I. Hope
Ray, an 81 year old African American man is in today for a recheck of his hypertension. Actually, it is not an accident that he is here the day after the election. 4 months ago, when I was planning his return appointment, and the date fell on October 31st, I said, no, Ray, I want you to come in the day after the election so that I can hear how you react to Obama winning the election. Doctor, I just can’t really believe it could happen, he said. I just don’t think they is going to let it happen, he said, shaking his head. Ray, I said, I think he is going to win, and I want you to be here when he does.
Today, walking in with Mary, my nurse, Ray practically jumps me, holds out is long right arm with a big hand and pulls me in a giant bear hug, practically knocking my glasses off. “You were right, Doctor, you were right!, he says. Later, when I get in the room, I decide to let him unload his thoughts and feelings before proceeding to check his blood pressure.
There’s something I never told you, he says. Oh? Remember I told you I was in World War II? I fought in the negro regiments. We had separate regiments. The army didn’t trust us so they wouldn’t give us any ammunition. I was stationed in Germany and France and worked as an engineer, protecting equipment and delivering ammunition. They gave us guns to watch guard, but they wouldn’t trust us to have ammunition, so the guns were empty. We could transport ammunition, or guard it, but we couldn’t use any and we couldn’t be involved in combat.
Afterwards when I got home to Mississippi, I figured I’d get a job pickin’ tomatos. But when they started treating me like a 2nd class citizen, you see I just got done fighting for peoples rights over in Germany, you see I just couldn’t take that any more. So I boarded a bus for Berrien Springs, Michigan and paid $19 for the ticket. That was in 1948. I got to Berrien Spring hoping I could pick fruit – peaches, pears, apples, whatever. But then we heard in Berrien Springs that there was a factory that had openings in Elkhart. So I took the bus, me and my buddy, over to Elkhart. There was a Gerber baby food factory there. We went in, they gave us a slip and said, “Go downtown and have a medical exam and come back here”. So I went into town, had the exam, and came back to the factory again. And they said I was hired, just like that.
Later that year, after I got settled, I voted for the first time. Now all the negroes had to live in the black part of town, on the east side of the railroad tracks. There was a drugstore there, it was owned by a white man, but it was in the black part of town, and that was where we voted. We had to go in the side door and that’s where I voted for Harry Truman. That was 1948.
I wanted to listen more, but I needed to transition into the reason for the visit, so I stood up and took out the blood pressure cuff. The blood pressure was normal.
I never thought I’d see this day, Doctor, he repeated, as I wrote out another prescription. Neither did I, I said. Thank you for telling me you thought he could win, doctor. I’ll never for get that. And one more thing, he says, with a twinkle, “You said if I quit smoking I would likely live to reach 90.” You have as good a chance as anyone, I thought.
II. Despair.
Stan, age 60, is sitting in the chair, his eyes down to the ground. He barely looks at me as I enter. It’s been almost a year since Stan has been in, and I wonder what has happened. He looks even more obese than last time. His enormous belly hangs out over a large “Vietnam Vet” belt buckle. His neck, face, legs, all swollen, overflowing. All 362 pounds. Looking down at his lab results I see that his diabetes has become completely uncontrolled since his last visit. He must have stopped taking his medicine. What happened?, I ask. I didn’t want to commit suicide and I didn’t want to live, he answered. So you stopped treating yourself? Yes, he answers, looking at the floor.
Stan has been depressed, on antidepressants, but to little avail. He is a modern day leper. He is on the sex offender list and can not travel, can not get a job and can not volunteer. “I thought I would pass my retirement traveling and volunteering, he says, but I can’t do either. “Have you thought about escaping?, I offer. Yes, I’d like to get to Mexico, so I can get away from this list. It is like eternal damnation. I wish that other crimes would go on a list too, like murder, robbery. But no, it’s just us sex offenders. Stan’s offence was having some illegal pictures on his computer. Now, after losing everything in his life, his freedom, his job, his self-worth, there is little left. What do you have left?, I ask. I have one friend he says. We like to go out sometimes.
How could I possibly motivate him to take care of his health I wonder. “It reminds me of how criminals were treated in previous centuries, I offer. “Oh?”, he says. “Did you ever read Les Miserables”, I ask. “No.” I write out the title on a prescription pad. You can get it on tape at the library, I think you might like it.
“Stan, I think you blood sugar is very high and it is hurting you. You should consider taking insulin to give your pancreas a break. The high blood sugars are damaging your pancreas and blood vessels.” After thinking about it a minute, he says, no , I’m going to get back to taking my medicine again and then I’d like to see how I’m doing in a month”. So we schedule an appointment in a month.
III. Apathy.
Al, age 52, is in for a check of his heart failure. Al is more or less eating himself to death. His weight is now up to 375#. He sits in the exam room with his portable oxygen. His face picked, bleeding from his nervous habit. His thin hair, long, hangs over the collar of his plaid shirt. The same plaid shirt and jeans he wore the last time I saw him.
“How are you feeling?”, I ask. “I’m doing OK”, he says, noncommittally. We review his recent echocardiogram. The medication has reversed the swollen heart, which now beats almost normally, except for atrial fibrillation, the quivering beat of the atrium that means we must keep him on blood thinners.
“I’m on disability now” he says. What do you enjoy doing?” I ask. Not much, he says. “Just keep up the house”. “Any family or friends?” I ask. “No, not really”. Feeling stymied, I scribble his prescriptions, and make plans to have him back in another 6 months.
