American Medicine: I survived the death knell thanks to the devil.

Ah-Qiong's business is very stable, with two to three orders per week.

Most of them are South Asian immigrants who cannot afford insurance.

A Bangladeshi female worker in Jackson Heights who injured her finger with a sewing machine.

A Fujianese kitchen helper in Flushing had half of his thumbnail chopped off with a cleaver.

A Pakistani porter suffered a broken rib after being crushed by a forklift in a warehouse in Jersey City.

There are also occasional gray areas of work.

A Dominican thug had his calf bitten through by his pit bull. The wound took three days to heal, and the lesion was green and had a sweet, rotten smell.

Lynn performed an incision and drainage, and the pus that was squeezed out filled almost half a paper cup.

"Doctor, you're much better than my previous veterinarian."

Cassie muttered from behind, "Was your previous vet treating you or your dog?"

Another Puerto Rican youth was hit in the buttock by a stray bullet, which lodged deep in his gluteus maximus muscle.

Because of the existence of "fingertip blunt dissection technique," this is almost Lynn's specialty.

Two minutes later, the bullet landed on the curved plate with a crisp "ding".

The young man paid 1,800 yuan, and then added an extra 200 yuan as a tip to round it up.

"Hey, the first tip."

Cassie's pen hovered in the air. "Which column should I write this in?"

"Add a column yourself."

Cassie carefully added a column to her notebook.

These orders are all processed on an assembly line.

Quick in and quick out, leaving no trace.

But the order in the third week was a little different.

The patient was a Nepalese kitchen helper who suffered severe burns to his right forearm from hot oil splattering in the kitchen of a restaurant in Dhaka.

The second-degree burns spread from the wrist joint to the elbow crease, with extensive skin peeling, a red and oozing base, and several areas showing deep second-degree burns resembling white wax.

He was brought here by the foreman.

Lynn didn't ask what the foreman's surname was.

Such people are very common in the United States, and are a standard feature of small South Asian workshops, employing mostly undocumented compatriots.

Work-related injuries are often taken to hospitals because the Social Security number will be entered into the emergency room system as soon as the patient is admitted.

Without a Social Security number, you have no identity.

Without legal status, it means ICE (Immigration and Customs Enforcement) will come knocking on your door.

"How much?" The foreman asked first about the price.

"2200".

"Too expensive, how about 1200?"

"If this area of ​​second-degree burn becomes infected, it will develop into sepsis within three days."

Lynn was already putting on gloves.

"If you bring him here then, it won't be 2200 anymore. You can also choose not to bring him and let him carry it himself. He'll most likely die, and if he dies, you can spend another 500 to have someone dispose of the body, which is cheaper than going to the doctor."

The foreman paid the money.

Lynn covered the wound with silver sulfadiazine cream provided by Arjun, and then made a moist occlusive dressing with petroleum jelly gauze.

The kitchen helper gritted his teeth the whole time, digging his fingers into the iron armrests of the folding chair.

After the treatment, Lynn gave him two strips of broad-spectrum antibiotics from Arjun Pharmacy and a tube of spare burn ointment.

"Change the dressing once a day. Keep the wound dry and avoid contact with water."

"Can't it get wet?" The kitchen helper was taken aback.

All the work in the kitchen involves being submerged in water.

"At least two weeks."

A week later, the kitchen helper came for a follow-up appointment.

The wound is healing well.

The newly formed granulation tissue is red and plump, with no signs of infection, and the amount of exudate has been significantly reduced.

Lynn secretly breathed a sigh of relief when she unwrapped the dressing to check it.

For a second-degree burn of this severity to heal so well without a sterile ward, it's half thanks to silver sulfadiazine and half thanks to the kitchen helper's tireless efforts in keeping the wound dry.

"Well done," Lynn said, referring to the wound.

The kitchen helper smiled, revealing a set of slightly crooked teeth.

He pulled a stack of bills and coins from his pocket, including twenty-five-cent notes, ten-cent notes, and even a few one-cent notes.

After counting for a long time, I found that I was short forty yuan.

"The rest...can it be next week?" His English had a heavy accent.

"OK."

The kitchen helper pulled out a lunchbox from a greasy plastic bag.

"Here, take this."

It's a box of curry puffs.

I made it myself, and it's still warm. I can smell the cumin and onions even through the lid of the lunchbox.

"My wife made it."

The kitchen helper pointed to his right arm, which was wrapped in gauze, and added apologetically, "I... can't do it now."

Lynn took the lunchbox.

The kitchen helper left.

Cassie sat in the driver's seat, munching on a curry puff.

I ate three in a row, but hesitated for a moment when I raised the fourth one to my mouth, and then put it back in the lunchbox.

"We'll save the rest for tomorrow's breakfast. We can still eat it after microwaving it."

She closed the lunchbox and placed it next to the twenty-five yuan microwave.

"Can he still go to work with his hand like that?" Cassie asked.

"No. All the work in the kitchen involves water."

"What should we do then?"

"have no idea."

Lynn really didn't know.

He could only treat burns.

In the fourth week, the kitchen helper did not come to return the money.

A few days later, Arjun called to check on the medication consumption, and Lynn casually asked about it.

"That Nepalese man..."

"What's wrong?"

"He was arrested by ICE."

Lynn paused for a moment, holding the disposable phone.

"His boss reported him."

"His arm was wrapped in gauze and he couldn't work. The restaurant owner was afraid he would apply for workers' compensation, so he preemptively made an anonymous call to ICE, saying there were illegal immigrants in the restaurant."

Lynn remained silent for a few seconds.

"Where is he?"

"Elizabeth Detention Center"

Arjun was referring to the federal immigration detention facility in New Jersey. "It's easy to get in, but hard to get out. Once you're on the waiting list for immigration court, it can take at least three or four months."

"His injury..."

"It's none of your business, doctor."

Arjun interrupted him, "There's a new job, in Jersey City, tomorrow night."

The phone hangs up.

Lynn stood on the concrete platform of the abandoned gas station, holding her phone in her hand.

Elizabeth Detention Center.

He had heard his colleagues talk about that place while he was rotating through the emergency room at the Metropolitan Hospital.

Overcrowding occurred, with hundreds of people crammed into a space that was only half the designed capacity.

Medical resources are severely insufficient. On paper, the policy is to "ensure timely and appropriate medical services," but in reality, one nurse has to take care of more than two hundred people.

The kitchen helper's wound needs to be dressed daily and kept dry.

Antibiotics need to be continued to suppress the infection window period.

In places like that, let alone changing dressings every day.

Finding even a clean piece of gauze was a problem.

If a second-degree burn wound is exposed to an unclean environment, Pseudomonas aeruginosa can colonize it within 48 hours.

Then comes wound liquefaction, sepsis, and systemic inflammatory response.

Then comes organ failure.

Then there is no more.

Lynn closed her eyes briefly.

He remembered the kitchen helper's arm wrapped in gauze, the lunchbox of curry puffs, and the pile of one-cent coins.

The wound is red and moist with plump granulation tissue; it should be fully healed in two weeks.

He was truly cured.

But so what?

The owner of that arm is now squatting in an iron cage where even clean water might not be available.

Meanwhile, the unscrupulous boss who reported him is probably in the kitchen right now scolding the newcomer, who also has no identity.

Lynn took the SIM card out of the disposable phone, broke it off, and threw it into the roadside ditch.

He jumped off the concrete platform and walked toward the ambulance.

Cassie was sitting on the back panel, legs crossed, pressing the calculator buttons loudly.

She had her Starbucks notebook open in front of her, and she was calculating the week's net profit.