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By Michael Fine, contributing writer
© Michael Fine 2019
This is a work of fiction. Names, characters, businesses, places, events, locales, and incidents are either the products of the author’s imagination or used in a fictitious manner. Any resemblance to actual persons, living or dead, or actual events is purely coincidental.
The crisis of the moment was rent. And that Sheila wouldn’t open her door.
Grace stood on the front step of Shelia’s trailer off Newport Avenue, near where Building 19 ½ used to be, and banged on Shelia’s door. She had called first. The flimsy aluminum front wall of the trailer shook each time the heel of Grace’s hand hit the door. No door bell. Just wires next to the door drooping toward the little rectangular spot where the door bell used to be.
It was October. The days had already shortened. A light rain was falling. Wet leaves were everywhere. They coated the ground, the step, the pink and blue awnings over the front windows of other trailers. There were wet leaves on the hoods and roofs of the cars, on the tiny lawns, on the lawn furniture and the grills and barbeques that sat beside those tiny lawns. The leaves were still red, yellow, and green. The air smelled sweet, of maple sugar.
Shelia, a woman of 72 with lung cancer, hadn’t paid her rent in six months. She spent her rent money on cigarettes and booze. She was going be evicted in six days unless somebody did something. There was a social worker at the Department of Human Services who had money to keep people from being thrown out in the street, but in order to get that money, Shelia needed to get herself to the Human Services office on Roosevelt Avenue and fill out a damn form. The office was two miles away. Two page form. She needed to bring her rent checks and her electric and phone bills. All Grace needed to do was to get Shelia out of bed, out of the house, over to Roosevelt Avenue and get her to fill out one form. No need to get evicted. At least not today. Not rocket science.
Shelia was a disaster, like most of Grace’s clients — what happens to people when you let bad genes, bad choices, lousy bureaucracy and a world that just doesn’t give a damn run things for a couple of generations, not that Grace’s own life and choices were so great. Shelia was behind in her rent. They were threatening to turn off her electric. There was the lung cancer, a thousand doctors’ appointments and chemo to be scheduled, getting Shelia back and forth — and all that medicine Shelia couldn’t afford. There was the man, that low life Shelia let live with her – twenty years younger than she was, addicted to Percocets, who didn’t work, who stole Shelia’s drugs and sold them on the street and who just hung around hoping Shelia would die, hoping he’d get the trailer and the car.
The trailer was a mess — papers piled on every table and chair, open cans left standing on the counters, black plastic garbage bags half full of clothes, or garbage, or cans of food that had never been put away, stacked on the floor. The car was a beat up Dodge Avenger from the eighties, with a broken off antenna and a radio that didn’t work.
Shelia had a family, sort of, a collection of old wounds and massive disappointments. She had two daughters, one who lived in Cranston with three kids and worked as a waitress. Daughter number two was divorced in North Kingston, no kids, a croupier at Foxwoods, and was into huge earrings, fake lashes and enough mascara to paint over America. Neither of the daughters wanted anything to do anything with their mother. Neither ever picked up their phones.
Sometimes it was more than Grace could do to pick up the telephone herself and talk to Shelia, let alone try to pick up the pieces.
At least Grace had a job. A profession and a job. She had always worked and would always work. Despite her own idiot boyfriend and the chaos he brought into her life. Despite it all.
Her job. Nurse care manager. Organize the resources necessary to keep people on Medicaid out of the hospital. Hospitals cost money. Lots and lots of money. Way more than it cost the state to pay Grace to be nice to people who are old, lonely, anxious and sick.
So that was what Grace did every day. Be a nurse. Be a nice nurse. Listen to the old, the lonely, the anxious and the sick. Try to organize their chaos. Try to keep them from dying from their bad choices, even if they kept doing the same stupid stuff, over and over. Even if they themselves don’t care if they live or die. Just keep them out of the hospital emergency room, and please try to keep them from spending so much of our money on what won’t change anything and is as likely to make them sicker as it is to keep them from dying, at least today.
No one tells the stories of nurses, of housecleaners, the stories of dog walkers or teachers or receptionists or bank tellers, the women carry the world on their backs, Grace thought, as she waited for Shelia to come to the door. Or not. There is no American Idol for the work most people do, no Olympics for taking out the trash or picking the kids up from school or emptying a bedpan or starting an IV. They have taken our work from us. No one sees us anymore. All people see are figure skaters and football players on TV. Young white women in slinky dresses and young gay men with short moussed hair waiting for the American Idol judges to rule, looking towards God and praying that the judges will choose them – them! So that they can realize their dreams. Not us, though. No one picks us. No one looks at us. The rest of us, the people who go to work every day and make the world turn – we no longer exist.
I’ve made one bad choice after the next, Grace thought, but nothing anyone else does seems to have a better result. You take one day at a time.
Shelia wasn’t coming to the door. Do I call 911? Grace wondered. Do I get a cop to break down Sheila’s door?
Grace had been to lectures. She learned about medical ethics. She remembered the principles, just words, really, that kept banging around in her brain. Autonomy, beneficence, non malfeasance, and justice. What does that all mean? Some professor’s words. No help whatsoever. Another white male doctor with big ideas and no sense, who couldn’t see what was right in front of his eyes. Autonomy, beneficence, non malfeasance, and justice. Not a chance. You take care of the people who need taking care of and listen when your heart speaks, even when you heart is talking trash.
Shelia’s back hurt. She didn’t want to get up. She didn’t trust social workers, she didn’t trust nurses, and her damn boyfriend had her car. He was at Foxwoods. Let them evict me, Shelia said on the phone. I’d rather live in the car. Die in the car, not live in the car, Grace thought to herself. She’s going to end up homeless and die in that car.
So Grace got in her own car, very cool 1996 red Thunderbird convertible, GRACE1 license plates, faster than a speeding bullet, and she came over.
I don’t care what Shelia thinks or what she wants, Grace thought. I’ll drive her to DHS myself. You don’t let a seventy six year old with lung cancer get evicted and die in her car, alone on the street in the winter.
Shelia heard the banging the first time but she didn’t want to get up.
That nurse never gets me what I really need, Shelia thought. Miss high and mighty. Don’t like Rodney. Don’t’ like me smoking. Drives the fancy car with the fancy license plates. Doesn’t get me enough of my medicine. Rodney takes the medicine, and then what am I supposed to do? She don’t know how much my damn back hurts. Hurts to move and hurts to breath. That cancer is all in my bones. All my bones. Hurts all the time.
She heard more banging. It’s the damned nurse, Shelia thought. I told her not to come. She come anyway, uninvited. UN-IN-VITED. The trailer is my problem, not hers. Nobody gets to live forever. I’d rather have my cigarettes and my pain pills than any old trailer. There’s mold in this trailer. It stinks down near the shower. Must have been something that died under there. Trailer’s good for nothing, just like me. Nobody’s gonna come and fix it. Nobody’s gonna come and fix the ceiling in the kitchen where the water got in. Nobody’s gonna come and fix the hot water in the bathroom faucet, which comes out no better than an old man come to tinkle. Need the money for cigarettes. Rather live in the car then give them up. Who cares about some old trailer nobody can fix anyway?
When Shelia didn’t come to the door, Grace thought, she’s lying in there unconscious or dead. They had talked on the phone. Shelia knew Grace was coming. She could have taken too many Percocets – but she said she didn’t have any Percocets. She could have fallen in the trailer. She could have hung up the phone and then just died, right there on the floor, purple as a violet.
If Shelia was in there, and just didn’t want to open the door, what then?
What if she does get evicted? If that’s what she wants. Isn’t it her right to live on the street? What if she dies? But everyone with lung cancer dies, more or less. But to die without even trying chemo, just because Shelia’s leech of a boyfriend keeps taking the car to Foxwoods? The chemotherapy might give her a couple of more months. Might also kill her quick. One choice was worse than the next.
Grace’s cell phone rang. It was the 250 pound asshole, calling again. Her own leech of a boyfriend, or boyfriend only when he was in the mood, when some other woman had hung up on him because he was too much to bear. Her bad choice. One of many. She let it go to voicemail.
If Grace called the police and they broke the door down, and Shelia was inside, and didn’t just want to talk to her or if she just didn’t want to go to DHS and get the emergency rent money, then Shelia would probably never talk to Grace again, and whatever relationship Grace had carefully and slowly built with her over two years would be for nothing – no money, no chemo, no meds, Shelia on the street. If Shelia was lying unconscious on the floor, and Grace didn’t call the police, then Shelia would probably die, and it would all be for nothing – no money, no chemo, no meds. Shelia was going to die anyway, something no money, no chemo and no meds could prevent. Grace too. Everybody. It was just about when, and how, and with how much suffering. About how much loneliness, fear and pain. Or about how much company Shelia or anyone else could stand.
Grace knocked again, longer and louder this time.
No answer. Inside, there were loud voices and music in the background. The blinds on the windows were drawn, but Grace could see flickering blue light reflected off the edges of each of the slats of the closed white mini-blinds. The television was on. Grace remembered that television. It was a big flat panel, about half the width of the trailer.
Grace took out her cell phone and called Shelia. No answer.
Then she knocked again. Louder.
“Shelia, you ok in there? If you don’t answer, I’m going to have to call the police, so they can come and check on you. You don’t have to come to the door. Just tell me you are okay,” Grace said, her voice loud enough to be heard across the street.
Autonomy, beneficence, non malfeasance, and justice.
As she entered the second “1” of 911, before she hit send, a car pulled up. Its driver hit the horn and Grace dropped her cell phone.
It was Rodney, in a beat up yellow Dodge Avenger.
Shelia was sitting on a worn olive green couch with wooden armrests that the varnish was worn from, in front of the TV which seemed three times her size, in a yellow and blue flowered housecoat, with her hair in curlers, a white kerchief with red flowers over the curlers, her eyes closed, holding a cigarette between the second and third fingers of her right hand, the cigarette burning into a thin dull off-orange metallic ashtray set on the couch in front of her. Her skin, which was more grey than pale, appeared blue in the constantly changing light from the television, which was from a reality show about police making arrests at night of women and men dealing drugs and involved with prostitution, their faces erased by the miracle of video technology, as the light from the television picture marched under and over the thin white blue fluorescent light from the hissing ceiling fixture. The air in the trailer was thick and moist even through there was an air conditioner running, and the trailer smelled of cigarette smoke, mold, and too much pine scented air freshener.
“Turn it OFF” Rodney yelled, as they came in. He slammed the front door.
Rodney was about 5’9” and covered with tattoos. He had thin, slicked-back thinning grey hair, pink tinted black rimmed glasses, a two day beard, jowls, a loose fleshy neck that made him look older than he was, and he had red watery eyes. He was wearing a worn black leather jacket, and had a metal chain that went from his waist midway down his thigh, and then back to his side pocket.
Shelia half-opened, and then closed her eyes.
“YOU GONNA BURN THIS PLACE DOWN WITH THEM GODDAMN CIGARETTES,” Rodney shouted. He walked to the couch, yanked the remote out of Shelia’s left hand and stabbed at the buttons.
Shelia shifted as though she were turning over in bed. The ashtray turned over onto the floor as the television went dark and the room suddenly shrank to its real size, just a fraction of the size it had been, moments before. Rodney leaned over Shelia, lifted her right hand with the care a violinist uses lifting her bow before the first note of a sonata, and with the two fingers of his right hand pinched the still burning cigarette from between the second and third fingers of Shelia’s right hand. He carefully placed her hand on the couch and stepped over her, so he could, with three or four steps, open the bathroom door, and flick the cigarette into the toilet bowl.
“Damn cigarettes,” Rodney said from the bathroom, his back to Grace and Shelia. “She is going to burn the place down, that woman.”
“Rodney!” Shelia said. “Where’s… my… smoke?” Shelia’s eyes opened for the first time, and she sat up.
“Better this way,” Rodney said, talking to himself. And Shelia fell back into her slumber.
Grace put the brown cardboard folder in which she kept each client’s paperwork, on the kitchen table and walked from the kitchen to the living room. Something needed to be done.
“Nurse is here,” said Rodney.
“Care manager,” said Shelia, her eyes closed, still slurring her words.
Shelia tried to sit up, but fell to the floor, onto her right side.
“I’m calling rescue,” Grace said.
The medical facts of the case were as follows. 72 year old smoker with no hypoxic drive, likely having taken too much narcotic analgesia, with underlying pulmonary compromise secondary to metastatic lung cancer. Too many cigarettes. Too much opiate pain killer. Absolutely not interested in beating this thing, this cancer. Someone else with a lifetime of bad choices.
Shelia’s body was forgetting how to breathe. There was carbon dioxide building up in her blood, which was making her sleepy, and together with the Percocet and Oxycontin – all those pain killers – was likely to halt her breathing all together. Shelia needed Bipap – a breathing machine. She needed to go to the emergency room and stay in the hospital to keep her breathing long enough for the sleepiness from the Percocets to go away.
Rodney spun on his heels.
“She won’t go.” He said, as he slipped his arm under Shelia’s neck. “She don’t want no hospitals. No more.”
“I don’t DO hospitals.” Shelia said.
“I got her.” Rodney said as he picked her up from the floor. He laid her back on the couch. He lifted her feet onto the torn tan hassock that was in front of the couch, and then brought a pillow and a blanket from the bedroom, which was at the far end of the trailer.
Shelia’s going to get evicted at the end of the week if I can’t get her over to Roosevelt Avenue, Grace thought. She’s going to die if I don’t call rescue. She’s probably going to die if I do call rescue. She’s going to live out her last days in that car or on the street. All she wants is a cigarette and then to be left alone to die in peace.
Grace’s cell phone rang again. She looked at the number.
And then she threw the cell phone against the wall with all her might.
The cell phone hit the wall in the kitchen next to the microwave with a thud then and burst into a thousand pieces. The walls of the trailer and the thin ceiling shook.
Rodney looked up and shrank a little into his tired yellow skin.
Shelia opened her eyes, took a deep breath, and sat up, still dazed. Then she closed her eyes and felt around her with her hands, looking for her smokes and a lighter, which she found on the floor next to her. Her hands shook as she took a cigarette from the pack and they shook as she put the cigarette in her mouth.
She spun the wheel of the lighter, her eyes still closed. She spun it once, twice and then three times. Finally the lighter caught, and made a blue and yellow flame which burned above Shelia’s thumb as she moved her hand toward the cigarette in her mouth, her hand swaying, see-sawing back and forth in the air, because she was too weak to control her arm and too groggy to remember where the cigarette actually was, from one split second to the next.
Grace caught Shelia’s arm in midair. She brought the hand and the lighter to the cigarette and held it there.
“Breathe,” Grace said. “Inhale. Open your eyes.”
Shelia opened her eyes a crack, just enough to see someone standing over her, holding her hand next to her smoke, and she took a deep drag, long and slow but deep enough to get her cigarette lit. She took her finger off the lighter button and let her hand fall to her side. The cigarette hung from her bottom lip.
And then she inhaled again, the end of the lit cigarette glowing orange in the blue-white fluorescent light, orange like the sun at dawn. Or sunset.
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Michael Fine, MD is currently Health Policy Advisor to Mayor James Diossa of Central Falls, Rhode Island and Senior Population Health and Clinical Services Officer at Blackstone Valley Health Care, Inc. He is facilitating a partnership between the City and Blackstone to create the Central Falls Neighborhood Health Station, the US first attempt to build a population based primary care and public health collaboration that serves the entire population of a place.
He has also recently been named Health Liaison to the City of Pawtucket. Dr. Fine served in the Cabinet of Governor Lincoln Chafee as Director of the Rhode Island Department of Health from February of 2011 until March of 2015, overseeing a broad range of public health programs and services, overseeing 450 public health professionals and managing a budget of $110 million a year.
Dr. Fine’s career as both a family physician and manager in the field of healthcare has been devoted to healthcare reform and the care of under-served populations. Before his confirmation as Director of Health, Dr. Fine was the Medical Program Director at the Rhode Island Department of Corrections, overseeing a healthcare unit servicing nearly 20,000 people a year, with a staff of over 85 physicians, psychiatrists, mental health workers, nurses, and other health professionals.
He was a founder and Managing Director of HealthAccessRI, the nation’s first statewide organization making prepaid, reduced fee-for-service primary care available to people without employer-provided health insurance. Dr. Fine practiced for 16 years in urban Pawtucket, Rhode Island and rural Scituate, Rhode Island. He is the former Physician Operating Officer of Hillside Avenue Family and Community Medicine, the largest family practice in Rhode Island, and the former Physician-in-Chief of the Rhode Island and Miriam Hospitals’ Departments of Family and Community Medicine. He was co-chair of the Allied Advocacy Group for Integrated Primary Care.
He convened and facilitated the Primary Care Leadership Council, a statewide organization that represented 75 percent of Rhode Island’s primary care physicians and practices. He currently serves on the Boards of Crossroads Rhode Island, the state’s largest service organization for the homeless, the Lown Institute, the George Wiley Center, and RICARES. Dr. Fine founded the Scituate Health Alliance, a community-based, population-focused non-profit organization, which made Scituate the first community in the United States to provide primary medical and dental care to all town residents.
Dr. Fine is a past President of the Rhode Island Academy of Family Physicians and was an Open Society Institute/George Soros Fellow in Medicine as a Profession from 2000 to2002. He has served on a number of legislative committees for the Rhode Island General Assembly, has chaired the Primary Care Advisory Committee for the Rhode Island Department of Health, and sat on both the Urban Family Medicine Task Force of the American Academy of Family Physicians and the National Advisory Council to the National Health Services Corps.