Resident Poem Saturday, Oct 31 2009 

No battle lines

No septal hematoma

No septal deviation

No discharge

No epistaxis

Welcome to The Oupatient Clinic Saturday, Oct 17 2009 

I’ve transferred to a full-time position in the outpatient  clinic. It’s across the street from the new hospital and right next to the old hospital. Sandwiched in between old and new, the building is a ghost of the past that promises a future to patients that enter it.

There is abundant evidence of both human misery and mitigation of human misery on all four floors of the clinic.  

The clinic experience” starts outside of the building. Dozens of patients, many homeless, are just hanging out in front. It’s part freak show, part party, part circus, part the only place to be.  As I walk into the building I smell, see and hear: mentally ill patients responding to internal voices only; angry exchanges between patients in physical pain; a chorus of crying children and parents who warn “Shut up or I’ll whup your butt”); patients hocking cigarettes (they call out  “loose square” – it costs anywhere from 50 to 75 cents for one cigarette), t-shirts, lighters, bags of peanuts, chocolate bars (the seller pitches the candy to women claiming it’s “Pretty ladies day”); people pleading and yelling into cell phones; a county worker cries out “medication refills” and hands half-sheets to interested patients with step-by-step instuctions on how to get  medication by mail.

The air is full and thick with clouds of metastatic smoke.   

The people speak a patois unique to the downtrodden and marginalized. Half sentences, grammatically incorrect word choices, slang sounds slurred spoken and stitched together utterances originate in drug-addled, battered brains and flap past broken teeth bloody, gingivied gums and busted crusted, spittle-laced lips.   

Patients stagger, wobble instead of walk, damaged and disabled arms and legs jerk intermittently and at weird asymmetric angles from broken and battered bodies bent over wooden canes or crutches, dented and dirty aluminium walkers with worn and torn faux leather seats. Patients are pushed roughly in beat up wheelchairs by bitter, burned out relatives. Bloody bandages on necks, patches on eyes weeping watery discharge, dirty plaster casts, nostrils plugged with plastic canula tethered to portable oxygen tanks, swollen pregnant teen bellies. 

The poundage is astounding. I have never seen more obese people in one place in my entire life. These heavy weights don’t hide the fat and flab. Just the opposite. Elephantine women with butts as big as hot air balloons wear made-in-China tight stretchy, neon lime and silver pants that serve only to accentuate all that stretch-marked flesh. The men are massive, gigantesco and positively waddle under the weight. It’s like walking through the land of the giants.   

Health workers in short white and long gray lab coats with picture ID necklaces swiftly enter and exit the building oblivious to it all, a singular goal of treating this roiling sea of humanity.

There is a stern elderly, demented man in front of the clinic almost every day and has been for years. He has matted gray-white, filthy knots of dread locks that poke out all over his head. He wears blue sweat pants and a thick, soiled blue coat. The man stays off to himself and talks to no one. Occasionally I’ve heard him go off on insane swearing tirades, repeating over and over again, “Fucking bitch.” Years ago, social workers staged an intervention to get the patient evaluated for medication and housing. It failed miserably. And so like a mostly silent sentinel, he watches over the clinic entrance every day. A no smiles, no handshake version of a Wal-Mart greeter.

Like the undead zombies in Michael Jackson’s video, Thriller, all roads for the medically indigent and uninsured lead to the clinic.

Welcome to my world.