April

As April begins, change is in the air. Spring has finally graced Milwaukee with multiple days of sunshine, we finally started our vegetable garden, and the city is buzzing with people emerging from hibernation.

Amidst the newness of this spring is the new reality of health care. April 1st marked the beginning of full Medicaid coverage under the Affordable Care Act in Wisconsin. This means many things to our clinic and patients. Most of our patients are now insured. This reality didn't really hit me until I started the goodbyes last week. I had been pushing people to sign up since October and repeated the speech about how they couldn't come back to the clinic hundreds of times. We can no longer care for our patients who are covered by BadgerCare (Medicaid) because we don't receive any federal payout. And, more importantly, they are now eligible for many services that we could not provide. As this process was beginning in October, I was excited and hopeful for the future of American medicine. As I hug some of my favorite patients goodbye, I feel conflicted and sad and also a little skeptical about the future.

Many patients say to me: "but Miss Abbey, my doctor is here, and you are here. I don't want to leave. Even if I do have insurance, those people don't treat me with the  respect that you do here. And they don't know my story like you do."

This is one side of the coin. I can't argue with the fact that we are asking people to leave behind a familiar place they enjoy, and starting over somewhere new. And in reality, having insurance in no way guarantees you find a doctor you like or that you will be treated with respect. Like many government funded safety nets, Medicaid has it's many hoops to jump through, overused help-lines, and long waits. I still hold the belief that this will be a good change in health care policy, and that it creates necessary safety nets for the poorest people in our country. But, I still find it hard to say goodbye.

As I was falling asleep this week, I discovered another side of this coin. I struggled with how upset I was that I won't see some of my patients again. I began to explore this emotion further and realized an interesting reality about myself. On paper, I should really be happy to see them go! People I care so much about can now receive G4OVG3 surgeries, important prenatal care, dental and eye coverage, and the list goes on and on. I had spent months advocating for some of these services for people, but as I became consumed in my own emotion, I have been unable to prioritize the realities of the people I claim to serve.

I think this is an interesting reality of non-profit work. What do we do when the system we want to change actually starts to do so? We spend our days trying to give people the tools to care for themselves and advocate for themselves, but are we actually rooting for them to succeed? As I hug people goodbye, I struggle with this.  I have become defined this year by my work as a nurse for people without insurance. Now they are insured. How do I fit in now? It would be naive to say that all need has been abolished by the ACA. In fact, it has created new holes and new margins that push people out.  But I still struggle to define myself amidst the change.


This week is going to bring many hard goodbyes and conflicting emotions. I feel sad, but also so lucky to be able to engage with people in this period of change. My prayers turn towards the clinics that will be absorbing thousands of new patients this month. I know many people whose lives will be changed, and I am grateful for the doors that are now opened to them.

The Challenge

My job offers me the unique gift of getting to know my patients very well. Because we see them on a 30-day schedule, I interact with most of them at least once a month, if not more. Many of them offer to me their stories of success and also of failure in health, relationships, jobs, finances- you name it, I usually hear about it. I often leave work full to the brim with the experiences of my clients. I am often left to ponder my own privilege and life experiences in the context of theirs. I spend a lot of time trying to immerse myself in this reflection personally, with my housemates, and with those I serve.

I recently decided to embark on a personal simple living challenge to explore some areas of my privilege more fully. Many of my patients live on fixed incomes. Often times the end of the month poses a challenge financially. This manifests itself in my experience in multiple ways. The food pantry and meal service that shares our space on Wednesdays is overflowing at the end of the month, many people cancel their appointments because they can't afford bus fare, and lastly I have an especially difficult time getting a hold of patients who have to turn off their phones at the end of the month because they can no longer afford to pay for the minutes. 

I decided last month, as an effort in solidarity that I too would turn my phone off the last week of the month. This proved to be a much different experience than I had expected. I told most people who I talk to regularly on Monday night that they could reach me on the clinic phone or my house land-line if there was some kind of emergency. The response varied among those I told of my challenge. The response I wasn't expecting was one that asked that I do not participate in this challenge and to please keep my phone turned on. I reluctantly turned it back on and was inundated with various alerts.

My initial response was disappointment. I had been looking forward to this challenge for weeks. My next response was to think a lot about the role technology plays in making sure we are always available to people's needs. We have become a society of instant gratification..forcing ourselves and each other to be constantly connected. Is it is really neccessary? Or has it become a kind of security blanket for us to know we can always reach someone?

My last response asks me to question how I treat those people I serve whom I can't get a hold of whenever I want to. This challenge happened during a week where I had to respond to a critical issue with one of our patients. He did not have a cell phone and is living at a shelter in the city. My inability to get a hold of him right away meant I had to drive to where he was staying after hours and deliver the message in person. As I was driving there, I realized that I was really angry that I had to drive there. How interesting that I so quickly forgot what I had attempted to do this week. I was quick to think negatively of this person for not having a privilege I had become too accustomed to having.

The disappointment has worn off. I now feel empowered to change my perspective slightly and remember to remain grateful for my constant blessings and privilege.

Repetition

It's been quite some time since I have had anything I felt was relevant or interesting enough to write a blog about and ask people to read. It's still winter, and it's always cold. I still go to work, and there's always too much to do. I come home, and still have 7 roommates. Each day feels the same as the one before it. I absorb the stories and experiences of each of them, and attempt to understand and relay them to my community.

This past week I was pushed to a breaking point at work. I felt the pressure of handling people's lives in a way I have never felt before. I didn't sleep much, as I was always thinking about something I could have done differently or a patient I needed to call and check in on the next day. I felt distant and scared and overwhelmed. But still, I felt as though each day was a carbon copy of the next. I woke up every morning knowing I would be the same kind of exhausted I was when I fell asleep the night before.

Yesterday, the Jesuit who presided the mass we attended gave me a much needed outlook on how I've been feeling the past few months. In Ignatian tradition, repetition is an essential component in prayer. A retreatant is asked to repeat words, phrases, and feelings during various parts of St. Ignatius' Spiritual Exercises. Repetition, according to Ignatius is how we:

Find God differently in the same place.

Boom. Finally some newness. This translated to me as: In the sameness of each day, find new ways to love or relate to my patients and community members. In repetition, we are able to see something more deeply or love more deeply. There are subtle differences that reveal beauty and mystery. Each day is an opportunity to perfect a skill, conversation, or teaching tool. The old saying is "practice makes perfect". Repetition is practice. Rather than dread it, Ignatius tells us to embrace it because there is always more to learn.

Find beauty/God/love/mystery differently in the same place.