Here are 2 Christmas stories to both break and warm the heart.

December 22nd, 1 o’clock. My patient, Emmet, drove me crazy. He had signed the list on the counter to talk to me and when I saw his name my heart sank. I dreaded meeting with him, didn’t call his name and instead called patients on the list that signed after him.  I hoped he would get tired of waiting and leave but that probably wasn’t going to happen because Emmet was homeless and had no where to go. He was caucasian, small in stature, sweaty forehead, beady eyes and sooo needy. It wasn’t clear what his diagnosis was. Psychiatrists at Fantus don’t put notes in the electronic medical record. Lovely. So I diagnosed him with a personality disorder. The man monologued in a sleep/deep snore-inducing monotone without pause. It was only necessary to utter an unhuh, okay, every couple of minutes. He would not stop. It was impossible to have a conversation with him – he did all the talking. He talked and talked and talked until I interrupted.

The monologue always covered the same issues: homeless, persistent cough, hep B, hernia; no money to buy transit cards; missing his mother.

A few months before, I had given Emmet $20 to buy a bus ticket to go see his mother. Elderly, sick and frail, she lived in a nursing home. He always referred to her as mother, never “my” mother. He would say, I need to see mother. That irritated me -him not using “my.” But instead of purchasing a bus ticket, he spent the money on other things. Emmet sheepishly apologized the next week in my office. I explained the apology wasn’t necessary because the money was given with no strings attached.

I went over to Firm A and found my buddy Ben, one of the attendings. I needed some advice. I knew Emmet was going to ask for money and I wasn’t sure what to do. I wanted to give him the money because it was Christmas and he should be with mother, but I didn’t want to set up a dynamic where I’d constantly be asked for money. I told Ben, “I’m running out of empathy for this patient.” He said he understood and asked if the patient drank or used drugs. He didn’t. Ben said he had given patients money before. We talked some more, he jokingly asked for money to buy a plane ticket to Nigeria, then I went back to Firm C with a plan A and B and called Emmet’s name.

The monologue began. Ugggh! Shoot me now!

It was almost Christmas and Emmet didn’t have money for a roundtrip Greyhound ticket to Moline to see mother. He wasn’t asking me for money though, he just wanted to let me know he was desperately trying to get back there to see mother for the holiday. And on and on he went, pulled back down into the whirlpool of his sad life, spinning the same sad stories in a circle without end. Mother, mother, mother… I stopped listening and thought about how to give him the money and get him out of my office. Once given the cash I wanted him to leave immediately. I couldn’t stand to hear him thank me profusely and submissively as he’d done when I gave him money the first time. I felt profoundly embarrassed by the cash transaction. The only way to do it was to be firm and rude if necessary – tell him I had another patient waiting and he had to go. I said, “Emmet, if I give you $20 will you accept it?” He said yes. I went to my green coat, took the blue wallet out and grabbed a crisp, green twenty-dollar bill and handed it to him. He was stunned and said thank you, Helen, and launched into another monologue. I got up from my chair and went into the hallway and replied, “You are welcome, Merry Christmas, but now you have to go, I have another patient.” Still launching. I got rude, “Now Emmet, you have to leave right now,” and I left him in my office and walked to the waiting room. Lucky for me another patient had signed the list and I called out the name as Emmet came through the door. He put out his hand to shake and said thank you again.

All I felt was relief that he was finally leaving the clinic. 

I sincerely hoped Emmet used the money this time for a bus ticket to Moline to see mother. I vowed not to give him money again.  

                                                             *****

December 22nd, 2:30pm.  Louva, of the clerks at the front desk, was on a mission.  She had one of the smokiest, raspiest, gravel-coated voices I had ever heard. And she was loud. She  informed me she was helping a patient get out of a nursing home in time to be home for Christmas. Nursing home staff insisted the woman had to have an appointment with her primary care doctor and get prescriptions filled. Louva  was working on that  – could I arrange transportation? Yes. The thought of anyone spending Christmas in a nursing home made me want to cry and was all the motivation I needed to make sure she got home to her family. I started making calls immediately.

Transportation arranged, patient left the nursing home and came to her clinic appointment the day before Christmas. Louva came to my office and said the woman and her husband wanted to meet and thank me for arranging transportation. I felt profoundly embarrassed. I didn’t need thanking. I was just doing my job, but I couldn’t say no, that would be rude. I wasn’t prepared for the train wreck that she was. The husband wheeled her into my office and she declared she was exhausted and in pain from sitting up for 5 straight hours (she had been laying in bed in the nursing home for weeks and didn’t realize the waits at County are killer.) 

The woman had stroked out; the right side of her face and cheek were contorted into a bulbous, super-tight knot and she spoke awkwardly out of the side of her mouth. Her pants were too short and exposed both calves. One was necrotic shades of blue, grey and purple. The other was encased in a hard, plastic, black boot that made me think of the villains in James Bond movies whose artificial limbs and gold teeth become dangerous weapons. The boot was very cool. But the purpose of the villainous, black boot was to heal the bone-deep, diabetic ulcers that were eating away at her foot.

They thanked me for arranging the ride and we chatted about life for a few minutes. The two had been married for 40 years. Wow! I asked what the secret was to such a long marriage. They laughed and said in unison – we love each other.

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