Jessica Gregg

The Reach

My first patient’s last drink was at six this morning. I am late, so it is almost nine before I see him. But still, it has only been three hours, and there is already a sheen of sweat on his forehead, and his hand shakes as he brings a paper cup of water to his mouth. 

He is thin, no shadow of a beard, no tattoos circling his forearms or crawling off his neck. Maybe in his early twenties? A man/boy. He reminds me of my son, Sam, and I think, “He is just a baby.” 

He perches on the hard black chair next to the exam room door, near a poster telling him it is okay not to be okay. I ask him if the light is bothering him. “No. No, it’s fine,” he assures me, “it’s not a problem.” But when I turn off the fluorescents overhead and switch on the little lamp in the corner, he sighs and leans his head back against the wall, and it is better. 

“I’m glad you’re here,” I tell him, and I mean it. 

He looks at his feet. “I’ll be okay,” he mumbles.

“Oh sweetie,” I say, “I know you will.”

I want to tell him that some mornings, I wake up with a trembly feeling of dread in my chest, or a flickering panic, for no reason other than I have an entire day ahead of me and I haven’t yet filled my mind with distractions from thoughts of not being good enough, fears of my kids grown up, maybe my husband gone, and me alone, wondering where everybody went. Some mornings, I think of my father, who died in a place he didn’t recognize, among people who barely knew him. I think, I can’t, I can’t, I can’t. 

Even if I’d been on time this morning, I wouldn’t have seen my patient arrive. As the doctor, I get to come in later, walking in the side entrance, past the line of people waiting outside. They start queuing before it is even light. Many have no housing, so they pitch their tents nearby and walk over in the predawn hours. Others are dropped off in cars driven by family or friends who park and wait, hoping. 

I generally pull up after the staff at front have explained that we’ll take as many as we can, but we likely can’t admit everyone; we don't have enough nurses, or beds. My arrival usually coincides with the Covid testing. Everyone must have a negative result to come in. Sometimes the test is positive, and I hear the nurse break the news. She says she is sorry, but the person won’t be able to come in after all, and she advises him to rest and hydrate if he develops symptoms. She says she doesn’t know where or how he can do that with no money and no place to stay, and she agrees it is horrible. She says again, she is sorry. 

When I first became a doctor, more than twenty years ago now, my children were small, my husband was still in school, and I was like the roadrunner in that old cartoon constantly zooming – from home to daycare to the hospital to the lub dubs of heart after heart to groceries to dinner to bath to sleep. I barely remember any of it other than a feeling of driving urgency and not enoughness. 

During my roadrunner days, I also filled in occasionally at a local “detox” where mostly indigent patients came to cut down or quit their use of alcohol and drugs. I’d travel from the hospital perched up in the hills down to a squat brick building near the river where I’d sit with patients in a windowless exam room furnished with a desk, an exam table, and wire racks stacked with boxes of scalpels, lidocaine, gauze, syringes, needles. I treated sinewy men with deep lines in their faces who said I looked too young to be a doctor and young women with long nails and Ugg boots who told me they were dancers – and then laughed sadly those first few times when I asked, with complete sincerity, “Ballet or modern?”  

Most of the staff who worked at the facility had histories of hard living and hard using themselves. I remember arriving one morning as a bearded man in the waiting room said fuck it, he was sick and needed a fix, and I heard the janitor respond, as he walked past, pushing a broom, “Nah, you got this, man. You can do this.” 

In the nurses’ station, I listened to a nurse croon, “I know, I know, I know,” as a thin woman with bleached blonde hair cried, and rocked, and cried. 

They were patients who asked for help in their shittiest of shit times and, with them, I stopped rushing. They trusted that place, its people, and me, by association. It was a trust I hadn’t earned, and I slowed down to live up to it. I loved that feeling, of being trusted, and living up to it. Now it is the only work I do. The only work I want.  

I ask my patient the usual questions about withdrawal. 

Does he have a headache and are sounds bothering him?

Yes, he replies, looking at his feet. Yes, his head is killing him. And yes, everything is too loud, and the sounds make the headache worse.

“And how is your anxiety?”

He opens his eyes and looks at me as if I have finally gotten to the only question that matters. Horrible, he says, now and every day, and the only way to get through each minute is to drink. But as soon as he starts, there is no stopping, and it has gotten so bad his boyfriend says he can’t come home again. But he has no one else and no place else to go. So now what will he do, he asks me. He has nothing.

“Oh honey. Oh sweetheart. I am so sorry.” I know the honeys and sweeties are not professional, but I don’t care. When I speak like this, I feel right, as if the two of us are in this together, and he can depend on me, and neither of us will be alone. 

But we aren’t really in it together and he can’t really depend on me. I will order pills that prevent seizures, pills that quiet the voices no one else can hear, and pills that steady tremulous hands. If he were withdrawing from heroin, or heroin’s nasty cousin, fentanyl, I would give him medication to quell the aching in his bones and to dampen a restlessness so deep that even in sleep he would kick, thrash, and moan. But I can’t offer permanent housing or help with rent that is long past due, and I can’t make a tired partner trust again. 

My father was a doctor too. And also a roadrunner. I’d catch glimpses of him in the morning as he left for the hospital before dawn, then maybe another glimpse at the dinner table, tired and quiet. Occasionally, he would have a weekend off or we would go on a family vacation, and I’d be surprised to find him with us, relaxing over coffee, or playing Risk with my brothers, the game laid out across the dining room table, infantries, cavalries, and artilleries scattered across the board’s continents. It would feel as if we’d suddenly been joined by a distant, mostly benevolent, uncle. 

I remember one summer morning, when I was about 11, my mother broke the news that my father would be coming home from work to take me out to lunch. Also, even though it was summer, I couldn’t wear shorts; I had to wear a blouse and pants, and I had to eat alone with my father. 

Oh, no. I told her. No, no. I did not want to go. She nodded. She said that didn’t think my father really wanted to go either. But he felt like he should know me better, and that as the child squeezed between two older brothers and a younger set of twins, I didn’t get enough attention.

It felt like being sentenced to lunch with the principal, or my pediatrician. We went to an Italian restaurant not too far from his office, the kind of restaurant that had linen tablecloths and quiet waiters. My father asked uncertain questions about school, what I was reading, who were my friends. I answered uncertainly back. The only part I liked about the meal was the unlimited bread with crispy tops and lots of butter. I think maybe that was the only part he liked as well. 

Now I want to go back in time and tell that sweet, striving man that I understand how hard he was trying. In fact, when I really think about it, I am stunned by the beauty in the effort effort, the gorgeousness in his reach. I want to go back and kiss him on his stubbly cheek and see the surprise in his eyes and tell him I know how much he loved me, that I remember that awkward lunch, and I love him in return. I love you, I love you, I love you. 

I’ve been trying to meditate, to get myself to slow down, to notice, to have more days with less fear. The other morning, my son called from college right in the middle of me trying to count a breath that had gotten away. I stopped trying to catch it and took the call. He said he had a funny story to tell me: a friend at school was leading a workshop on microaggressions and emailed Sam to tell him to be sure to attend. Sam is gay, and he says this is the same friend who sends him monthly updates on HIV vaccine trials, just because. He says she also told him she is so troubled by racism, she is “almost Black.” 

Sam reports these incidents with relish. I know he wants to make me laugh. I also wonder if he wants me to see these slices of his life, and to admire, as I do, how he navigates the complexities of a world gone haywire. I rack my brain to find something to tell him in return that will give him a glimpse of my life, maybe surprise him. I only manage the obvious and nothing new: I love you, I love you, I love you. 

My second patient is full of words, energy, and methamphetamines. He is in his mid 40s, and compact: short hair, short stature, and not stringy like so many other patients. Nourished. He doesn’t wait for me to ask questions, but jumps in, telling me he used crystal that morning to stay awake, but that meth isn’t really his thing. His problem is the blues, the fentanyl. Everyone is using them, and everyone is dying and that is why he is here. He tells me he used just before the doors opened so he’s feeling fine, but he knows it won’t last and he’ll start to kick soon. He wants to get off all of it, for good, and he is hoping for a spot in our residential treatment center: a bed, three meals a day, counseling.  

He is sitting on the same hard black plastic chair near the same poster assuring him about okayness, and I’m a few feet away on a stool in front of the computer, typing and nodding. I ask him what his withdrawal is like, which symptoms are the worst. He says, “Well, when I get sick, I gotta tell you, I can get an attitude.”  He says it in a confessional tone, but confessional like we are both thirteen-years-old and it is 2 AM at a middle school sleepover. It makes me laugh, which makes him laugh, and it is such a nice moment. 

Later, I ask our case manager and the counselors in charge of admissions if we can find my funny patient a spot in our residential treatment program. They tell me no, he has been barred from several programs for violence, most recently for beating his girlfriend. They tell me this nicely, but it seems that they are looking at me with some exasperation: every time, so naive. Maybe I just imagine it, but that doesn’t mean it isn’t also true. 

I see a similar exasperation on my daughter’s face when I ask how she is getting to the party, and she tells me she does not plan to drive; she and her friends will take the bus. I think it means they will be drinking, maybe stoned. One of her classmates was shot last year, a stray bullet in the head late at night in a neighborhood not far from ours. Last month, her school went into lockdown while a man with a gun stood outside looking for I-don’t-know-who. I don’t know what leeway to allow when the horror is over, what constraints to impose, or the right words to say. I tell her my phone will be next to me all night until she is home. She calls, “Okay mom,” over her shoulder, barely listening. Affectionate, exasperated. I hope she understands what I am saying: You are everything to me. Be safe. Don’t die. I love you, I love you, I love you. 

After we’d all grown up and moved out of the house, when his responsibilities to us were complete, my father left my mother, and then his work, and then most of his friends. I’ll never know for sure, and he’s not around to ask, but I think he retreated so far and so completely because he’d spent decades holding it all together, trying to seem less sad and anxious than he was. He was a man not okay with not being okay, and it was much easier to not be okay alone. 

He eventually remarried, to a tall, quiet woman who’d once been his patient and who had a passing resemblance to my mother. I didn’t know her well and only visited them rarely, but to my eyes it seemed they had a marriage founded mostly on a joint appreciation of Fox news and a commitment to not get in each other’s way. When my father started to forget things, and then to forget violently, shouting for keys to the car he was no longer safe to drive, ransacking cabinets for whisky that would only make things worse, the foundation did not hold, and she left him. 

We kids settled him in a nursing home in Los Angeles, near my eldest brother, Stephen, who would visit weekly, pouring Kahlua into our father’s Ensure to get him to drink it, and driving him to the beach, where they would sit quietly together in the car, and stare at the waves. Then Covid hit and the nursing home closed to visitors. We tried Facetime but my father found it confusing. He stopped eating, and wouldn’t leave his room, or his bed. Stephen was allowed to see him only at the very end. He said dad was tiny, a little bird-man who would likely not have recognized his son behind the yellow gown, mask, and goggles, even if he’d regained consciousness.

Sometimes that is the image that wakes me in the middle of the night and sends my thoughts in unwelcome directions. I imagine my father awake, like me, in the dark. Unlike me, he doesn’t know where he is, and he wonders why we’ve all left him. He wonders if we will ever come back. 

I try to be okay with not being okay with my father’s death and with pre-dawn emptiness, sorrow, and fear. To be okay with not being okay with the possibility that I may end up alone as well. 

I know my not okayness pales next to my patients’ not okayness. I also know that sadness and pain and loneliness, even when less than, keep me tender and aware. That maybe my lack of okay may really be okay: A minor dystopian superpower. 

We have several other posters dotting the walls of the medical area. They are all beautiful, printed on thick, textured paper with stunning artwork. One of the other doctors bought them all on Etsy, with her own money. There is a poster with multicolored hands reaching for the sky and the words “Human. Kind. Be both.” And another with painted butterflies: “The sun will rise, and we will try again.”

I’m embarrassed, remembering how I’d giggled with my patient about his attitude which, it turns out, was not okay. I’m too eager, I tell myself, to find okay where it doesn’t exist. Maybe marriages dissolve, and people die alone and afraid, and there is nothing okay about it. Maybe I am too ready to call survival hope and to honey and sweetie my way past despair. To suggest to my patients it is possible to make lemonade – even though the lemons are long gone and lining the pantries of those who have homes and kitchens and money to pay for them.

How dare I? How dare we? How dare we and our posters suggest that this terrible not okayness is just fine. That humans are kind. That just because the sun rises, they should try again. Perhaps our beautiful posters help me feel okay with others’ suffering. Perhaps for my patients they are an assault.  

But I’ve seen patients stop and read, sometimes take a selfie with a print, text it to a parent. My colleague told me about one petite woman, still a little high on meth and wearing the hot pink scrubs we provide on admission, who gave a shout of joy and did a short interpretive dance under one of the posters when she saw it. I don’t know which one it was, or what it said. And I don’t know if she even remembered it once the drugs were out of her system and her euphoria gone. Maybe she had a spot waiting for her in residential treatment, or maybe we’d found her a shelter bed, or maybe nothing. Maybe we had exactly not one thing to offer when she asked, “What now?” Maybe, absent any methamphetamine-fueled delight, she looked at the posters and thought, “This is what you have to offer? This is it?” Maybe she thought, “Fuck you.” 

And if she did, who could blame her? 

But maybe – and I know I am grasping at straws here, I really do – maybe she looked at the posters in the sober light of day and applauded the effort. Maybe tired, wrung out, no place to go, she saw how hard we were trying, and still saw beauty in the reach.  

Jessica Gregg: I am a physician and writer and have published stories and op-eds in The American Scholar, Commonweal, The New England Journal of Medicine, The Washington Post, Health Affairs, JAMA, Time magazine, The Fix, Salon, and Huffington Post.