Bad, Bad Choices.

Texas isn't exactly known for its mercy toward the poor. Medicaid is almost impossible to get onto here, food stamps are even tougher, and medical services for people too rich for Medicaid and too poor to afford a doc are practically nonexistent. As bad as my state's attitude is, though, there are states that are even worse--and those states send their neurosurgical patients straight to the Sunnydale CCU.

She was a great-grandmother and not even fifty. Three decades of poor nutrition, nonexistant dentistry, crappy medical care for her hepatitis, and cooking meth to feed her ever-growing number of kids had left her in quite a state. She came to us with three abscesses in her brain, a pseudoaneurysm in one carotid artery, and a mycotic aneurysm that had blown out in a spectacular manner, leaving her mostly unresponsive. We put her on three different antibiotics, two different drips to keep her blood pressure up, and clipped off what we could of the aneurysm.

Her family kept showing up, all of them living in one room of the short-rate motel two blocks from the hospital, all cranked out of their fucking minds. Not a one of them, except her youngest daughter, had the slightest idea that things might be really, really touchy and bad. Nobody seemed to understand that no, she wasn't in a coma, and she wasn't just going to wake up and ask for a Coke if they talked to her. Eventually, either because they ran out of money or ran out of meth, they all went back whence they came--except for her youngest daughter.

She'd taken care of Mama for the last three years, in between taking care of her own firstborn and getting pregnant with a second. When Mama didn't take her lactulose and her ammonia went up into the one-twenties, it was Youngest Daughter that called the meatwagon and got her to County. When Mama's meth lab blew up in her face a few years ago, it was Daughter who learned how to change the bandages on Mama's arms.

Daughter, contrary to what I expected, was incredibly sharp. Ignorant as hell, but by no means stupid. She had no clue as to what the basic anatomy or processes of the human body were, but once I explained things to her in fairly simple terms, she caught on immediately. More than that, she drew the correct conclusions about what was happening to Mama and what was going to happen, and was sensible about them.

I thought about her--the daughter--last night when I couldn't sleep. The odds are against you from the get-go if your mom had her first kid at fourteen and those kids have kids that are as old as you, her last child. Between the amphetamines, the men coming and going, the near-certainty of domestic violence, the lack of cash for groceries, it would've been easy for her to have had five kids by eighteen rather than just two, and that last with a guy who seemed pretty stable. Not one person in a hundred would be able to get past the handicap of being a poor, Midwestern, meth-cooking-trailer-trash-high-school-dropout statistic, but at least she had brains.

At one point, as we were talking about Mama's chances of survival (dismal) with her family, I wanted to grab Daughter and drag her out into the hall. "Ditch the weed until you can piss clean for a drug test," I wanted to say, "then get your GED and have somebody watch your kids while you do a two-year RN program. You can earn seventy grand a year, get out of that shithole you're living in, and send your kids to college. You're an extraordinarily smart woman. You can *do* this."

Maybe I will, if she's there when I get back.