…Life Beyond the Window a short novel by Sahara Sutter The Fairy Tale was merely propaganda

“I bought this lot several years ago with the intent to build a house overlooking the water. It is four acres and one of the very few here that has not been built. Someday, maybe, I will get around to it. Until then, I park my boat around back and spend my evenings there when I can’t make it home. It serves as a jumping off point to clinics outside of the area. I cannot store much in the way of supplies here and it has been broken into twice in the past five years. Others here on the water try to keep an eye on it for me, but you know how that goes.”

The Torpedo came to a stop with the headlights shining on a bobbing small houseboat on the water. Antonio left the car and walked toward a small locked wooden mailbox. A key kept under the box opened it to reveal a rechargeable flashlight plugged in at an obtuse, yet very functional angle to accommodate an electric line. He grabbed it, slid the switch to the on position, and closed the mailbox.

“Yeah, I love it when a plan comes together. It is always a crapshoot. And finding your way in the dark around here can land you in the water” he said carefully feeling his way around.

“OK, I will get out of your hair and thank you for your time, company and transportation. Cindy --- I don’t even know your last name. How do I find you?” he asked.

“I thought you would never ask …wait … here is a business card. It was my work and cell number,” as I handed him the card.

He glanced down at the card… “Really?”

“Really.”

“Your last name is Peterson, too?” he asked.

“Peterson.” I replied.

“Great name and one that should be something I can remember, not that I could forget today. Thanks, Cindy.”

I handed him his fanny pack. “Yeah, your parents should have adopted me. I could have saved them some paperwork on the name change. Anything you need? Are you sure you have what you need?”

“I don’t ever need much of anything. It keeps things simple. Do you have an ink pen?” I quickly dug around my glove box and produced one. He was writing on the back of my business card as he said, “Please take care. Drive carefully. It can be quite dark out here if you had not noticed. If you take this driveway out to the road, turn right and that will wind its way into the main drag with signs to get you to 44 and head east. Here is my cell number if I can help.” He handed me my card back with his number on the back. “Do you have another card?”

“Sure,” I said and handed him another from the front compartment of my purse.

He walked away, but not before flashing a slight hint of a smile. I felt badly leaving him in a cold, dark shore and headed toward a boat of the same characteristics.

I stayed a few minutes to provide the benefit of my headlights before creeping back along the narrow path through the woods on the way back to the road. What a day and what a way to forget the rest of the world and enter a new one.
The trip home was uneventful. I found my way without Italian influence or directional nagging. Along the way, I tried to make a conscious effort to remember the way to the houseboat.

Once I got home, I found all as I had left it only darker and colder. The cats had found themselves individual parking places to sleep out the remainder of the night and into late morning. They barely noticed my arrival. The Torpedo seemed happy to be back in her concrete reinforced bunker and instantly relaxed into hibernation mode right next to the mail jeep. The house did not look too bad considering the unchaperoned feline frolicking that had no doubt occurred. A few throw rugs were caddywhompas and one chair was overturned. Hardly worth a call to the Human Society requesting they come and incarcerate them for being unruly kitties. They have certainly done much worse. My drapes were still hanging, the indoor plants had not been violated and crudely relocated, the bed pillows had not been shredded and the contents of the trash and dirty laundry basket were not displayed all over the house. Wow, what had happened to my heathens?

I tried telling them what my day had been like but my words barely registered in their notice. So, I merrily chatted away to myself and realized it may be awhile before I would be able to get to sleep.

So, into the shower for a long warm smoothing time and into some soft, warm jammies and a cup of herbal tea with honey from the microwave before sitting on the couch with my feet up and reflecting on the events of the previous 24 hours. How can I make sense of any of it?

I leaned back and just tried to feel my way through it the day. Before long, I had the sensation of floating and gently rolling up and down on the ocean. Birds above me were squawking, the waning sun kept my facing side a bit warmer; my lower legs were hanging in the water while sitting astride a surfboard. The cool air was descending to bring in a change in seasons. Life was grand – so focused on the future, yet taking a moment to savor the moment with only a slight hint of guilt and without a comparison to what lies ahead. Quite unlike the dominate thoughts of trying to put everything in life in its proper ladder climbing order and narrowly targeted toward a goal without considering the proper time and place for each. Without a thought toward loss or of the essential missing elements being put on hold for the someday that will never come again.

Operator – Can You Help Me Place this Call – Jim Croce

As with all other things, I planned to continue my schedule of every few weekends at the Oak Hill clinic. There I watched the working poor as they tried forever to get a dime ahead to have a moment when they did not worry about how to feed their kids or get enough gas to put into a decrepit car to get to work. They worked in fear of the boss who would readily replace you with someone else eagerly waiting for a job and convinced it was the golden opportunity to solve all their problems. These people were working their tails off to get through the day and hoping the next did not come too fast. When I was not managing data collection for grant applications, I did what I could to find large lots of toothbrushes being auctioned on eBay to give out. Occasionally, I would teach about hygiene, safe sex, childhood immunizations, and community services to help with food, transportation, training, and electricity. Despite all of our efforts, the working poor continued to arrive with miserable colds, terrible rashes, and painful joints. There was no end to their pain or needs and a definite paucity of resources.

More specifically, not only having had any visits of my imaginary self from the past, I had also not been able to make sense of any of it or explain it in any way that I felt comfortable telling others about. Maybe it simply was the result of dire need of a break from work and day-to-day life. Truthfully, though, I have been further up the creek and more stressed out in the past without the resulting images and unconscious communication with something or someone who no one else can acknowledge or see. So part of me was wondering still what it was all about, while the other part was grateful I no longer felt compelled to explain it, while yet another part of me really missed the visits and very much looked forward to the next one.

With that being said, while the apparitionist “Cinderella” was making herself scarce I got another visit of sorts from another unbelievable entity.

My office voicemail at my paying job was flashing with a message. Generally, I’m not in a big screaming rush to listen to these as generally they are questions from others who can’t figure out how to get something to work and by the time I returned the call not only have they figured out they have moved on and completely forgotten what the question was. I found that I often play the role of tech support and the help desk for personal friends and acquaintances who ask me things like “how do I open two windows on the same screen or how can I retrieve something that I deleted last week?”

Therefore, I was a bit surprised to hear the recorded voice of Antonio. I was also dismayed that I waited three days in my perpetual procrastination mode before even attempting to listen.

His voice was instantly recognizable and I felt a rush of adrenaline awakening my senses. Why in the world would this person be calling me? Not that I hadn’t thought of calling him, but I just could not think of a good enough reason to do so. I did not want to be like my techno-challenged friends who used me as a personal helpdesk. I did not want to ask any favors or for anything. I knew my chances of running into him again were incredibly remote as he chased all over the world for supplies and funding and policy and political influence for the bigger cause of helping others.

“Cindy,” he said. “I’m guessing you got home okay and I hope everything is going well. I would like to talk to you. We could use some help in DeLand, and I told Salihu that I knew just who to call. Please call my cell and let’s see if there is something we can do. Have a great day and give the cats a hug. Oh, by the way, Frank was discharged the other day and he is doing great. We got his ribs taped up, a splint for his shoulder and some follow-up care and transportation to the nearby clinic outside of St. Augustine. He should do just fine.”

How so like Antonio. He was a genuine oddity by every measure conceivable. Unique, yet nondescript. He lived not in his body but rather was a pure soul that used his arms and legs for transport.

Before calling him back, I briefly contemplated what lame excuse I can think of for not returning his call immediately. Ultimately, I wagered a bet with myself that he would not even ask; time just did not seem to be something that he noticed or kept track of. I was almost also willing to bet that if you asked him how old he was he would have to stop and do some math to figure it out. Time was more like a playground that he ran around in, tried out, and enjoyed all the pieces of equipment at random and unpredictable intervals instead of any linear progression through the park.

I closed the door to my office and dialed his number on my personal cell phone. Mostly because I did not want anyone accusing me of mixing personal and work matters let alone utilizing company equipment to do so. My employer was a bit fussy about such things and anything I can do to prevent further problems down the line was such a simple task and was well worth the effort.

His phone rang and I expected to get his voicemail, as he would be quite busy. Much to my surprise (I should be over being surprised with anything regarding Antonio by this point), he answered the phone and not only answered the phone, but answered it with “Hellooooo, Cindy!”

Before I could respond, he added, “can you hang on for just a second, I am about done here…. Please don’t go away I will finish up and I will be right back…. stay online.” In the background, I could hear the clanking of some handheld instruments and some brief instructions to the patient regarding how to care for the wound and how he wanted to see the patient again later this week along with what hours the clinic would be open and what times he would be there. He also added that if he was not available to ask Laurie to look at the sutures. He reminded the patient to be careful and to tell his wife hello from Dr. P.

“I’m sorry - just had to finish that up. The poor guy had a run in with some broken glass while picking up trash on his West side run this morning. How ya doing?” he asked.

“I’m doing fine. Back to work and everything is back to usual and keeping busy. I wondered how you were doing. I’m glad you called,” I replied.

“Honestly, Cindy, we could use some help if you are available. We lost one of our PA’s to some family issues in Wisconsin. I am not sure he is going to be back anytime soon – and of course, his hundreds of patients did not go with him. We also would like to start up a database that would compare and contrast the health needs and expenditures of those who routinely utilize their clinic versus those who land in the Emergency Room. We need a mechanism to collect some accurate data and history and inventory of supplies and funding sources for that matter. I need some irrefutable and absolute hard-core evidence that what we are doing is worthy of support for more than humanitarian reasons to make believers out of politicians and those who hold the purse strings. I wish I could give you more details in something besides just a vision, but truthfully, that is where we need you to help us out. Whatever time you have we would be most grateful for. Tell me what you think,” he said.

“Wow. You know how to make a girl feel special. How can I turn down such an offer? I will have to look at my schedule and see what coverage they can arrange for the Oak Hill clinic and of course I still have this full-time job that gets in the way of my life on occasion. So, I am not sure at this point when or how much time I have available but I will certainly do what I can to free up anything possible. Whom do I talk to about schedules, time, and places? I’ve never been to the DeLand clinic so I’m not real sure even where it is located.”

“It might be best if you speak with Sal about some of this. He is my right arm when it comes to day-to-day operations and coordinating everything. There is not much of anything he does not know. He has trained me well on how to get things done and he probably knows me better than anybody - at least he should. He’s my son. Give him a call at 386--555-1943,” Antonio replied.

“I look forward to meeting him! Especially if he is anything like you. I have to get off to a meeting now but I will call him this afternoon, which will also give me time to look at my schedule. Thanks so much, Antonio. I appreciate the thought,” I said.

“Ok Cindy, I have got to run. Keep in touch. Take care. Later.”

The contents of my cranium did a slight spin on its axis. On the other hand, perhaps the room was rotating faster than my eyes could keep up. It was kind of the disorientation euphoria of riding a roller coaster in the dark and I’m not sure why because I had just agreed to take on yet more work on the when I was overwhelmingly suffocating on the heap currently surrounding me. Besides, DeLand was a town I avoided at all costs. It was a place filled with bad vibes, home to horrible memories, unfinished business, Stetson University, and the specter of grandpa.

Somewhere Over the Rainbow – Norah Jones

After that, I checked my schedule at the clinic. Usually I worked two Saturdays a month. My next weekend to work was two weeks away. That gave me some time to check out the DeLand site and see what I wanted to do before needing to make any schedule changes in Oak Hill. They would have some problems covering for me but wintertime patient volumes usually dwindled in this area as the migrant workers headed further south in search of crops and oranges in need of help. I would think that trend would likewise apply to DeLand, but who knows.

Then, as is common for me before I make decisions such as this, I conducted my own reality self-check. What am I doing, why, and is it a good idea? Interestingly, the answer to all three questions was the same. I did not know. That should be a red flag to consider things further and to ask more questions, dig deeper, find out more, put a decision off for a day or two, wait a bit, ask for more opinions, discuss with others, the list goes on. Nonetheless, I could think of only one thing to do. I picked up my cell and called Sal.

The phone rang twice before an incredibly polite and soft-spoken man answered.

“Hello. This is Sal. How may I help you?” At first, I thought I might have called the Hilton reservation line by mistake. I made a quick mental comparison with how the phone is answered in the Oak Hill - when and if it is answered. Manners are not at the top of things to keep in mind there. People were overworked, hurried and without supplies – like paper and pens. Every call was one more impossible problem that they seriously wanted to resolve before six more just like it walked in the door. Sal had the verbal patience of a Saint and the calming phone demeanor of Archangel Michael. He welcomed whatever it was I had to say via ESP vibes sent by AT&T.
“Good morning” (I was hoping it was indeed still morning. I had not looked at the clock since I arrived to the office this morning), “This is Cindy Peterson. Dr Peterson asked that I call you.”

“Ms. Peterson. He told me to expect your call. Thank you for calling. Please tell me what I may do for you.” I liked this guy already.

“He asked me if I might be available to help with the DeLand clinic every now and then. I took a look at my schedule and found I am available this Saturday but I also want to work around your schedule at the clinic. What days and times could I best help you?”

“Ms. Peterson, our clinic stays pretty busy and we are just most grateful for any help at any time. Please, you are in charge here. You tell me,” he said in his gentle and convincing manner.

“OK, how about this Saturday? I would like to come and look and see what I can do. What time and where are you folks located?”

“We would be most glad to have you here! Usually on Saturdays, patients start showing up about 8 am and we try to close up by five. Of course, there are exceptions. Our clinic is at 846 Michigan Ave, near the Baptist Church and in an old storefront. You can park around the back. Look out for the drainage ditch – you can get stuck there very easily. Also, wear something comfortable and if you have some alcohol hand gel for your personal use, please bring it. We do not have running water or paper towels here sometimes. The city is having some problems maintaining water pressure while they change out the water system. It should be fixed by next week. The paper towels are back ordered and might be delivered by Saturday.”

“Sal, what can you tell me about your clinic and the patients?” I asked.

“Our clientele is mostly very poor working people without means for health care or insurance. Most speak at least some English but there is always someone here who can translate for you if you need it. Our supply of medications is limited. We do what we can to get samples from Pharmaceutical representatives, but they are not always willing to share. Some local physician offices will donate their unused meds to us on occasion. We mostly patch up injuries, do assessments/physicals, plenty of education, and make referrals when and where we can. Most of our supplies are donated and we do have some benefactors who are likewise concerned about the health of our poor and support our efforts.”

“I am very much so looking forward to meeting you and I plan to be there Saturday morning. Please let me know if I can do anything further before then or if things change for any reason, you have my number,” I said.

“I likewise look forward to meeting you and as sure as the sun will rise on Saturday, we will have plenty of opportunity to help others that day. I wish I could say we could fix all the boo-boos in the world but on the contrary, I can guarantee that there will be plenty here to do and that we and the patients will be deeply grateful for your assistance in whatever capacity you can provide it.”

College was to some a myth not unlike perhaps the dashing prince who shows up on the regal white horse to swoop you away to an endless land of happiness and joy for all forever and ever. It simply is not remotely accurate and I am unsure why I could not entirely let go of the hope behind that fairy tale. I refused to accept the world and all the nastiness and horror within its mountains of shattered humanity. That reality, incidentally, was not taught to you in school. (Perhaps to keep students from flooding out the front doors in all haste). Nonetheless, the system that I so abhorred produced the people that I so loved.

The amazing part of health care came down to self-esteem on the part of the patient and support systems and the fact that somebody somewhere in their lives gave a damn for them. Someone thought they were important enough to provide an opportunity to share some joy and concern for the god-forsaken world of the discarded misfits.

The entire realm of health care is not about health at all, but instead about the person -- letting someone know that you cared and were willing to donate some of your time and effort and energy to make life a little better for them. I often wondered how people got through the day in some situations in which they found themselves. I marveled at how they could extend themselves to likewise take care of others such as children and parents when they had absolutely no resources, no coping skills, and no ability to adequately care for themselves. I wondered what was ultimately to become of those residing in a primeval quicksand determined to engulf every glimmer of sunshine and shred of hope. What these people needed were things that no one could accomplish on individual basis. This included clean running water, sewer systems, means to store food safely, adequate clean clothing, and an educational system that was safe and nurturing. I have no doubt that some of these things were not even within the vocabulary of parents raising their children on migrant farms.

Yet, these people could miraculously be the most innovative, caring, and thoughtful inhabitants of the planet – far surpassing those of extravagant means. Instead of pleasing the demigods of corporate finance, or pursuing the intolerant dictates of researched best practice, there was no denying a greater force of touching and feeding souls.

What happened to my country I had served that it could not provide something as banal as a tongue blade to help these patients? Perhaps most importantly, well okay not most importantly, but certainly worthy of consideration - how was this new clinic experience going to affect my outlook on life once again? Will I be able to maintain my stamina in hopes of providing significant help for this population without depressing myself within the larger myth that is health care? Is Salihu asking for my help because they are seriously desperate or because Dr. P. honestly believes that maybe I can be an asset to his organization? Provided, of course there is enough organization to the organization to be considered one.

Nonetheless, I was anxious to see what next Saturday would bring. I got onto the Internet to Google the site and do a MapQuest to find out how to get there. It was not surprising to find the clinic was hardly located in the higher rent end of town. There are several abandoned buildings around and the area was known for a high crime rate and random acts of violence. At least in Oak Hill the residence, staff, and neighborhood had grown to know me and I felt safe in that environment. Never have I encountered a situation there that seriously scared me other than the one time when the crack addict showed up demanding drugs. We pride ourselves on not calling the police except in absolute emergencies to help our public image. We are not there to scare the local residents. The clinic should be a place to go in search of help and not one that could result in a terrifying experience. The overwhelming number of people who attended the clinic were patient and grateful. They attempted to pay us with homemade bean soup, goat cheese, and ingenuously resourceful handmade trinkets. One middle-aged lady even begged me with tears in her eyes to please take her grandchild. She wanted the best for him and for some misguided reason, thought I could provide that. I wondered if the clientele in DeLand would have much in common with what I was so familiar. I know the west side of the county had more migrant labor camps than was typically found on the east side. My Spanish, at best was minimal and generally limited to the numbers from one through 10. I am assuming Latin was not a helpful option with this population or any for that matter.

I was hopeful that most of my work could be done with the computer system thereby escaping some of the heart-breaking social and emotional entanglements that come with the patients and their impossible problems. Computers seem to be less inclined to go out of their way to create their own problems. For example, few had drug addictions, smoked, drank alcohol, became pregnant or called abandoned cars home. Granted computers can have their share of bugs - some of which were contagious. However, they have no goals, ambitions, or hopes. They merely existed within the realm of their self-accepted limitations and agreed to be nothing more than what they were. Nonetheless, computers were largely easily fixable. You could make them something more; you could make them function better; you could find solutions to problems that were logical, predictable, and reliable within controlled drop down lists without all the messy sticky social situations and human elements of emotion and despair getting into the way of your work.

Even when I was in PA school, I preferred working with comatose patients because it limited the problems to those of which I knew how to address and in some cases could fix, prevent, or repair. These interventions were under my control and quite unlike the walkie-talkies who go out and interact with twisted, dysfunctional, and aberrant social and health systems.

Furthermore, I have often wondered why being poor had to mean so much more than being unable to go on a cruise, buy a diamond ring, drive your dream car, or get a facelift. Why did poor go so far into the roots of existence and well beyond dictating what you ate or how you ate it but into if indeed you ate it all or were able to survive what little often ‘former dumpster food’ you just ingested. Why did the degree of poor literally become the measure of life and death? I have often wondered how humans got a toehold on this planet at all. How did we survive before pizza delivery and Dial soap? Who would have wanted to survive in a damp cave without an electric blanket, pillow, or a toothbrush whilst knowing that any type of wild hungry animal could be joining you at any moment and with little means to defend yourself? I wonder today if survival for some of these people is any easier than that. So many people are born with nothing into a world determined to keep it that way? I suppose we could spend lifetimes looking for justice in the grand design. Perhaps it would just be better to abandon that search and do what we can with what we have while we have it.

True to the Google search, the clinic was located in an abandoned storefront strip mall and smack out in the middle of what could politely and generously be described as the ghetto. I was instantly glad I had not brought the Torpedo and that I had opted for the mail truck instead. While still unique within this community, it seemed to arouse less interest. Furthermore, it was easier to lock up and since there was no trunk it was easy to see that there were no contents within the vehicle were worthy of the amount of effort needed to be expended to break-in. Being mindful of Sal’s comments, I parked around back and steered clear of the ditch. The back of the building was home to several battered trashcans and a creeping colony of black mold growing up the back wall. The roof overhang was in dire need of repair. I walked around front and was grateful there was enough daylight peeking through the trees to make up for the shattered and non-functional streetlight above. At least, I noticed that the broken glass had been removed and attempts had been made to reduce or remove whatever hazards possible on the grounds.

I had brought with me only the essentials – my stethoscope in a lab coat pocket over a pair of jeans and button down cotton blouse, a Phillips head screw driver to break into computer cases if needed, an ink pen, hand gel, and box of lollipops that I had found to be the best medicine for many patients at the Oak Hill site.

The windows were open, the screen door led into a room about the size of an average large living room. There, at the front desk, was a gentleman in his late 20s of Indian descent with a welcoming smile upon his face. I instantly realized that the polite voice I had heard several days earlier on the telephone lived within this man.

“Ms. Peterson?” he asked.

“Actually, I do best with Cindy. But yes, that is me,” I replied.

“I am very happy to meet you. I am Salihu and I have heard so much about you from my father. Welcome to our clinic. I know you will enjoy your time here very much and our patients will be very happy to meet you. Dr. Peterson is at the health department today. He is negotiating with the charity organization there attempting to procure some flu vaccine for clinic. I am not sure if he will be here or not. You just never know.”

“I am very happy to meet you. Dr. Peterson is just simply an incredibly remarkable individual who never seems to run out of energy and is very passionate about his work. I am hoping there is some way that I will be able to assist you and your clinic. Would you mind if I took a look around the place?” I asked.

“Come, I will show you. It does not look like much but we do an amazing amount of work and utilize everything we have to the maximum. We may not always have what we need when we need it, but eventually we do find a way to get some of what we need at least some of the time. My background is in social work and I have access to many community resources and contacts that can aid in finding assistance for some of our patients. The trick is knowing how to properly apply this in the correct amounts and in the correct situations. As of course with all things in need, there is never enough to go around. So I try to be generous with the love, yet I must be frugal with the management of supplies and resources to ensure we can help the most in the most cost effective and efficient manner. Sometimes it is quite a juggling act and if there is ever a question, I generally cave in and side with the patient. I’m sure some of my contacts think that all I ever do is ask for a free handout but in reality we do try to trade and barter as much as humanly possible to get through the day and still make a difference for those who show up in here looking for help.

“Some of those who come here have substance abuse issues, a very few have full-blown cases of AIDS, most have issues coping with what life has dealt them. The health department, about two miles away, handles most of the HIV/AIDS patients. If they do show up here, it is for other reasons, usually chronic illness, colds, or rashes. We don’t do obstetrics care. We just do not have the equipment to do it well and there is a pregnancy clinic three blocks away that specializes in this and does a better job than we ever could. It does not mean that some of our patients are not pregnant and we do some pregnancy testing here but that is about the extent of it. We get many minor injuries, which we can patch up depending upon the extent. We also have a minimal supply of antibiotics, antihistamines, and tons of vitamins we offer as needed all free of charge. Otherwise, we write very few prescriptions because our clientele just cannot afford to purchase the medications.

“Basically, I am the triage area where I get the basic information of why the patient has shown up. Often patients are reluctant to provide real names, addresses, and accurate data of birth and lately I have given up trying to get Social Security numbers. We do have some frequent fliers who show up often and it is not uncommon for their name to change from visit to visit. We do require that they are currently working at least 20 hours a week. Proving that is a bit tricky at times. We like to see a paycheck stub with their name on it or they will tell us their place of employment and I will call to verify. They do change jobs often and sometimes have multiple jobs part time. At times, they will try to use a pay stub from another person or give me a phone number that is out of order. If their need is not acute, I will reschedule them to a time when they can provide the necessary info. In reality, we can treat non-working folks, but they should really go to the health department for their care. It comes down to limited resources. I try to schedule patients as I can, if they call. Otherwise, they must wait in line as they show up and as emergencies take precedence. You will see how quickly things get busy in a few minutes as I will be putting chairs outside which will be the waiting area. When the weather is bad, I do what I can to make room inside for them but that means things get fairly cramped very quickly. Sometimes I ask if the less acute patients can come back in two to three hours… but then they have transportation issues which makes it difficult for them to return.

“This folding table has concrete blocks under it because it is used as our exam table and this is where most of the assessments take place. We have a rolling curtain over there that we use for privacy. In this closet, we have the basic supplies for securing and cleaning and dressing wounds. The only sink we have is located in the back here. And here is where we wash and reuse our gloves. That may be something you have not done before but here the patients are a bigger threat to you pathologically than you are to them. We do have clean and sterile gloves but we must use them judicially. The refrigerator with the vaccines is in the back room and our lab draws here are limited to blood glucose finger sticks. All other draws are sent to a local lab. I will have to help you with the funding part of the process.”

“Sal, is there anything here you do not do? I am guessing you do the supplies, ordering inventory, patient scheduling, verifications, assist with finding funding and community resources. I bet you are the one who washes the gloves. I am willing to bet you are inspected on occasion and have a ton of regulations to abide by. Who else works here to help out?” I inquired.

“Oh yes, that would be Milner, a PA who comes in three times a week and Laurie. She used to be an RN, but ran into some tough times and now works as an Aide. She is homeless and her schedule is a bit unpredictable. But she is great with the patients They just love her to death. She will make some assessments and do some education. Sometimes, when it is really cold out, I make her spend the night here and sleep on our exam table. She takes a shower here each week. Milner should be in today about 10:30. He works night shift at the local Emergency Room and tries to get some sleep before coming in.”

“Where are your medical records?” I asked.

“Right now, they are filed between my ears. Documentation is something we are working on. Dr. P wants to get this information into a database so we can start showing the world that applying small amounts of health care can make big differences. I hear you know computers very well.”

“Don’t believe everything you hear to any great extent. Yes, I work with informatics and can easily create data bases but looks like what you need here is a process and perhaps some equipment,” I replied.

“That is part of the issue. This clinic gets broken into about once a month. They never take medical equipment, the refrigerator, the ceiling fans, or the furniture. They leave everything so we can continue working but the computers have never seemed to stay here long. They disappeared with predictable regularity. I was concerned about putting patient information on them because of privacy issues. We need to come up with a better system,” Sal explained

“Ok, that is something I will work on. Maybe together we can come up with a plan that will work. What are you using now to keep track of things?”

“I have an iPad that stays with me wherever I go. It is not ideal for everything, but it has the virtue of still being around the next day when I take it home with me,” Sal replied.

“I can’t believe you run this place with such a small group of people. How do you folks manage?”

“We run – fast. We have cut back our hours to only three days a week – Mondays, Wednesdays and Saturdays. Saturdays are usually the busiest. Sometimes a student will come in to help out, but right now the regulars are only Milner, Laurie, myself, and my father.”

I made a cursory look over of the place, trying to memorize where was what and review what Sal had told me. Though a cracked, curtain-less window, I could see one person walking slowly down the street and likely headed this way despite it being another 40 minutes before the official opening time. This clinic was smaller than the one in Oak Hill and sounded as if it may be busier.

I noticed the artwork on the walls was limited to single pieces of paper put up with thumbtacks. Some appeared as if children had drawn pictures of people working in the clinic. A few others had sayings to help patients and workers get through the day. One in particular caught my attention. On a single piece of lined notebook paper and handwritten by the same author over what appeared to be several months was the following:

- How wonderful it is that nobody need wait a single moment more before starting to improve the world. Anne Frank

- What an honor it is to be trusted with the care of the most precious person in another’s life at the time they are most venerable. Welcome to health care.

- If the WHY is important enough, the HOW becomes easy.

- Let go of frustration – it needs you much more than you need it.

- If everything is under your control, you are simply not going fast enough. Mario Andretti

- Just for today, be nice to someone different from yourself. Someone you do not like, someone easy to overlook. Someone you did not notice; someone you were afraid of. Some people are dying from lack of attention – share yours with them.

- There is always a better way. Your challenge is to find it.

- Kindness makes life worth living.

- How can you make the world a better place? Start 10 feet away – with the elderly person sitting on the park bench or the homeless guy at the corner, a foreigner who speaks no English, a single mom on welfare, someone of a different religion, a rapper, a businessman, and the bus driver. Simply say good morning and smile. Make the world a better place, one person at a time – speak the universal language of acknowledging another human being.

- Start by doing what is necessary, then do what is possible, and suddenly you are doing the impossible. Saint Francis of Assisi

- Do not let anyone leave you without being better or happier because they met you.

- We cannot solve problems by using the same kind of thinking we used when we created them. Albert Einstein

- It is the quality of our work which will please God and not the quantity. Mahatma Gandhi

- We can do no great things. But we can do small things with great love, and together we can do something wonderful. Mother Teresa

- Either do or do not. There is no “try.” Yoda

AJP

And so it began. Salihu opened the front door and a few timid, but polite locals walked through the door and were greeted by Sal with a smile on his face and generally by name. He checked their identification if necessary and wrote the patient’s name and their major complaint on a small piece of paper – often with previous scratched out information written on the backside. From there, he directed them to a row of chairs along one inside wall of the room.

One at a time, I invited them (sometimes there were multiple’s as children tag along with mothers or adults came with elderly parents) to my makeshift exam table. There I introduced myself, talked to them, tried to get a sense of what was going on, what was their history, what was it that led up to their chief complaint, and complete an assessment. Most of the problems dealt with pain, a few had rashes or GI concerns. All of them were friendly and happy to see me. Frequently, I needed to consult with Sal to inquire about resources and supplies and how we went about getting things like x-rays and referrals - which for the most part entered the realm of highly unlikely. I bandaged boo-boos and discussed dietary habits, inquired about their living situations and tried to find the best ways to make them comfortable with what little they had. Each one of them left me with a hug and a smile and in return, I presented them with their favorite colored lollipop.

Sal was most gracious and tolerant with my no doubt slower than usual assessment and patient throughput. I genuinely found the experience enjoyable albeit I also was feeling the need more than anything in the world for a shower within the first 10 patients. It was interesting to talk to them and find out how they lived in what kind of work they did. Most of them were migrant workers, some worked on loading docks, some worked for small sanitation businesses such as those who dig a hole for septic tanks, a few drove the truck and picked up road kill from county roadways, and several worked for the city landfill. To the best of my understanding, none of them had any type of insurance; they did not qualify for Medicaid or Medicare, and most had never had a primary health care provider that they had seen more than once or outside of the emergency room - other than in this clinic.

A good day was one in which they could make someone else laugh and find a comfortable place to sleep at the end of the day. Their resources existed only in the moment, rarely beyond the next meal and sometimes they borrowed on meager favors of an entire week to just hold fast to any fleeting hope. Their work was often much like a paper wrapper on a Big Mac – necessary but very temporary. Yet their collective genius endured in finding an endless array of sinking lifeboats upon an eternal sea of challenge. I was struck with how being so poor was a very stressful 24 hour a day job in survival and the vast numbers of the unseen poor in society.

From their appearance, it was obvious they were making do and getting by with very little. Some of them mentioned getting food at a local food bank or clothes and shoes from local charities. I learned a lot of the services nearby just within a few hours of talking to the patients and their families.

As Sal had said, Milner did show up about 10:30. He was a tall guy, about 6 foot, with a medium build and freckles that led up to an outcrop of hopelessly curly red hair, that I’m sure he kept tied back if for no other reason than to dispel comments regarding comparing him to a clown or perhaps Ronald McDonald. He showed up smiling and I instantly got the impression that this was his common manner and approach to life. He appeared to be laid back yet in control of his work, doing what he wanted to do, how, and because it simply was who he was.

Sal excused himself and asked waiting patients if he could please take a moment to introduce myself to Milner. Of course, the patients politely complied and Sal brought Milner to me, as I was about to finish up with the patient. Upon the exchange of hugs and lollipops and the patient heading out the door, I turned a find Sal standing there with Milner in tow.

“Cindy, I have someone here who I want you to meet and I think you will become fast long-lost friends for all eternity. Cindy, this is Franklin Milner. He has been with us for quite a while and I do not know what we would do without him. When we are not keeping him busy, he works at the Samsula Emergency Room as the PA where he patches up half of the world on night shift. He is great with patients, he makes some absolutely wicked pancakes, and he can imitate Pavarotti beautifully, and frequently performs impromptu arias while stitching up people. I think it is his version of whistling while he works.”

Sal turned to Milner and said, “Milner, this is Cindy. She is a PA also. This is not only her first day here, but it is the first hours of her first day here. So far, she has been kept busy cranking through patients in doling out plenty of TLC and lollipops. I think she’s going to catch on quickly to how we do things here.”

“Cindy, nice to meet you. Dr. Peterson had told me last week to expect to see you. He confessed that he had not asked you yet if you would come, but that he was absolutely convinced that you would do it. I’m glad to see that things worked out and I look forward to working with you,” Milner said with a soft southern accent. “Please feel free to ask for help at any time. We try to get as many patients seen as quickly as we can here but also it is not like working in the Emergency Room with someone timing your every move and forever trying to make things more assembly line efficient. A big part of our care here is getting to know our patients and to understand where they are coming from. It is a different kind of meatball medicine and one that I just love if only I could make a living at it! What kind of problems have you encountered so far? How has it been going?”

How could I not love these people? Never before had I been made to feel so welcomed, so needed, so worthy, so… Family. This just could not be real and if it was real by some chance, it simply could not last long. Surely, somewhere at some time, the corporate backstabbing knives would come out from the hiding places; well concealed behind those warm smiles and friendly hugs. Haunting flashbacks run deep, I was reminded.

“Milner, this is great. I am so happy to meet you. I will readily admit my bedside skills are not the most current. I last worked in Bayfront a few years ago. Medically, I work in the Oak Hill clinic a few days each month but mostly with grant writing and administration. More drama than trauma.” I replied.

“Don’t worry then, you will see almost anything here. We call 9 -1-1 if anything serious shows up from major wounds to angina to eminent delivery. They get here quickly and take care of the situation. We have some oxygen, and an EKG with some airways attached to the side of the cart, but that would be the entire contents of our crash cart. What the people need more than anything is care with a capital C. They need to know we will do what we can to help them get through the day.”

“Sal has been most helpful in showing me around and helping with resources. I do not entirely understand your documentation system or what to do with some of the limitless problems these folks have. In Oak Hill, the main issue was insect bites, tooth decay, and back pain. Never did I see as much head lice as you have here. And without treating the environment, I can’t see the future in providing RID,” I replied.

“Our patients here tend to live in communal areas. They are wonderful at sharing everything – clothing, bedding, utensils, and kooties. You are correct about the lice. The environment is overrun with it and treating a patient is not going to cure the problem in this case. I am guessing the Oak Hill clients are more spread out geographically. Here, thanks to the swampland, there is one big pocket of poverty where all of our clients live. There are good and bad elements to it. You identified a bad one. I tell you what, would it help if we worked together on patients today? I would appreciate the help – that is a rare thing here and maybe you will get to see how things have found a way to work here incredibly well,” he said.

“That, Mr. Milner is the best idea I have heard in the past six months.”

Make Your Own Kind of Music – Cass Elliot

Sal, Milner, and I quickly put together a rhythm. Get ‘em in, fix ‘em up, move ‘em out, and repeat. We saw dozens of clients with a variety of aches and pains, lacerations, and respiratory issues. We handed out vitamins and Tylenol and showed them how to make hot packs out of socks and slings out of rope. We made referrals to free dental clinics. We gave out what few flu shots we had to those at high risk. We washed and bandaged feet, arms, and heads. We saw people who I cannot image how they could possibly hold down a job – who could barely walk or talk. We also saw those with a quick sense of humor and surprisingly well versed on current events. Some brought us wildflowers picked from along the road on the way. Some brought us trinkets of items found in trashcans. Each brought a trampled and twisted glimmer of undying hope and gratitude by the bucket.

The time passed quickly and I could tell that sleeping tonight would not be a problem once I could chase away the sights and sounds of the day away from my brain – which tends to go into hyper gear at night. Before I knew it, Milner was asking me what would I like for lunch. He usually bravely bought something from a local store just really to show support of the neighborhood. But he was selective of what he ventured to actually eat – mostly processed stuff and seldom the handmade sandwiches of meatloaf or boloney. I am not sure I would go much beyond a Twinkie and maybe a coke. However, as luck had it, it quickly became a non-issue.

Sal’s phone rang. He had to stand up to answer it because the phone was in his pants pocket. Antonio was calling. He had the vaccine from the health department and he was on his way back to town from Daytona. Will be about 40 minutes but he has pizza with him and some cans of coke. Would anyone there be interested in helping him eat this? That offer was difficult to refuse.

According to Milner, the clinic usually asks the patients if it would be ok if they stopped for 15 minutes to get something to eat and take a break. Of course, dependent upon and emergencies or patients who had to get back to work quickly to keep their jobs. We adjusted to accommodate them. Today, it was quiet at lunchtime. There was a small folding card table in the back of the room and the chairs from the waiting area were brought there as available for the staff to take a load off for a few moments.

In the meantime, there was a lull in the action. Milner walked over to a chalkboard I have not noticed previously. It was easily viewable from the waiting area. I went to go see what he was doing. The chalkboard had some very basic health information. Flu shots will be available next week. The Blood Mobile will be at Wal-Mart next Wednesday. Remember – Never, never, ever shake a baby.

Beneath it all was the saying of the day. The one that Milner was about to erase said, “If you don’t know where you are going, you will wind up somewhere else.” Yogi Berra

He erased it and wrote in very plain, simple letters – and incidentally without the first hint of his mild southern draw, “The longer I live and the more I see, the further I am convinced that the most effective means to improve the world is one person at a time.” Unknown

“That is impressive. How do you remember those? Is this something you do every day?”

“I collect sayings and use them whenever I can – on emails and cards and things. Some people collect dead insects and specimens of mold. I collect words. I try to change it every day that I am here. Sometimes I am sure I don’t get the quote exact, but I try to do the best I can.” Milner had a slight smile, as always.

“How many do you think you have and how in the world do you manage to keep them all in your head without getting lost going home at night or in your case, the morning?”

“It is just one of those things that sticks in my head. I can’t explain it.”

“I write a bit – just for giggles mostly. If I come across any good sayings, I’ll keep ya in mind,” I said.

“Thanks,” he said.

“Sal, what can I do for you? Need some gloves washed, plants pruned, bandages starched and ironed?” I asked.

“Actually, if you have a few minutes, would you mind throwing any gloves you used in pan in the sink in the back to soak? I try to keep them in the cleaning solution for at least 4 hours before rinsing them off. Getting a head start on that now may get me out of here a bit early today. I will finish the log for this morning and make a few calls to replace some supplies. Thanks!”

“Ya know Milner, I was wondering what kind of consent we get from these folks,” I was walking toward the sink with a load of gloves.

We have each patient sign a paper stating they realize this is a non-emergency clinic with limited supplies and services. We have no narcotics on premise and cannot prescribe any pain medication. They must provide evidence of employment to be treated and must be 18 years of age or older. Dr. P was reluctant to even give flu shots for fear that word would get out that we have syringes. He went out of his way to try to get nasal influenza without any luck. But he saw the need for the vaccines outweighed the problems we may encounter with drug seekers and here we are. So far, we have not had any problems for a while.”

About that time, a middle-aged lady walked in requesting some help. She was panicked, frightened and out of breath. She claimed someone was after her and wanted to take her away.

Sal recognized Anabelle immediately and ushered her into her building and behind the portable screen. I checked out the street for signs of someone following her - there was no one anywhere.

Sal, in his very gentle voice told Anabelle she was safe here. That no one could take her away from this place. He got her a drink of water and sat down beside her. He told her how nice she looked today and asked if she had been taking her medicine. She shook her head no – she forgets and besides you know he would poison my pills if he could.

Sal looked at Anabelle and said. “Anabelle, would you trust me to keep your pills?”

“Why sure, honey. I’d trust you with the world,” she said.

“Ok, then you bring me your pills and you come by here and see me every day at lunch time and I will give you one to take. That way no one can mess with your pills and I will get to see your pretty face every day. How’s that sound?”

“Darlin’ I’d be mighty grateful like. Are you sure you don’t’ mind?” she asked.

“Anabelle, for you, I’d do anything, but you have to take your medicine. So, go home, get them, and bring them back here. But first, let me go take a look outside to make sure no one is out there looking for you.” Sal went out the front door and made a cursory glance up and down the street to find nothing out of the normal.

“The coast is clear Anabelle. Go get those pills and bring them to me. Then, I will just be heartbroken if you don’t come and say hi to me every day at lunch time!”

A calm, smiling Anabelle strolled out the door and down the street as if she did not have a concern in the world.

“OK, that looks like there might be a story behind it,” I said.

“Anabelle’s entire family was murdered when she was six. She survived because she hid in the trashcan outside the front door. It took police 2 days to find her because she would not come out when the incident was over. 40 years later, she is still afraid whoever murdered her mother and her two brothers is coming back for her. She has some major psychotic breaks when she forgets her meds for a few days. I am not sure my plan is going to work but it was worth a try. I am not sure how I can be here every day for her, I will do what I can,” Sal said.

“Next time she is here, I would like to meet her. She sounds like an interesting person,” I said.

“They are all interesting, all of them. It is amazing.”

“Speaking of next time, would you know your schedule for next week? Milner has a date to go see his sister get married in Tampa. We could use some help if you are available?” Sal asked.

Lean on Me – Bill Withers

“I will take whatever you have… if that means 8-11:30 and 3– 5, we will find a way to adjust. Are you sure it will work for you?” he asked.

“Yes, but I will absolutely need to get cleaned up, change and out of here by 11:30. The ceremony is in downtown DeLand – it is not far. I’m so sorry,” I really did mean it.

Just about then, the back door opened and a smiling face carrying two pizzas strolled in with a six-pack of Coke.

“Antonio’s pizza delivery comes packing the goods! How ya ’all doing this glorious day?” Antonio said.

“Hi! I remember you. You are that person who sings in the rain and drives torpedoes around town. The one with the psychotic cats and who loves Cuban food and strawberry smoothies. The lady who does laundry and delivers Fig Newton’s! By the way, I just heard from Frank’s follow up. He is doing fine. Thanks so much for joining us at our clinic. You get the first piece of pizza! Come, everyone, have a seat, grab a drink. Sal, did ya barricade the door and let the dogs loose?” Antonio was pumped about something.

I cleaned off the table and grabbed some newly acquired paper towels to use as plates. I washed my hands and joined the crowd at the table. Pepperoni pizza in one box and green pepper and bacon in the other.

Antonio had everyone raise a piece of pizza to my honor and we all chowed down. It was cold but not bad at all.

“I did not realize you were such a great cook!” I said.

“Yup…I cook out at all the best and fanciest drive-throughs in town. If they can shove it through a window, I will eat it.”

“Sal, 100 doses of influenza vaccine should be here Tuesday from the Health Department. Will you be here then? If not, I will change things to be here. They could not provide a time though - so it may be a wait. Maybe, if you see Laurie, she could help that day. Remind me, and I will go by and see if I can find her this afternoon when I leave. How have things gone today?”

The questions and yammering went on among all of us without much regard to associated answers or order.

Sal and Milner proceeded to list names of those patients who had been by and what type of treatments we had done. Milner was very gracious with his comments of my assistance and me. Sal updated Antonio about Anabelle and her medications.

“I am not sure how I am going to pull this off. I can’t be here every day to give her medication but she was headed for another break. I can’t believe she is anywhere near compliant.”

“Maybe if I can catch Laurie, I’ll ask her if she has any idea how Anabelle is doing with her meds. Maybe we can see her three times a week – on the days when we are open. Do you think Anabelle could keep track of what days to come by?” Antonio asked.

“I think actually she could because I know she has to walk right by here on the way to her sons' house every day. She could just come in on the days we are open and pop a pill then.”

“Ok, I know Laurie sees her quite often. Let me see if she has any ideas or info. So, Cindy, what ya think of the place?”

“You have quite a different group of folks than what I see in Oak Hill. More chronic illness and at young ages. How long has the clinic been open and you doing this?” I inquired.

Just then, a knocking was at the front door. Sal, Milner and Antonio instinctively took one more large bite of pizza before getting up and leaving the table. Wow - a six-minute lunch still beat the no lunches I usually got at work.

And so it all resumed. This time a middle-aged woman was beating at the door, frightened and bleeding… all over.

“Rosa! Come in. Can you make it to the table?” Milner and Antonio each took a side of a rather large black lady and held her up as they moved her up on the exam table. She was out of breath and obviously upset.

“OK, you got here. Let me listen to your chest and let's see where you are bleeding," Milner said.

I had grabbed the blood pressure cuff and gloves for Milner. Antonio went and locked the front door and pulled the blinds shut. Unlike Anabelle’s fear of someone being after her, Rosa’s nemesis was very real, very violent, and well beyond unpredictable.

“Rosa, did Trevor follow you here?” he asked.

“I dunno. I was hurtin’ too bad to look back. But ya know that would be just like him to come looking for me,” she replied between breaths.

“You have some good lacerations or cuts down your arm here. Do you know how he did this?”

“He found this folding knife the other day and said he wanted to show me how it worked. He just started slashing and laughing – like some kind of mad man.”

“Rosa, that is a good description of him. You know he has done this type of thing before. Did he hit you anywhere too?” Milner was polite. Antonio was examining her other arm and prepped to sew her back up but not before taking a look at her back, checking out a few ribs and palpating her abdomen. Milner did a check quick check of pupil reaction.

“Oh yeah. You know he like to do that. Got me in the tummy and the side of my head too.”

“Seems to me we gave you a tetanus shot about six months ago when you cut your foot. Do you remember that?” Antonio asked of Rosa.

The need for medical records with pertinent history became even more apparent to me during this exchange. Memory was not an acceptable substitute for factual evidence.

“OK, let’s get a good look at things and get them fixed up. Are you able to move everything? How about any pain on deep breathing….” and so the assessment went. I got a few suture kits, and lidocaine, and we all went to work.

Sal managed to contact Rosa’s son and arrange transportation and a place to stay. The police were notified of the domestic violence - not that they were not quite familiar with the ongoing Rosa and Trevor show.

“Hey Sal,” Antonio blurted out.

“What can our friendly pharmacist do for Rosa with some antibiotics?” he asked.

“I’ll make the call right now,” Sal replied.

As Milner was finishing up stitching the final lengthy laceration across her forearm, he broke into a soft chorus of Row, Row Your Boat. Apparently the clinic had bad luck hanging onto a radio or any device that could produce music, so as I had been told, Maestro Milner frequently produced his own. I was absent mindedly cleaning equipment and instruments and found myself joining in. Before long, so did Sal and Antonio. Even Rosa was trying to keep up with the syncopation. From the clinic was a broken barbershop quartet, plus one, of meager talent to entertain world and ourselves. As the repetitive nature of the song finally started to wear out, I finished with ‘ha-ha –fooled ya, I’m a submarine’ -- to that Rosa laughed so hard she nearly fell from the table and Milner nearly accidentally stabbed her with the needle. Nonetheless, each of us thoroughly enjoyed ourselves, each other, and the interlude of happiness we created in a sea of hurt.

“Amoxicillin 250 mg for a week -- $3.23,” Sal covered the phone and yelled across the room to Antonio.

“Make it 500 mg for 10 days at 7 bucks and we have a deal,” he responded.

Finally, after off-loading and checking what vaccine he was able to bring with him, Antonio announced he was off to go see if he could find Laurie and pick up some dressings from a nearby physician office that was closing up practice. The lone physician decided on an early retirement after he could not find a way to financially keep the doors open. Antonio was going to ask him about volunteering a few hours a week as well.

“Cindy, thanks again. Milner and Sal, we could not do this without you. Would you mind if I took the left over pizza with me?” he said.

“Go for it,” I replied.

“I have had enough to get me through the week,” said Milner.

“No problem, let me get you some hand wipes for them too,” a wise Sal said.

With that, Antonio got into his late model car that looked right at home in this neighborhood. It was obvious that vehicle maintenance or an occasional car wash was outside of his usual concerns. Pizza and hand wipes in tow, he headed west.

“Does he ever get through the day with anything left over?” I asked Sal.

“That would be against his nature. He gives out everything he has, including every ounce of energy to each and every day. We throw anyway very little here. Every day we receive a thank you from every corner. I am guessing he is taking the pizza to Laurie and her friends. They can put it to good use.”