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The other side of Roxham Road

I’m in Labour and Delivery. I have a grand multip with ruptured membranes in labour, so I do not dare to leave the floor.

This 41-year-old woman just switched to me after her obstetrician retired. She has had all her previous eleven babies at another hospital and I want to make her feel safe. My vacation starts tomorrow and not a moment too soon. I have compassion fatigue. 

It’s not often I find myself agreeing with Quebec’s Premier Francois Legault, but I had sympathy for him when he confronted Trudeau about the flood of refugee claimants coming to Quebec via Roxham Rd. 

I work at one of the two hospitals that take the lion’s share of these refugee claimants. The Jewish General hospital has a history. It was founded by a marginal and underserved community to provide culturally sensitive care for their patients and a workplace for their doctors. It has always served refugees. My daughter, coincidentally, works as an FM-OB at the other refugee friendly hospital.

Because of U.S. politics, refugees, mostly Haitians, are flooding across the border at Roxham Rd. They must destroy any evidence that they lived in the U.S. to be accepted here. This always includes destroying their prenatal records.

At the time of this story, the holidays have also ground the bureaucratic process to a crawl. 

One patient I see is a lovely woman. Her husband hovers protectively around her. When I open her chart I almost fall on the floor! She has been here a month, this will be her fourth repeat C-section and she is 34-weeks. While my resident examines the patient, I contact the midwife from PRAIDA, the agency that deals with refugees. “Why,” I ask her, “have you sent her to me? She obviously needs an obstetrician.” 

“I know,” says the midwife., “I have been looking for an obstetrician to take her for more than a month with no luck so far. I’m sorry to dump her, but I’m desperate.”

An hour and six phone calls later, I have secured an ultrasound appointment, an obstetric evaluation and follow-up and a C-section and tubal ligation booking. I have more patients to see, but luckily my nurse clinicians and resident have picked up the clinical slack as I battle the system. I then run around and review all the patients. Once all is settled, I sit down for a minute and talk to the couple. They tell me the husband found a construction job two days after getting his working permit. They found an apartment, and registered their children into school. “How did you manage to get this all done so quickly?” I ask.

“This is our chance,” he says. “Here we can live, work, educate our children. I’ll do what it takes. Education is the most important thing. That’s what we can get being here.” 

They leave. “So do you think their kids will work here when they become nurses or doctors?” I say to resident and Clara, the nurse clinician.

“Yup, unless they become immigration lawyers,” laughed Clara.  I finish the clinic an hour late with a headache but feeling we had done good work.

At the next clinic there is another story. This time I had a panic call from Dina, who coordinates appointments. “Please Perle, can you see her right away? She has just arrived, she’s 37-weeks, I’m on vacation after tomorrow.” My beautiful Clara agrees to see her while I’m teaching the next morning. The next day, I pop out of the teaching room to see this new patient. Her belly looks stuck on to her stick thin frame. Her eyes are dull. It has taken her almost two hours on public transit to reach the clinic. 

Even with the Creole interpreter on the phone, her history is hard to understand, since she speaks a rural dialect he tells me. She is living in a furnished room with her husband and two year old son. I find out that she has not yet started to receive her welfare payments. She has the paper that says she will be covered but still needs an interview. Her glucometer reading is 2.8, there are ketones in her urine. “Are you eating?” I ask her. She looks at her little boy who is happily playing with some trucks. “Not much,” she says. I give her husband a list of charities and agencies that could help, but when Clara calls most of them are closed for this week. I am in a panic. This woman is clearly starving herself so that her child can eat. She seems to have fallen through all the cracks.  She barely responds to us. Is this PTSD, some other diagnosis or is she simply malnourished?

The advantage of working in a CLSC is that you are not working alone. I sprint down the hall to see Jaycee, our social worker, who used to work at PRAIDA and knows the ins and outs of the system. Clara calls our public health maternal-child nurse, upstairs. Even though she is only supposed to give food support to women living in the geographic area served by the CLSC, she comes down with some food coupons. “I sent an emergency request to her CLSC; these should hold her until they can see her. They are pretty stretched, they have so many refugees.

We draw all her prenatal bloods and get an ultrasound appointment. We find some toys and books for the little boy. Jaycee spends an hour with the couple filling forms, getting things arranged. She is enormously effective and tenacious. I am so grateful for my team. Finally I finagle a taxi ticket home for the tired, hungry family. This has taken another hour of my time. I go back to the teaching room, where all the residents are waiting for me. I have been running back and forth reviewing cases, just putting out fires and doing the minimum. I don’t feel that I have given my best as a supervisor today. When I go home, I am sad. Unlike yesterday’s patient, I am not confident this family will find their way here. 

I think about my own grandparents who arrived as refugees two generations ago, escaping war, starvation and violence. This could be them.

In the next few weeks this patient is my biggest challenge. Paperwork is done. The clinic staff have collected baby goods, boots and clothes and even bus tickets, because one nurse found her begging for fare outside the metro. Her CLSC has not yet called. She has almost no food. Her landlord has found someone who will pay more for their miserable little room. He announces that they have to move three days before her due date. So Jaycee moves them to the PRAIDA shelter. I slip her some money, I dream about her, I am leaving on vacation but I hope she delivers before I go.  

She comes into L&D early one evening. They call me; she is in latent labour so they will send her home. “No, no, please keep her! She’ll deliver in the metro!” So the nurses and my colleagues agree to admit her. Marie-Maude, one of the veteran Creole-speaking nurses, takes charge of her and she has a safe and easy delivery at 2 a.m. She does, however, miss her preliminary immigration hearing.

Now a few days later, in L&D, it’s change of shift. Jessica takes over the nursing care of my grand multip. “I don’t know why she is still pregnant.” I say to Jessica, after I examine the patient who is progressing, but very slowly. “The head is in a transverse position, maybe that’s what’s holding her up. “

“I have an idea,” says Jessica, eyebrow raised. “Gimme an hour, and we will reassess.” 

I am fading now, but I grab some water and some pretzels from the vending machine. Back in the nursing station I see Marie-Maude. 

“Allo Cherie,” Marie-Maude comes and gives me a hug. “You look tired.” I appreciate her warm smile. “I am leaving on vacation tomorrow. I can’t even be nice anymore! Thanks for taking care of Madame A, the other night.”

“Oh the poor thing,” says Marie-Maude. “But Cherie, you were nice to her, eh?” I am touched by Marie-Maude’s warmth and support.

At that momentum, I hear a scream and a yell. “Dr. Feldman!”

I dash into the patient’s room. She is kneeling on the bed, her bum facing me. Jessica is holding the head in her hands. “OK, OK, deep breaths, everyone,” I say as I guide Jessica through the rest of the delivery because I have no gloves on. 

After this, we are all laughing. Jessica is pleased to have actually done a delivery. The patient is pleased to have had good “warm and heimish” care. I am pleased that these two patients delivered before I left, so I can leave without worrying about them. 

I change out of my scrubs, put on my coat and boots, ready to leave for the sun and the beach. Ironically the resort I am going to is on the other side of Hispaniola, the very island my patients have escaped.