By Jill Muhrer
Breathless, Maria calls my name. We’ve known each other for twenty-five years. Even so, her pressured speech is hard for me to follow. When I turn towards her, she slows down.
“Doctora, Doctora por favor I need to talk with you now.” All those discussions about the differences between doctors and nurse practitioners, and she persists. “I understand that you’re my nurse practitioner,” she often says, “but you are and will always be my Doctora.”
Impressive, she has evaded the triage protocol. I take her into a room before anyone notices. I trust our relationship enough to bend the rules knowing she wouldn’t ask unless…
“I need my medicine. I can’t come in to see you. I’ll lose my job. Please can you refill them? As soon as I can, I’ll come back.”
It has been months since I’ve seen Maria. She is overdue for diagnostic studies. Out of a concern for safety, we don’t refill medications unless testing is completed to check the status of her illnesses. All of the obstacles—Maria’s work schedule, transportation issues, and lack of insurance—make office visits nearly impossible. Maria’s employer threatens to fire her if she misses any days at work.
When not at work, she visits her son in prison, hoping for his release. Since the addiction he has been a different person, which breaks her heart. She hasn’t given up on him. After all he has always been a good child, standing by her through difficulties, even paying for her medicines. When he accompanies her to visits, he takes notes and asks questions. She tells me stories about him. “Everything seems to slow down and make sense when he is there.”
She misses him. The rest of her family is in Nicaragua, so far away from Camden, New Jersey. She sends money to her parents when she can. Things have definitely been tight. No time to worry about herself.
During COVID, her hours at the poultry factory have been extended to cover staffing shortages. Breaks are rare, which means no time to check her blood sugar, eat, or take her meds. What’s worse is that there is no protective gear or social distancing. She fears for her life, but what choice does she have? She depends on the income which is below minimum wage and often works six days a week to make ends meet. Work is work!
I am torn about the risks of stepping outside our guidelines for safe care. On the other hand, if I don’t refill her meds, she will stop taking them, which she’s done before with disastrous results. I give her two refills and a slip for laboratory testing which she can get through charity care. I tell her I will not be able to do this again and to call me if she has any problems. I offer to bring in the social worker to discuss resources. She declines and says, “We’ve been through this before. I know my options. I just have to deal.”
Isn’t there something I’m missing? More I can do for her?
I give her a flu vaccine, making sure she is up-to-date on preventive vaccines. She agrees to return within four to six weeks. She gives my hand a squeeze. As she leaves, I notice tears in her eyes.
Several weeks pass. I worry when I can’t reach her. My worst fears come true when I see her name on the list of patients hospitalized with COVID. According to hospital records, she waited until her symptoms became severe, her oxygen level so low she needed intubation.
Maria’s hospitalist tells me that she isn’t expected to survive. I take the long walk to the hospital for one last visit. I enter her room. We are both unrecognizable—me in my protective gear and her with all of “the machines and tubes.” I reach for her hand as I speak to her. There is no response. Her hands, which once accented her speech, are now cold, stiff. Odder still is the even rhythm of her breathing controlled by the ventilator.
When it is time for me to go, I gently give her hand one last squeeze. Even through gloves, I can feel the callouses.