All Saints House

 

Samuel K. Parish

blindcaduceus@aol.com

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     "Come anytime and as many times as you want. There's always a need for volunteer help," said Sheri, the director of All Saints House.

     Galen had visited Nashville a few times over the years, usually for short trips to go shopping with his mother. After high school, he only passed through the town when traveling back to Oakmont College. Galen decided to volunteer at the clinic the last week of July, the month before starting his senior year as a Pre-Med student. It was his vow to Michelle to expand his viewpoint of the real world.  

     Michelle was glad to hear he had kept his promise, and she agreed to show him around Nashville. She knew the experience would take Galen out of his comfort zone. She wanted to expose him to a side of life he had never seen.

     All Saints House was located in downtown Nashville on 8th Avenue South, a short walk from the bus station. It occupied an older building converted from a grocery store that had opened in the 1930s. 

     Galen arrived at eight o’clock in the morning and parked his car behind the clinic down a one-way alley. He brought a notebook and pen as instructed by Sheri. He walked toward the main entrance at the front of the house through the debris of trash that littered the alley.

     A wooden sign in the small grassy area in front of the house identified the place and times of operation. The sign had a quote from Mother Teresa, 'I see God in everyone, and especially in those who suffer.'

     Galen felt it was a fitting quote for a clinic that offered free medical services to those who had no insurance. As he opened the front door, he felt good about himself and the week ahead. He wasn’t blind to realities of life, but he easily ignored them.

     "May I help you sir?" asked a well-dressed, young Asian woman at the front desk behind a sliding glass window.

     "Yes, I'm Galen Stafford. I'm here to volunteer. I'm supposed to meet Sheri."

     "That's right. Come on back, Galen. I'll show you to her office. By the way, I'm Mia and I'm glad you came to help out."

     Galen expected the clinic would be rundown, chaotic, and unprofessional, but he was surprised to find it clean and well organized. The building structure was showing its age, but the interior was like any clinic with modern furniture and exam rooms.

     His expectations were wrong again when he was introduced to the director, Sheri Lewis, a tall, thin African American woman of about thirty. He wasn’t sure what to expect from the director, but he didn't expect someone who looked as if she’d walked off the cover of Vogue. She would have been at home in the corporate board room of a major health organization, but she had chosen the non-profit world of indigent care.

     "Galen, we always appreciate when students come to the clinic. It's a different world from what most pre-med students have dreamed of when entering the field of medicine. This morning I want you to watch the introduction video about our mission and code of conduct. After that, you’ll spend the rest of the morning with Mia at the front desk to see how patients are registered. She’ll show you how to obtain the health history. The forms are standard medical history forms. It’ll give you the chance to talk and get to know the people we serve." Sheri easily ran through the short speech she’d given hundreds of times to the volunteers who came through every year.

     “Any questions, Galen?” asked Sheri, as she turned her back to retrieve a volunteer packet from the file cabinet.

     "I'm a pre-med student, and I don't know anything about treating sick patients yet. I have a long way to go. It makes me uncomfortable in the clinic environment. I don't want to do something wrong," Galen said anxiously.

     Sheri faced Galen, and said, "The patients can tolerate your lack of knowledge as long as you don't have lack of caring. They know you're not here to make money. They’ll teach you about healthcare, just listen to them. All Saints House is about medicine as a service industry, not a profit industry. In the years to come, you'll have to decide which industry you're in."

 

     Carlos was probably the friendliest eight-year-old child on earth. When he arrived at the clinic with his mother, Maria, he walked down the hallway while his mother registered to be seen for stomach pain. Carlos wasn’t sick that day; he came along because they had no babysitter. Everyone in the clinic knew Carlos. He enjoyed talking to the staff when they weren’t busy with other patients.

      “Maria, come with me. Carlos, you can stay in the lobby and talk to our new volunteer, Galen. He’ll stay with you,” said the nurse.

      Carlos reached out his hand to Galen and said, “Nice to meet you. Are you a real doctor?”

      “No, not yet. I hope to be a doctor some day,” said Galen.  

      "Carlos, can I get you a drink of water?" asked Galen.

      Carlos politely responded, "No thanks, sir. I'm fine. But I'd like to read to you."

      "Sure. What do you want to read?” asked Galen. “We have a few magazines and children's books on the shelf in the corner."

      "I brought my own book. I'm supposed to write a book report for school. They give us a book to read for the summer and when we go back in August, we turn it in." Carlos spoke at a level much beyond his age.

      "Homework in the summer? That's no fun," said Galen.

      "I don't mind. I’d read something anyway, so getting points at school for reading is even better." Carlos sat next to Galen as he pulled a book out of his backpack.

      Galen noticed a large scar on the left side of Carlos' face that extended from the left eyelid down to the corner of the mouth. The scar caused a deformity in the lip when he smiled, which he did often. Galen was interested in the history of the scar, but he wouldn't ask Carlos.

      Carlos opened the book to a paper marker and said, "The book is called Hatchet. Gary Paulsen wrote it. It's about a boy named Brian who’s alone in the wilderness in Canada after his plane crashed. It was just him and the pilot, and the pilot died. Brian was on his way to see his dad; his mom and dad were divorced. He'd never been in the wilderness. Every time something happens, he finds a way to survive. I like the book and already have half of the report done. I'll start reading to you now."

      "Okay, I'm listening." Galen crossed his arms and relaxed in the chair. Galen saw passion in the young boy’s eyes as he read with expression as if performing in front of an audience.

      Carlos had finished two chapters by the time his mother was finished with her appointment. She returned to the front desk to set up a return visit and said, "Carlos, you bothering that young man? He's got work to do and you’re making him listen to you read."

      Galen said, “He’s not bothering me. I’ve enjoyed it. Carlos is an excellent reader. I can tell he loves books.”

      “Besides basketball with his cousins, reading is his favorite activity,” said Maria.

      "I noticed the scar on his face, what happened?" asked Galen.

      "Carlos was attacked by a neighborhood dog when he was four. It was a terrible injury, and I thought his whole face was gone. We called an ambulance, and they took him downtown to the emergency room. They cleaned it up, x-rayed his face, and then we waited for three hours. The ER doc called a plastic surgeon to come, but he never came.

      Galen asked, "So who finally repaired it?"

      Maria said, "Well, a frustrated ER doc did. He was angry by the time he got around to it because it took over an hour to sew it up. He even said that it needed a plastic surgeon, but we’d have to call one the next week for follow up in the clinic. So we did. We called three different plastic surgeons offices, and the response was the same. You see, we’d call and they would ask before making the appointment, ‘Do you have insurance?’ I told them we’d make payments and try to get on Medicaid, and they said they didn't do Medicaid work either. The scar is large and permanent, but it don't seem to bother Carlos none."

      After leaving the clinic, Galen couldn't get Carlos out of his mind. He knew the scar would’ve been minimal if a competent plastic surgeon had repaired it, and the lip deformity would never have existed. Galen was angry just thinking about it.
Galen remembered his classmate, Phillip, at Oakmont, whose father was a plastic surgeon in Georgia. Phillip would brag about the money his dad made. He never billed anyone, only cash payments up front.

      One specific statement stuck in his head. Phillip said, "If you're going to be a doctor, specialize in something like plastics or derm. People are willing to pay for your services. You won't have to deal with all the poor people on Medicaid, and the losers with no insurance."

      Galen remembered it because Phillip said it as he got into his new Corvette and revved the engine. Galen thought about Carlos and his demeanor and intelligence. He knew Carlos had already transcended the scar, but the scar was a representation of healthcare focused on profit. It represented an attitude of, 'What's in it for me?' Galen vowed it would never be that way when he was in practice. He believed in helping those in need regardless of ability to pay.
Galen arrived each morning at All Saints about fifteen minutes before opening time. There were always a few patients standing on the sidewalk waiting for the doors to open. Most had appointments, but if they didn't, they knew the staff would squeeze them into the schedule if at all possible.

      Sheri was accurate in stating that the patients would teach Galen about healthcare. Each day there were several issues that surprised Galen about specific pathologic presentations. Most of the surprises were about a system that allowed so many to slip through the cracks of the best healthcare system in the world. At the end of each day, there was usually one encounter that occupied Galen's mind as he lay on the couch before sleep. On Friday, July 3rd, it was Doris Mitchell who was his teacher of the day.

      Doris had turned forty-one the week before the visit, and the clinic staff had sent a birthday card to the motel where she lived. Doris made sure to tell everyone how much she appreciated the thoughtfulness. She made her way through each staff member to give them a hug.

      "Thank you for remembering my birthday," said Doris to each staff member.

      It was clear that Doris had no other family than those at All Saints. She came almost every other week for her blood pressure check and to get medication samples. It was debatable which was most therapeutic, the medication or the love and caring she received from her friends at All Saints.

      "Doris, this is Galen Stafford. He's volunteering from Oakmont College this week. I’d like you to teach him about high blood pressure and strokes," said Sheri, as she introduced Galen to Doris.

      Doris had a wide smile, which showed the absence of several teeth.

      Doris said, "I'd be glad to tell him everything I know about everything, and after a minute we'll find something else to talk about."

      Doris entered the room with a limp as she obviously had weakness along the left side. She used a cane to help stabilize her gait. She had to lift the left leg higher with each step to keep the foot from scraping against the floor. The left side of her face was also slightly drooped. Her speech was clear, not slurred, and her mind was sharp. She was someone Galen would have passed on the street without giving a second glance, afraid of being asked for a donation.

      "Mr. Stafford, I'm gonna sit in the chair here, and you can sit on the exam table. It's hard for me to get up there, and would take me forever to get down," said Doris. She sat down resting both hands on the cane in front of her.

      Galen didn't know where to start, so he decided to ask an open-ended question. "What can you tell me about yourself?"
Doris was never at a loss for words and started the conversation promptly. "Let's start at the beginning. I'll try to keep it short and relevant, but if I get off on a tangent, just say so, and I'll get back on track. I don't want to bore you."
"I'm interested in anything you have to tell. I'm here to learn about people and health, so I think it’s all relevant." Galen tried to make her feel comfortable and not rushed.

      Doris began the story of her life. "I was born in Muscle Shoals, Alabama in 1941 and had a happy childhood. When I look back on it, we were poor, just like everyone I knew in Muscle Shoals. I was pretty healthy until I was nine years old and got a bad throat infection. I was in the bed with fever for three weeks. It took me nearly six months to get my strength back. I remember hurting all over. My joints were swollen and my pee was a dark color.” Doris looked toward the ceiling instead of directly at Galen.

      She continued her story. “We lived down by the river in a cottage that had been moved up the hillside after the Pickwick Dam was built, but that was a few years before I was born. Anyway, back to the story, the doctor came to the house after two weeks and started giving me shots of a new drug called penicillin. After that, I started to get better. It wasn't until I was pregnant at twenty-four that I found out I had a problem with high blood pressure."

      "So you have children?" asked Galen.

      "No, I was pregnant but lost the child in the fourth month. That's when they told me I had high blood pressure. I began to swell and get short of breath with walking. The doctors at Colbert County Hospital did a bunch of tests. They said my blood pressure was high, my heart had a murmur, and my kidneys were damaged. They put me on medication which made everything better.”

      Galen asked, “What led to the stroke if your blood pressure was well-controlled?”

      “About a year after I lost the baby, I got married to Charles. He worked for the railroad, good job, good money, and we had insurance. We moved to Tennessee and bought a house. Life was good during those years. But I guess all good things come to an end,” said Doris.

      “Was Charles a good husband?” asked Galen.

      “He was a good man, but he liked his alcohol. One day he went to work drunk, made a mistake, and got fired. So, he got another job but a lot less money. We lost the house and had no insurance. Up to then I did fine on my medication. Then Charles was killed one night when he crashed his car into a concrete barrier out on I-40 near Dickson. I couldn't see a doctor after that, so I didn't have my medication any longer."

      Galen asked, "Why couldn't you see a doctor? Did you not have a car?"

      "Yes, I still had a car. I had no insurance. I called doctor’s offices in town, but got the same response. It was either money up front or no visit at all. They would say, 'Go to the emergency room if you're having a problem.' I did go there a couple of times. They’d give me a prescription for my blood pressure pills and tell me to find a doctor. After I got the bills for those visits, I knew I couldn't keep doing that. I couldn't pay those for sure.”

      “Didn’t the hospital have some type of charity policy to help?” asked Galen.

      Doris said, “Their charity policy was through a collection agency.” She was able to laugh, even through a life of poverty and loss.

      “Collection agencies were calling and threatening to take everything, but of course everything important in my life had already been taken. The hospital owned several of the clinics in town, too. I’d call for an appointment and they’d refuse to see me because I still owed money to the hospital where I was told to go in the first place."

      Galen was surprised to hear that a hospital would turn an account over to a collection agency. He still had a view of healthcare where charity was sometimes necessary, if not routine.

      "Was your medication expensive?" asked Galen.

      "No, it only cost about twenty dollars a month, but since I didn't have a doctor, I couldn't get a prescription. I knew the treatment was simple, and it always worked; I just couldn't access the system to get a prescription.”

      “When did you have the stroke?” asked Galen.

      Doris continued, “It was four years ago. I moved to the motel the previous month. I tried to get out of bed one morning, took a step, and fell to the floor. I knew something was wrong. My left side wouldn't move, and I couldn't see very well. My head had a terrible pain, too. I crawled to the door and opened it.”

      Doris paused and gazed toward the floor. She had tears in her eyes as she replayed the events in her mind.

      “Thankfully, one of the neighbors found me lying in the doorway and called the ambulance. I spent a month in the hospital. They told me I had a stroke with bleeding in the brain. My blood pressure was off-the-wall high. As you can see, I survived.”

      Galen said, “You’re a strong woman. You’ve been through more than most people could stand in a lifetime. When did you start coming to the clinic?”

      “All Saints opened the clinic a month after I got out of the hospital, and it was just two blocks from the motel where I lived. I started coming here, and everything has been good since. They see me once a month and give me samples of my medication. I come every two weeks for the nurse to check my blood pressure."

      "What about the heart murmur and kidney problems you mentioned earlier? Do you still have to see the specialist for that?" asked Galen.

      "I'm supposed to, but there's no way I can afford that. I work every afternoon at the consignment shop. That pays my rent and food. The clinic does a blood test once a year to make sure the kidneys are still working."

      Galen couldn’t understand a healthcare system that made it so difficult to get treatment early for a simple problem like hypertension. A few dollars per month could have prevented the thousands of dollars of hospital care and would have prevented a permanent disability. Doris had been a great teacher. She was better than a textbook. 

      Before Galen left the room, Doris said, "I know why the system works the way it does.”

      “You do?” asked Galen.

      Doris said, “Yes, I do. During the last visit I made to the neurologist he was late. I had to wait a couple of hours for my appointment. I sat there and read magazines and would occasionally get up to stretch my legs. I walked over to read a statement posted in a frame on the wall. It was called a mission statement for the hospital. I don't remember the words exactly, but basically it said, 'We are here to provide the highest quality of health care for our patients, and the best return on investment for our generous investors.’ I figured that people like me, with a lot of needs and no insurance, were not good for the investors."

      Galen was glad to have met Doris. He would have many professors in the years ahead, but few would teach him as much as Doris.    

 

     George was sixty-two years old when Galen met him at the clinic on the last morning of his week-long visit. He’d been there several times in the previous two years for treatment of cough and shortness of breath. He was an ex-smoker thanks to help from All Saints smoker’s cessation classes and a few weeks of medication to reduce the nicotine craving. Most ex-smokers relapse, but George was motivated and saw the benefits of fewer episodes of bronchitis and asthma.

      He met Galen the day he came for recheck of his blood pressure. The clinic kept him stocked on his medication with free samples. Several medical offices in the area would send pharmaceutical samples when they were within a couple months of expiration. This allowed the patients at All Saints access to medications that they could never afford otherwise.

      Galen opened the lobby door and said, “George, come on back. I’m Galen, a medical student volunteer.”

      “Hello, Galen. Nice to meet you. Are you here long?” asked George.

      “No, this is actually my last day,” said Galen.

      “Let’s get your weight first, and then I’ll check your blood pressure. Are you having any new problems or medication issues since your last visit?” asked Galen.

      “Nothing new,” said George. “I’m feeling well these days. Life is good.”  

      George spoke intelligently and had a distinguished voice like a lecturer of Shakespeare whom Galen had at Oakmont. 

      After the formalities were done, George surprised him with a question. "What kind of doctor are you?"

      "Oh, I'm not a doctor; just a pre-med student hoping to become a doctor someday. There are so many specialties; I'm not sure which one I’ll choose."

      George had heard this response from most of the pre-med students he’d spoken with in the past.

      George responded, "There are many specialties, but there are only two types of doctors, caring and uncaring. I've been around the block a few times in healthcare and seen several doctors, so I can spot the types easily.”

      “I plan to be one of the caring types,” said Galen.

      “You already have been. For instance, the short time you’ve spent here in the room is twice as long as some doctors spend for the entire visit.

      “I once got a copy of my medical record from my family doctor before going to see the lung specialist. I read the reports of my clinic visits and there were several pages of physical exam findings and counseling on my conditions, but it never happened. He never did any of those things. He charged for extended visits and never spent more than five minutes and almost never took his stethoscope out of his pocket even when my complaint was shortness of breath. I asked him once if he would look at my right knee that was painful and swollen; he said to make another appointment since he only could take care of one problem each visit."

      Galen said, "I haven't been around patients much, but I agree it must be frustrating when you have a doctor like that. Hopefully, they’re few and far between."

      "You'll find they’re not few; they’re legion. The key to becoming the caring type of physician is what you’re doing right now, talking to the patient. I don't know if they teach it in medical school, but it’s becoming the lost art of medicine."
Galen had no other obligation at the time. He was content to continue the conversation with George until the nurse was ready for her part of the visit.

      "If you don't mind me asking, what kind of work do you do?" Galen inquired. 

      "I'm a CPA at Regional Wealth Corp downtown on 4th Avenue. That's what I tell everyone, and it's true except that CPA stands for Certified Parking Attendant and has nothing to do with accounting."

      Galen chuckled softly at the explanation.

      George continued, "I was the last of five children. Two of my brothers died in World War II. I missed the war because of bad asthma. So I went on to college, then seminary. By 1945, I was placed in my first church as an associate minister."

      Galen had an astonished look. "You were a minister?"

      "I was and I am still a minister, except now I minister to a different type of congregation. Like now, our conversation is a form of ministering to each other.

      “I minister to all the executives who arrive in the parking garage every morning at Regional Wealth with a smile. Most of them don't seem to notice. The garage gate can never open fast enough for them since they have important things to do. At the end of the day, it's even worse; the worried furrowed look on their faces.

      “But I was a traditional minister, in a church I won't name, for twenty-eight years. I was married, no children, had a decent income, and even health insurance. Life was good until I made a bad decision. All it takes is lust to turn a minister into a CPA." George was obviously comfortable telling the tragic tale of his life.

      "The rest of the story is straight-forward. I had an affair with a widowed member of the congregation. This led to divorce, loss of my position as a minister, and the complete separation from my denomination.

      “My contract had an interesting clause which stated that all benefits such as retirement and health insurance would be forfeited if I committed any act that disgraced my position as a minister. So, the end result was that I became a pariah in the eyes of the church. This occurred about eight years ago.

      “I moved to Nashville to start life over, and here I am. I had no chance of working as a minister any longer. I found odd jobs and eventually the job at the parking garage which is stable. I work for an hourly wage as an independent contractor with no benefits. It allows me enough money for an apartment and food, but no insurance. That's why this clinic is so important to me. I get my medication and get to see some nice, caring people."

      Galen said, "Wow, that doesn't seem fair, the way you were treated."

      "Galen, I made the decision to have the affair. The church did what they thought was right in the circumstances that I created. You'll make some good and bad decisions along the way, and life won't be fair. It's up to you to decide if you can show love and caring in the face of adversity." As George was talking, the nurse opened the door to inform him that the doctor was ready to see him now.

      Galen stood to leave. "George, good luck. I think I've learned more from the visit than you have, but I appreciate your candor in our conversation."

      George said, "It’s been a pleasure, Galen. May St. Raphael, the patron saint of healers, be your guide through life. That's my prayer for you."

 

     On his last evening in town, Michelle wanted Galen to see the sights downtown. They walked from Broadway through the crowded sidewalks down to 2nd Avenue. The restaurants had long lines and wait times of over an hour. They decided to grab a quick snack and coffee in a cafe and head to the river. Although the excitement of all the bars and live music was inviting, they wanted somewhere quiet and calm. The Riverfront Park was peaceful, and they sat on the grass to watch the boat traffic on the Cumberland River slowly float by.

      "It's been a great week, Michelle. I'm glad you introduced me to All Saints House. I remember our conversation last year when I felt you portrayed me as an arrogant, greedy bastard," said Galen. He knew Michelle's view had been correct.

      "So, you had a good time there?" asked Michelle.

      "It wasn't so much a good time as it was a valuable time. I learned so much about how our modern healthcare system works, and I wasn't impressed with most of it. The people who need the care the most often can’t access it because of money. That doesn't seem right to me."

      "Mom and I know all about that first-hand. All Saints helped us when we had no other way of getting care", said Michelle.

      "I wish I could change the whole system where it all worked like All Saints. The industry of healthcare in America is set up to provide huge profits. Even if a small portion of the profit was put to good use, we could provide all the basic health needs. Most of the patients I met this week need basic medicines and access to a clinic on a regular basis." Galen's vision of his future in medicine had changed in the past week.

      "I hope you keep the same excitement to help people once you're out of medical school. If you do, you'll be a WBD."
Galen asked, "What's a WBD?"

      "World's Best Doctor," said Michelle. "Unlike my dad, who went the other direction as a doctor to become a WBA."

      "Okay, what does WBA mean?" said Galen, expecting something sarcastic.

      "WBA stands for World's Biggest Asshole," said Michelle. "Mom said he didn't start out to be a WBA, but he caught a terrible case of greed and it became terminal." 

      The sarcastic remark brought a loud laugh from Galen as he rolled over on the grass.

      Galen said, "Now that's a classic statement. I'll have to remember that. It’ll probably be pertinent many times in my career."

      "I wonder how people start out with a benevolent heart and end up infatuated with money and all the material things that money brings. Mom always said Dad was actually a nice person until he tasted some degree of success, then he desired a bigger house, a better car, a higher position in the hospital, and eventually a younger wife.

      “She always said the M.D. degree stood for 'More Demanding,’ at least in Dad's case. Now that he's a CEO, I doubt he has any recollection of the days when he actually cared for patients. Galen, you should never forget your roots. The people you've seen this past week are just like us. A few small changes and any of us could be waiting in line at a charity clinic to get medical care." Michelle’s voice had taken a more serious tone.

      Galen spoke as the setting sun cast shadows across the river. "I agree that all it takes is an unfortunate event to change your life. People should have a right to good healthcare without going bankrupt or having a collection agency bothering them for expenses just because of an illness or injury.

      “I remember what you said, Michelle, last year when you challenged me to come to All Saints House. You said, 'The blindness to the truth occurs slowly,' and that has stuck with me because people like your dad don't change overnight. They make small compromises in their values slowly over time and eventually transform into a person unrecognizable from their original self."

      Michelle said, "You're better than most, Galen. Just don't go blind like so many do." 

 

 

About the Author

  • Photo of author

         Dr. Parish is a full-time physician in Family Medicine in Naples, Florida. He is a Kentucky native and alumnus of the University of Kentucky College of Medicine. His twenty-two years of experience has varied from non-profit and for-profit medical groups in addition to private practice. He is a member of the Florida Writers Association, Backspace Writers organization, Thoreau Society, and life member of the Ralph Waldo Emerson Society.
         The short story, All Saints House, is part of a larger work-in-progress which addresses the coming-of-age of a young physician faced with the challenges of practicing medicine in the world’s most expensive healthcare system fueled by desire for greater profits.

     

     

     

     

     

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    Published: June 5, 2013