Narrative Matters: The Power of the Personal Essay in Health Policy

CHAPTER 3: BEARING WITNESS: PATIENTS’ STORIES

CHAPTER 3 BEARING WITNESS PATIENTS’ STORIES
¡Despierta! Daniel J. Derksen Pizza Ship W. Richard Boyte Where’s David? Janette H. Kurie Maria Mahlon Johnson Voices from the Clinic: AIDS Then and Now Abigail Zuger The Yellow Baby Fitzhugh Mullan Blind Faith and Choice Rhiannon Tudor Edwards
¡Despierta! A physician’s stark encounter with the grim human toll of a preventable public health problem. Daniel J. Derksen W e had just spent a pleasant morning with our three-year-old daughter watching mule deer feed at the edge of a high mountain meadow near Chama, New Mexico. Jesse, a recently retired family friend, had showed us where he’d lived while herding sheep as a youngster in the mountains above Tierra Amarilla. The excursion had been a welcome reprieve from hectic lives—mine as a family physician in Albuquerque ; my wife Krista’s as an OB/GYN. We headed for home early in the afternoon to avoid night and July Fourth traffic on the winding two-lane highway between Chama and Española, which is northeast of Santa Fe. We did not leave early enough. Twenty miles before Española, a small pickup truck with two intoxicated teenagers had crossed the center line, slamming into an oncoming station wagon driven by a man with his wife and two young boys inside. No emergency vehicles had arrived. A few people stared helplessly at the mangled vehicles. None of the passengers had been wearing seatbelts. A Country Jaunt Gone Awry I pulled off the highway. Krista and I sprinted to the collision while Jesse remained behind with our daughter. Trauma is an inadequate description of the carnage we confronted. Two boys, about seven and eight years old, had been dragged from the station wagon and placed on a blanket. Five or six people looked on, unsure of what to do next. Neither child was breathing, although both still had pulses. I wiped the inside of the mouth of the boy Volume 19, Number 6: 280–254. November/December 2000. closest to me with the cuff of my long-sleeve shirt and began mouth-to-mouth resuscitation. He was a beautiful child, hardly a scratch on him, but the sweep of his mouth stained my sleeve with blood. At the time of this accident seven years ago, the death rate in New Mexico for young motor vehicle occupants was more than twice that of the United States as a whole. New Mexico led the nation in alcohol-related motor vehicle crash fatalities, with 26.7 deaths per 100,000 population versus a national rate of 15.6. Those grim numbers have improved somewhat since the bloody accident I witnessed, as has motor vehicle fatality nationwide over the past century. But progress has been uneven in states such as Mississippi, Wyoming, Montana, and New Mexico, which share a combination of risk factors for high motor vehicle fatality rates: miles of rural roads; high speed limits; low per capita income; and lax enforcement of drinking laws, seatbelt use, and speed limits. The Battle for Two Boys It was miserably hot. The boy’s pupils were fixed and dilated, but his pulse was strong and his skin color pink. My mind was whirling, due to hyperventilation or to the sun. A state trooper arrived and began directing traffic, towering over the boy and me, shielding us from the sun. Krista was on her knees examining the other child when an orthopedist ran up to offer assistance. They determined that resuscitation was useless. The boy’s neck was swollen and bruised, obviously broken. They turned their attention to the small pickup. Both teen occupants were dead, crushed in the collapsed cab. Two open beer cans remained undisturbed in their dashboard holders. Empty beer cans were scattered throughout the cab. The smell of beer permeated the stifling hot summer air. The opportunity for intervention had passed. Despite laws, seatbelt use is low in New Mexico, and intoxicated drivers are common. More than twothirds of New Mexicans killed in motor vehicle accidents are not restrained. As many as a quarter of the state’s children travel in cars without wearing seatbelts or using child safety seats. Often because of alcohol, New Mexico’s highways are some of the nation’s most lethal, especially on weekends. The situation is worse on rural highways and Indian reservations. Adult seatbelt use within the Navajo Nation was only 8...