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Dr. Joy Baker’s patients travel 40 miles on average to see her. Some pull up in their own cars, but if they’re too poor to own one, they might hitch rides with friends or on the Medicaid van, which must be scheduled three days in advance and also can run early or late.
She was in her early 20s, and she had severe rheumatoid arthritis in her hips. It had gotten so bad that she had to pull out of college. She had developed hip flexion contracture, which means her hip was stuck in a fixed, bent position. Even if she tried to stand up, her head would nearly touch the ground.
Fifteen years ago I had a patient with bladder cancer that had spread to her kidney. We decided to remove the kidney, but afterward the X-rays showed the cancer was much more advanced than we’d thought. Now I was faced with telling her that she was probably going to die.
I kept glancing in the direction of Twin B. The staff was huddled around the baby, and I saw they were moving more quickly than they would for a normal newborn. I caught the eye of the attending neonatologist, who shook her head. I felt sick.
She was a college student who developed what’s called fulminant liver failure, which happens to probably 2,000 people a year in the country. Without a liver transplant, she would have died within a week.
She was a middle-aged woman who’d been driving on a two-lane highway when a deer ran out in front of her. The deer went through the windshield and was pinned there. She was trapped inside, the deer kicking her in the face over and over again until they could extract her from the car.
We did a lot of planning and dry runs, but I was still a bit nervous. This treatment is rarely used, and the last time it was done here at Emory was probably 25 years ago.