Category: Nonfiction

Categories
Homelessness Nonfiction

Shame.

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.

Categories
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.

Categories
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.

Categories
Nonfiction Observations Reading

King Solomon’s Ring.

I often smiled to myself while reading King Solomon’s Ring by Konrad Lorenz. In this delightful book he shares stories of animal intelligence and character that humans often disregard. It reminded me of the botanical garden at UCLA.

The botanical garden at UCLA is not large, but it had tall trees with thick trunks and rugged bark, ferns with luxurious leaves that stretched along the edge of a small stream, and bright hibiscus flowers that beckoned butterflies and hummingbirds. Footpaths wound through the garden to quiet corners and pockets of shade. The garden offered respite from urban university life.

During my last year of college at UCLA, I helped with research projects in a behavioral ecology lab. One project I worked on involved scrub jays. They are related to crows, which means that they are intelligent birds.

Near the entrance to the botanical garden were two small chessboard-sized platforms, each on a post. This is where I did experiments with the scrub jays.

Prior to working with the birds, I prepared peanuts. Some peanuts I did not open; I merely painted them in one of four different colors. Other peanuts I opened, but took only one or two nuts out before gluing the shells back together. For some peanuts I removed all the nuts before gluing the shells back together. I also painted these manipulated peanuts.

Scrub jays can distinguish different colors. A bird will shake a peanut in its beak to discern how much food is inside.

I don’t remember the exact experiments, but this was the general procedure: I would place two peanuts, each a different color, on a platform. Scrub jays, their legs marked with rings, would appear one at a time to select a nut. Part of the task was to see if scrub jays could learn what specific colors meant (e.g., “red peanuts never have nuts in them; green peanuts are always full of nuts”). Another part of the task was to see how quickly scrub jays learned to adapt to changing circumstances (e.g., “something is different—now the green peanuts are empty and the red peanuts have some nuts in them”). I spent about 15 to 20 minutes several times a week putting pairs of peanuts on the platforms. The scrub jays would land on the edge of the platform, look at the peanuts, pick up and test the peanuts, and then fly away to a nearby tree with a peanut. I scribbled down my observations and readings from my stopwatch.

I did this for several weeks, maybe a month. It was fun. (Scrub jays usually learned within two to three trials what different colors meant and could retain this information over time.)

Once my time at the lab was over, I still took walks in the garden. Scrub jays saw me enter the garden and followed me, often for over ten minutes. They flew from branch to branch, sometimes trailing behind me, sometimes flying ahead of me on the path.

This occurred for months after I had stopped leaving peanuts for them.

I took walks in the garden before I joined the behavioral ecology lab. Scrub jays never followed me around then. I can only assume that the scrub jays learned to recognize me and hoped that I would leave peanuts for them.

My experiences with the scrub jays pales in comparison to Lorenz’s work, but it felt both magical and eerie to see scrub jays following me around—always in silence and never too close—as I took walks in the garden. I can only wish that everyone will have such an experience at least once in their lives.

Categories
Nonfiction Observations

The Golden Rule.

People in the meeting room returned to their seats: The Governor was about to enter the room!

The judge, wearing a smart blue suit, rose from his seat. He fastened a button of his single-breasted jacket and ran a hand along both lapels.

An urgent whisper: “Are we supposed to stand up for him?”

The judge looked around: Nearly everyone had sat down, but a few were standing.

“I’m going to stand up,” he murmured. “People stand up for me.”

The judge adopted his best posture. The door to the room clicked open. The Governor walked in. Everyone but the judge was seated.

“Ladies and gentlemen, the Governor,” the seated host announced. The audience burst into applause.

Smirking, the judge sat down with haste.

“I guess I was the only one,” he mumbled.