I feel so helpless as I read/listen to the news about our nation’s inhumane management of the immigration issues. As a local San Diego resident and physician, my sister Irene shares stories that humanize the experience for me. First, even the border patrol are human. Recently, Irene rode her horse up, unnoticed, on a Border patrol agent riding his government ATV doing donuts and wheelies in a sandy area in the Tijuana River Valley where they patrol for undocumented folks.  Cynically I said, my tax dollars at work, then I grew kinder and said, letting off steam at what must be a thankless job.

On a more serious note, Irene run’s a procedure clinic. She excised a childhood mole on the leg of a middle age woman which had gone through some changes. Much to Irene’s surprise, it came back as malignant melanoma. So she needed to go back and do further excision with a two centimeter margin around the previous lesion site. This was pushing Irene’s surgical skills, but the woman I’ll call Carmen, could afford the $20 Irene’s clinic charged, but a trip to dermatology/oncology was beyond her reach. So Irene, made the most of her surgical skills, a part of family medicine training and honed during additional years of practice and helping residents gain good surgical skills. She cut deep, into the fat tissue and placed plenty of deep tissue sutures to support the closure of the large excision. Her elliptical cut came together pretty well. Of course, as a perfectionist she wished she’d made a more gradual tilt on the angles, but the area healed nicely and she accomplished adequate margins on her biopsy. Now what?

Irene’s neighbor, a dermatologist, had no interest in helping her patient. A call to the academic medical center and a discussion with the secretarial staff led her to a very helpful dermatologist who was amazed at what Irene had accomplished. “Carmen could see me, but I have to charge her $550, rules of the system, unfortunately.” And that’s true, physician efforts to provide free care have been eliminated by Medicare rules. Next steps for Carmen would be a sentinel node biopsy, imaging, and chemo. We can only guess the cost of that, and the $550 to see Derm?

Carmen told Dr. Irene that she’d need to scrape to come upwith the sum. Her daughter would have helped her, but she was deported toMexico. The academic dermatologist reviewed what to watch for: return of alesion at the site of excision, swelling and tenderness of nodes in theinguinal area, any mass that shows up between the excision site and thedraining lymph nodes, and any unexplained symptoms like blood tinged sputum.

 So that would have tobe good enough? “Border Medicine,” Irene said.

 “She could go toMexico. It would be cheaper,” I said.

 “Sure, but she’dnever get back into the US.”

We both shook our heads into our smart phones.  “Border medicine,” Irene repeated, “You do your best, butyou’re always hedging your bets.”

Perhaps that these are life lessons. We do our best, and askthat of others. But to avoid Burnout—a popular word in health care circlesthese days—we need to remember to do donuts and wheelies in the parking lot,the rest areas. I hope it all gets better, but that will take time, good intentions,and slicing clean margins.