They were musicians and journalists, a nurse from Africa, and a fallen man of the cloth. They were a contractor, a house painter, and a professor of mathematics. They were a lawyer from Afghanistan, a pediatrician from Iran, a mercenary out of the jungles of Central America, and an officer of the Army of the Republic of Vietnam. They were undocumented, disabled, or unemployed workers. They had worked on the railroads and the docks, in carnivals and hospitals, in factories and fields. They had worked as prostitutes, pimps, pushers, and panhandlers, or still did. They worked any number of low-wage jobs. They were veterans of wars both legal and covert and veterans of prisons and jails. Lewis had been a personal assistant to Red Skelton. Martin had been an athletic coach; he had an unfortunate thing for boys. John was a Reed College graduate but never took advantage of the fine education he got.
I worked in a clinic of last resort and these were my patients. They came from across the street or from across the globe and various spots in between. They were the dispossessed. They’d lost their homes, their jobs, their families, their friends and communities, and their homelands. They’d lost their opportunities, their prospects, and their civil rights. Or never had them to begin with. They’d lost their health. Some had lost their sanity as well. I was their doctor and they came to me for help. Much of the help they needed I could not provide.
They all lived in poverty. Many didn’t speak English; some of them couldn’t read. Some were on the streets because they were too cognitively disorganized to access the services to which they were entitled, like Social Security Disability. The majority had been abused, physically, sexually, emotionally — as children, adults, or both — at the hands of family, institutions, or states. Some abused themselves as well, with drugs and alcohol, but also with razor cuts across their forearms. Or Drano in their vagina. They told me stories from their childhood or their marriage or their war years that I could barely stomach to hear. Most were poorly educated. Many were born into a wretched circumstance and nothing ever changed for them after that. Others had fallen on hard times or bad choices or both. But most had been poor their entire lives. Not much had ever trickled down to them. Economic boom or bust, it didn’t matter.
They came to the clinic in clothing too thin for the cold. They came in layers of cheap shirts, vests, sweaters, dresses, and pants over saggy long underwear, a great strategy for living on the streets. They came in clothes too heavy for the heat because they were jacked up on too much meth or crack and couldn’t stand the cold. They came in long-sleeved shirts to hide their tracks. A few came veiled. Older women from somewhere else in the world usually came in black shapeless dresses, except for Lupe from Honduras who favored bright-colored, short-sleeved frocks. Ronald came in wide-lapelled, double-breasted suits, patterned ties in loud colors, and a spiffy hat set at a jaunty angle. I’d tell him he looked like a million bucks and boy did he love to hear that.
Some patients I saw only once. Some I knew for more than 20 years. They complained of all the usual things. They also complained that their bones were cold or insects lived under their skin. Shirley complained that a surgeon had ripped out her organs years ago and left her rotting deep inside. Lois complained that the neighbors were pumping poisonous gases into her vents. Carol claimed that five men had raped her from front and behind in the middle of the day in the middle of downtown Portland in an alley that did not exist — a fabrication, I suspected, that was not nearly as horrible as what she had actually endured as a child and refused to talk about. Their complaints were never trivial. To complain of something that does not matter is a privilege accorded only those with means.
Mr. Popov was the oldest at 99, a Russian journalist with a state-sanctioned job during the Soviet era, who became increasingly paranoid in his old age and I thought to myself, no wonder
. Jamal was the youngest at 16 and appeared to be a boy, but said he wasn’t sure, that his body was different. I suspected an undiagnosed condition of intersex rather than trans-sexuality, but he was too frightened to be examined and I never saw him again.
I learned that being poor meant grabbing the good things that came along because you never knew when they would come again.
The patients were sometimes deaf or blind, and Lida, who’d been sold off by her father into a marriage with an older man who would tie her to the bed, was mute. Regina had been hysterically blind for years. She gradually regained most of her vision and I decided not to take credit. I think she decided it no longer suited her to be blind.
Reggie offered to be my houseboy; he claimed he had experience and knew how to treat a lady right. He was drunk, so I laughed it off. Franklin wrote a letter detailing what he imagined doing with me in bed. I fired him. Stephanie suffered a homoerotic obsession with me, which the psychiatrist told me about afterwards. She tried to kill herself after the last of many times she called me at home and I hung up on her. Boundaries were sometimes an issue.
My patients quit smoking. They quit alcohol and heroin and methadone and crack and meth. They quit the guy who abused them and quit hooking. They quit being assholes and tried to be better people. Lots of times the quitting didn’t last; sometimes it did. When they disappeared from my practice it was because they’d been sent up to prison or a mental institution or had moved to a sunnier clime or had finally gotten a job with health insurance. Very often I had no idea where they’d gone.
A few of them overdosed in the waiting room or the restroom of the clinic. We revived every one of them. Kristine hid inside the playhouse we kept in the corner for the kids and wouldn’t come out. Ted, who was psychotic, threatened to shoot someone he knew and we had to empty out the clinic and call the police. Many more of them threatened to kill themselves and these ones usually did not. Others came in cheerful with plans for the future and then a week or two later would blow out their brains. Two of my patients shot themselves, one hanged himself, another took an overdose. Two men, two women, all white and native born. People of color don’t suicide as much.
Most of my patients died before their time. Of liver failure, heart failure, lung failure, kidney failure. Failure of the spirit. Much less often of cancer, because that was for old people. Many were found dead, in their beds or lying on the floor. George was found sitting stark naked and slumped in a chair pushed against the wall. George was young and apparently healthy. Many of those who died were not the ones I expected. This was hard on me.
They called me Doc, Doctor, Doctor Kullberg, Doctor Patsy, and just plain Patsy. I let them decide. Sometimes a guy would take the liberty of calling me by my given name to manufacture a chumminess he calculated would seduce me into giving him whatever he wanted. It was always a guy who did this. I called the patients mostly by their first names, but not always. Sometimes I called them sweetie. The older I got, the more I did this.
They brought me gifts. A bar of peach soap, embroidered linens, Russian chocolates, a Wandering Jew, a pen and pencil set, turquoise ear rings, and a mechanical Santa who danced to a Christmas ditty. They drew me pictures in pen and ink. They painted and fired a ceramic plate. They wrote me poems and shot videos of themselves. They composed and framed photographs and collages. They burned their favorite music onto CDs.
I learned that living in poverty entailed a lot of waiting, for the check or the decision, to see the specialist, to get a pair of glasses, to get out of jail, to reach the top of the housing list. They were always in line for something. I learned that being poor meant grabbing the good things that came along because you never knew when they would come again. That “a long time” when you are living in poverty often meant two or three weeks. That the dispossessed were smart to guard against their own expectations. That there are some events that people never recover from, especially the loss of a child. That some people had the fortitude to endure the unthinkable. And that I never would have been as brave or resourceful as they were.
What I learned was that I had to change many of my assumptions. That meeting people where they were at did not mean letting them walk all over me, that people lied to me much more than I wanted to believe, that being nice was not always the best strategy. I learned that I, too, could engage in lying and subterfuge, if I had to. I learned that making mistakes was inevitable and I had to come to terms with it or leave medicine. I learned that medicine was full of conflict with patients who wanted what I could not give them and didn’t want what I could. I had not expected it would be like that. I learned that I was not nearly as tough as I wanted to be. I learned that I had lots to give, but the best of it was not advice or information or prescriptions or referrals. It was affection and validation and consolation. It was to be their witness.
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served for more than two decades as medical director at the Multnomah County Health Department and as a primary care doctor for persons living with physical, mental, and addiction disorders. She has written award-winning articles about health and medicine, and in 2015 published her first novel, Girl in the River
, about the intimate life of a working girl in mid-20th century Portland. Kullberg and her husband live in her hometown, Portland, Oregon, where she facilitates writing workshops for incarcerated women through Write Around Portland and volunteers as radio engineer at Portland’s community radio station, KBOO. On the Ragged Edge of Medicine
is her most recent book.