Tales of the Clinic
A story collection on Barbara's experiences at an urban clinic.
All stories are by Barbara Ramsey unless otherwise noted.
The doctor learns a lesson
I asked him a question: What if he were the doctor and I were the patient?
I WAS A THIRTY-SOMETHING white woman practicing family medicine in a small clinic in East Oakland. Bill was a middle-aged black man who came to the clinic for medical care on a regularly irregular basis. He was a guy who liked his liquor and his ladies in equal measure, and many of his medical problems stemmed from one or the other or both. He found it inconvenient to keep appointments to address his high blood pressure and malfunctioning liver. But he was good about dropping in from time to time if he felt poorly, especially if he had symptoms of a sexually transmitted infection.
Bill and I were both skilled at diagnosing these kinds of problems and I appreciated his matter-of-fact attitude. Some guys who came to the clinic with penis-related complaints were mortified to see a female physician. Bill respected my straightforward approach and I his. He always allowed me the requisite time to give my HIV-prevention spiel and I spared him anything resembling a “Bill, I’m disappointed in you for not wearing a condom” lecture.
What troubled me was his blood pressure. While gonorrhea was a bother, uncontrolled hypertension was far more likely to kill him. He’d periodically accepted a prescription for meds, but basic math convinced me that a 90-day supply of pills shouldn’t last him for a year, despite his reassurance that “Nope, don’t need a refill yet—I’ve got plenty still at home.”
While Bill sometimes told me what he thought I wanted to hear, he wasn’t usually masking. He seemed willing to present his real self and that wasn’t common with other patients. I, on the other hand, often felt it necessary to conceal myself, especially when it came to certain emotions, especially anger. Anger was one hundred percent unacceptable to me while in a room with a patient. But one day with Bill, I let it out.
The problem was that I really liked the guy. He combined self-confidence with a knowing self-deprecation. He had a kind of pride that didn’t preclude genuine humility. He was charming, he was funny, and he was smart. So I was mad at the person who was risking Bill’s life by not taking his meds: Bill.
I just blurted it out. I told him I was mad that he wasn’t taking his blood pressure meds regularly, mad that he failed to show up for half his appointments, mad that I seemed more worried about his health than he was. Then I asked him a question: What if he were the doctor and I were the patient? What would he do with a patient like him?
Bill looked right back at me. “Well, I sure wouldn’t give up on a fella like me,” he said.
He was right. He’d give me an accurate job description—all my training summed up in a sentence. Bill continued to come to the clinic on a regularly irregular basis for another ten years, until his death. I miss him. —Barbara Ramsey
Staff training
One morning Shirley came into my office and asked, “Dr. Ramsey, what causes seizures?”
OUR CLINIC WAS FOUNDED by Native American activists and focused on caring for Native Americans, though we also served our entire multi-ethnic neighborhood in Oakland. We also made a point of hiring staff from among our patients. Most had little formal education and required a lot of on-the-job training, especially our receptionists. They were often the first point of contact for patients and needed to be warm and welcoming but also cool enough to handle difficult situations.
Shirley Kaiviti was our main receptionist. A Miwok native, she’d married a guy from Fiji, and had been a regular patient of ours for several years before we hired her. Tall and heavy-set, she wore her dark hair down to her shoulders and had a calm, impassive look and manner. She rarely expressed emotion and I never saw her perturbed in any way. She was perfect from the jump.
One morning Shirley came into my office and asked, “Dr. Ramsey, what causes seizures?” I was always keen to teach staff about health and disease. Shirley had never seemed very curious about medical matters, so I responded eagerly to her question.
“Well, a seizure is like an electrical storm in the brain,” I said. “Any one of us can have a seizure if our electrical signals get fouled up badly enough.” I didn’t want her to stigmatize a patient for being epileptic or “wrong” in the head.
“A lot of things can cause a person to have a seizure,” I said, and then went on to describe several of the common causes, including head injuries and withdrawal from alcohol. I explained how we all rely on regular waves of brain activity for consciousness and how disruption of those waves can cause us to lose consciousness.
Shirley listened patiently, just nodding her head. Finally I paused and Shirley said, “Cause somebody in the waiting room is having one.”
As I rushed to the front desk to investigate, I realized that the staff member needing some on-the-job training was me. Next time Shirley posed a medical query, I decided the best response would be, “Great question! Why do you ask?”
The daughter
Bill hadn’t ever mentioned her. Doctors were doctors and family was family.
ALTHOUGH HE FAILED to take the meds I prescribed or curtail his drinking and smoking, Bill memorably once told me not to give up on a guy like him. And I never did. When a chest x-ray revealed a tumor in his chest, I was committed to getting him a complete work-up. But there were obstacles.
Bill had been a longtime resident of East Oakland with many close friends and neighbors. Unfortunately, that neighborhood had become increasingly dangerous over the years. When the crack epidemic hit hard, older people like Bill became the targets of addicts desperate for even a little money. There were drive-by shootings just a block or two from our clinic—at noon, in broad daylight.
But Bill was a bright and resourceful guy. Six months before his cancer diagnosis, he found a small apartment in a subsidized housing development twenty-five miles away. The pleasant Bay Area suburb near a BART transit station was far safer than his old neighborhood, but he lived alone without a car and was now far away from his old friends. Though there were no drive-by shootings, there were also no neighbors he knew. And the hospital where he could get diagnostic studies and treatment was a forty-five-minute BART ride.
I was a family physician with limited expertise in lung cancer care. I gave him as much help as I could, but his work-up was mostly performed by other doctors. I did manage his referrals and kept track of his overall situation. And I anticipated the usual difficulties. He would need transportation, home care, and emotional support.
When I asked Bill who might go with him for this series of treatments, he said, “No one. I can do it by myself.” So, I decided to accompany him on his first visit with the radiation oncologist. Partly I wanted to go for selfish reasons. This doctor had a good reputation and I wanted to meet him and forge a connection, both for Bill’s sake and for future patients who might need cancer care.
The oncologist was cheerful and competent as he walked us through a description of the treatment plan, which involved a series of radiation treatments. These would require Bill to shuttle back and forth between his home and the hospital over many weeks. He seemed unconcerned. “That’ll be fine,” he said. “No problem. Things will turn out.”
After the visit was completed, I had a quick private conversation with the doctor. I explained the complexities of Bill’s situation, but he seemed as unconcerned as Bill. “Just call the cancer society” he said. “They have volunteers who can provide transportation, help with meals, all that.” His nurse gave me the phone number and I drove Bill home. On the way, I explained about the cancer society assistance that was available. He sounded dubious. Other people meddling in his business? He wasn’t sure he was interested.
Once we got back to Bill’s apartment, I asked if he would please show me around his new place. The apartment was small but tidy and clean. He invited me to sit down on a well-worn sofa. “Bill, this could be a difficult next few months,” I said. “You’re going to need other people’s help. You know that don’t you?”
He didn’t agree but was willing to discuss it. I asked him if he’d told any of his old friends back in Oakland about his diagnosis. “No,” he said. “They have problems of their own and don’t need to know about this.” His attitude didn’t surprise me. Several of my patients over the years felt a cancer diagnosis was the most private of subjects, occasionally even shameful. Simply to speak of it was to invite darkness. I had one patient who could never say the word except in a whisper.
I asked Bill if he had family he could talk to. No, his siblings were dead or in other states. I asked if there were any other family members. No, just his daughter.
His daughter! He’d never told me he had a daughter. She was the child of his first marriage and lived in Virginia. He said he talked to her over the phone sometimes but hadn’t told her about his cancer. He couldn’t be bothering her with his health situation. She had a husband and kids and an important job with the state government.
“How about if I call her?” I asked. “I can tell her about your cancer diagnosis and then you won’t have to.”
“Sure, if you want to,” he said quietly.
He gave me her number. It was about 6 pm on the east coast, so I figured I had a good chance of catching her at home. She answered on the third ring. I explained who I was and the reason for my call. After a few words of preparation, I explained her father’s situation.
“Daddy!” she said. “Oh my God!” She was flustered and confused. When she caught her breath, she asked all the pertinent questions, which I answered as best I could. Then I heard loud thud. “Oh, I’m sorry,” she said. “The suitcase just fell off the bed. I’m trying to pack as we talk.” Pack? “Yes, ma’am, because I’ll be taking the next plane. I’m coming to California to be with Daddy.”
I handed Bill the phone. “She needs to talk to you.”
She did come to California and handled everything expertly. It turned out that she had been calling and visiting Bill regularly over the past fifteen years. He hadn’t ever mentioned her because it had never occurred to him to do so. Doctors were doctors and family was family.
His daughter talked him into letting the cancer society people help out and she arranged for many details of his care. That first time she stayed long enough to take charge, then delegated appropriately. Bill only lasted another eight months, but his daughter and her kids returned several more times before he died. He’d been right all along. Things turned out.
The vaccine line
“I’m next!” said the taller one. “No you’re not!” snapped the other. “I was here first.”
MEASLES IS A TERRIBLE disease. Its complications include blindness, pneumonia, and encephalitis. It’s also more contagious than most infectious diseases. If ten people are infected with tuberculosis—not just exposed to it, but actually infected—odds are that only one will get sick. If you simply expose ten unvaccinated kids to measles, nine of them will probably get sick. Once they’re infected, up to twenty-five percent of them will require hospitalization.
Few people remember it now, but there was a significant measles outbreak in New York City in 1989. It spread in waves and pulses to Philadelphia, the rest of the East Coast, and then westward to Chicago and beyond. Because vaccination rates were fairly good, the spread was slow. But in 1991, it arrived in the Bay Area. The local epicenter was Oakland, where my clinic, Native American Health Center, was located.
People were scared. Images of kids in the ICU crowded the nightly news. They wanted the vaccine. Our clinic, in the middle of the hardest hit area, was ready. We set up special Saturday morning clinics and radically stripped down the way we processed patients.
We had only two requirements. All kids had to be accompanied by an adult who at least claimed to be the parent or guardian. We didn’t ask for proof. And the parent or guardian had to bring the child’s vaccination record card with them. In California at the time, vaccination cards were bright yellow and though the cards could be mutilated, lost, or chewed by the dog, most people did an astonishingly good job of holding on to them.
As the gatekeeper at our special Saturday clinics, my job was to eyeball the parent or guardian and review the yellow cards for the one, three, or seven kids they brought. Once I’d made sure the child hadn’t yet been vaccinated, they were ushered into a room for the procedure.
On the very first Saturday, we had a line out the door. I felt great—we were providing a vital preventive service that would keep a bunch of kids out of the hospital. And after working out some first-day glitches, the line moved quickly, the kids were fairly well behaved, and the staff was at peak efficiency.
But after two hours of standing at my little podium reviewing yellow cards, a problem arose. Two women stood directly in front of me, each with several children in tow. A few minutes earlier, I’d noticed them speaking loudly and aggressively to one another. Now they were in front, jostling to be next in line.
“I’m next!” said the taller one.
“No you’re not!” snapped the other. “I was here first.”
“You’re a lying bitch. I was here first.”
Then they both turned to me and demanded to be next.
While I’m fundamentally conflict-averse, and would ordinarily have tried to ignore this, I worried this was about to boil over into fisticuffs. Somebody had to do something and that somebody was me. Fortunately, in that instant, an idea spontaneously came to me. I looked each woman in the eye and said. “Which one of you is going to be gracious enough to let the other one go first?”
The taller one squinted and hesitated, not quite comprehending. The other one had a pensive look, considering her options. Then suddenly, she spoke up. “That’s okay, let her go first.” she said with a superior tone. “She can go ahead of me if she wants it that bad.”
The taller one came forward. “Yeah, let me go first. Here’s my kids’ cards,” she said. But she looked dazed and unsure exactly how she’d won the battle. I waived her and her kids through.
Relieved that my idea had worked, I turned back to the second woman. “Some people!” she harrumphed. But I noticed there was a huge smile on her face. I had one, too.
No thank you
“I found this on my kitchen floor this morning,” he said, holding out the bag to me.
AS A DOCTOR at an inner city clinic, I encountered a wide range of people with a wide variety of dispositions. One of my sweetest patients was a guy in his early fifties who I’ll call Lloyd. He’d developed schizophrenia in his early twenties and had been hospitalized on and off for decades. I met him after he’d come out of these experiences relatively intact. Some clinicians would have called him a “burnt out” schizophrenic. He no longer had hallucinations or delusions and was better able to connect with the reality outside his head.
His suffering had gifted him with a warm kindness, an ability to care about others who had also suffered. He continued to be fairly paranoid at times, but wasn’t on psych meds and was able to hold a job. He was a security guard at a local porn theater. Since he was short and scrawny, I always suspected he must have been the manager’s cousin. I couldn’t imagine him successfully scaring off a rampaging porn patron. The theater provided him with a threadbare uniform and a tiny paycheck.
Lloyd also had daughter, a lovely 14-year-old named Kisha, and he was a proud father, frequently updating me with her progress in school. Due to his psychiatric history, his ex-wife had custody of the girl. But as his mental state had improved, she’d allowed him to care for the teenager on weekends.
One day, he came to clinic highly agitated. His ex had decided their daughter could no longer stay with him. She said his ground floor apartment, which the girl had described to her in lurid detail, just wasn’t good enough.
“My ex thinks the place is a dump. She’s worried that the back door doesn’t shut right, that raccoons or rats or whatnot could get inside. She thinks Kisha isn’t safe.”
Many of my patients lived in substandard housing with peeling lead paint, leaky roofs, and decaying floors infested with all manner of things. Though I’d never seen Lloyd’s place, I could imagine. Apparently, the landlord never repaired anything, including the plumbing. Lloyd said he kept it clean but couldn’t afford to repair it himself.
“Maybe you could spend time with your daughter at your ex-wife’s place?” I ventured.
He explained that his ex had a new husband who didn’t want him around. He understood. He hadn’t been a very good husband and now she had a better one. “What can I do?” he asked. “My apartment needs to get fixed or Kisha can’t come back. Can you help me?”
That kind of request was common. As a physician, I was often the only authority figure in my patients’ lives, other than their pastors, to whom they could appeal. But I rarely had either the power or the skill set to provide the kind of help they needed. Fortunately, I had colleagues, including a clinic social worker who I felt sure would know what to do. I’d also recently learned about a new renters’ advocacy group that aided people in predicaments like Lloyd’s. A week earlier I’d heard one of their staff members describe their services with gusto.
I reassured Lloyd we could get him the help he needed. “Thank God!” he said. “I was afraid you wouldn’t believe me, that you’d say it was only in my head—which is why I brought proof.” He pulled out a burlap sack and jerked open the top.
“I found this on my kitchen floor this morning,” he said, holding out the bag to me. I hesitated. The sack was a strange shape. I didn’t want to get too close, but couldn’t help myself. I peered in. Coiled inside was a giant snake.
I leapt backwards. “Don’t worry, I killed it before I put it in the sack,” Lloyd said. “You can keep it.”
Now, I’m not especially afraid of snakes, but I certainly didn’t want this sack. I didn’t want it in the exam room. I didn’t want it in the clinic. Like Dr. Seuss’s Sam-I-Am, I felt like shouting, “I do not like it here or there! I do not like it anywhere!”
Instead, I simply said, “No thanks. I think you should hold on to that. It’ll may come in handy later on.” I suggested that the renter’s advocacy group might want to take a look. I also wanted to dissuade Lloyd from dumping the dead snake into one of our trash cans on his way out.
“Okay, I’ll keep it,” he said, putting it back under his chair. “It’s a big one, alright. Just slithered in on its belly this morning, maybe through that hole in the boards by the back porch. I’ve seen ‘em in the backyard before but never inside the house. That’s just not right.”
“I couldn't agree more,” I replied, and then hurried out to grab the social worker.
The sponge count
There were things inside his body that weren’t supposed to be there.
LET US CALL HIM Mr. Jones. I had worked as a family practitioner in a small East Oakland clinic for less than a year when he arrived as my first patient of the afternoon. Jones had never been seen at our clinic before and his chart was blank except for name and date of birth. He’d been scheduled for a half hour visit.
A wizened guy in his 60’s, he looked at me suspiciously as he began to recount his story. He’d been having “stomach trouble” for several years and doctors hadn’t been able to help him. He launched into a lengthy story of his various interactions with doctors. Some of the story was clear enough—stones in his gallbladder and a surgery, maybe last year, that was supposed to remove them. Other parts of his tale didn’t quite make sense or seemed outright nutty. People were out to get him. There were things inside his body that weren’t supposed to be there.
Once I’d gotten as much info about his abdominal difficulties as I could, I took the rest of his medical history. He’d broken his arm in his 20’s. Once he’d had pneumonia. And yes, he drank every day and sometimes passed out. No, he wasn’t bothered by that. His drinking wasn’t the problem. His drinking made his problems tolerable.
By the time I’d finished his history, we’d been in the room for forty-five minutes and I had two patients waiting. I apologized for not having time to conduct his physical exam and encouraged him to return in ten days for a follow-up visit. I’d do the physical and we’d proceed from there. He continued to eye me with suspicion but agreed to return.
I WASN’T SURE HE WOULD. And I wasn’t sure I could do him any good. He was a long-term alcoholic, possibly with a psychiatric disorder that caused paranoia or even delusions. Perhaps there wasn’t a separate psych problem and he suffered from brain damage associated with alcoholism. Neurological impairment can lead to memory loss and people make up stories to compensate. His medical problems might not be solvable by the likes of me.
He did return in ten days, right on schedule. Starting at his head, I examined his eyes, ears, nose, throat, neck, lungs, and heart, finding nothing remarkable except a slightly rapid heartbeat. Then I got to his abdomen. Sure enough, there was a scar from his gallbladder removal. I was familiar with such scars from patients who’d had the good old-fashioned abdominal surgeries common before laparoscopic procedures became the norm. But this scar wasn’t normal. It was chronically inflamed, thickened and red, with open, weeping lesions.
I asked if his procedure had really been done more than six months ago. The scar looked fierce and recent. I tried to palpate his belly with my hands, but his abdomen wasn’t just tender, it was exquisitely tender and abnormally distended. I was freaked out. Mr. Jones might have neurological problems, all right, but those were the least of his worries. He got dressed again and I discussed my findings.
“Yes,” I said, “Of course you’re having belly pain. You have something very wrong going on, a dangerous medical problem. You should go to the emergency room for an evaluation today.” I wanted him admitted to the hospital immediately.
He explained, calmly, that he would do no such thing. Those doctors at the hospital had made him worse by doing their infernal surgery. He wasn’t going to give them another chance to hurt him. “Oh yes, those doctors want me to come back. I know that,” he said. But he wasn’t going.
I was accustomed to patients resisting instructions or treatments. There’s a certain dance, a give and take that’s required. But this was different. I knew when I was meeting a wall and this guy was a wall. Ultimately, he did agree to come back the next day for further discussion. That was as good as I could do. I had some blood drawn for testing and told him I’d be talking to other doctors prior to his next visit.
Immediately after he left, I called the hospital where he’d had his gallbladder removed. It was a good hospital with a mission to care for everyone who walked through the door. Against the odds, I got through to the surgery department immediately and—either accidentally or providentially—got their best guy. He was relatively young, up and coming. He performed more surgeries per week than anyone else on staff. Indeed, he’d performed the surgery on Mr. Jones.
I still remember the sound of his excited voice. “Jones? Mr. Beaumont Jones? You’ve seen him? He’s alive?” He sounded both incredulous and overjoyed. I told him what I knew. He explained that yes, Mr. Jones had his gallbladder removed seven months earlier. The surgeon had seen him several times after the surgery, but no, Mr. Jones didn’t heal as expected. His post-op course was what you’d expect only if you expected the worst.
Surgeons are responsible for everything that happens during an operation, but they rely on many others to help. There’s always someone—a surgical tech or a nurse—who performs what’s called a sponge count. A “sponge” is a piece of gauze. The person who does the sponge count keeps track of exactly how many sponges there are at the beginning of a procedure and how many at the end. A sponge count can be wrong, but it’s rare. For those rare cases, every piece of gauze has a tiny string woven in that shows up on an x-ray. When the surgeon ordered an abdominal x-ray, there it was, a tiny string.
But Mr. Jones had walked out of the hospital after the x-ray and never returned. The surgeon called but couldn’t reach him at his house. He sent letters explaining the situation and asking Mr. Jones to please come back to the hospital. No response. Then Mr. Jones apparently moved to another residence, and no one knew where. The surgeon feared for Mr. Jones’ life but couldn't figure out what else to do.
Turns out Mr. Jones did receive those letters from the hospital and read every one. He knew there was something inside him that shouldn’t be there and had tried to tell me that on his first visit. But he didn’t want to return to the place where they’d left something inside him, even if it endangered his life.
I couldn’t fault the guy’s logic, but I had to persuade him to speak to the surgeon. When he saw me the following day, we had a long discussion. I got the surgeon on the phone and the two of them talked. I believe there was something in the surgeon’s voice. I’d heard it, too—the joy of finding Mr. Jones alive—that ultimately turned the tide. Mr. Jones agreed to go back to the hospital.
A follow-up surgery was scheduled, but I worried Mr. Beaumont Jones might change his mind again. He’d given us his new address and the surgeon sent a social worker to check in with him a couple of days before the repeat surgery. I also decided that this was a rare case where a house call from Dr. Ramsey was warranted.
I made a date to go to his house the day before the surgery. When clinic was over for the day, I drove to his home, a big old Victorian built in the day when this part of Oakland had been orchards and farms, long ago. The ramshackle and decaying house had been converted to a group home with a landlady who acted as a gatekeeper. Most residents were single men receiving some kind of assistance or disability payments to pay their rent.
Mr. Jones met me on the ground floor in a living room that was the shared space for visitors and family. He was reserved, reluctant, and resigned. I tried to be as encouraging as I could. “You’re going to feel so much better once this is done!” I said. “In another two months you’ll feel like a new person.” I knew I sounded way too chipper. Still, he promised to be at the hospital the next day, rain or shine.
And he kept his promise.
Snack time
Sometimes a cheesecake isn’t what it seems.
I ALWAYS CRAVED sweets during my long afternoons at the clinic. Our work was often frustrating and our patients complicated. To compensate, all of us—receptionists, nurses, medical assistants, doctors, outreach workers—held frequent potlucks and staff birthday parties to reward ourselves with food. We used any excuse to fill the break room with goodies. Many on my staff liked nothing better than a hot piece of fry bread with all the toppings. I enjoyed that, too, but for me, dessert was the thing. My favorite bakery was a Just Desserts store in Oakland. They made a Kahlua cheesecake that I especially loved, and I made sure all my friends knew it was my favorite.
One morning, Sue, a co-worker I liked, left the clinic early to attend a noon baby shower. She promised to make up for her early departure by bringing back leftover food from the event. Good deal, I thought.
Shortly after lunch, Sue returned and as promised presented me with a generous hunk of cheesecake. It was beautiful—the exact shade of caramel that only Just Desserts could achieve by adding the right amount of Kahlua. I was busy with patients and didn’t have time to eat it then, but the vision of that cake stayed in my head all afternoon. It kept me going for the next several hours as I went from exam room to exam room. Finally, around four o’clock, I had a few extra minutes and returned to my desk. The creamy looking wedge of cheesecake sat there, just as I remembered. My wait was over. I grabbed a fork and plunged a big chunk into my mouth.
F******k! It was putrid. Truly horrid. I involuntarily spewed it out of my mouth and by the merest of chance it landed in my large, government-issue garbage can. This can had probably been serving its country since World War II and continued to perform well that day, perfectly catching the foul projectile. Relieved that I hadn’t spewed onto the floor, I scraped the rest of it into the can. I wanted my desk to be free of every last trace of… what? What the hell had I just tasted?
Still, I knew Sue was bound to return any minute to ask me how I liked it. And the evidence of my opinion conspicuously stared back at me from the garbage can. I hastily grabbed some junk mail, threw it on top of the food, and shoved the can under my desk just before she walked in the door.
“So how’d you like it?” she said. “Pretty amazing, huh?”
“Oh wow, yeah, really amazing.” I struggled to keep my composure. “Do you know how it was made?” Sue, I knew, was a cook and a bit of a health food nut.
“Well, you’re never gonna believe it. There weren’t any dairy products in it, and no sugar either,” she said. “The whole thing was made with tofu and rice syrup and seaweed products!”
I looked directly at her and spoke the simple truth. “I’ve never had anything like it,” I said, and she left my office, smiling.
Desk Job
Either Diana was a drug dealer or Shirley was a liar.
I FOUND OUT about the cocaine on Monday morning right before lunch.
“Diana is selling coke, right here in the clinic,” Shirley said. “She keeps it in her desk.” Shirley was our main receptionist and a woman of few words. Diana was my medical assistant, the person who took patients to the exam rooms, recorded their vital signs, and helped me with blood draws and vaccines and the like. My patients depended on their work every day. I didn’t want to think badly of either of them.
But now either Diana was a drug dealer or Shirley was a liar. Even my well-honed mechanisms of conflict-aversion couldn’t make this go away.
I asked Shirley how she knew. Her answers were credible and delivered in a flat, even tone of voice. Neither gloating nor gloomy, she sounded like a court reporter reading back testimony to the judge. I believed her. And she gave me names of other clinic staff who could back her up.
Sure enough, Shirley’s story checked out with the others. That Diana was dealing coke had apparently been common knowledge for months, which made me feel foolish. She did it right under my nose in a small office that I was nominally in charge of running. What else didn’t I know?
Reluctantly, I trudged up the third floor steps to my boss’s office. Marty Waukazoo was behind his desk, finishing a phone call. As the clinic’s medical director, I avoided involving Marty, the executive director, in the day-to-day running of the clinic. But this was over my head.
“Marty, we’ve got a problem,” I said as he he put down the phone. I was flustered and unclear on our options. But Marty took the news with equanimity. Having been to more than one training for executive directors, he seemed clear-headed about the legal and HR issues. And as a graduate of a local drug and alcohol treatment program, he was wise in the ways of habituating substances. This problem was right in the middle of his wheelhouse.
“Tomorrow I’ll notify Diana that I need to see her here in my office at eleven o’clock sharp,” he said. “You be here, too. We’ll talk to her together.”
Marty and I had worked together for more than fifteen years at that point and I’d come to appreciate certain leadership strengths he possessed. But dealing coke in the middle of a health clinic? Where was that in the employee handbook? What would Marty do?
The next morning came too soon. I dreaded the conversation. But when I went to Marty’s office a bit before eleven, he was relaxed, sitting at his desk as if it was a perfectly ordinary day. Diana arrived on time and Marty had her take a chair directly across from him. I sat in an uncomfortable wooden seat off to the side. A tall, lanky Native woman, Diana often had a rather bored, insouciant demeanor. With us, she doubled down on that overall vibe, adding a dollop of I-have-no-idea-why-I’m-here.
Marty got right to the point. In a matter-of-fact tone, as if commenting on the weather, he said, “Your co-workers have told Dr. Ramsey you’re selling cocaine here on clinic property.”
She didn’t bother to act surprised, bewildered, or even just taken aback. She went for totally pissed off. “That’s a lie! That’s not true! No way!” Her lower lip stuck out, defying us to challenge her.
Marty deflected this nicely. “Unfortunately we have no choice but to suspend you while we investigate,” he said. “This is a serious charge, a criminal allegation.” I was suddenly glad that Law & Order was one of Marty’s favorite shows. He knew the lingo perfectly. I sat on the sidelines, nodding.
“Your suspension begins this morning,” he said and started to explain what a suspension entails. But Diana couldn’t hold back. “You can’t do this! I only sell coke on my lunch hour,” she said. “You can’t tell me what to do on my lunch hour.”
I was gobsmacked. Even the dumbest perp on Law & Order never gave it up that easy. And she was about to make it easier yet.
“You can’t suspend me,” she said. “In fact, I don’t even want this stupid job. I quit!” She said this confidently, like a woman with a lucrative side hustle.
“Ok then,” Marty said, magically producing a a blank piece of paper and a pen. He slid them over to Diana’s side of the desk. “Just write ‘I resign from my job as a medical assistant at Native American Health Center’.”
She grabbed the pen with snarl on her face, eager to prove she wasn’t bluffing. As she wrote, I reflected on the fact that, while she’d never been a very good medical assistant, she’d always had beautiful penmanship. A real plus.
“Date it at the top,” Marty added. “It’s the seventeenth.” He had the tone of a bank clerk helping an adolescent write her first check.
When she was done, Marty instructed her to remove her property from the clinic premises and called his assistant to escort her downstairs. The whole business, start to finish, had taken less than ten minutes. I leaned back in my chair, stunned.
Marty looked over at me with a smile. “Wanna go to lunch?” he said.
An Apology
“Whatever you do, don’t tell anyone,” he said. I nodded and he left.
ONE DAY AROUND LUNCHTIME, Marty Waukazoo, the executive director of the Native American Health Center, paid me an unexpected visit. He stepped into my office and shut the door behind him. “Dr. Ramsey!” His voice was unusually distraught. Did a grant get pulled? Had someone died? His tone was alarmed and alarming.
“I have something to tell you. I’ve had it with the Board of Directors! I’m sick of this, I don’t want it anymore. I’m going to hand in my resignation!” He was angry and determined. My mouth fell open but I couldn’t think of anything to say.
Marty was the glue that held the clinic together. A longtime member of the Bay Area Native American community, he provided one of the central bonds that knitted together our little non-profit organization and the people it served. He was also a recovering alcoholic whose struggles helped inspire patients and staff members. If he suddenly resigned, especially in anger, our entire institution would be threatened.
“Whatever you do, don’t tell anyone,” he said. I nodded and he left. The office was suddenly empty except for me and my half-eaten cheese sandwich. For the next hour I took care of patients, answered phone calls, and discussed lab results with one of the nurse practitioners. But I was flooded with anxiety about Marty. What had just happened? What would happen next?
The clinic manager at that time was a fiercely intelligent, gregarious nurse named Kathy Asfeh. A recovering alcoholic in her thirties, she had special insight into patients with addiction issues. She appreciated that Marty was a fellow alcoholic, which gave her a sense of camaraderie with him.
She walked into my office, took one look at me and said, “What the hell’s wrong with you?” Though no one had noticed a thing in the past hour, it took Kathy exactly two seconds to sense my distress.
“Nothing, just a lot of patients to see, I guess.”
“I saw Marty come outta here awhile ago. What’d he say to you?” I suddenly felt like I was five years old, trying to hide something from my mother.
“Oh, I can’t tell. I promised him I wouldn’t.”
“Promised him?”
“Well…I mean, he told me I couldn’t. I mean…” Then I spilled everything. Kathy listened, but was utterly unconcerned with Marty’s imminent resignation. That floored me. Instead, she focused on the fact that he’d dumped a bad piece of news on me and then forbade me to speak of it.
“That’s classic dry-drunk behavior,” she said. “He can’t stay sober if he gets away with shit like that.” She set her shoulders and raised her chin. “I’ll be leaving the clinic for a little while. If anyone needs me, tell them I’ll be back by four o’clock.”
A few hours later, I was in my office jotting notes in a chart when Kathy reappeared—with Marty. She pulled on the sleeve of his suit jacket until he was standing right in front of me. “Marty has something to tell you,” she said.
He looked at me directly. “I apologize for what I did earlier. I wasn’t being fair to you.” He sounded compassionate and concerned for me and my feelings. I’d never seen him looking so vulnerable yet so full of purpose. “I hope you’ll forgive me.”
“Of course! It’s okay,” I rushed to reassure him. “I understand you’re under a lot of pressure.”
“That doesn’t make it right. I shouldn’t have done that,” Marty said. I wanted to hug him. I’d rarely received an apology both so courteous and heartfelt.
“Well, I’ve got a clinic to manage. See ya later,” said Kathy. She strode away, humming to herself.
I never learned what set Marty off, but he didn’t hand in his resignation after all. He and I continued to work together for another twenty years. We had our ups and downs, but there was always a strong bond between us. Kathy helped mix the cement.
The crook and the coup
She had bragged in writing about raising money for an organization she’d defrauded.
By Kerry Tremain
EVA CRAVEN. If you needed a name for your novel’s villain, you’d probably reject that one as too obvious, too trite. Yet Eva Craven is in fact a villain in my story. I didn’t make her up.
In 1996, roughly halfway through Barbara’s twenty-year tenure as the medical director of the Native American Health Center, there was a coup. Marty Waukazoo, a member of the Lakota tribe and former basketball star from South Dakota, was the clinic’s director. A tall man, Marty hunched over slightly when talking to people and ambled down a hallway as if he were still dribbling a ball. He was utterly serious in running the clinic, but also wickedly funny, with the style of humor that lulls you into worrying that he’s lost the thread of a story before smacking you upright with a punchline.
Like a lot of nonprofits, the clinic’s board of directors was responsible for recruiting new members. But the members that year let their number dwindle to four. All were Native Americans. A couple had pasts with other Indian organizations that, especially in retrospect, were amiss. Once they were four, they starting voting themselves various perks, such as new laptops and monthly stipends. They contemplated starting new businesses, including a Taco Bell franchise, using collateral from the medical building the clinic had managed to buy a few years earlier. They hired business consultants to help them “monetize” the clinic. Eva Craven was a key player in their schemes.
Marty grew increasingly suspicious of these goings-on and finally, at a board meeting, he asked pointed questions about some of their expenditures. They fired him on the spot. He recalled with a smile that as he was being escorted out of the building, a staff member hurried after him to get a requisition form signed.
When Barbara learned what had happened, she drafted a petition that was signed by the entire medical staff. On threat of resignation, they demanded Marty be reinstated. This initiated a standoff, with the board making moves to mollify the staff and splinter them from Marty while the staff felt an obligation to continue serving their patients for as long as possible.
Fortunately, in years prior, Marty had been to every rubber-chicken dinner organized by Democratic officials in the county. All were all on a first-name basis with him, rightfully considering him a leader of the local Native American community. He also had unanimous support from local health care officials. So, when Marty called on the East Bay’s powerful state assemblyman, he got right on it. In the meantime, we organized a protest.
ONE WARM SUMMER AFTERNOON, the rebel army convened at our home in Berkeley. In the backyard, one guy cut lengths of 1x2s for the protest signs. Indian tacos and soft drinks were passed around. Giggling little kids chased each other through the yard while older brothers and sisters helped mom and dad paint signs and staple them to sticks. When Marty arrived, we went upstairs to talk. Before he was forced out, he had managed to spirit away copies of the board’s business dealings. Eva Craven’s résumé was in the stack and was surprisingly detailed. I offered to dig into the documents.
Google was still a couple years away, but Eva turned up in a basic internet search as a member of the Republican Central Committee of Alameda County. The Republicans being a tiny minority in Alameda County, the list did not read as an august group. Her title was “Entrepreneur.” I’m pretty sure that’s not the one that, say, Steve Jobs or Larry Ellison would have given.
Near the top of her résumé was an organization I’ll call American Homeless Veterans. She claimed to have raised over a hundred thousand dollars for them. I called their main number, gave the man who answered my name, and said that I was hoping to learn about their experience with Eva Craven. There was a long silence.
“Do you know where she is?” His voice was nervous, distraught. “Not exactly,” I said.
Another anxious pause. “Hold on a minute,” he said and put down the phone. When it was picked up again, there was a new voice.
“Hello, I’m the executive director here. We’re trying to locate Ms. Craven.”
“Why?”
He hesitated. I reassured him by conveying the purpose of my call.
“Well,” he said, “I’m not surprised you’ve had trouble. She took a lot of our money. She called people on our donor list and instructed them to write checks to “Homeless American Veterans”—a slightly different title—after she’d set up a personal account in that name. We were too embarrassed to call donors back and say they’d been deceived. Honestly, we didn’t really want it to get out. We thought it might dry up our funding. But I sure would like to talk to that woman.”
Eva Craven had some chutzpah, I thought. Or was clueless. She had bragged in writing about raising money for an organization she’d defrauded. I gave the poor guy what information I had on her and then started going further down the list of her references. Though not so egregious as the first listing, they turned out to be filled with phony numbers and little lies. Marty and I took the information to the assemblyman.
Local papers covered the protest in front of the clinic a few days later. Though the board threatened to fire staff members if they had any contact with Marty, nearly all of them walked out and joined the picket line.
In the end, the resolution turned on one man, the state’s Attorney General. Only he had the authority to oust a corrupt nonprofit board, and he was a Republican. I never got the complete story about what went on behind Sacramento doors. My best guess is that the assemblyman sent the AG our research and called in a favor. But nothing moves quickly through the legal system. The AG sent their own investigators. Months went by.
Finally, later that fall, we learned the verdict. The AG’s office gave the four board members a choice: resign or be further investigated. They grumbled about their “mistreatment” but all chose to resign. A couple of them had other things in their past they surely didn’t want a prosecutor digging around in.
At the jubilant victory party, Marty quipped, “At first, I didn’t know why they fired me. I was just standing there. I didn’t realize I was standing between them and the checkbook.”
When I later investigated officials for stories I covered, I continued to be surprised by how often the corruption was in open view. But I never encountered anything as brazen as listing a crime on your résumé.
Dog Bite
Three people were killed over an innocent mistake.
WHEN RON ENTERED my exam room, I couldn’t know that his visit would lead to the deaths of three people. He wasn’t a regular patient of mine at Native American Health Center. I had seen him at a variety of Indian community events around the San Francisco Bay Area. He was a tall, amiable guy with long dark braids and a ready smile. But that day, he was agitated.
Ron worked at Native American agency in San Francisco that helped people find jobs and housing. He was was often asked to carry work documents to both sides of the bay. Ron liked driving and getting out of the office, so he didn’t mind. That day he’d been tasked with getting a signature from an agency employee who lived in East Oakland and had been home with a bad cold. Ron headed out thinking it would be a simple afternoon drive, early enough to avoid rush hour traffic.
But Ron was given the incorrect address, two-digits transposed by accident. It was this simple mistake that ended in tragedy. He went to the wrong house, a slightly funky one-story bungalow. Ron strolled up the front walk and knocked at the screen door. “Hello, anybody home?”
Glancing inside, he could see an older man in a wheelchair watching TV at the other end of the living room. He knew his co-worker’s dad used a wheelchair, so he felt sure he was at the right place. “Hello, is Leo here?” he asked, more loudly this time. Still no response.
The screen door was unlatched, so Ron stepped inside to get the man’s attention. That was a mistake. A big pit bull came out of nowhere and lunged at Ron, sinking his teeth into one hand. Ron managed to yank his hand from the dog’s mouth, step back onto the porch, and shut the screen door. Breathless and bleeding, he looked up to see a medium-sized Latino guy with multiple tattoos and a growl of his own.
“Who the fuck are you? Whaddya doin coming into my house?” The man glared, the pit bull at his side.
“Isn’t this Leo Archway’s house? I came to give Leo some papers.”
“There’s no fucking Leo here so get the hell off my property and don’t ever come back.” The man slammed the door.
Ron retreated to his car, wrapped his bloodied hand in an old towel, and headed to our clinic, just a few blocks away. As I unwrapped his hand, he told me what had happened. There were several shallow puncture wounds and some adjacent lacerations, but nothing too worrisome. The bleeding had stopped, so he didn’t need stitches. I cleaned the wounds, bandaged his hand, prescribed some antibiotics, and then explained the most important part.
“You need to call animal control,” I said and gave him their number. “That dog has to be checked out for rabies. The antibiotics won’t kill the rabies virus.” California has a fair amount of rabies, mainly in wild animals. But Ron’s attack seemed unprovoked—the modus operandi of a rabid animal.
“I am not going back to that guy’s house ever again!” Ron said.
“You don’t have to,” I said. “That’s animal control’s job. But first they need to take a report from you. It can wait til tomorrow morning if you want, but no later. Rabies is the only infectious disease I know of that’s one hundred percent fatal if untreated.”
“OK, I will,” he said. We arranged for him to come back in three days’ time to re-check his wounds and find out how the rabies investigation was going. That investigation would turn out badly, although neither of us could have possibly anticipated just how badly.
Two nights later as I was headed to bed, I passed my husband in the living room and overheard a TV news announcer: “More on today’s tragedy here in East Oakland.” Our clinic was in East Oakland, so I paused. “Earlier this afternoon, police were called to check on a possible rabid dog at this East Oakland residence.” The video cut to yellow police tape around a porch. “The house was the residence of Eduardo Rodriguez, an alleged drug dealer who owned a pit bull.” I sank down on the couch, stricken.
Rodriguez had run the animal control people off the property the day before. They called the cops. And when Rodriguez saw two uniformed officers coming up the walk, he started shooting. The policeman in front had his gun holstered when he was shot. The cop behind him drew his gun and returned fire, then retreated to his car to call for backup. In the ensuing battle, three people died—the first cop, Rodriguez, and his father, still in his wheelchair. The dog was caught in the crossfire.
The next day, I saw that Ron was scheduled for an afternoon appointment. I wondered if he would show up. What could be going through his head and heart? I also felt oddly connected to him as a distant player in the tragedy. I’d done everything by the book. But if I’d omitted instructing Ron to notify animal control, those three people might still be alive. I was suddenly struck by how impersonal causality can be, and how impervious to our own sense of guilt or innocence.
Ron came to the clinic at the appointed hour. In the exam room, I found all six foot four inches of him huddled in a small chair. The fear and pain I’d seen three days earlier were replaced by a distant, mournful look. I removed the bandage to examine his hand, which was healing. There was no evidence of infection. Physically he was fine.
But he told me he’d been going over and over the events. Should he have double checked the address? What if he’d just stayed on the porch and simply shouted more loudly? Could signing the contract have waited another few days until his co-worker recovered?
I tried to be reassuring. “It’s not your fault, Ron. You were just an innocent by-stander in all this. You didn’t do anything wrong.” I kept talking, but I don’t think either of us heard a word I said.