So there I was standing in front of my patient. She was sitting in a chair beside her bed in the Cardiovascular ICU, her thighs being squeezed in by the pressure of the recliner's arms with bulging hospital gown hiding that the recliner had arms at all. She was in her late 60s, diabetic, and continuing her heart attack right in front of my eyes; it was evolving in medical speak. She was eating Wendy's. A chicken sandwich with mayo and a baked shell of butter and sour cream with a splash of potato for flavor. I was standing there looking from her, to her obese daughter, and then to her older sister. "Why don't you just smack me in the face." I was amazed at the amount of control I had of my voice and words. I was almost certain there would be a four letter word or two coming out considering the complete contempt and disgust that I felt at that moment. Of course her chubby cheeks and double chin sagged in a horrible frown. "You are sitting there eating fast food, in the Cardiovascular ICU, while your heart attack is continuing on until it finishes the damage it is going to do. Just spit on me."
A month earlier:
There was a group of Greek police in riot gear standing in front of the "gate" that led into the Idomeni Refugee Camp in Northern Greece. It had been very hot the last few days. Which was strange for early April. Refugees, volunteers, and civilians all looking at each other to see who might know what was going on. There was a commotion, a buzz of frenzied terror. Standing outside the gate, as I had been on my way into the camp, those of us that were closest to the scene were slowly backing away. It wasn't something I consciously thought about. The panic and yelling coming from the crowd, the crowd that didn't speak English, did not need a translator. Looking back, it reminds me of one of those disaster movie scenes where there is a big ruckus and everyone is frightened and running, but still looking back, trying desperately to understand what was was causing such chaos. People were running in this large pack, like a swarm of bees, towards the outer edge of the camp. If I didn't know that it was an empty cornfield behind them, I would've sworn there was a tidal wave coming. My eyes followed the front of the swarm. Arms waving and voices likely yelling to get out of the way because the crowd parted as the swarm came closer. I anxiously looked ahead of the swarm wondering where they were going or what they were heading towards with such high stakes. My eyes were darting, taking in as much as possible, what happened, what could it be... there were rocks being thrown at the police, a group of 3 or 4 young men rocked a dumpster, back and forth, back and forth, until it turned over completely. The swarm of refugees appeared to be men mostly, but the women- the crying women were right there with them on the outskirts of the swarm, not wanting to slow it down or get in the way, but running along beside as best they could. I caught a glimpse, the tiniest opening in the swarm at just the right second, and my jaw clenched. My eyes filled because I knew, but yet, didn't know- that a refugee had been hurt, injured in some fatal way. They carried him by his arms and legs, running as fast as they could possibly go in their six legged race. It was the MSF (Medicine Sans Frontiers or Doctors without Borders) medical tent they were going towards. Murmurs and translations were jumbled all around me. The sound of sirens in the background made sense now.
The Greek Police had run over a refugee, near the tea tent. Why? How? After the swarm stopped at the medical tent, the rest of us rubberneckers started to spread apart, for the ambulance, and head closer to it, to the tragedy. It felt like a week that the ambulance just sat there but it apparently had picked up very precious cargo and began down the dirt trail toward the road.
He was hanging blankets up to create shade for his family. The hot sun and dusty wind was infuriating. It was hard to escape. His wife and three children had survived their desperate flight from Syria, through Turkey, and onto Greek soil by way of the "Mafia". The had reached the border of Greece and Former Yugoslav Republic of Macedonia. It was the path to possible freedom. To family that already lived in western European countries; to Germany that had been accepting all asylum seekers from Syria. They made it through the hardest parts of the their journey to freedom. He had fallen backwards while he hung the blankets, some say he appeared to pass out, probably from the heat they said. He fell onto the ground, directly in front of a Greek Police van. It was said that part of his head had been run over. It was said that he was quickly scooped up and a swarm of refugees took off with him while others began throwing rocks at the police van. Windows shattered and tires were flattened. The cry went out through the camp, "The Greek police just ran over a man!" It wasn't a lie. It also wasn't the whole truth.
As the ambulance left and the crowd ever so slowly dispersed, I went toward the medical tent. The dry, dusty ground had a very large area that appeared to have been watered, as if flowers were expected to pop up. Of course it wasn't water but blood and yes, his skull had been crushed by the tire. The young man, in his 30s, left a young wife with three young children. He died and was to be buried there in the small town near the border. I have thought of the young family he left behind and wondered where they are now or what had become of them. I think of the doctors, nurses and medics that took care of this young refugee fleeing his decimated country where war seemed to continue until even the soil gave in. As of June 2018 34,618 men, women, and children have lost their lives fleeing from war and oppression in Syria. This is just one of them.
My return to the US after almost two weeks in northern Greece was an amalgamation of exhaustion, self-righteous anger, and incredulity. Which is why I found myself in front of my patient, telling her to just spit on me. Did she know, understand or even grasp the monumental gift she had been given? Did she realize how many other possibilities would have left her dead decades ago? If an ICU bed costs $5000/day (that's a low estimate), her outrageously fortunate self was receiving the benefit of top tier healthcare bestowed onto her for $3.47/minute: NO QUESTIONS ASKED. It was on this night, with this patient, that I knew my nursing career in Intensive Care would not be lasting much longer. Medical professionals carry heavy patient loads, working as best they can to ensure that the patient has the greatest possibility for the best possible outcome. Our performance is graded on those outcomes, mine personally and the hospitals' overall. Not one ounce of accountability is required to receive healthcare in this country. Our freedoms "are not so we can do what we want, but to do what we ought" -Jim Caviezel. When it comes to our personal health, to what should we be held accountable?
