BMJ, doi: 10.1136/bmjusa.03060006, (Published 3 July 2003)

Filler

The mother of ten whom life treated cruelly

From BMJ USA 2003;June:334

"Doctor, this is Mrs. Jones at the Social Service Department of El Paso County. I'm calling about Amelia Sanchez, who is on welfare. She has a youngster with a high fever, and I wonder if you'd go out and see the child." She knew I would do it without sending a bill. I took off at once for an address on South Conejos Street, a kind of ghetto for Chicanos in Colorado Springs. Amelia's was the only home I ever visited in Colorado Springs that had an indoor "outhouse," a pit privy in the basement.

Amelia was an obese Mexican American, a charming woman and the mother of nine children. I took care of the sick baby, and afterwards I made one visit after another to Amelia's home. Amelia's husband had been unable to work for years because of his "bad back." Every time I visited he reeked of alcohol.

One day, during one of my visits to Amelia to care for a sick child, she said cheerfully, "Doctor Mac, I'm so happy. I've got a job, and I'm off welfare. Now I won't have the welfare people bawling me out for spending a few dollars on a birthday present for one of the kids."

I soon learned more about Amelia's job. After getting up at dawn and fixing breakfast for nine children, she walked six long blocks to the Blue Spruce Café, where she washed the breakfast dishes. Afterwards she rushed back to the little house on Conejos Street and fixed lunch for the children. She walked back to the Blue Spruce and washed luncheon dishes. Then she went home, fed the children dinner, and walked back to the Blue Spruce to do the dinner dishes. I never heard her complain.

One day Amelia walked into my office and said, "Doctor Mac, I'm pregnant. After I have this baby, I want you to tie my tubes."

"Look, Amelia," I said, "I'd be delighted to tie your tubes, but I must tell you that if you have your tubes tied, you will have committed a cardinal sin in the eyes of your church." I always felt an obligation to consider the religious dictates of my patients.

"I don't care, Doctor Mac," Amelia replied. "The church isn't going to feed my children." After I delivered her tenth baby, I tied Amelia's tubes.

A few months later Amelia presented with dyspnea on exertion, and my examination revealed congestive heart failure, but with no discernible cause. I had a very competent cardiologist see her, and he, too, was at a loss to understand why she was in failure. I dearly loved that woman and was devastated when she died a few days after I admitted her to the hospital. I obtained consent for an autopsy, which revealed extreme mitral stenosis, so extreme that it produced no murmur.

Amelia had finally been relieved of the burden of one pregnancy after another, and then the curtain fell for the last time. Heaven knows how many women I cared for during my years in practice, but I will remember Amelia with great affection for the rest of the days that remain for this old man.

Washington, DC. DOCTOR1MAC{at}aol.com

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