My name is Shannon and I am a family doctor. I work for a safety net clinic that is affiliated with Planned Parenthood and sees primarily uninsured and Medi-Cal patients. It is my daily privilege to interact with and witness the lives of a delightfully diverse group of patients from all backgrounds and cultures, identities, and ways of life. We speak Spanish and Persian and Vietnamese; we are queer and straight; Catholic, Muslim, and secular; we are migrants and fourth generation Angelenos; we tackle everything from depression to diabetes; and we use whatever bathrooms we want. And my staff—I could go on for days about my staff. Let’s just say they are mission-driven and scrappy. They are cultural brokers and cupcake bakers. They are my logical family on the days that my biological family doesn’t get to see me.
And my staff—I could go on for days about my staff. Let’s just say they are mission-driven and scrappy. They are cultural brokers and cupcake bakers. They are my logical family on the days that my biological family doesn’t get to see me.
The election changed a lot of things for me. More importantly, it changed things for my patients. There is so much uncertainty—for the health care coverage of my patients, for my clinic’s access to state and federal funds that allow us to provide safety net services; there is even uncertainty that my clinic will be able to keep its doors open and serve the community in the foreseeable future. For those of us who fought tooth and nail for the passage of the ACA (Affordable Care Act), believing that this was our best shot at making health care for all a reality, the shift in the political climate and government priorities feels downright traumatic.
On November 9th I trudged through my clinic doors feeling overwhelmed and without the energy or the bandwidth to know where to start. My staff had questions in their eyes, and as I mumbled my way through our morning huddle, and, as I avoided their eye contact, I was acutely aware of the fact that I was going to have to pull it together. It took me a while, though. It took a patient to get my act together.
Ronnie was a sweet 26-year-old African American woman with a truly inspiring story. She came to us for the first time in 2014, uninsured and needing emergency contraception. At that visit, my nurse practitioner noted that she had not had any routine health maintenance in years, so she scheduled her for a well woman visit/pap test. When Ronnie returned for that visit, staff helped her enroll in Medicaid expansion through the ACA and for the first time in her adult life, she had health insurance. This was when I first met her.
When Ronnie returned for that visit, staff helped her enroll in Medicaid expansion through the ACA and for the first time in her adult life, she had health insurance.
Ronnie was soft-spoken and shy, and she was struggling with depression, poor self-esteem, and the health sequelae of morbid obesity. Her childhood had included an absentee father and a mother with too many of her own issues to be there for her as a parent. Her step-father, who is now deceased, sexually abused her throughout her adolescence. Her mother had seven children, none of whose fathers were involved in their care. Ronnie was the oldest by several years. She had dropped out of school at age 16 to care for her younger brothers and sisters, because her mother was not able to. In doing so, she had extinguished her own dreams and hopes for the future. She was deeply depressed, and just barely hanging on for her siblings.
In our first few appointments, we talked a lot about what she needed in life to survive, and how she could best care for her siblings. At her fourth visit with me, she informed me her mother was pregnant again. This was a huge setback for her, because she understood it to mean another baby that she would be raising. She needed more support. We agreed to have a regularly occurring appointments, and soon we were addressing her depression and history of abuse. She got a therapist, a social worker, and proper psychiatric care. We worked on managing her weight through healthy diet and exercise. We also had a lot of conversations about what she needed to go from “surviving” to “thriving,” and how she was going to set up her siblings for success.
One day, she came in and announced that she was going back to high school, at age 24. She had just spoken with her younger sister, who had very poor attendance at school and was talking about dropping out. Ronnie had come to the conclusion on her own that the most important gift she could give her siblings was the example of her own achievement. I remember her saying, “How can I tell them to stay in school when I didn’t do that myself?”
I remember her saying, “How can I tell them to stay in school when I didn’t do that myself?”
So, back to school she went. She did show up in my office a few weeks later in tears because she felt so unprepared and so out of place. She worried that she didn’t fit in socially because she was “old” and worried that her best efforts would not be enough. She didn’t know where to sit in the school cafeteria at lunch time, and felt that she didn’t know how to make friends, and that her experience was not relatable to her peers. High school was overwhelming. But she worked very hard and stayed true to her goal of graduating. She did well. She brought me her grades every semester, which I dutifully scanned into her chart—my weird doctor version of displaying it on the refrigerator. She kept me regularly updated on her progress.
Last June, Ronnie graduated with a 4.0 GPA and won the award for “most inspiring student,” as voted by her peers. Her little sister is still in school, too. For her graduation present, her boyfriend brought her to a Beyoncé concert. As she excitedly recounted what it was like to see her favorite performer live, she said, “Beyoncé is the only strong black female role model that I had in my life growing up.” Today Ronnie is in community college, and she is studying to be a nurse. Without health care, I don’t think Ronnie would have gotten the treatment she needed to be able to tackle the enormous challenges life presented her with. Her successes are a balm for my soul as a physician, and she couldn’t possibly know that as much as she needs me as her doctor, I am grateful to her for being my patient.
Her successes are a balm for my soul as a physician, and she couldn’t possibly know that as much as she needs me as her doctor, I am grateful to her for being my patient.
At our last visit, she asked me what would happen if our clinic closed or was unable to see I her anymore. I didn’t have a good response for her. This was not a woman that I was going to lie to by telling her not to worry, that “everything is going to be alright.” So instead, I told her that I didn’t know, but I was going to work hard to make sure that we would be there for her in the future. This interaction changed my perspective. Ronnie, my patient, called me to action, and I gave my commitment to be her advocate.
