Author: Maria Yang, MD

In her right hand was a white plastic bag marked with a smiling yellow face. “Have a nice day” and “Thank you!” were printed on the front.

She had tied the handles of the bag into a square knot. The resulting loops dangled from her hooked fingers. The bag swung with each step she took while walking north on Park Avenue.

Her destination was an apartment between 73rd and 74th Streets. As taxis, cars, and delivery trucks raced past, she caught glimpses of the short grass, leafless trees, and stunted bushes that grew in the median of the avenue.

The plastic bag bumped against her leg and she reflexively extended her arm. Though she knew that the contents inside would not break or spill, she did not want to jostle the bag.

The doorman looked up when she walked into the building. Pewter stripes adorned the lapels and sleeves of his navy blue suit. The knot of his black necktie was crooked. He smiled at her in recognition.

“How you doin’ today, miss?” he asked, wrinkles appearing at the corners of his eyes as he smiled.

“Fine,” she said. “I’m here for apartment 13X. He’s expecting me.”

“Go on up,” the doorman said. Glancing at her plastic bag, he asked, “You got any lunch for me?”

“Not today,” she said, smiling.

“Next time, all right?” He winked at her.

She walked across the black and white checkered floor, underneath the chandelier that resembled a glass jellyfish, past the single pink orchid in the white ceramic vase, and stepped into the elevator. She felt the bag tap her leg again.

That was the portable flip-top sharps container that nudged her thigh. The brown paper sack inside the plastic bag also held a 3cc syringe with a 21-gauge by 1.5-inch needle, a pair of bright blue nitrile gloves, several small squares of gauze, one band-aid, three alcohol pads, and one container of hand sanitizer. The vial of antipsychotic medication waited inside its small box.

After exiting the elevator, she turned left, walked across the wooden floor of the hallway, and stopped in front of apartment 13X. She rapped on the black door three times.

“Who is it?” a muffled voice immediately responded.

“It’s Dr. Doe,” she said.

“Dr. Doe! Are you here to give me my injection?” he asked.

“Yes,” she said.

The locks on the door began to unlatch.

When she was sixteen years old, she said, “I wish old people would stay inside. They walk so slow. They take up too much space on the sidewalk. Who wants to see them with their canes and walkers, anyway? It’s so depressing.”

When she was forty years old, she said, “I like to see old people out and about. It’s nice to see that they are still active. When I’m that old, I hope I can still walk around like that.”

When she was seventy years old, she noticed that the youth walked impatiently around her. She said, “I used to make fun of old people when I was younger. I thought they were so slow and weak. Now I guess I am one of them.”

After crossing her arms in her lap, she looked up at the cloudless sky before glancing over her shoulder.

“Thank you for pushing my wheelchair,” she said.

I have instructed my bridesmaids to wear Alfred Angelo dress number 7174 in sapphire. The groomsmen will wear periwinkle windsor ties with their chalk stripe tuxedos. They must wear vests. I’ve never liked cummerbunds.

The three year-old boy said nothing when I asked him about the burn on his shoulder. Its shape looked like the hot, steel surface of an iron. He also said nothing when I asked him about the purple-green bruise that stretched from the side of his neck to his right ear. When I asked him about his parents, he looked away.

My bouquet will have orange circus roses, apricot roses, and miniature calla lilies. A lavender bow will wrap them together. My maid of honor will have the same bouquet, except orange freesia blossoms will replace the calla lilies. Her bouquet will be a third smaller than mine.

Her oncologist sent her to the hospital again. Last month, her five-foot, six-inch frame weighed 108 pounds. This time, her weight was 91 pounds. She gasped from the effort of sitting up in bed. The stomach cancer was winning. Her husband pulled me aside and asked, “Do you think she will make it to her 26th birthday?”

The wedding invitations will have dimensions of five inches by seven inches on 110-pound cardstock in eggshell white. The swirls at the top will be plum in color and the charcoal text will be in serif font to provide contrast to the flowing lines. I’ve ordered 100 purple “pansies in the basket” LOVE stamps from the post office.

“I’m going to be late for work!” the 73 year-old woman screeched. “Why won’t you let me leave my own home? I’m going to be late for work!”

Her daughter, her eyes red, wiped her nose and looked away.

“Who is she?” Mother screamed at me while pointing at Daughter. “Why won’t she let me leave? I’m going to be late for work!”

Daughter put her hand over her mouth. Her shoulders quivered.

My wedding dress will be ivory in color and satin in material. It will have a dropped waistline and an A-line silhouette. The gown will be floor-length and have a chapel train.

My wedding will be perfect.

It was his third visit to the emergency room in three days. The staff immediately recognized him. In the past year, he visited the ER over 100 times. That’s twice a week, every week. The ambulance services also knew him well. Good Samaritans would call 911 about a man who was lying in the gutter. Ambulance workers found him on the streets, barely conscious, and reeking of alcohol.

His liver was rotting from the incessant flow of liquor. As a result, fluid that his body could not absorb pooled in his belly. Doctors used long needles to drain it, liter by liter. He spent days in the detoxification unit. Nurses regularly hovered over him, watching for tremors that could quickly overflow into seizures.

Though he had returned years ago from the war, his mind was still overseas. Crowds made him uncomfortable, visions of mangled bodies invaded his thoughts, and guilt overwhelmed his conscience. A half-pint of whiskey helped him forget all of that. A few tall cans of beer dulled the pain in his belly; three or four more helped him ignore the strangers who looked at him with disgust. Finally, a pint of vodka put him to sleep at night. Alcohol was his constant companion, the only one who understood, the only one who brought him comfort.

That comfort never lasted. Only after the alcohol had washed out was he aware that he was killing himself. In the hospital bed, he was contrite and swore that he would never drink again.

With a pocket stuffed with prescriptions—this one is to prevent the fluid from collecting in your belly, this one is to keep toxins out of your blood, this one is to decrease craving for alcohol—he wandered out of the hospital with only a referral to the homeless shelter. Where else could he go? There he learned to use his shoes as a pillow so no one would steal them, though sleep eluded him because of the crowded and noisy conditions. People bullied him for money and food. Shelter workers had little power to protect him. Fed up with the constant chaos there, he fled back to the streets and sought refuge in windowless alleys. Police officers gave him tickets, then arrested him, for trespassing and sleeping outside. Youths, seeking entertainment, urinated on him or tried to set him on fire.

Burdened with this additional stress, he believed that liquor was his only savior.

His unpaid hospital bills—fees for ambulances, emergency room visits, medical procedures, nursing care, medications, lab tests, meals—came to hundreds of thousands of dollars. Everyone knew that the costs of his care would only increase if his cycles in and out of the hospital continued. Something had to change.

So, instead of sending him to the shelter after another admission for alcohol detoxification, the hospital referred him to a supportive residence. He now had an austere room to himself. A dedicated group of people worked with him so that he could get better. They were invested in keeping him indoors, out of trouble, and away from alcohol. If he did leave to drink, he was nonetheless welcome back inside. These caseworkers talked with him about his drinking and his health. They encouraged him to take care of himself. People believed that the costs of this intervention would be less than the costs to society otherwise.

Though it took time for him to settle in, he eventually drank less alcohol. He returned nightly to the residence and avoided the police patrols. He started visiting his physicians at their clinics regularly. No one needed to call 911 for him anymore and, as a result, his hospital visits decreased significantly. Though he still avoided people and crowds, he began to smile. So did everyone else.

You’re taking your medications every day, right?” the doctor asked.

“Yeah, yeah,” he said.

“Good. Here are prescriptions with three refills each.”

“What’s the green pill for again?”

“The green pill?”

“Yeah, the green pill, the one kind of shaped like an egg?”

“Uh, I’m not sure. You can ask the pharmacist when you pick up your medications. But if you’re taking all of them, then you’re doing the right thing.”

“Okay, doc. Thanks.”

---

When he got home from the pharmacy, he placed the white paper bag on the table. Dropping himself into a chair, he tore through the stapled top of the bag and pulled out the plastic orange vials. He arranged them in a row on the table.

“One, two, three, four…” he counted as he tapped the white caps. “… ten, and eleven.”

Glancing up, he reached for the shallow candy dish near the middle of the table. A few colored specks were caught within the spaces created by the etchings in the glass.

His eyes passed over the labels on the vials:

• Take one tablet by mouth twice daily.
• Take one tablet by mouth every day.
• Take one tablet by mouth every night.
• Take…

He quickly removed the twist-off caps. His fingers fished out the wads of cotton, which he left on the table. He poured all the pills into the candy dish. His right index finger stirred them into a colorful mixture.

---

Before going to bed that night, he picked up his toothbrush. His eyebrows suddenly lifted.

“Meds,” he mumbled.

He carried a drinking glass from the bathroom out to the kitchen. He scooped up a handful of medications and examined his hand to make sure he got at least one of every color and shape. He tossed them into his mouth and chased them down with water from the glass.

---

“You take your medications every day, right?” the doctor asked him the next month.

“Yeah, of course,” he said.