Food for thought: Hard times?

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Today I'm reflecting on just a few of the things I heard from patients in just a single half-day at Grady Hospital . . . . .

• Hurt in an accident so now have chronic back and neck pain due to a disk injury. Due to poor performance on a job that involves manual labor, was "let go."  Tried to get a few other jobs but never went beyond middle school and "not too good with secretary stuff that involve reading." This month got an eviction notice. Will likely have to move into a shelter.  
• Off drugs and alcohol for almost fifteen years.  Lost job. Has three adult kids--one with a family living in a one bedroom and another with unstable housing due to mental illness. Other child just got married and patient "don't want to be a burden on nobody." Could move back with "old man" but not her first choice since "he still use and still drank" and "he one of them 'mad drunks' that like to hit on you when he get to drankin' too much." Probably will live in her car until gets another job. Drank an entire six pack of malt liquor last night due to "nerves bein' bad."
• Overweight but affected by an illness that required high doses of steroids. Gained more weight due to steroids. Due to being overweight has terrible arthritis. Needs to exercise but finds it hard due to weight and pain. Needs to lose weight but on fixed income and relies upon "meals on wheels" for food which is not low fat at all. Can barely walk due to pain and probably needs knee and/or hip replacement. Can't get replacements due to weight. Needs to lose weight before replacements will be done, at least seventy five pounds. Can't exercise or change diet because. . . . .
• Terrible toothache and mouth full of decayed teeth. Thought this appointment was with a dentist. Gets referred to dentist to get tooth extraction but will need at least the minimum co-pay. Doesn't have a single penny. Literally.  Received some pain medicine and antibiotics. Found a place that will give the antibiotic for free but for pain medication has to pay. Really needs the pain medicine. On way to see dentist who decides on no pay treatment on a case by case basis. If isn't deemed a suitable "no pay" patient, will either have to find the money or just deal with it.
• Makes exactly three dollars too much to qualify for medicaid and exactly sixteen dollars too much to qualify for food stamps. Pays for medications out of pocket. All ten of them.
• Previously homeless, likely due to mental illness. Came to Grady, and finally got a diagnosis. Has never been gainfully employed due to uncontrolled mental illness and incarceration. Receives disability due to mental illness, just enough to pay for apartment and live in government housing.  Two months ago, check cut in half due to child support judgment. Getting evicted in a week. Can't go to family because estranged due to mental illness. . . .

Wait. . . . .what did I have to complain about again? Oh, yeah. . .that would be a whole bunch of nothing.

***
Happy Tuesday.

Parking meters.

*details changed to protect anonymity, based on an amalgamation of true events.

"My patient is back," spoke one of the residents in our clinic one day. She had just signed out one of her new patients with me a few moments earlier, and when we both returned to the room for my supervisory encounter, the only thing we found was an empty room.

"She was paying the meter," one of our nurses chimed in while passing us by on our way back to the exam room. I nodded, knowing this scenario well. Parking in the garage is often too expensive or too much of a hassle for some patients. Other than getting dropped off or taking public transportation, the only other option for many of our patients is feeding a meter and keeping your eyes on the clock.

Once we reached the room, the patient had a few more questions. I instructed the resident to go back to the patient she had just started seeing, and sat down to wrap up the visit with the woman who I originally thought was AWOL.

She apologized a few times for her absence, and then launched into a set of excellent questions. Overall, I was impressed by her knowledge of her body and enjoyed the challenge of fielding her queries. On a sheet of paper, I drew a picture of her liver, explaining how her cholesterol pill worked. She probed about side effects, and we dove into that, too. Overall, it was a good encounter. She folded the picture up and put it into her purse with a satisfied smile. I was happy to know that she thought it was a good encounter, too.

"I have to admit to you, doctor. . . . . Grady is nothing like I imagined it would be."

I'm pretty sure it was meant to be a compliment, but something about the way she said it didn't quite feel like one. The patient, who I estimated to be somewhere in her forties, reached inside of her handbag and nonchalantly pulled out some lip balm. After giving a quick swipe to her lips, she pressed her mouth together and nodded. "If I hadn't lost my health insurance, there is no way I would've been in here. No way. I mean. . . no offense."

Uuuhh, yeah. No offense.

I decided to take the high road. I wasn't sure if she realized that she was actually talking to someone who could hear her--hello?--and who happened to not only work at but love Grady Hospital.

"Yeah, a lot of people say that once they come here," I finally replied.

"I don't know," she continued while still rubbing her lips together intermittently, "I guess I thought there would be people running through the doors with bloody gun shot wounds or a bunch of vagrants sitting next to me in the waiting area."

Vagrants?


That's amusing. I wasn't sure I had ever used that word in a sentence during idle conversation. Vagrants. I raised my eyebrows and smiled. I wasn't sure how to respond to that.

"And the doctors." Oh mercy. "I'm really impressed with you all. Seriously. Everybody I've met here is so . . . .smart. You guys were like regular doctors anywhere."

Yowza.

She pulled a Coca Cola from out of her tote bag, untwisted the top and took a quick swig. "I hope you don't mind me drinking this pop while I wait. Whew! I'm parched."

"No, I'm fine," I replied before I could even decide how I felt about it. I had a fleeting consideration of telling her (as a return dig) about how much sugar one gets in just one can of Coke (ten sugar cubes, actually) but decided against it. I instead focused on her quasi-compliment. "I'm glad you've had a positive experience. I really am. I hope you'll come back to Grady to see us."

"I will be coming back," she replied with a smile. "Not that I have a choice about it."

Uhh, okay.

"I mean. . .now that I know what Grady is like, I would come back any way. This experience was totally different than I expected."

I cocked my head to the side and smiled at her as she reapplied yet another coating of Chapstick. She popped the tube back into the weathered designer purse once again, and looked slightly embarrassed when she noticed that I was watching her. In those few seconds I had already started imagining parts of her story.

A northerner? Perhaps. From the minute we started talking, I knew she was no Atlanta native, particularly because she kept saying "you all" instead of "y'all." But her reference to soda as "pop" sealed that assumption. Definitely no Georgia peach.

College educated? My guess was yes. Who says "vagrant" or "parched" in random chit chat unless they were forced fed such words in a required English class at a university? I vote a bachelors degree at least. Maybe even an advanced degree.

"Is. . . uuhhh. . .everything okay?" She went ahead and called me out for studying her. Against my better judgment, I told the truth.

"No. . .everything is fine. . . . I was just wondering about. . . .you know. . .your story." There. I was totally honest.

This encounter for a medication refill of her blood pressure and cholesterol medications was over. I had already missed the window to ask personal questions under the auspices of "getting some background information" or "we ask everyone this." At this point, I was just curious.

"You're not from Atlanta, are you?" I explored. I needed to feel her out first.

"Oh no. . . . .I'm from Chicago, but I've been here forever. Well, since college. But it feels like forever."

Ding. And ding.

"I guessed you weren't from these parts when you said 'pop.'" We shared a light chuckle. She seemed open to talking about herself, so I went on. "So, 'Chi-Town', how'd you end up at Grady?"

She shook her head and sighed. I was obvious that she got the meaning of that loaded question. Like not how did you end up here literally. More like how did you end up here-end up here.

"Do you really want to know how?" she replied with a icy gaze in my direction. I nodded quickly. She sat there with her eyes closed; shaking her head. The right side of her mouth turned upward in a sarcastic half-smile. She sighed once more and shook her head again, this time almost rhythmically. Like she wanted to shake the memory she'd just conjured up out of her head.

"I'm sorry. It just pisses me off every time I even think of it."

She was taking to long to spill the beans. My mind started filling in the blanks.

A bad divorce? Didn't pay your taxes? Laid off by a Fortune 500? A chance encounter with Madoff?

"Parking meters," she finally said, now scowling. "F--king parking meters. That's what brought me here."

Huh? I knew that Ms. Wilcoxson had just told me that she was out paying one, but now I was confused.

"What do you mean 'parking meters?'"

This time she launched right into the explanation:

"I came here to go to college a while back. I was at the AUC (AUC = Atlanta University Center -- a consortium of historically black colleges in Atlanta including Morehouse, Spelman, Clark Atlanta, and Morris Brown College) and fell in love with Atlanta so stayed."

"Okay," I said, facilitating her story. I wanted to hear more.

"My degree was in Finance, and after that I went for an MBA. At first I was working for a big company in marketing, but always had that entrepreneurial spirit, you know?"

"Yeah, that makes sense."

"Well, anyways. . . .I was always a great cook. Me, my momma, my nana, my sisters, and even my brother--we know how to burn in the kitchen. We used to have a booth at The Taste of Chicago and everything. So. . . I opened up a restaurant downtown about eight years back."

She told me the name of it, already predicting my next question.

"Really? My husband and I have been there. That's your place?"

"It was."

"Wow, I'm sorry. . . . the economy?"

"No," she answered dryly. "Parking meters. F--king parking meters."

Every time she used the f-word, I bristled a little and sat up a bit more in my seat. This ultra-polished woman who used words like "parched" and "vagrant" didn't seem the type to be flinging f-bombs around unless there were no reasonable alternatives in the lexicon.

Without thinking, she quickly reached for the lip balm and nervously rolled it over her lips for the umpteenth time. "They put f--king parking meters in front of my business. Right there. All up and down the street. Two dollars an hour. Quarters only."

"Damn." I covered my mouth, realizing that a profane word in this instance was also my expression of choice. It felt suitable.

"At first, it wasn't that noticeable. But over time, it annihilated us. My lunch crowd, my dinner crowd, my breakfast regulars? These are folks that come downtown to handle business, and stopped at my place for a quick minute, you know? Who has all those quarters? It's easier to just find a drive-thru." When she shook her head again, I thought I saw steam coming from her ears. "My customers kept getting tickets. Twenty-five dollar tickets. Then they stopped coming altogether. It was just too inconvenient. And Atlanta just isn't a pedestrian city like Chicago is, you know? Folks drive here. And when you drive, you need somewhere to park."

Now I was shaking my head. I was speechless.

"Those parking meters took me out. They really did. Such a simple thing, right? Who even thinks about what parking meters might do to someone's livelihood? I'm sure all the powers that be thought, 'What's the big deal? It's just a few quarters.' I'm sure all they were thinking was that it would bring money into the city. Lower some taxes. Simple enough, right?"

Damn. This was some real talk. I shifted forward and sighed.

"I tried everything. Specials, advertising, all that. And my place used to do well. We stayed busy. Eight years of steady, good business. But . . .finally. . . . I had to just let it go. Let it all go." She looked like she would cry if I said another word, so I waited. I knew more than anyone the danger of being provoked when you're right on the tippy-tip edge of crying.

The emotion passed, and she let out a big sigh. "So that, Dr. Manning," she announced with an exaggerated smile while leaning in to read my badge, "is how I found myself at Grady Hospital."

I sat in silence, not really knowing what to say. Words like "everything happens for a reason" or "it's darkest before the dawn" didn't really seem appropriate. Especially when something as simple as parking meters--effing parking meters--snuffed out everything you worked for.

::sigh::

Ever since that day, I remember that conversation every single time I see a parking meter. Especially one in front of a small business. I say a tiny prayer for those establishments as they disappear into my rear view mirrors, and hope that my patient managed to open her restaurant elsewhere. But mostly, I reflect on how something so seemingly insignificant can be so pivotal to someone's everything. Someone's life.

A bad divorce? Nope.

Laid off? Nope.

Buzzzz. And buzzzzz.

Correct answer? Parking meters. Effing parking meters.

I will never look at them the same.