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These people have been my patients for so long that, like it or not, they feel like family. They depend on me and in a weird way, I think I need them too.

“Your Uncle Denny had a car accident," my mother said over the phone. "He hurt his shoulder pretty badly."

“Uncle who?”

“Your Uncle Denny from Syracuse."

“What’s Uncle Denny doing driving at his age?”

“He has to do all the driving now that your Auntie Sheila’s eyesight’s gone.”

Gone? I thought. Where did it go? I just saw Aunt Sheila and Uncle Denny…Was it three years ago?

My mother mentioned several other relatives and updated me on their life progress and medical problems. Aunt Sarah is in a nursing home, Cousin Frankie retired from the police force, Uncle Tommy had a stroke. It seems like my extended family is having a run of bad luck when it comes to their health. I said good night to my mother, picked up the lunchbox that my wife made for me, and went into work.

In the ER I scanned through the computer census and a familiar name caught my eye. One of the sickle cell patients that used to frequent my old ER was down the hall sleeping under a blanket. I approached the gurney and woke him up. “Hey Tyrone…Tyrone wake up!” I tapped him on the forehead and lightly shook his shoulder until his eyes squinted open and focused on me for a second before closing again.

“Hey Doc," he said. "I think I’m due for my next dose.” He smacked his lips twice and scratched his nose and then his eyes opened again and he asked “Wait a minute…where am I? Ain’t this Jefferson?” I nodded in agreement. “Hey Doc, how come you down here?”

“I quit Einstein and I started here a few weeks ago. How’s your Moms doing Tyrone? Is she looking after that foot?”

“Yeah, yeah, she a’ight." Tyrone struggled to sit up on the gurney. "What time is it?”

“It’s almost midnight.”

“I gots to go. Hey Doc can I get one more shot and then go home?”

“I guess so." In the eight years that I’ve known him, Tyrone has never been in a hurry to go anywhere. "Where do you have to go?”

“Me and Moms are taking Ta’yisha to North Carolina tomorrow so she can stay with my cousins for the summer.” Ta’yisha was Tyrone’s little sister. She had managed to escape the sickle cell gene, but she had bad asthma and was frequently in the ER.

“OK, but make sure your Moms takes her insulin like she is supposed to and make sure Ta’yisha brings her inhaler with her to your cousin’s house.”

“For real Doc. Thanks a lot Doc, you really gonna like it here. Everyone real friendly down here.” He then put his hand out for me to shake which I don’t like to do because Tyrone has a bad habit of getting his Dilaudid dose and then masturbating into the sheets. Doesn’t matter that his gurney is parked in the middle of the hallway.

I realized then that I know as much about Tyrone and his family as I know about my own. I know Tyrone’s favorite video games and his sister’s favorite TV shows (America’s Funniest Videos – she thinks it’s hilarious when someone gets hit in the crotch) and their mother’s problems with her diabetic foot ulcer. I know a lot about the personal lives of my other patients too.

An ER is a place between worlds. I had a colleague that called it “backstage at the theatre of the absurd.” This job requires familiarity and contact with the respectable, daylight world of soccer moms and lawyers and people that make their living when the sun is still up but it also forces us to meander through the weird twilight world (the Japanese call it “the floating world”) that exists when the sun goes down and is populated by people that come out at night. Sometimes the transition is jarring.

Most days the nurses do a great job of keeping the two worlds apart and it’s unusual to have the president of the PTA sitting next to Kevin the homeless racist with cracked, swollen, pungent, elephant feet. Occasionally the bank teller from the suburbs with the twisted ankle will find herself sitting next to BettyLou the crackhead prostitute with the colostomy that she sells out to special customers, but that doesn’t happen very often. I’ve interrupted conversations between Leon the 400 lb. schizophrenic with out-of-control alligator-skin eczema and the terrified Starbuck’s barrista with the mochaccino steam burn on her hand. Leon wouldn’t hurt a fly, but he can be a little frightening to the uninitiated.

These people have been my patients for so long that, like it or not, they feel like family. They depend on me and in a weird way, I think I need them too.

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