I have just gotten home from a long day at the family health clinic when the phone rings.
"This is Stephanie from Great Expectations," a friendly voice says. "What are you doing to meet quality single people these days?"
"Nothing, really," I admit, trying desperately to think of a way to escape.
"We know how hard it is to meet quality people," Stephanie continues cheerfully. "So we do all the work. We screen our members carefully, so you can be assured of meeting only the best through us. What do you do?"
"I’m a medical student."
Stephanie is thrilled and tells me that most of her clientele are professionals with advanced degrees. She is convinced I will have a great time with their service. Her enthusiasm, I have to admit, is infectious.
She is talking about head shots and videos. Something she has said bothers me, but I can’t figure out what it is. I remember my day in the clinic.
I set the bone of a 3-year-old boy with a fracture that was ten days old. A deep cut from a different accident gaped on his forehead—it should have been stitched immediately, but it was too late now. His mother had smeared lipstick and bleached hair with two-inch roots. She seemed caring but distracted.
"I worry about him," I told my attending afterwards. "I don’t think he’s growing up in the happiest, gentlest home."
"I worry about her," she told me. "Can you imagine, bringing him in a week and a half later?"
Next, I had seen a 70-year-old man from Mexico who had never been to a doctor before. "He’s very nervous," his granddaughter told me. Around his neck were a dozen amulets: tiny cloth bags, a wooden crucifix, and metal saints with multicolored auras. His history and physical examination suggested chronic hypertension and raging diabetes, but he assured me, smiling, that he had always felt completely well, apart from his daily headaches.
Then, there was a 40-year-old woman with schizophrenia, brought in by the caretaker at her board and care facility for her annual visit. She had the slow speech of someone taking long-term psychotropic medications and the bad teeth of a chronic smoker. The caretaker, who had known her for years, could tell me every detail of her history and questioned me closely about possible interactions between the medications she was taking. But she, my patient, stared blankly in answer to my questions.
I remember my frustration with each of these patients —those who are not well-cared for, do not take good care of themselves, or simply cannot do so. It is much harder to look after these patients than the ones who do everything right. There is so little we can do to fix the bigger problems in their lives.
I don’t think my small patient with his broken arm would be considered to be among "quality people"—at least not if judged by the quality of the care he is receiving at home. And I can’t picture my 70-year-old patient on his first doctor’s visit making the grade—he does not even speak English. Or my patient with schizophrenia with her blank silences; surely mental illness would be a disqualifier.
And I remember going on rounds last week with a physician who held two crisp, new $20 bills in his hand, magician-like. "Which one of these is worth more?" he asked his startled medical students. "They’re the same," somebody mumbled. The doctor-magician threw one of the bills on the scuffed hospital floor and stomped on it viciously. "Which is worth more now?" Silence. "Neither one," he said. "No matter what a person looks like, what kind of shape they’re in, how they’ve been treated—every human being has the same worth. Remember that."
I snap out of my stupor. On the phone, Stephanie has moved on to the joys of romantic evenings with dark, handsome, professional strangers. "Would you like to join our membership and start meeting some quality people today?"
"No, thanks, Stephanie," I say, my words and senses finally returning. Hanging up, I feel a flash of gratitude for a job that lets me meet plenty of quality people every day.