Thursday, October 9, 2008

Entitlement Zones

I looked at the clock. It was only 4:30 AM. My back was killing me. Not sure what I did but I had somehow strained my back. I slowly got up, walked carefully to the kitchen and downed 800 mg of ibuprofen. Within an hour I was comfortable enough to sleep. By the time I awakened a few hours later, the back pain was almost gone. I am a big fan of early mobilization following muscular back injury so I set about my tasks. By 2:00 in the afternoon the pain was back and the repeat dose of ibuprofen was not as effective. But, stubborn and trying to practice what I preach, I pushed on.

Part of my day was a trip to the local Wal-Mart. I have a love/hate relationship with Wal-Mart. I hate how it results in the closure of multiple small businesses in town. But, I love going to one place for all the crap I need. Besides, if you are in the mood to see some weird shit, head right to your local Wal-Mart. Not long ago, I saw a family of 4 who collectively would have weighed in excess of 1,500 pounds, riding electric carts, and raiding the ice cream freezer. Now that’s quality entertainment. But, I digress.

Today, my list included bottled water, mouse traps (the little bastards moved in when the weather started to cool) and fabric softener (obviously, not my list). But, by this time my back was killing me. I was determined to keep going and refused to take anything stronger than ibuprofen. I pulled my truck into Wal-Mart and started looking for a parking place fairly close because I was now limping and walking slow. As I pulled through the parking lot I noticed that all of the close-up parking spots were for handicapped people and every one of them was filled. I never knew there were this many handicapped people in my town. I thought, “Gosh, the inside of Wal-Mart must look like a casting party from Doctor Zhivago.” As I circled the lot I saw two cars pull into handicap parking whereupon the owners threw the blue handicap card up on their mirror. They then jumped out of their car and skipped into the store like Michael Jackson entering a day care. I thought, “Handicapped my ass. These people are in better condition than I am.” I did not see one person that I, using my medical judgment skills, would consider handicapped. As I was entering I ran into a friend and commented on the handicap parking issue. He looked and said, “Those are not handicap parking spaces. Those are entitlement zones.” I thought, “Boy is he right.”

Many times emergency department patients have wanted me to sign one of those damn forms so they can get lifetime handicap parking. I always reply, “I’m sorry Mrs. Washington. You simply have an ingrown toenail. Now that I have wedged it you will be dancing in a matter of days.” They rarely see the humor in my comments.

I have never received entitlements. I was pretty much raised by my grandparents. They were simple folk who lived through the Great Depression and two World Wars. There was nobody to help them. Herbert Hoover sure as hell didn’t give them a handout. They fended for themselves. In medical school, we lived from student loan to student loan—raising a young family on $500 a month. I remember breaking the penny jar and sitting on the floor rolling pennies trying to get enough money to buy a box of diapers for our daughter. I would have gotten a job rather than asking for help.

Entitlements are a two-edged sword—they can help and hinder. Now, I am not talking about social security retirement or pensions. I am talking about a lifetime of Medicaid and welfare and food stamps. It breeds a culture of laziness. I have a relative-in-law (never married) who has three kids. All seem to have some disease process or condition that allows the family to receive three checks for social security monthly. As a result, the whole damn family would not know a job if it bit them on the ass.

My Wal-Mart story is not over. After I limped through the store and completed my list, I opted for a human (I think) to check me out. My back was not up to self-checkout (which never works). Ahead of me were two women and two young children. The oldest was obviously the mother of the other woman. They had enough groceries to choke a horse. And, they were all name brand crap like Del Monte, Campbell’s, and so on. The total surpassed $300.00. Without a blink, she whipped out her food stamps and paid. Then, for her daughter’s basket, she paid with a state welfare card. Then they whipped out cash (crisp twenties) for the beer and cigarettes. Finally, they asked for help to the car with their basket. I paid quickly and limped back to my truck. Low and behold there were the welfare queens—parked in handicapped parking. Furthermore, they were driving a fairly new Mazda SUV and one was talking on a cell phone. The poor souls! They barely have a pot to piss in. Right.

I have tried to take a stand against such abuse. For example, when I am treating a febrile baby when working in the pit, I will explain to the mother that the infection is viral and antibiotics are not needed. Then, I detail how to treat the fever with Motrin or Tylenol. After spending 5 good minutes explaining the situation I hear, “Aren’t you going to give me a prescription for Amoxil?” I look at her and quickly decide against trying to educate her on antibiotic abuse and superinfections. Anything more complicated than operating a vending machine would overwhelm her intellect. I explain, again, that the infection is viral and antibiotics don’t work against viruses. She gives me a blank look. Obviously, she only has three neurons: one is infected, the second is infarcted, and the third is inhibitory. Time to send in the nurse. Nurses can fix anything. Five minutes later here comes our best nurse--frustrated. She says, “She wants a prescription for Tylenol—she can’t afford it and if you write a prescription, Medicaid will pay for it.” I begin a slow burn and remember rolling pennies for diapers. So, I went in the room. Mrs. Gonzales is on the cell phone having an animated conversation about the most recent Matt Damon movie or some other critical issue. Her purse is open and therein I see a pack of cigarettes. She has a cell phone and a pack of cigarettes and can’t afford Walgreen’s brand acetaminophen for her rug rat? So, I lie. Medicaid says we can’t prescribe over-the-counter meds. Surprised, she says, “Dr. Sataranyanassayaty always gives me one.” She is describing an idiopathic condition. Her doctor is an idiot and she is pathetic. She says, “Well, if Angel gets worse, I’ll take him over to St. Elsewhere. They have better doctors.” I said cynically, “Yes they do—the best!” I think to myself, “Good. I hope at St. Elsewhere she ends up with a third-year medical student from a Caribbean medical school on his first rotation in the pit, all the time trying to get the his English verbs and nouns to agree. C'est la vie.”

We have banks failing and people are hurting. Entitlements lead to crime and societal degradation. They have decimated many communities. Interestingly, first generation immigrants and their children excel (just take a look at any medical school class). But, when the third generation is here, then they are in the same rut as many Americans—looking for the government to support them. While the US is dealing with a big financial crisis, I think the first act should be to stop foreign aid (turn it into American aid) and start culling the various entitlements. In my state, virtually anyone—chiropractors, optometrists, maybe even veterinarians—can sign those handicap parking forms. It needs to be better regulated. Perhaps if more people walked from the back of the Wal-Mart parking lot they would not need those electric carts or handicapped parking. Handicapped parking should be saved for the Christopher Reeve’s of this world, parents with kids who have spastic cerebral palsy—you know, real handicaps! It is high time to end “Entitlement Zones” But, this is just a blog so I am doing nothing more than pissing in the wind. My back hurts.

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