I cultivate a keen interest in politics in spite of myself.  Every election cycle I look on with – I’ll admit – bated breath.  My horse this time is Obama.   Last time it was McCain.

So I’ve been a little surprised at myself when it comes to the immigration debate.  I know conservatives are REALLY into this one, but I just never cared about it.  Who cares?!  My ancestors probably hopped a fence (or Ocean, as it were) to get here, and they probably didn’t meet with much of a warm reception when they arrived either.  So let ’em come, I figured.  They’ve got as much right to this place as me.

Today, my lackadaisical opinion on the matter was surely challenged, if not changed.  I was called to see a patient in antepartum early this morning.  She was 26 weeks along in her pregnancy with cramping and reports of bleeding.  I was told to hurry there because she had 4 kids in the room who all needed to get to school and she needed to know if she was staying in the hospital or going home.

It turns out that this woman speaks only Spanish.  She doesn’t have 4 kids, she has 7.  She lives in a shelter.  So do some of the kids.  Others are in foster care.  She is pregnant again, with her 8th.  While seeing her, we notice a significant deceleration of the baby’s heartbeat.  The baby recovers, but it could be an ominous sign so we decide to keep her for another 2 hours to see if there are more problems.  There is also concern that although she has stopped bleeding, she will start again.  So we order an ultrasound for fetal viability and placenta placement.  We add a biophysical profile to that – another test.

Antepartum is basically a set of exam rooms that function like an ER for pregnant patients.  The cost of running an antepartum unit is eye-poppingly expensive, especially with all the tests we ordered.  Also, to make sure our communication with this patient was perfect, we made sure an in-the-flesh translator was in the room with her.  Since we decided to keep the patient for an additional two hours, we made sure the translator also stayed with her.  The cost for this whole thing was probably in the range of $4000-$8000.  Maybe more.

This woman has no insurance of any kind.  Not even state funds for her kids.  This is because she is here “illegally” and has no documentation to allow her to get support for her kids.  Furthermore, she refuses birth control, and has lots of children.  She effectively has state employees working just for her to get her kids shuttled off to public school, which is also not paid for or contributed to in any way by her.

This patient had no further decelerations and was sent home.  But if she had bled significantly again, she probably would have needed to deliver the baby.  The standard of medical care in this case is to ship her by helicopter to a higher-level hospital with a neonatal ICU where the odds of her 26 week baby surviving are better.  The level of care required to save a baby that age is tremendous.  The cost would rival my medical school debt.

Last week, more school levies were proposed for our neighborhood.  I want to support them, but property tax in this area is already a heavy burden.  Trying to support 4 kids on a resident’s salary, paying taxes even on the loan repayment grants I get because I’ve sold my soul to the Army Reserve, I found it hard not to be resentful toward this woman.  I’m happy to say that I didn’t really come to this conclusion until after she had left and so I think I treated her with equality and good medical judgment.  But after she left, and I thought about how much she is taking from this system that really does survive on actual dollars from real humans like me, I was angry.  My daughter has been asking me to teach her to ride her bike now all week long.  This is because her two other friends just got bikes and are starting to ride with their Dads.  I leave my house in the dark in the morning, and come trudging home still in the dark, usually late for dinner.  I missed it altogether tonight.  Patiently, my sweet little girl hasn’t continued to ask me about bike-riding lessons.  She knows it’s hopeless.  Her dad works from dark ’till dark and if she wants to learn how to ride a damn bike like her friends, it’s up to her.

I work this hard because I – yes – generally like my job.  But it’s also true that I work this hard because to really build a community of mutual benefit is expensive.  Nobody can freeload.  The whole thing falls apart if everybody doesn’t do their part.  This is how the kibbutzim failed in Israel.  Freeloaders – the achille’s heel of communism.

So, I know, I’m complaining instead of proposing a solution.  Do we build a HUGE fence?  Seems inhumane, somehow.  Do we brand undocumented immigrants, give them some sort of societal scarlet letter?  Do we round them up and deport them?  I want to be fair to everyone who needs help.  But I want to be fair to me too.

I guess I don’t know the answer.  I do know that staying home and playing with my kids, teaching them to ride bikes and read and do math while other people provide food, housing, transportation, cable T.V. (high-def, if possible, please), education and clothes is in many ways an enviable life.  It is the life of a king.  But to provide this to thousands of people pouring into this country every day is impossible.  It is certainly demoralizing to me.