I pause at the crosswalk in front of the Family Health Center of Worcester (FHCW) as a dozen or so patients and staff members disembark from city bus route # 7.....
My 10:00 well child check, 11:00 diabetic follow-up and 11:30 low back pain are among the passengers. I wave at the family and scan the other faces for the translator they usually bring to appointments. FHCW employs Spanish, Portuguese, Vietnamese and Albanian staff to translate for our largest immigrant groups, but this family is made up of Nepali-speaking Bhutanese refugees.
I have seen members of the family frequently since they first arrived in the U.S. and Worcester several months ago. They had their initial physicals done at the immigration clinic run by the Health Center, chose to continue care and were all assigned to me as their primary care provider.
"There is someone here who can help you with that" was a phrase that the translator repeated many times, as I went to my preceptors to determine who exactly in the health center could best meet their needs.
Our chronic care team showed the grandmother how to inject insulin and limit her rice intake; a patient advocate helped enroll the four year old in Head Start; and the Homeless Families Program helped the family find a new place to live when there was a fire in their apartment building. I wave goodbye to the preschooler as she follows her mother down the hallway to the WIC office and I stop at the cafeteria to pick up some coffee before starting my day.
My morning session contains the diversity of patients, pathologies and social dynamics usually seen at FHCW. My first patient is an African American male with hypertension who came in for a blood pressure check, medication refills and housing forms that needed to be filled out.
"English or Spanish?" I employ my most common refrain, before starting a complex visit in Spanish with a middle-aged Latina woman followed by our HIV team. She has had a cough for over a week and I send her to the health center radiology and laboratory departments on the first floor before going to greet my Bhutanese family.
My last appointment of the morning is a gentleman with a history of depression and opioid dependency, who receives suboxone at FHCW. Unfortunately, his mother died three days ago and he has been thinking that he might also be better off dead. I call the behavioral health fellow into the room and together we evaluate the gentleman and make a safety plan. My colleague walks him over to Community Health Link, the mental health and substance abuse rehabilitation center across the street.
The battery on my laptop blinks red. There is never a dull moment at FHCW.