Tuesday, May 1, 2012
Life at Grady: What you see
"Excuse me, doctor. I hate to bother you."
That's what this woman said to me one evening as I made my way out of the hospital. My stride was brisk; it signaled that I was on my way somewhere and that I wasn't exactly looking to be stopped. But on this day, I can't say that I was exactly in a hurry. My husband was picking up the children and taking them for haircuts that day so there wasn't any hard deadline I needed to make.
But still. It had been a long and mentally tough day. I was ready to go. For real.
I abruptly stopped in the hallway and gave her my attention. "Ma'am?"
Even though I stopped, I know that my body language was still communicating otherwise. Rocking side to side on my feet, hand on the strap of my tote bag, cell phone in my hand just waiting to be used. Sure, she had the floor for a moment--but only a moment.
"I hate to bother you, but I was just wondering if you might be able to give me some money to get something to eat. I don't never ask people things like this but when I saw you I thought I would just see what you said."
Now. Let me be honest. This? This is not an unusual thing to encounter at a place like Grady Hospital. Just ask anyone who has worked at Bellevue in NYC or Jackson Memorial in Miami or Parkland in Dallas or Cook County in Chicago or Charity in New Orleans. This is bound to happen to you at least once in a public hospital. Maybe even more than once. As for Grady, we're the safety-net hospital serving metropolitan Atlanta and all of its surrounding counties. Our patient population ranges from elders on fixed incomes who marched shoulder to shoulder with Dr. King to the newly uninsured to undocumented immigrants to our large population of homeless or unstably housed folks who are doing what Stevie Wonder called "living just enough for the city." So that means that getting asked for spare change or a few spare bills while inside of the hospital is common enough to leave your feathers unruffled.
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Some days, I just reach into my pocket and give whatever I have. I don't allow myself to think about what the person is going to do with the money or whether or not they are telling the truth. Almost always I find myself wondering whether or not I did the right thing. Asking myself things like, "Did I just buy someone a hit of crack cocaine?" Then I shake my head and tell myself that I did my part and the rest is up to someone far bigger and greater than me.
Then there are the days that I feel more critical and nitpicky. It's almost always after a rough week on the wards with lots of wretched social issues crippling my ability to care for my patients. Those are the days where I drive home fuming about how much I hate crack cocaine or any other kind of highly addictive illicit drug. My mind declares a war of sorts that manifests as mini-battles taken up with any and everything suspicious for drug involvement.
This was one of those days.
This was a simple enough question. Nitpicky, yes, but still a simple question. No, I wasn't trying to be passive-aggressive either. This was just a piece of information that I needed before deciding what I'd do next.
"Yes, ma'am," she replied.
I looked at her carefully and then nodded my head. "Alright. Let's go upstairs to the cafeteria. I'll buy you something to eat right now. Let's go." I waved my hand and prepared to walk toward the cafe.
"Uuuhh, see I'm at Gradys 'cause my daughter she in the hospital here. I want to go to visit her before the visiting hours is up, you know doc? So, you see what I'm sayin', I 'preciate you being willing to go get me something but what I was hoping you could do is just give me the money so I could get it a little bit later."
That whole convoluted answer immediately made me feel tired. I rubbed the side of my neck and craned it sideways. My eyes narrowed as I listened to her and my pulse quickened. "But I thought you said you were hungry? Listen, it's only five-something. You have a bunch of time before visiting hours is up."
I stopped there and immediately felt bad for assuming the worst. I tried to clean it up. "I'm sorry to hear about your daughter."
You know--the one that's in the hospital.
I pressed my fingers into my neck again.
"Oh, my daughter? Uh, yes ma'am. She okay. She just had a baby tha'as all. But, you know, I'm really just trying to get up there, you know what I'm sayin', before it get too late. So I was gon' go to the McDonalds or something after I saw her. So I mean, if you willing, you could just give me the money and I could take care of it. You ain't got to go all up to the cafeteria and all that."
She was talking fast and shifting from side to side nervously. The urgency in her voice didn't sound like that of a person who was simply hungry and that's it. She also looked to be somewhere in her mid-forties so it was certainly plausible that she could have a daughter somewhere in the hospital.
So I'll just go ahead and say what I was thinking. I was staring at this woman who stopped me in the lobby for some money and trying to discern whether this was an unfortunate plot by a person who was anxiously seeking a hit of something. And it feels terrible to admit that but it's true.
"I hear you," I finally said, "but listen, I'll walk you up to the cafeteria and buy you something to eat right now if you are hungry. I won't give you money, though."
She started laughing out loud and smiling when I said that. It was odd considering nothing I had said seemed to warrant such a thing. She continued with her jittery movements and side-stepping. "But doc, ain't you got a lot to do? You look like you on a mission, see what I'm sayin', so even if it's just something like one or two dollars, you know, I could jus--"
"Ms.. . . tell me your name?"
"My name Kathy."
"Okay, Ms. Kathy. So listen. You're right, I do have to go. But I have some time to go to the cafeteria. I'll get you a hot meal and you can save it or eat it right then and there. Okay?"
So I sort of marched off in the direction of the stairwell near the cafeteria. And now that I am replaying that interaction, I am slightly ashamed of the way that I did. It was almost begrudgingly.
But it had been one of those weeks.
Ms. Kathy followed me up those two flights of stairs. We entered the turn stall leading inside the cafeteria and instead of hitting the hot line, she went toward the sandwiches. She picked up two tuna sandwiches and a bag of potato chips. She also grabbed two Coca Colas.
"You don't want anything hot?"
"No'm. This good. This what I want."
I didn't say much more after that. I paid for her items and handed them all to her.
"I sure 'preciate you," she said while shoveling the sandwiches, chips and sodas into a plastic bag near the check out.
"No problem. Nice meeting you, Ms. Kathy. And congratulations."
She looked at me with a puzzled expression.
"On your daughter. And the baby."
"Oh, yeah . . yeah. Thank you, hear?"
And just like that she scurried down the hallway with that same pressured urgency.
I stood in the doorway of the cafeteria for a few moments thinking. Thinking about what Ms. Kathy had selected to eat, thinking about her behavior and thinking about all of the patients I'd seen that week with some kind of drug addiction. All that thinking in these situations is mostly futile, but nonetheless I still stood there thinking. And just like that, I felt like I'd been duped.
Damn. What if she wants to just sell the food? Or trade it for a rock? Damn.
Like always, I did my best to remember those Bible stories that tell of God approaching people in different forms asking for help. This was the only thing that would make me feel like I hadn't been hoodwinked and bamboozled.
Instead of taking the stairs back down I strolled over to the main elevators. And there she was--Ms. Kathy. Standing and waiting along with several others. She held up the bag and smiled big and wide in my direction. I gave her a nod and leaned against a wall several feet away from her. This was my way of telling her that she didn't need to thank me any more. Then again, I probably just didn't want to think about it anymore.
Even though I was on the other side of the hallway I kept watching her. Offering people that same overzealous laugh and watching their awkward responses. Tapping her feet and bopping around like some sort of windup doll. I sighed silently and this time clasped both of my hands behind my neck. A picture of Nancy Reagan on those anti-drug campaigns from my school days popped into my head: Just say no.
The more I watched Ms. Kathy, the more I wished I had. Said no, that is.
It was one of those days, see. One of those weeks even, so this was where I was. Frustrated with drugs and poverty and strongholds and all of it. I was two beats away from going right up to Ms. Kathy and flat out asking her about all of this. Like whether or not she really was hungry and if she had actually made as much of a fool out of me as I was feeling she had.
Fortunately the elevator opened up before I could.
Everyone filed into the elevator and one nice man pushed the ground floor button. I stuck my hands down into my white coat pockets and faced forward. Just as the doors began to shut, I noticed fidgety Ms. Kathy still standing outside. I pulled my hand from my pocket and thrust it between the door before they could close. An alarm went off and the doors instantly parted again.
"Ms. Kathy?" I called out to her, "You coming on the elevator?"
With her right hand she pointed upward which lifted the bag again since the straps were around her wrist. Then she said, "Y'all going down. The mother-baby unit on the fourth floor, remember?"
Oh right. That.
She leaned in so I could see her face as the doors were closing. Still appreciative and smiling. And perhaps, still nothing more than hungry and low on funds. My face grew warm as I replayed her voice in my head:
"The mother-baby unit on the fourth floor, remember?"
My bad, Ms. Kathy. It sure is.
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Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
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