The waiting room chairs are empty. Crumpled newspapers in both Spanish and English are scattered on the floor, and candy wrappers in various shapes and colors are strewn around the bases of the chairs. The office is finally quiet, and the silence is haunting. The day has been busy, and the noisiness lingers despite the quiet. I can still feel the patients’ presence, and I worry. Did I miss anything? With the new schedule at our community health center that encourages double and triple booking, it can be challenging to find enough time to provide patients with safe and comprehensive health care. As I’m finishing up my paperwork, I hear the distant sound of reggae music. Is Leroy, the custodian, here early? His presence is calming. I settle back down to my work.
Why did the day seem so impossible? Was it my first patient of the day Irene who is schizophrenic and was shouting over and over in a shrill monotone, “I can’t breathe. Something is crushing my chest. I know it’s the flu. I don’t need to go to the hospital”. Or was it the new patient from Turkey who had recently been discharged from an unknown hospital in New York City who had no records, and who carried a mix of Turkish medicines and standard cardiac medicines from her recent hospitalization all in empty boxes? She had no insurance, couldn’t afford the confusing mix of medicines that she had run out of, and couldn’t find a “heart doctor” that would see her without payment. Her daughter was angry that we couldn’t provide samples of these medicines, and it wasn’t even clear which medicines were appropriate. Then there was the patient who needed a suspicious ovarian mass removed as soon as possible but was unable to get an urgent gynecology appointment because she was a new patient. Her entire family that I had never met before suddenly materialized, and everyone was feeling panicked. Another patient broke down crying because her mother was dying in Nicaragua, and she couldn’t travel to be with her.
The reggae music is now filtering up to my office. Is that Leroy singing? I re evaluate the day. It wasn’t totally unproductive. My schizophrenic patient calmed down and agreed to go to the hospital. I came up with a generic medication list for my patient from Turkey, and the social worker scheduled her to see a cardiologist who would accept charity care. I lined up an appointment with a gynecologist and scheduled preop testing for the patient with the ovarian mass.
I head downstairs and am greeted by the reggae music of Leroy whose job is just beginning. He will be working all night - the only one responsible for cleaning the entire 3-story building. He also has the challenge of trying to do the work of 3 or more people all by himself within a limited amount of time. He walks me to my car even though it isn’t his job. We have an outdoor lot, and there is no security after 4:30. Leroy dances and sings along to the music as he cleans. His Jamaican accent adds another dimension to the rhythm.
He pauses. “You look tired”.
“Well I am, but at least my shift is over”.
He laughs. “ Mine is just beginning”.
“Look how beautiful the sky is” he says, gazing up at it. “ It reminds me of Jamaica. In Jamaica we would never work like this. We know how to rest and enjoy life”.
He continues, “ Imagine this. My house is near this huge waterfall. You can practically sit under the waterfall and feel the power of the water. The sound is deafening. Nearby is a coconut tree. If you look up, you can see the coconut on top. For a small price, a boy will climb up and bring you the coconut. You split it in half and then you drink the coconut milk, which is green not white like the kind they sell here in the supermarket. You taste it, and it is so fresh. You let some spill onto your face because it is rich, creamy and good for your skin.”
His voice is lilting with the beat of the music. I sit down. ”If you look straight ahead, you can see fields and a full sky…space like you can’t imagine. Then you have a sip of a red stripe beer…it is a lager. You sit back and listen to the waterfall. What more do you need?”
“I’m trying to get back,” he says. “It’s so expensive, and I have to work. I changed jobs because I thought this job would be easier. It’s worse. In my other job I traveled and never saw my family so I changed to this job because I can stay in one place. Well I’m in one place all right. I’m always here because I don’t get hardly any days off. No time to see my family and not enough money to go home. I make it work though. I know one day I’ll get back. No use complaining.” He laughs. The beat of the music along with his raspy voice is hypnotic.
The parking lot is dark now, and we can barely see the outline of my car. No matter how busy Leroy is, he finds the time to walk me to my car.
“Leroy,” I say, “when I come in tomorrow I know the place will sparkle. Thanks for all of your hard work and for making sure I get to my car safely.”
“No problem,” he says. His smile is contagious.
As I get into my car, Leroy waits to make sure I am safe. In my mirror, I see his stooped figure outlined against the modern “state of the art” medical building, and as I drive off, I realize that it is Leroy’s classic style that is cutting edge.