In Manhattan my patients are healthy. They make their appointments in advance. They make appointments, period. They have allergies, muscle injuries and viral infections that don't require reports in triplicate to the CDC. They are all very nice. They kindly tolerate my young ineptitude. They like me, I think; they listen to me. They require astonishingly simple solutions. A prescription for Allegra, Xanax, Ambien. Felxeril for the back spasm. Cipro for the urinary tract infection. Zithromycin for the viral infection that won't respond to antibiotics but for which we dispense without pause. Because they are white? Or well enough off to....what? Write a letter to The Times? My doctor wouldn't prescribe me a drug for which I have no indication? Because it's easier?
But it is. Write, scribble, sign, satisfaction.
The nurses say good morning to me, every single day. They know everything and they steer me through the inanely simple without need for pride or humiliation. The entire office is so nice I hang half frozen, waiting for the shoe drop. They are actually urinating in my coffee. They spit in my yogurt. My challenges are now to recall the more mundane trivia about medicine. What is the name for an infection in the bed of a nail? What do you call an uncomplicated infection of the sweat gland not colonized by flesh eating bacteria? What is the ideal range for a well control diabetic's HgB-A1C? Well controlled diabetics. Uncomplicated infections.
It alternately amazes and terrifies me.
Across the water, over the bridge and into the streets of loud trash and music, just simple miles apart, I am small and white and invisible. Across the East River, down in the black streets of Brooklyn, my patients have not had their colonoscopies, do not get regular mammograms and are not well controlled diabetics. The cannot, or do not, or will not make appointments in our small clinics, waiting instead for the stroke to arrive, the foot to become gangrenous, the cancer to grow completely through the large intestine. Across the water, on the unblanched roads admist the red brick projects, I struggle to understand the words and accents of my fellows, my peers, my attendings. I am powerless in every way I can think of: there are no simple solutions, no uncomplicated infections, no well controlled diabetics; I have to wait until those who I rely on to help me feel like getting around to the task at hand; I have to decipher cryptic medical records delineating dense medical histories and differentials; I have to proceed without the benefit of typed reports or adequate information; I do not walk into a room to find instant, intact respect because I am in a white coat with a stethoscope. I have to work against my gender, my age, my skin color and my dress. I have to sift through the tangled mass of five comorbid diseases in patients no less human than those across the river.
In Manhattan I come home calm and dry. In Manhattan I come home well fed and on strong footing. In Brooklyn I come home diaphoretic and suicidal. In Brooklyn it is a struggle to stand up hard enough against everything crashing down around you. In Brooklyn I can offer very little in the way of simple solutions. In Brooklyn I am the one who needs Xanax. In Brooklyn I feel hopeless, helpless. In Manhattan I feel guilty.
And yet, at the end of the day, if given a choice, I would cross the river and take the bridge. Helpless, hopeless, pale and invisible, I am no more visible than my patients. Powerless against the enormous forces of race and culture and religion and habit. Against socioeconomics and education and regional mores. Against myself or them or the system. In Brooklyn, because there are no simple solutions, we all come out of it distinctly different humans. In a place of uneasy options and all of us messily swept up in it, we are in it together, divided as we may be.
