Nonfiction Observations


My husband was in the aisle seat, I was in the middle seat, and The Man was in the window seat.

The Man had one white earbud in his ear; the other one was dangling in his lap. His right thumb swiped through several screens of his smartphone in less than a second. He heaved a sigh.

“This is f*cking lame,” he muttered.

The plane was supposed to take off 15 minutes ago. At that time the captain had announced that the plane had technical difficulties, but he anticipated that we would be up in the air soon.

The minute hand continued to sweep its arc across the clock face; soon we were 55 minutes behind schedule. The Man spoke into the microphone of his white earbuds:

“Hey, it’s me… yeah, we haven’t taken off yet… yeah, we were supposed to take off like an hour ago…. This f*cking airline sucks… Whatevs….”

The captain picked up the intercom phone. The Man mumbled something and then pulled the earbud out of his ear.

“I’m sorry, folks,” the captain said. “I thought that we could get this situation under control, but we can’t. The plane’s indicators are telling us that the nose isn’t in neutral position, even though other instruments and external measurements say that it is. I can’t risk flying this plane like this. Safety comes first, so we’re going to switch planes. I’m sorry, folks. The flight crew will tell you where to go shortly.”

Quiet murmuring moved through the cabin.

“F***********CK!!!” The Man screamed.

Then he punched the wall of the plane.

Silence filled the aircraft. I could hear The Man breathing.

I forced myself not to turn my head. My husband also kept looking straight ahead.

“I’m sorry that you have to start working,” my husband said, though his lips did not move and no sound came from this mouth. It was a telepathic message. I sighed in response.

I looked over my shoulder. The people seated behind me were staring at The Man with alarm. A flight attendant about five rows away shot a dark look at The Man, but did not move closer.

Don’t reinforce bad behavior, I reminded myself, wondering if I should say something. I didn’t have enough information at this point to know what to do next. Do I ignore him? Do I pretend that nothing happened? But what if he escalates his behavior because no one is acknowledging his distress? But what if he punches me if I ask him what just happened?

I glanced at him. The Man was chewing on his fingernail. His leg was bobbing up and down. The single earbud was back in his ear.

Okay. Go.

“It’s really frustrating, huh,” I said while grabbing the personal belonging stowed under the seat in front of me. If he tried to hit me, at least I could throw my bag at him.

“Yeah! This sucks!” he exclaimed. The woman in front of him turned her head a few inches to look at him. She swiveled her head back around. “I fly back and forth across the country every week and it’s been a sh*tty week and I just want to get some sleep tonight because I have an 8am meeting tomorrow and I usually fly a better airline and this is just f*cking ridiculous.”

“We all just want to get to where we want to go….” I kept my bag on my lap.

His leg stopped bobbing and he pulled the earbud out of his ear.

“Yeah. I mean, I guess this f*cking plane problem doesn’t happen a lot, but why this plane? At the rate we’re going we won’t get into Seattle until 1am.”

My husband’s posture relaxed as The Man shared his duties as the Vice President of Something Important at The Company Where Important People Work. His Important Boss was expecting A Very Important Report. No one seemed to understand how difficult this Important Report was; it was hard for him to get the Important Report done given all of his other Important Duties.

The Man slumped back into his chair and sighed.

“… but, I guess the most important thing is that we get there safely, right?” he said. He flashed a warm smile at me. I smiled back at him. My husband demonstrated an extraordinary fascination with the contents of his bag.

“So, hey, what do you do for work?” The Man asked.

I paused.

“Oh, I do stuff for the county.”

His phone chirped. The Man looked down and his thumbs began to tap out a message as he mumbled, “Oh, that’s cool.”

Homelessness Nonfiction


I was sitting in a seat that faced sideways. Scenes of the city flashed past as the train sped to the airport. I looked down and adjusted my bag so it wouldn’t slip off my lap.

When I looked up, he was seated across from me. He had a small smirk on his face.

“Hey,” he said. His eyes glanced at my bag, then returned to my face.

“Hey.” I knew his name, but did not say it.

“Where are you going?”

“To the airport.”

“For work?”

“Yeah.” It was mostly true.

“I’m going to the airport, too. Trying to get back home.”

The blue sleeping bag was sliding off his lap. He grabbed it as it unfurled onto his dirty white sneakers. His tee shirt was too large for his slender frame: When he leaned forward to stuff the sleeping bag back onto his lap, the neckline drooped. He ran a hand through his hair to push the long locks out of his face. The blue-purple bags underneath his eyes suggested he did not rest in the sleeping bag the previous night. Though red wisps surrounded his blue irises, he didn’t look intoxicated.

He was coming off of heroin when he first became my patient. Cranky and bellicose, he snarled, “Leave me the f-ck alone—you’re asking too many f-cking questions.” After eating a few meals, taking a shower, and getting some sleep at the crisis center, he spoke: His father, whether drunk or sober, beat him; his mother tried to kill herself three times in their home before he was ten years old. His uncle introduced him to marijuana when he was 11; he dropped out of school at age 16. He worked in construction when could get work; he sold drugs when he couldn’t. He eventually got his GED at age 19; he worked in welding, landscaping, and carpentry. He saved enough to buy a motor home when he was 25; his mother succeeded in killing herself in his motor home shortly thereafter. He fled the state and into the arms of drugs for comfort. He slept under bridges and dug through trashcans for food. He and I met about six months later.

“Can I use your phone?” he asked.

“I’ll help you when we get to the airport.”

He looked disappointed. Turning to a man sitting nearby who was using his thumbs to send a text message, he said, “Hey man. Can I use your phone? It’ll be a short call.”

“Oh, no, it’s not personal, I don’t let anyone use my phone, sorry, it’s not personal, it’s just my personal policy—”

“It’s okay. I get it.”

He looked up at the ceiling and sighed. It had been a few days since he had shaved.

The second and third time he came through the crisis center he asked the nurses if I could be his doctor.

“YO DOC!” he shouted at me the last time he was there.

I shot him a stern look and murmured, “Shh!”

He turned the baseball cap so it sat askew on his head. He winked at me. “I’m feeling better. It’s gonna be all right. I’m gonna try to pick up work in construction and save up money so I can go home. The city’s too big here. I can’t be using dope if I wanna buy a plane ticket.”

The doors of the train slid open. No one who entered captured his interest. Leaning forward over his sleeping bag, he said, “The sun’s coming out. You know what happened since I—”

“Have your tickets ready,” the fare police barked. Two of them had stepped into the car moments before the train doors closed.

His shoulders slumped. He looked down.

The fare police scanned my ticket without a word, then asked to see his ticket.

He dug around both pockets of his pants. His sleeping bag slid to the floor. He fished out a ticket stub and handed it to the fare police.

“This isn’t a current ticket.”

He looked down.

“Do you have another ticket? A current ticket?”

“No, sir—”

“You can’t ride the train for free. Everyone who rides the train needs to buy a ticket.”

“Sir, I’m sorry—”

“It doesn’t matter that you’re sorry. Hey, I think I’ve seen you before. We’ve had this conversation before, haven’t we?”

He said nothing. He began to stuff his sleeping bag back onto his lap.

“Do you have money to pay for a ticket?”

“No, sir—”

“—I’ll cover his fare,” I blurted.

He looked at me.

“Thank you, miss, that’s very nice of you,” the fare officer said. Turning to him, he said, “You’re lucky that this lady here is willing to pay your fare.” Without asking me for any money, the fare police then walked on.

He and I sat in silence for the rest of the train ride to the airport. I glanced at him a few times; he was looking out the window. It looked like he was gritting his teeth.

When the train arrived at the airport, he cradled the sleeping bag underneath his arm and squeezed through the mass of people to get out of the train first. He walked with haste to the descending escalator; he was stepping off of it as I was stepping on.

As he walked towards the terminal, he looked up and scanned the crowd. He saw me looking at him. He held my gaze, then turned away before disappearing into the airport.

Nonfiction Observations

Acts of Aggression.

The curls of his hair fell past his neck and a green knapsack hung from his shoulders. He plodded up the sidewalk and began to drift towards the curb.

His arm shot out and his fist slammed into the window of the vegetable truck. He paused, then punched the window again. The window did not break.

Nobody was seated in the vehicle. The vegetables and fruits painted on the side of the truck continued to smile. The man pushed the button at the stoplight and waited for his turn to cross the street.

Three men, each in a dark business suit, were walking north. Because they were shoulder to shoulder they occupied the entire width of the sidewalk. One held a cup of steaming coffee; another adjusted the trench coat slung over his arm; the third tucked his new cell phone into his pocket.

A man wearing a reflective vest, carrying a broom, and pulling a rolling trash can was walking south. Upon seeing the three men he began to move away from the center of the sidewalk and towards the building.

The three men approached, their paths straight lines. The man in the vest stopped and pressed himself and his supplies against the building. He looked down. The three men brushed past and looked only straight ahead.

The red dot of the laser pointer appeared on the sidewalk. It wobbled in the shadows, uncertain of where to go. Finding a target, it lurched up and landed on the white jeans of a woman waiting for the traffic light to change.

The red dot quivered as it rested on the woman’s butt, as if it were trying to stifle its own laughter. It clung to her as she crossed the street.

Education Lessons Medicine Nonfiction Reflection

We Want to See Them Better.

When he and I first met he told me that he had a doctoral degree in psychology, was the CEO of the jail, and could speak 13 languages. To demonstrate, he said, “Hong tong ching chong lai tai!” He then punched the door to his cell and shouted, “GET THE F-CK OUT OF HERE, B-TCH!”

I did.

The next week, he answered my questions about the pencil drawings on his walls.

“My name is John Doe,” he said, the words spilling out of his mouth. “You all think my name is Peter Pan, but it’s not. It’s John Doe. See my name up there?” He pointed at the “John Doe” he had written in two-foot high letters on his cell wall. “That’s my name. My people call me John Doe. I am the leader of all the people. I am the leader of all the Asians. I am half-Asian.”

Nothing about him looked Asian.

More weekly visits occurred.

“I can speak 13 languages,” he said again. “Tingee tongee tai tai—;”

“You’re making fun of me,” I interrupted.

“I’m not,” he said, smiling. I’d never seen him smile before.

“No, I’m pretty sure you are.”

“I’m not. Aichee aichee—”

I walked away.

“Hey! I’m a doctor! I own the jail! I CONTROL ALL OF THIS!” he shouted at me.

I kept walking.

One week I was trying to speak to a man in a nearby cell. John Doe was shouting: “The police are pigs! They don’t know anything! I hired all of them! I own them!” His vitriol bounced off of the concrete surfaces of the cell block; I couldn’t hear anything but his reverberating voice.

“Excuse me,” I said to the man. John Doe was still shouting when I arrived at his cell door. He fell silent.

“Could you please not yell for ten minutes so I can talk to another guy here?”

He nodded.

“Thank you,” I said, returning to the man.

Two minutes later, John Doe started yelling again. I sighed.

“That John Doe—he really pushes my buttons. I don’t know what it is about him—people have said and done much worse things, but there’s something about him….” I said in exasperation to my colleagues. “I mean, I know he’s ill, but…!”

He declined to take medications. He followed his own prescriptions of daily showers, three meals with extra fruit if he could get it, and daily bodyweight exercises. He rarely slept.

Another week the same situation occurred again: I wanted to talk to another man in the same cell block as John Doe, who was shouting.

John Doe stopped yelling when he saw me approach his cell.

“Could you please not shout for ten or fifteen minutes so I can talk to another man here?” I asked, resisting the urge to shout at him.

He nodded. I didn’t say “thank you” this time.

I completed my interview with the other man. John Doe remained silent the entire time. I was surprised.

“Thank you for not yelling. I appreciate it,” I said to John Doe on my way out. He nodded.

As I walked out of the cell block, I heard him shouting again.

More weekly visits occurred. John Doe still declined to take medications. He stopped speaking to me in faux-Asian languages, though would occasionally speak in gibberish that I did not understand. He stopped shouting whenever he noticed that I had entered the cell block.

“You’re not a real doctor,” he said one day. “You must be a nurse.”

“What makes you think that?”

“You’re a woman. Women aren’t doctors. Maybe you’re a clinic assistant. A really smart clinic assistant. But you’re not a doctor. Women can’t be doctors. I’m the president of all the doctors and hospitals. I own all the hospitals and jails—”

“Okay. Is there anything I can help you with today?”

A few weeks later, John Doe was no longer in jail. A judge declared that he wasn’t competent to stand trial due to his psychiatric symptoms. He went to the state hospital to receive treatment.

More weeks passed. He eventually returned to jail once his competency was restored, but he didn’t return to psychiatric housing. My colleagues who evaluated him upon his return, however, shared news about John Doe with enthusiasm.

“He’s taking meds now and he’s better. He’s polite. He answers questions. He doesn’t talk in fake languages. He doesn’t shout. I mean, he’s not warm or friendly and he doesn’t talk much, but he can hold a conversation. He’s definitely better.”

“What?” I exclaimed. “Are you serious?”

I wanted to see him. I wanted to see him better.

Despite that, I never did: He would not have found my visit therapeutic or helpful. The only person who would have felt better after that visit was me.

One of the greatest rewards in health care is helping and seeing people get better. This is particularly true when people have severe illnesses. We want to see them better. It gives us hope that other people who have comparable symptoms—symptoms that scare us, worry us, sadden us—will get better, too.

“How will [action x] change your management?” That’s a question we often talk about. If that lab study won’t change what you do, don’t order the lab. If the patient’s answer to your question won’t change how you proceed, don’t ask the question.

John Doe was no longer my patient. He was better. I didn’t need to see him to believe it.