An older man sat in my exam room this week. He had been hit by a car, minor injuries, afraid to get checked out.

Before he came in, he asked, "You're not going to send me to the hospital, right?" 1/

He had had bad experiences before, was afraid of missing important appointments to keep his benefits. Being poor in Washington state is a full time job. 2/

But after examining him I knew I couldn't let him go home. He would get worse. His wound would probably get infected. When I told him, he hung his head, and said, "I understand." I felt like I had failed him. 3/

But how to get him there? He had been hobbling around for days but couldn't safely walk.

If we had a functional healthcare system, a van would have taken him to the clinic. We could get an x-ray and wound care and send him home. But this is America, so I called an ambulance. 4/

I called the dispatcher. The dispatcher connected me to fire. The fire dept declined to come. Then connected me back to the dispatcher. Then, to the police. The man, sitting across from me, started to sob. 5/

I told the dispatcher to wait so I could comfort my patient. He was afraid of the police. But he finally calmed himself. I gave report to them, and finally to the ambulance. 6/

We waited for 30 minutes. I had other patients waiting, all with their own urgent concerns. But I couldn't leave him. I sat there and listened. He told me about his family, his childhood, his church, his past drug use, his faith. 7/

He was kind and fragile and it felt like tectonic plates shifting in my chest watching him, thinking of him so alone in the world, so vulnerable, that someone had hit him with a car and he had been too scared to ask for help. 8/

When the ambulance arrived he was calm. He thanked me for listening to him and he started crying again. I saw my other patients, went home, and sobbed. 9/

I love my work but I don't know how to keep working in a country so cruel that it tells old people who have trouble getting dressed alone to pull themselves up by their bootstraps. 10/10