Back From The Front…
…Which is an awkward position, come to think of it. This go-around my work was in Fontana, where I spent the last four months (minus the week in New York) filling in for a pediatrician at a family clinic.
If you know not where Fontana is, you have lots of company. It is part of the Inland Empire, a name only a real-estate promoter could have come up with. Surrounded on all sides by freeways and bisected by old Route 66, it is hardly the jewel of anyone’s empire. Asked by my wife to describe it after my first week, I said it “was like Iraq without the glitter.” Especially along 66, there are shuttered businesses, lonely palm trees, and countless acres of countless acres. Just across the freeways are burgeoning signs of life. Rancho Cucamonga, just west of I-15, is a lovely community with a gorgeous shopping mall (Victoria Gardens) and even a minor league baseball team, the Quakes (who play their games at The Epicenter). Because the 65-mile commute would have been insane and likely destroyed my 6-speed transmission, I opted to spend five nights a week at the local Comfort Inn, which was tough on Cynthia and me both.
Medically the stint was enjoyable, with the usual assortment of checkups and minor illnesses. I did see some rarities, including a set of twins born on different days (five hours apart), a girl with Turner’s Syndrome (one X chromosome missing), a number of autistic children and a lot of kids in foster care, something I used to see regularly in my early days in Van Nuys. Because of the new law regarding middle school and older kids needing a whooping cough booster, we were overrun with teenagers all summer. Most of them needed other vaccines as well and many had not seen a doctor in years. Because I enjoy that age group a lot (some pediatricians don’t) I tried to chat with them and provide some guidance and encouragement. I was struck by the large number of high school kids, mostly Latino, who were following the age-old American dream and heading to college to pursue careers including medicine. In many cases their parents barely spoke English, and I imagine many were illegally in this country. I saw virtually no tattoos or gang stigmata.
The overall downside to the experience was twofold. First, in far too many instances the government-sponsored health care provided to many of the parents promoted several kinds of abuse. Every day there were patients barely ill at all whose parents came in to get a written prescription for readily available substances such as acetaminophen, ibuprofen and Pedialyte – because it was “free”. Moreover, so much of the paperwork was excessive, mandated by some bureaucracy such as WIC, the school district, the state and federal governments. Because Head Start, a typical government program that marches on despite its manifest failure, requires three-year-olds to have TB tests, hearing and eye exams which none of them need or can do, the medical assistants waste hours each day.
The other disturbing trend which is nothing new but seemed worse than ever was the rampant obesity. Generally the entire family was overweight but not always. Despite frequent presence of a family history of diabetes, hundreds of kids I saw were already showing early signs such as acanthosis nigricans, blackening of the skin about the neck and armpits as well as central adiposity, the excess obesity around the midsection known to be a red flag for heart disease. Pre-adolescent children should have a BMI (body-mass index) of about 15, rising into the low 20s as puberty advances. I saw 80-pound four-year-olds, three-hundred-pound teenagers, and everything in between. Even many infants were already obese, and convincing their families was often futile. Addiction to the bottle and excessive milk intake in the second year not only contributes to fat babies but often ruins their teeth, a condition called “nursing-bottle mouth” which is actually life-threatening in some cases. I’d often look out into the general waiting room and see what the future holds in store for these obese kids; countless cases of diabetes with its attendant morbidities, lost years of productivity and a huge drag on our tottering health care system.
Only in America could “poverty” be associated with too much food!