By Sasha Cuttler

When the cuts hurt

THE ARGUMENT AGAINST the recently enacted Care Not Cash was an elegant rejoinder: because the care's not there. Now that the safety net has been discarded, a sign should be placed over the entrance to San Francisco General Hospital: "Welcome middle class." Because most of the people now looking for a regular doctor or nurse practitioner aren't homeless. Many of them are working. Many of them do without life-saving medication and procedures because they fear the bills. Many of them don't speak English. All would benefit from primary care.

When people walk off the street or call with a question, they reach Patient Referral, where I work. Our job is to evaluate their symptoms and ensure that they find a medical provider for help – from same-day emergency/urgent care to primary care with a regular doctor or nurse practitioner. They may have to wait ... and wait ... but eventually they'll get to the front of the line and be able to get answers to their answers and an appropriate referral and advice.

The questions vary but are related to illness and injury and money. My questions include "Do you have health insurance?" The answer to that is generally no. But because our mission is to serve all San Franciscans, we attempt to find them help. Sometimes it means asking if they're in unbearable pain. Then they must go to the emergency room. Sometimes it means they won't be able to tell me directly, because they don't speak the languages we speak in Patient Referral.

Right now I can call for the interpreter to assist a Cantonese-speaking man, while I amuse him with my ability to say "no problem" in his language. If the plan to save money by laying off interpreters goes through, there will be a very real problem.

When the interpreter arrives, I can have him or her translate disturbing facts such as "I'm sorry, but you cannot have a regular doctor's appointment until five months from now." And "I'm sorry that you have been diagnosed with lung cancer and the private hospital says your insurance is not effective. Please wait while I try to find you an appointment to see one of our doctors." If he's lucky, perhaps the oncology clinic will be able to help.

By next week Patient Referral will be closed. Nurses will still evaluate the relative urgency of the person who walks into the hospital. But nobody knows how people will find out where and when to look for care, other than the emergency room and the urgent care clinic.

I won't understand the Chinese man anxious for evaluation of his lung cancer; many of the interpreters are being laid off to save money. He arrived very frustrated and frightened due to a lack of access at a local private hospital. Nobody understood his dilemma because there was no professional interpreter available at his last visit to the doctor. Today I was able to listen sympathetically, offer nursing advice, and comfort a man who asked, "Does this mean I'm going to die?" After July 1, I may have to request that he bring a family member who is bilingual. Would the patient like to discuss his prognosis while his child searches for the word for inoperable?

The city's workers voted on a contract to help San Francisco have a balanced budget. They will likely continue to take home less pay, while caring for more and more uninsured people with fewer and fewer resources available. I hope the Cantonese-speaking man will come to the Board of Supervisors hearings on the proposed cutbacks. I pray he found a caring provider despite his loss of insurance and advanced lung cancer. I think they haven't cut the budget for interpreters at City Hall.

The Coalition to Save Public Health can be reached at (415) 575-1740, ext. 108.

Sasha Cuttler is a nurse at San Francisco General Hospital.