Journal of the American Academy of Physician Assistants:
doi: 10.1097/01.JAA.0000431516.43690.14
Mindful Practice

Need freedom

Katers, Laura A. MS

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Laura Katers is a second-year PA student in the University of Washington-Seattle MEDEX Physician Assistant Program.

Tanya Gregory, PhD, department editor.

James Burle had been many people. Last night at the sleep lab where I'd been working the graveyard as a sleep tech for 2 years, he told me he once was a professor of majors. And before that, a movie star. Holding his hands in a V, he moved them away from his chest and smiled. “See?” he said proudly. “Move-V.”

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Now we're waiting together just outside the hospital doors. It's 5:45 am and the cold keeps me awake, but James seems unaffected. He wears only pants and a light sweater, his fat fingers reaching for his second cigarette in 5 minutes. I watch him rip the filter off and throw it to the ground. A “No Smoking” sign hangs nearby, but James doesn't notice, his whirling blue eyes never settling for a moment. With the thin paper dangling from his lips, he fumbles in the deep pockets of the Dickies overalls he wore to bed the night before.

“I bought these 6 months ago,” he said, pointing to the overalls. “I wear them every day.” He finally pulls five lighters from his pockets, sifting through them until he finds the red one.

The second cigarette stirs up a string of coughs so hard I begin to cough too, forceful into the dawn, my own breath puffing up like smoke. He looks in my direction, his eyes watering. He looks away. He hadn't met my gaze all night.

Earlier, he asked, “Are you homeless?” I smiled, thinking of my clean clothes and the fact that I was working when we met. “It's okay if you are,” he said, his voice sincere. “You have rights.” I thought of the mental illness in my own family and nodded, knowing that I, like so many others, was possibly one diagnosis and a paycheck away from sharing the streets and fighting for space with this man.

The wind outside erupts and sends the cold next to my skin; the sun is a gentle orange to the east. “I'd sure like a cup of coffee for myself,” James says into the shadows. “I been drinking coffee for 42 years.” He nods. In 17 days he will be 53. He twitches his head. His hands. He mumbles.

“Here is something for yourself,” he begins, hands already fishing for another smoke. I lose him for a moment in my breath. He forms his hands into a V again, moves them away from his chest. He looks my way but not at me. “You are a movie star,” he says. “That is something for yourself they cannot take away.” He laughs a little, an odd sound coming from his lips.

I am heavy with the silence that follows.

James told me they beat him and the rest of the residents at his group home. He told me the doctors are involved in a conspiracy to take away his rights. They told him he would never be discharged. I brushed it all away like dirt, shrugging him off as a poorly medicated mind. But then I began to wonder. Before, instinct had always told me who to believe.

I'd barely batted an eye at James' disfigured feet, yellow toenails ragged. The result of malpractice, he had said, angrily. I remembered the way he stirred his before-bedtime coffee with the pointed end of his comb—oblivious, content. Like a child. I remember seeing scars.

“You know what, professor?” I say, for he wants to be called that and I want to give him something. He doesn't look at me, his eyes wide and staring straight ahead.

I follow his gaze, realizing I have nothing to say. Or rather, what I want to say has become its own muddled word salad, perhaps incomprehensible even to James Burle.

We sit quietly, the ember from James' cigarette a slight nod to the warmth between us. At 6 am a white van comes to pick him up. He doesn't say goodbye as the heavy metal door slides closed; there is no wave as the wheels turn toward the exit, the farewell plume of exhaust like a lung-filled cough. I get up, the sun an orange burn across the pavement.

Back in the sleep lab, I can still smell his skin; still see his wild eyes and thin hair. I look over the lines of the patient questionnaire that James had filled out; my eyes move to the typed word Comments. Next to that, I find a space, now filled in with his fierce, bold lines, block letters that eerily mimic my own: NEED FREEDOM.

Written so hard the pen nearly pushed through the page.

© 2013 American Academy of Physician Assistants.

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