Hard Times

The sun lights the waiting room but the fluorescents are on overhead anyway. The woman next to me eats Pringles from a long red can as the young couple across the aisle fill in sheets of paperwork on a clipboard. I try not to look at his face; the right side is significantly swollen with a line of black stitches running the length of his nose. He wears his black sweatshirt hood over his head, not wanting to be noticed. A girl with pigtails and shiny black boots ambles around the thighs of an man at the check-in desk. He signs to her, looking down, his lips move in words, repeating the sign again. His hair is grey. He is unshaven, wearing beige linen. As they pass me I notice his daughter's hearing aid is bright green behind her left ear.

The patient appears in the waiting room with his son. His steps tentative, he walks with both arms bent, shuffling and trailing behind his son. The son cuts his mother off, encouraging his father to speak at the beginning of the visit. The father describes a fall in the shower, where he split the head of his humerus. His voice is light, feathery. His face reveals no emotion. The wife takes up the thread as the patient stalls. She is freckled with dark red hair. She speaks adjusting her gaze to the people in the room, describing her husband's last day at work, when he said he couldn't do it anymore. He gave up practicing medicine afraid he'd make a mistake, and a patient would suffer.

They have no health insurance. The spouse is hoping to get a full time position with health benefits in the company where she works, leaving the husband alone at home. With no patients to occupy his mind, a painful arm and limited contact with others, his depression has darkened. The physician behind the desk talks about decompensation; how a urinary tract infection, cold, flu or broken arm will intensify the Parkinson's disease. Pain amplifies the symptoms of PD, making sleep elusive and scarce. Without sleep patients are prone to hallucinate. As he goes through the physical exam, the clinician emphasizes he believes in providing pain medications to patients in pain, it's what the prescription is for. Later, the ailing doctor can wean himself. The right hand of the broken arm is swollen from disuse. The other doctor encourages the patient to use his hand; squeeze a ball, move individual fingers.

He would like to order physical therapy, but he knows the patient has no insurance and no Medicare. He encourages the patient to exercise, perhaps with a stationary bike, citing a recent study where the benefits of exercise on the brain were sizable. The wife gathers the prescriptions to leave, rising from her chair. Her coloring and substantial body mass contrasts sharply with the angular knees that poke from beneath the taupe trousers of her husband. Indeed, he has lost twelve pounds in the two weeks since the last appointment. What will he weigh when he returns?