Split 

Room in the Metropolitan Museum of Art in NYC

Shadows watched from the corners of the room… ever present, ever vigilant. 

She waited.

Footsteps in the hallway. Raucous laughter. 

The door flung open and he stumbled in, drunk, clinging to the arm of a woman.

Who was it this time? 

It was hard to see clearly in the dim light. 

Her.

Their eyes met for a long moment. Silent words passing between them. Then she turned her attention back to him, allowing him to undress her. He fumbled. The process took much longer than it should have. 

Naked.

She glanced at the mirror again, seeing the other woman once more, the one who looked like her but was more charming, the one whose laughter came more easily. She was the one who was not ashamed of being naked, the one who demanded love and attention from everyone.

The drugs made her beautiful and charismatic. She knew the flame could not burn this high for very long. It would go out soon, extinguishing her in the process.

But it was worth it. 

Every day was worth the price to avoid the loneliness again.

Shopping Around

Macy's in New York City

“She doesn’t have physical exam coverage and her insurance only allows three office visits per year. No lab coverage. No preventive care coverage. She needs her blood pressure and diabetes meds refilled but she cannot come in for a physical.”

I’ve seen this a lot lately.

“No problem. Tell her to come in for a regular office visit so we can at least check her blood pressure. I will code a 99214 and she may get a 30% discount off that as a cash pay patient. I can send her to a discount laboratory for labs that will save her hundreds of dollars. In October she can get a $99 mammogram at one of the local imaging centers. Her flu vaccination she can get cheap at the health department. We will just have to postpone her PAP another year.”

So she came in….

Crying.

“I pay over $700 a month for this insurance.  I work for myself and with my diabetes no one will cover me otherwise. I can’t afford anything else. They told me that all of my doctors were covered and my meds were covered. They lied.”

She did not read the fine print. Not that she really had any other options available to her… 

It used to be like this ten years ago. People with expensive but essentially useless policies. Here we go again. Now, at least, I have access to a discount laboratory. 

This Far and No Further

Statue of Polish king in Central Park

Raccoons are not cute

Neither are possums or armadillos or squirrels. Don’t even try to argue the point with me because it’ll get you absolutely nowhere. I used to be like you, in love with all of God’s creatures. 

Not any more. 

I am not against wildlife, mind you. I am content to share my yard. If an animal wants dig up and trash my potted plants over and over again looking for God knows what, I am cool with that. But so help me, if one decides to crawl into the attic or walls of my house and DIE, we will have words and many of those words will consist of only four letters.

Here’s the thing….

I love my house. It is not a big house but built in the 1940’s it has tons of character. It is big enough without being pretentious or too expensive to cool in the hell heat of summer. It is located in the center of a little city/town. Best of all, it’s completely paid for. No mortgage.

Now, the thing about old houses in this area is that they are built on pier and beam, meaning there is a crawl space under the house that could fit a grown man on his hands and knees. As you can imagine, animals like that area quite a lot, too. Warm or cool depending on the season. Hidden. Food nearby. What’s not to love?

Shortly after buying this house, the first hint of odor wafted through the walls upstairs. Within 24 hours it was very clear an animal had died somewhere. I searched everywhere to try to find that carcass. Never could find it. Do you know how long it takes the stench of a liquefying animal to burn off? 

About five days, as it turns out.

Now, I am certain I am not the only one this happens to. Dead animals in your walls is of those dirty little secrets no one ever wants to admit to for fear of being judged… like enjoying oral sex. But it happened to me and my house several times a year for a number of years. 

Dead animals were not the only problem, though. Hoards of bot flies would descend upon the house from time to time like a plague straight out of Egypt. You know how flies are. 2-3 buzzing about feels like a lot. This was over fifty. Inside my house. All at once. Bot flies like dead animals. They LOVED my house. I am a pretty good shot with a fly swatter now, after all of that practice. 

Almost as bad as the flies and the stench was waking up to an MMA fight in progress in my ceiling in the dead of night. And did you know that chewing sounds are magnified by sheet rock? Sounded like some sort of jack hammer. The sleep deprivation was real, people. I would hear loud noises in the yard and run outside only to find entire families of animals, specifically raccoons, scrabbling up the side of my house. 

How were they getting in?!??????!!!

Finally, I was at my wits end. My family and I had endured QUITE enough and I was ready to torch the place, paid off or not. How could I in good conscience pass off this to someone else?

I couldn’t.

So I scoured the internet for advice, all of which was most unhelpful. Those animals practically scoffed at the nauseating stench of the red fox pee that was sprayed all over the house and property. The only thing it deterred was me. You name it, I tried it.

The man of the house took to using one of those *humane* traps, thinking if we could catch them before they ended up in the walls and attic that might help. We placed *inhumane* traps throughout the attic crawl spaces that could be reached. We caught dozens of raccoons, possums, and armadillos. Animal control knew my voice well.

“Yeah, yeah. We know who you are and where you live…” the man on the other end of the line would growl.

Something tells me that they were not taking those animals *away* to release them. 

One day, whilst bemoaning the vermin issue with a neighbor who was experiencing similar issues, I was informed that an old lady down the street was feeding the raccoons by putting food out for them at night. Rarely have I felt a desire to do violence against another fellow human being but this was one of those times. She did die eventually but not by my hand…

You know what seemed to work? Chicken wire. Chicken wire all over the eaves and attic vents. Chicken wire along the base of the house. Chicken wire anywhere an animal might try to weasel its way inside.

And…. that lady down the street? She stopped feeding the wildlife…. 

The Artist

Room detail, Metropolitan Museum of Art in NYC

Over twelve years ago I met an artist.

What she had was a gift. I never had to tell her what to do. It was like she just knew. Left to create on her own she did the most amazing work.

Today was my last appointment with her. 

My hair stylist is retiring and I am grieving. She was the first and only person to ever take charge of my hair and make it look GOOD. She made me feel better about my hair, about myself. I cannot put into words how important and life changing that was.

When I ask patients what they do, often I’ll get the, “I’m JUST a…. fill in the blank.” Hair dresser, office worker, mail handler, Mom, etc. I hate, hate, hate that phrasing. 

Never doubt that what you do has an impact. No matter what your job happens to be, it matters to someone. 

It matters to me.

Maybe I will find someone just as good. 

Maybe I won’t. 

I loathe this kind of change so it will be a growing experience regardless but for now, I grieve. She was an artist in the true sense of the word and she will be missed.

With a Prayer

St. Patrick's Cathedral in New York City

I have prayed out loud with a few patients over the years at their request. I will admit, however, that I am personally very uncomfortable with public displays of my faith. I am not sure my prayers carry the weight and power that some people believe that they should. I feel somewhat hypocritical for that reason, as if I am selling a faulty product. 

That being said, I do pray privately for patients on a regular basis:

Please, God, protect my patients from my mistakes. Help your love for them to show through me…

When I pray for others, do I believe I am swaying God in any way? Not really. Prayer is not so much about others as it is about me, a sort of mindfulness. I need a reminder that I am a fallible human being and that I must demonstrate compassion to those who are vulnerable. I struggle with that from time to time, just like the next person. 

I could write a book on the various things people do to bargain with their God when they are desperate and in that respect I am just like them. I have my own rituals and my superstitions, my own pleading bargains that I have made. Some may mock me for that. 

Faith, though, keeps me sane. 

And that is good.

Recognizing Patterns

“I did an internet search for my symptoms and after doing a bunch of reading, this is what I think I have….” She pulled a sheaf of papers from her large purse and passed them over to me. 

Erythromelalgia.

I scanned through it quickly.

It wasn’t anything I had ever heard of before, but then her symptoms were not something that I recognized either. Hands that turned red and burned like they were on fire. They got better when she raised them up overhead or ran them under cold water. It had been going on for years. The pain was excruciating and now occurred at a more frenzied rate to the point she was afraid to leave her house.

“I think you might be right,” I told her. 

Now, if I were honest with you and with myself, I would admit that my pride didn’t want her to be right. I wanted to be the hero. I wanted to be the one with the answers, not her and certainly not Dr. Google, but here we were anyway. 

We did bloodwork to make sure it was not caused by something more serious and she started aspirin. Like magic, the pain was gone. Somehow, she still considered me her hero even after I told her I probably never would have figured it out on my own…

Several months later, a new patient showed up in my clinic telling me of the pain she was experiencing in her hands and feet. The pain came and went with no rhyme or reason. It burned terribly, kept her for doing things for fear it would appear.

“Do your hands and feet change colors?”

 “YES! They turn red and I have to elevate them or run them under cold water to get them to stop.” Over the years she saw half a dozen specialists and was diagnosed with all manner of things: Fibromyalgia. Anxiety disorder. Neuropathy. Malingering. 

She cried. She had clearly suffered and I suspect the implication that she was crazy was just as excruciating as the physical pain itself. 

This time I got to be the full on hero. “You are NOT crazy. What you are experiencing has a name and a treatment!”

And by golly, she got better.

I have patients who come in all of the time and say sheepishly, “I know I shouldn’t be reading online but…” 

But what if that first woman had not? 

Maybe I would have referred her to someone who could eventually figure it out. Maybe she would have ended up like the second patient spending years suffering, passed from one specialist to the the next, always told it was all in her head. Then when that second patient showed up, I wouldn’t have had an answer for her, either. 

Patients teach me new things every day, sometimes it is something simple… like keeping my pride in check so I can actually hear what patients are saying.

The Tipping Point

Buildings in Philadelphia

“Do you have an appointment?” she asked.

“Nah. I’m just going to sit here until the weather passes,” the man said gruffly. He sat down in the corner out of her line of sight.

She shrugged and slid closed the clear glass window to the waiting room. He didn’t look threatening. Rain was pouring down outside. What did it matter if he sat for a few minutes?

He began talking into his phone loudly, clearly agitated about something. Patients looked at each other quizzically, shifting uncomfortably in their seats. They stole furtive glances at him, watching him mutter into the phone pressed against his face. It was impossible to hear exactly what he was saying between the growls.

When is the nurse going to call me back? Please let it be soon.

As he was talking the phone rang loudly. Clearly, he hadn’t been talking to anyone at all….

Then he stood, yelling into the ringing phone, threatening to kill anyone and everyone. As shaky fingers dialed 911, he bolted out of the door and ran across the parking lot never to be found again.

Perhaps I’m a silly dingbat but people behaving like that never would have bothered me in the past, at least not where I would have taken them seriously. 

Now though? We were all shaken up. I find myself wondering what is lying in wait around the corner of every person’s mind. I get nervous at airports and look over my shoulder at large events. Where is the next explosion going to come from? Who will fire the next bullet? Could I have stopped them?

Fear is sexy. Fear sells. Fear drives a wedge, keeping us from reaching out to help others. Fear protects us. Fear hurts us. Fear is necessary and yet it multiplies and it divides us. 

Part of me wants to just stay home, to never go anywhere anymore and then I remind myself that acts of courage are the only way to really combat fear. Anger only feeds fear. So does isolation. 

And so I get onto airplanes and take my kids to places that probably live as targets in someone else’s mind so that at least for me, fear will not win. 

Power Lines

Power lines

“Hey, Doc. Remember me?”

I quickly glanced again at the name on the chart. He was a new patient. His name did not ring a bell. I squinted at his face. Dark beard and hair with some gray in it, a bit shaggy, but fairly well groomed. Lips. No. Then his eyes. I remembered the eyes from somewhere….

My heart caught and my fingertips went numb.

“How do I know you?” I asked, playing dumb. 

I knew good and well who he was. 

He smiled at me. “February 14th, 2016.” He paused a second to let it sink in. “That was the day you found me guilty of aggravated sexual assault and sentenced me to 10 years in jail.”

I quickly tapped a help message on IM to my office manager. 

“I don’t remember…”

“Sure you do, Doc.” He leaned forward close, too close, and spoke again in barely a whisper. “They made a big deal about who you were during jury selection. Got out a bit early. I had very, very good behavior. Not a day went by, though, that I did not think about what I was going to do to you when I got out. I have a very good memory.”

He sat up straight. There was a knock on the door and my office manager popped his head in. 

“This visit is over. Leave,” I rasped, embarrassed that my voice caught in my throat like a frightened fool instead of conveying strength and force. 

Damn.

A look of mock hurt crossed his face and he laughed. “Fine. See you around, Doc.” 

He sauntered out, slowly, pausing before rounding the corner to look over his shoulder and wink.

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In case it needs clarifying, this IS a work of fiction.