Questions

Hospital internist called asking for help. "He is about to leave, perhaps in next half an hour, but I need your help."

We endocrinologists tend to get exasperated with such last minute calls. For the types of problems we deal with, most of which are longer-term diseases, time of hospital discharge is not a very opportune moment. Yet I held my patience. And the internist was no cavalier soul trying to cover up her incompetence at the last minute of patient care. She was a genuinely concerned doctor.

The patient was a young man with type 1 diabetes and required insulin to sustain life. He was brought into the hospital after he collapsed following heroin injection. Just a few days ago, apparently, he was released from prison. He was unemployed, did not have health insurance, and did not have money to buy insulin.

This doctor was concerned about what would happen with his need for insulin once he left the hospital.

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The patient was a huge mess. His problem was a product of addiction, poverty, social-politico factors beyond the comprehension of a doctor who cared for patients with hormonal disorders. I can recommend and adjust medication dose but enable access to a medication? That is beyond me. What did she expect me to do?

That was my first reaction.

But she had reached out in desperation. So we talked to each other for a while to see if there was any way out. At the end, we came up with a plan. We decided to switch him to a cheaper form of insulin that would be injected just twice a day. Hospital pharmacy would dispense a vial that would last him at least 2 weeks. I would schedule a follow-up for the patient at my clinic with diabetes educator within a week and with myself in 2 weeks. My clinic would provide him some free insulin samples that the pharmaceutical companies gave us and enroll him in drug assistance program offered by these companies.

He did not show up to the appointment with the diabetes educator. But showed much later to see me. Having had type 1 diabetes for most of his life, he had a good knowledge about diabetes self-management. He was living in couches of his relatives: ex-wife, father and brother. He had been getting insulin samples from one clinic or another and sometimes using friends' insulin.

I talked to my clinic staff. They immediately arranged for insulin that would last at least 2 months and started paper-work for patient assitance program for providing long-term insulin.

At the end, he said, "I really appreciate the thing you guys do."

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That is the nature of this profession. We deal with the failures: failures of normal physiology and failures of persons, society. A patient should not be foraging for insulin in the most wealthy and powerful nation on earth. But that happens. Why is a different question. And it is at the receiving end of these failures that we, doctors, are positioned.

It is a good position to be. Especially if you have support to be able to make things happen. To have opportunity to tell yourself, I helped another individual in need, in pain, and in suffering. That opportunity to assertion of a meaningful life is what motivates many of us to seek or pursue this profession.

Yet, I know, there is now a constant variable whose shadow will follow me in all my interpretations: that of an immigrant. After starting my professional practice at the country I was born, experiencing being a doctor there for a few years, I am now back to practice in the country I was trained at. How much a claim an immigrant doctor has to meaningfulness of his vocation? Is loyalty to individuals in pain, suffering any different when you are an immigrant doctor? How and why, if the answers are different? These are some of the questions.