By: Kaylyn Merrifield – Class of 2015
I open the heavy wooden doors of the clinic. As I enter the room I see a myriad of faces turn towards me. Patients of the clinic who have not met me before; they do not know who I am or why I am here. From seeing me they have already made some assumptions. I am dressed in clean clothes and neatly put together. This alone, without a word from my mouth has made it very obvious that I am not a patient here. There is an air of discomfort with my strangeness and the conversations humming throughout the room drop off into silence.
I try to make eye contact as I say my hellos but few raise their eyes to mine. I am an outsider: and rightly so. I look around the waiting room and take in every detail. It is a warm sunlit room- well used and well loved. The space is small and every bit of it is used to its capacity. A bulletin board boasts resources for food banks, clothing donation distribution, support groups for HIV/Hepatitis C, and local emergency housing. Not the typical community bulletin filled with yard sales, fitness classes, and missing pets. The chairs are mostly full, although the clinic doesn’t officially open for another 15 minutes. We have all gotten here early with anticipation for one thing or another, and now we wait.
As I take my seat in the waiting room I look out at the faces of the people around me and see a man dressed in many layers who is slumped down in his chair like a crumpled rag doll. A knotted winter scarf holds up his pants; he is unshaven and his clothing is worn thin and patched with dirt and stains. He is wearing two different shoes. He is slack jawed and the tips of his fingers on both hands are black and hard. I pause and hold my breath as I look to see if his chest is rising. My mind races to come up with what I will do if it is still. It rises and falls and I can now catch my breath too.
To my left is a couple with a baby and a garbage bag full of belongings. The young mother rummages for something to keep the baby entertained. I hear her asking her partner about how much formula they have left While most of the patients here make frequent panicked trips to the social work office and talk with ODSP on the phone frantically: this couple sits together and quietly makes conversation amongst themselves. They laugh often as they talk and play with their little girl, a brief moment of serenity in contrast with the surrounding harsh reality. I feel privileged as though I have been allowed in on a private moment within this family. They have a tired happiness about them, a worn love.
A young woman rushes in making apologies for being late. I smile at her and turn my attention back to my notes before I realize she is making these apologies specifically to me. She is very thin, every angle and bone accentuated by the clothing she is wearing two sizes too large. She returns my smile and starts telling me her story and although I want to listen to every word I feel as though an explanation is in order. I explain that I am only a medical student – but that I will be with her for her visit with the doctor and I would be honored if she would share her story with me. She proudly tells me that she has been “clean” for almost a month now and I congratulate her and ask what initiated the change. She looks over at me and tells me that her drug habit had gotten so expensive that it was a choice between buying drugs and being able to feed her dog. She chose her dog. I feel a knot in my throat as she tells me that he is helping her save her life. She is animated and although seemingly frail when she tells me about the things she has been through she speaks of strength beyond imagination. Her words and her kindness find their way to my heart and I am filled with a sense of awe and thankfulness.
We look at the clinic schedule and our first patient is the man who is slumped over the chair in the waiting room. He is a heavy IV drug user with a very difficult relationship with the law who follows up at the clinic for monitoring of his Hepatitis and addictions. Attempting to wake him up is no easy feat. He mumbles something incomprehensible and swats us away. The doctor does not give up but does take a step back. He asks if it would be better if they moved their appointment to another day. We look through the latest notes from the last ER visit and see that this patient is in end stage heart failure. The frostbite on his fingers is actually more likely ischemic emboli from an endocarditis, and the reason he is so exhausted is because he hasn’t been able to get a good nights sleep for months. He wakes up incredibly short of breath- gasping for air- struggling to fight this feeling of “drowning in his own skin”. In the ER consultation notes regarding medication and treatment compliance it reads, “it is highly unfortunate that I cannot prescribe common sense”.
Our last patient leaves a lasting impression. He enters the office distraught, tears welled up in his eyes: his housing stability has been interrupted. Since his last visit to the clinic he has been evicted from his apartment. He talks to us about coming home to a pile of his stuff on the front porch and different locks on the doors. The treatment he has received spending nights on the street is a tale of cruelty and harassment. As we talk to him we realize his distress is not at all about where he will sleep tonight or where he will go. He wants so badly to prove he is stable enough to start on the difficult Hepatitis C treatment regime. He is afraid that one more thing in his life has migrated beyond his control. He has gone through treatment before with success- and with his new serotype of Hepatitis C he is equally optimistic about his ability to save his body from this virus. His hope is catching and I am thankful that he is the last patient I will see on this day at the clinic.
I walk back through the heavy wooden doors and through the noisy soup kitchen. I have been given something that I wasn’t expecting today a reminder that nothing in this life is promised to you. Each day is a gift, and we can make choices in how we spend them regardless of the setting. To have a life where very basic things are missing; access to health care and resources, food, money, decent treatment by society. To have to survive all that and to still be: inspiring, hopeful, happy, and graceful. The people that I met at the clinic that day were able to be truly resilient in the wake of collapsing supports and spiraling self-destruction. That is a life worth examining.