I begin. “I have someone in crisis because her brother was just murdered. She’s medically stable at 36 weeks gestation. I want to admit her overnight for a Psych evaluation in the morning.”
“We can’t keep her.” Sean responds as I expected. “There is no medical indication. We are too crowded already. And no insurance nor medicaid will pay for a psych admission on an OB unit. We have too many non-billable expenses. She’s a Psych case, not an OB case.”
“Sean, you know the Psych unit won’t accept patients this late in pregnancy. She needs to stay overnight and get a hold of herself. Her brother was just murdered, for God’s sake.”
Sean shakes his head, “We practice obstetrics. She doesn’t need us today.”
“Sean” I flirtaciously lock his eyes with mine,“We dedicated our careers to keeping mothers and babies healthy. Ashana is asking for our help. She had nowhere to go. She is here alone. Believe me if I could avoid this, I would. Unfortunately, this hospital’s protocols require me to consult with you for a non-labor situation.”
“I won’t authorize it.” He responds, “We are not a psych unit!”
“That’s news to me!” I smile and tilt my head to the right. We both roll our eyes and chuckle remembering various family dynamics we daily encounter. “Seriously Sean, I refuse to discharge her home. So, it’s your choice. I can transfer her to you right now. Then you can discharge her. Let’s see how you feel when she’s found injured or dead after you sent her home.”
Sean leans his head back, looking toward the ceiling. He doesn’t have time for this. “If we admit her, the chart will be reviewed for a non-billable diagnosis.”
“Fine.” I quip. “I’ll talk with the hospital’s interrogation board the same way I’m talking to you.”
“What do you suggest?” He sighs.
My cheeks broaden to a smile, knowing I’ve won my friend over, “I’ll keep her overnight for fetal observation, per your consultation. She’ll eat dinner, then I’ll order either Ativan for anxiety, or Morphine to knock her out for a night’s sleep. In the morning, Psych can make a plan for her. She’ll be here less than 24 hours so the cost will be minimal.” After a brief pause, I add, “Sean, your heart knows this is the right thing to do.”
Sean’s shoulders relax. He nods assent.
I give him a quick thank-you hug, then turn to walk back to triage.
Sean calls out, “Don’t make a habit of this!”
This week the western world prepares to celebrate the birth of a child born into poverty from an underage teenage mother who was traveling with an older man. After he grew to adulthood, this baby was crucified because he dared preach of a peaceful world.
The recent plight of America’s holiday murders finally opens public discussion about firearm access. America must face ugly realities already familiar to inner cities because an armed madman opened fire on innocent children and teachers at Sandy Hook Elementary School. America is shocked that this happened in the mostly caucasian middle class town of Newtown Connecticut. Only the week before there was a shooting at a shopping mall in a Portland suburb, and today another in small town Pennsylvania.
Sadly, American inner cities are accustomed to the slow slaughter of their youth. This video, less than 8 minutes long, addresses the increasing homicides in Oakland California and grass roots efforts toward solutions. Increasingly, children are collateral damage to the casual violence.
These inner city deaths occur with such frequency, either singularly or with only a few victims at a time to poor people with brown skin, that the press does not celebrate them. Murderers usually escape without investigation. Their annual death toll come to many times that of last week’s innocent deaths in Newtown Connecticut.
As of late November 2012, Oakland’s homicide count alone was already at 115 (link here).
The problem is greater than “gun control”. It’s a multifactorial issue of poverty, lack of opportunity, lack of direction, lack of educational resources, deeply embedded anger in a growing segment of our population, and more.
A nurse co-worker of mine recently posted this photo on facebook:
My work gives me the privilege of welcoming new babies in the economically and racially diverse Bay Area. Every week families discuss memories of a recently murdered loved one who will never meet the new baby to be born into my hands. The absent family member who was murdered within the last year is usually a husband, brother, father, cousin, nephew, uncle or son.
Bystanders are also shot but not necessarily killed. One laboring woman incessantly scratched at a tangled scar which had grown over shrapnel embedded in her arm. Several years before she did her best to dig shrapnel out of her arm herself, after she tired of the 10 hour wait to be seen in Highland Hospital’s emergency room. She had been splayed in crossfire because in her words “I was walking down the wrong street at the wrong time.”
Too many of my patients say, “It’s not safe to walk in my neighborhood” when I suggest they take a daily walk as part of an exercise regimen to help their diabetes or blood pressure.
Our nation is complicit in senseless shootings through collective acceptance of easy access to firearms and inadequate educational and work opportunities for the poor. Social inequities, lack of opportunity, mental illness, and poverty have historically been a recipe for small and large revolts. Small constant revolts have been occurring in America’s inner cities for years. The media pays attention now that this violence spills over to white communities.
During this season of rebirth, may we remember the only guarantee when a baby takes his or her first breath — there will be a last breath. Society can minimize the chances of a premature last breath caused by preventable violence.
Hopefully the mourning community of Newtown Connecticut inspires national discussion and some active solutions. For all our sakes.
Maybe therein lies today’s celebrated end of the Mayan calendar – the end of the world as we know it.
Juliana Buhring has nearly completed her trip around the world by bicycle!
She will reach her goal as the fastest women to pedal around the world – 18,000 miles / 29,000 kilometers in 140 days. Yesterday she crossed the Italian border to re-enter her chosen home country.
Since July, 2012 Juliana pedals to raise awareness and funds to help children adapt to mainstream society after an upbringing in high demand groups or cults.
Juliana co-authored “Not Without My Sister” with her sisters, Celeste Jones and Kristina Jones about their childhood within the Bible-based organization “The Children of God” or “The Family”. Their book was a best seller in the UK and Australia with graphic stories of pedophilia and flirty fishing to seduce potential recruits.
Read more about “Not Without My Sister” by clicking here.
Juliana accomplishes the extraordinary once again. She began her journey in July 2012 from her current home in Bell’Italia, across Europe, North America, Asia, the Middle East and now is on the final legs to her home.
Tax deductible donations to support Juliana’s ride and her cause can be made directly to Safe Passage Foundation here. Safe Passage foundation advocates for human rights of children raised in high demands organizations and provides support and resources for those who leave the controlling groups of their upbringing. Please specify that your donation is a sponsorship toward Juliana Buhring’s bike ride.
To learn more about human rights issues for children raised in cults, please read Safe Passage Foundation’s website by clicking here.
Auguri e Buon Viaggio to Juliana!