Caterpillar to Butterfly

I walk in the room and see a husband and wife sitting on opposite sides of the exam table. I've seen him before. He's a gentle and sweet African American man. I've never seen his wife, my patient today. She has a heaviness about her; brows furrowed, shoulders slumped. I start talking about her medical issues and she asks her husband to leave the room.

"You look depressed. Do you feel sad about something?" I ask her. I have no idea what will unravel. She tells me her aunt recently passed away. She passed away two years to the day after her mother passed away. "I visited my aunt in Tennessee before she died. She didn't know who I was." She continues her story in a monotone voice telling me she doesn't understand why this woman would die on the same day as her mother. "Why would God do that? My mother and aunt were so close. They were best friends." I tell her that hospice workers notice people holding their death for a special day. "Maybe she chose this day so she could be with her best friend. Maybe this is the day SHE wanted to die," I tell her. She looks down and then back at me. "I never thought of that. Is that really true? People do that?" "Yes" I tell her. "It's true" She waits a few moments and then says, "I like thinking of that. My heart feels better than it's felt in two years."

As some sadness lifts from her heart, she now smiles and sits up taller. She begins the story of her childhood. "My mother was fierce and wonderful" she tells me, eyes now sparkling. She tells me she grew up in Memphis and her mother and aunt took her to civil rights marches. She was a little girl when they took her to hear Martin Luther King speak. She says kids were at the marches to protect the adults from being attacked by dogs. She looks at me in the eye and speaks slowly and deliberately. She's drawing me into your childhood. I'm convinced to pay attention. She remembers being a little girl at a civil rights march. A dog was growling at her, pulling on the leash ready to attack. At the other end of the leash was a "mean son of a bitch looking cop." She says, "I can still remember thinking that dog was going to attack me. I dream about it sometimes." She tells me how much white people did for them. "They put their lives on the line for us and they didn't have to do that. They haven't been thanked enough for what they did. I really think so. They need to be thanked. We couldn't have done it without them." She continues, "My mother always loved Tony Bennett and so do I. He wasn't afraid to be a part of the civil rights movement."

She's animated now and looks like a different person than she did ten minutes earlier. "I remember when we were first allowed to go in a store through the front entrance. People were still afraid to do that so not many people did. But my mother? She would roll her shoulders back (she sits up tall and demonstrates her shoulders rolling back), grab my hand and we'd walk proudly through the front door." I find myself fighting back tears. I want to stay all day and listen to her.

She tells me her kids have no idea how lucky they are. They say, 'Hey dude, whatever.' "They don't know how they got here. "They think they've always had it this good," she says. I tell her she needs to write these stories down. Write them down for her grief, for her children, for all of us.

She tells me she has never told these stories out loud and thanks me. I tell her she has given me a gift, sharing something so intimate to her. We hug each other and both have tears in our eyes. We have come from two different backgrounds, fighting for the same cause, meeting in a clinic room, embracing each other. I walk out of the room and feel like I've gotten up too fast. I'm lightheaded and in a daze. I've been listening to greatness, something so wonderful and deep. I stepped back in time and now I need to adjust to life on the other side of the clinic door. I've watched a caterpillar turn into a butterfly before my eyes. I realize she has so much more to say.

She and her family helped change our country. Her mother was "fierce and wonderful" and together they fought a fierce and wonderful fight. They helped us elect the first African American president. This warrior is poor and has no health insurance and that isn't right. I can't stop thinking about her.

Knife Attack

He's 22 years old and a new patient to the clinic. He's hispanic with a crewcut. He's wearing shorts, sandals, and an undershirt. He's here with his mother. He says he needs to have a knife wound repacked. As he takes off his undershirt his mother winces and looks away; I drop my jaw in amazement. His abdomen had been filleted open and after a long surgery is now stapled shut. The wound extends from below his breastbone to his pubic bone, about 12 inches. "Can you take out these staples?" "Oh no, you need to go back to the hospital for that", I say. I see a bandage taped on his left side and a long gash on his left arm which is closed with stitches. "What happened?" I ask as I inspect how perfectly his core had been stapled shut. "I don't know man. I don't really remember. Some guys came at me with a knife." His mother winces some more and says, "I have hard time looking." Spanish is her first language. 

He says he drove to his mother's house after he was attacked outside a Mexican restaurant and then was taken by a medic to the hospital. "You drove?!" I imagined his guts spilling out in his car. "Your car must be full of blood." "Yeah man. The cops have my car now. Do you think I'll get it back?" "So you were able to drive to your mom's house but you don't remember who attacked you?" It occurs to me I'm not the only one to ask him that. When the police questioned him in the hospital they must have said the same thing to him 15 different ways. 

He was put back together at a county hospital which is also a trauma center. This kind of attack, unfortunately, isn't new to these doctors. I imagine a young doctor, anxious for the trauma training, hurrying to be the first to scrub in. Stomach, spleen, liver all closely inspected for damage, guts put back to their proper position, then meticulously stapled shut. 

"Can you pack this wound again for me?" pointing at the bandage on his left side. "The nurse at the hospital told me it's 7 inches deep." (Wounds like this need to be repacked everyday so they can heal from the inside out). He tells me his mother feels sick when she does it so he does it himself. I pull what seems like an endless amount of gauze from his side. His wound looks good. He's done a good job these last couple days. I clean it and repack it. As I push the packing tape in, I don't feel any resistance for just about 7 inches. Then, finally, I can't put anymore tape in. I clean the gash on his arm and rebandage it. I send him home with enough supplies to pack his gaping hole by himself over the weekend, keeping in mind that most people wouldn't be able to do this on their own.

A drug deal gone bad? A gang attack gone good? A random slaughter? For a moment I put myself in his mother's place, one of my kids brutally attacked with a knife. But then as quickly as I'm in her shoes, I'm out. It's too unimaginable. 

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.

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. 

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.

Surviving

Sometimes I think about all the patients I see who have dead children. Some from an act of violence, some from a disease; lives full of tragedy. Recently, a woman came to our clinic as a new patient. She brought with her a box full of her medical records. She was petite and pretty with short light brown hair. She looked her age at 45 years old but she's had more tragedy than anyone should be expected to survive.

She begins her story, listing the horrible things in her life with the same emotion given to reading a shopping list. "I have hepatitis C. I think I got that a long time ago when I experimented with drugs and now I have cirrhoses of the liver."  She stops looking at the papers in her box long enough to say, "Oh and I've been treated for PTSD". "What's your PTSD from?" She continues her list, licking the tip of her index finger and sorting through her papers."One of my daughters was murdered by a boyfriend. I watched another daughter's husband being murdered in my house..." 

I turn away from my computer and look at her, in horror. I lean against the wall to sturdy myself for more. She goes on, "I was stabbed in my back by my ex-husband and then when he and I were in the car one time, he reached over and punched me in the face so many times that I've had 8 facial reconstruction surgeries. Now my ex is in prison for molesting his new wife's daughter." She smiles sometimes but never cries. The only words I could muster up were, "Oh my God." I am not only struck by the things she tells but by the emotional detachment with which she tells it. She's busy finding the papers she needs to show the doctor. She's busy surviving. 

Suburbia Verses Inner-City

Yesterday, I was sitting outside a coffee shop in my quiet suburban neighborhood, when suddenly an overweight woman wearing an apron ran out of her ice cream shop, yelling and pointing at a young man who was running away from the scene. "He stole the tip jar!", she yelled. "Does anyone have a cell phone?! Someone, call the police!". Within one minute two police cars arrived and as I watched them get out, hands over their guns, I couldn't help but laugh. Has working at my clinic jaded me? All this police activity for someone who stole a tip jar from the ice cream shop. I tried to imagine a frantic phone call to the police station near my clinic about a stolen tip jar. I could see the officer answering the phone and then looking at it with a quizzical face, shaking his head at the idea that someone would bother the police for this, then hanging up. 

Today, I was busy assisting with a procedure on a patient when there was a little action outside the clinic. The security guard told me he was standing in our parking lot and was watching and listening to two men argue. All of a sudden, one of them pulled out a gun and shot it, missing the person with whom he was arguing. I'm assuming he meant to miss since they were in such close proximity. As he was telling me the story, one of the doctors asked what happened. When he told her, she very casually  said, "Oh, is that what I heard." And then continued working at her desk. 

Our security guard's only weapon is his walkie-talkie. His company hasn't even provided him with a cell phone. So he stayed outside to keep witnessing, and asked a patient to go in the clinic and call the police. He then called his boss and told him he really thinks he needs a cell phone. Gee, ya think?