At our last visit, she asked me “not to forget us” and gave me a photograph of her family. She included a picture of her daughter, whom I had never met. I had missed her by four years almost to the day because she was shot and killed driving through her neighborhood in the middle of the afternoon.
I first met Mrs. P early in my training as a physician in New Orleans, a city with a rate of gun violence on par with cities in South America. She had many uncontrolled chronic diseases, requiring over ten daily medications, and at least quarterly medical visits; she frequently missed both doses and appointments. As an eager intern, I had tried to clean up her med list, ask about transportation, and prescribe only from the $4 lists at local pharmacies in hopes of decreasing barriers to care. After a few months, it became clear that her limitation was care itself — and the fact that she didn’t. Since the loss of her daughter, she had stopped caring what happened to herself.
Many of my patients are survivors of Hurricane Katrina, so I have a low threshold to screen for depression and its triggers. Mrs. P was indeed severely depressed, so much so that her voice was almost unchanged as she told me how her daughter had been caught in a shower of gunfire while running errands a few years prior.
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