Sunday, May 24, 2009

The Safety of his Car

He's dressed in dirty blue jeans with a urine stained front. His plaid flannel shirt has seen better days. His head is covered with a blue baseball cap. He apologizes for his appearance. He's never been to the clinic before and he's here because he's had a headache for a week. I take his blood pressure and it's high, no doubt the reason for his headache. He tells me he was told he has high blood pressure a year ago at the emergency room but he hasn't taken any medication for this. 

He tells me he's safe in his car. He's been living in it since his wife and kids left him. He says apologetically, "I never used to look like this. I know I don't look very good now. I don't like to be around people or open spaces." He tells me about the voices he hears in his head. He knows they aren't real and he constantly has to remind himself of that.  I watch his eyes dart around the room like a caged tiger. I know he wants to escape. "Have you seen a counselor?" I ask him. He says no and tells me he knows he needs to be on medication but he can't afford it and it's too hard for him to leave the safety of his car. 

"Where do you get your food?" I ask him, imagining him waiting in a crowded food bank line and wondering how he can tolerate that. "I steal my food." "How do you do that?" What follows is a detailed explanation of how he regularly steals his food from the grocery store. "I bring in an empty paper bag from that store and I start filling it. I usually pick one part of the store each time I go. If I go to the produce section, I make sure no one who's working there sees me. Then I walk towards the check-out line and just walk out with another customer like I know what I'm doing." "And you've never been caught?" "No. But sometimes I think they know I do this and just look the other way."

He tells me his car was ticketed for being parked too long so he has to move it. He doesn't know where he'll go. He's afraid since he can't pay the ticket, his car will be towed soon. "But that's your home" I say to him. I tell him I want him to meet with the social worker after his doctor's appointment and he agrees. I can tell he's been here too long; too long away from the safety of his car. 

I go to check on him after his appointment with the doctor but he's gone. He leaves before he can have his blood drawn. He leaves before he can be treated for his headache. He leaves before he can meet with the social worker. 

I haven't seen him since.

Wednesday, May 20, 2009

Apology accepted

As I walk past the area where someone sits to get his blood drawn, a man stands there waiting. He's a tall African American man with a fit body. He extends his hand to me, "Hi there. I want to apologize to you again." I look at him and can't think of why this man is apologizing to me. He looks familiar. "Boy, I was really in a bad place when I talked to you like that. I never talk to people that way." I nod my head pretending that I know what he's talking about and hoping he will say something to jog my memory. "It's been ten months since I've had a job and now I'm moving to Atlanta for a construction job." I'm starting to remember now: 

Almost a year ago, this same man comes to the clinic wanting his pain medication and some results of blood work. When I meet him in the waiting room, his arms are crossed and he's very agitated. I tell him I can discuss his blood work but he needs to come back in a few days for his medication as he's too early for his scheduled prescription time. He gets very angry and I even hear him say under his breath, referring to me, "Bitch." I step back but don't get defensive. My only interactions with him up to this point have been good ones. I leave him to look at his chart. I'm reeling a little bit by his behavior and being called 'Bitch.' I take a few recovery breaths as I look in his chart. There is nothing alarming about his behavior noted. 

I bring him out of the waiting room and have him sit on a chair in the hall. He is angry looking and doesn't look at me. I say, "Hey. What's going on with you? I've never seen you act like this before. You're being very disrespectful to me." I watch tears come to his eyes. He tells me he just got laid off. He tells me two weeks earlier he had to identify his brother's body at a morgue. We talk for a few minutes about his life. As we part, he extends his hand to me and apologizes. A few days later, he comes back to the clinic and asks to see me. He apologizes to me again.

Now ten months later, "I had no right to talk to you the way I did. I want to thank you for how you handled everything. What you said to me was exactly the right thing." I am struck by the thought he has given this, still apologizing to me almost a year later. I put my hand over my heart and tell him how touched I am. He says to me, "I'll never forget the respect you showed me." I thank him and tell him he can let this go now. I wish him luck at his new job.

This interaction reminds me to step away from a bad situation and give it some breathing room. It also reminds me the importance of giving someone space to tell their story. 

Monday, May 18, 2009

The Emotional Layout

I've had a long absence from my blogging. I have many stories and sometimes it's too tiring to write them down. I will focus on some stories in my next few blog entries. Some will still portray human resilience and some will portray ugly desperation. 

The economy has depleted the few safety resources our patients have had and this has turned their already chaotic lives inside out. They become desperate with their physical and emotional pain, even more trapped than they once were.

Many patients are on a scheduled monthly narcotic prescription. Often, patients try and get their narcotics a few days, a week early. Is their pain so uncontrolled this month that they needed to use more medication? Or are they wanting it early to get some extra to sell? Often patients lie about stolen or lost narcotics in order to get more oxycodone (percocet) that they can sell on the street. At times my job has been turned into a detective, such as asking to see police reports for stolen prescriptions and sometimes finally busting them for their lies. Many of our patients surround themselves with others as desperate as they are and so I believe some stolen narcotic stories. Others just don't make sense. On occasions when someone is caught in a flat out lie, we don't get the police involved. We tell them we can treat them for their medical problems but they can no longer get their narcotic prescriptions through our group of clinics. It's time consuming and tiresome for the staff.  

We are seeing more depression and  suicide attempts, more anger and volatility, more illness. I don't feel as emotionally or physically safe there as I once did. I believe some patients are a step away from pulling out a gun and using it. Our former security guard was very good. He had a strong presence and good intuition. He even patrolled around the clinic and asked people doing illegal activity to leave. Our staff felt safe with him there. He took the bus to work and started receiving threats from those who recognized him on the bus. I don't think they were our patients, but rather those he'd been keeping his eye on outside the clinic. So he quit. The security guard we've had for almost a year wants to be earnest and is a nice guy but having him as a security guard is a joke. He's about 5'4" and is terrified to approach anyone. When he's needed, he doesn't know what to do and has come to me for direction. I have often seen him asleep in the lunch room. Stories about him and others to come.