Cottonwood

The first change I noticed was the direction--I was driving away from downtown and my usual route to the hospital. Into the foothills of the west, on a road called Sweetwater, I drove. Wishing I was biking instead of driving to the Cottonwood clinic, I was otherwise stress-free this morning. I listened to NPR on the radio recapping last night's Oscar Awards ceremony. After an eight mile drive on a route Anna and I frequently road bike, I saw a sign indicating Cottonwood's entrance. I turned right and after a few small curves and turns I arrived at a gate with a keypad and speaker. I pushed the "push to talk" button and waited a couple seconds before a pleasant-sounding lady asked my business. I told her my business, a medical student on a rotation assigned to follow Dr. Onate. She opened the gate, instructing me to park and walk into the first building on the left.

I parked, gathered my pencils and notebook, clipped my ID onto my shirt, checked for outstanding nose hairs in the rear-view mirror and got out of the car. It was a breezy morning and every tree in the clinic was dancing. I love that. I walked into the first building on the left and announced who I was. I was given another ID by the receptionist and also told where to find Dr. Onate's office.

"Follow the path past the Lodge, the tennis courts, the pool on the right, and the garden. Onate's clinic is the last long building on the far end of the campus."

"Great," I said.

I walked outside and headed east down the path. The grounds are well-kept at Cottonwood. The walkways are straight-edged and cut through gravel landscape. Every five feet is a tree of some variety. After fifty feet of walking I passed saguaro, rosewood, texas rangers, pine, queen palms, ocotillo, oak, mesquite, and mountain laurels--which happened to be in bloom with their intoxicating grape-smelling flowers. It was the kind of landscape you find at a Sedona or Scottsdale resort.

The campus buildings are constructed of rough-hewn stone, the color of sand. The windows, doors and rooftops are a light blue. The buildings blend with the background mountains and sky. Walking east I passed various staff, starting their day. There was no rush in their walk, at least not the rush you see in the hospital halls of University Medical Center.

I passed the Lodge, tennis courts, pool, and gardens and found the last building on the lot. I walked into the middle door into the reception area. Inside I saw three teenagers sitting--or rather laying sideways across plush armchairs--reading magazines and chatting.

I walked up to the reception desk and introduced myself. The receptionist was the first person I saw on campus who looked really busy. Normal busy for a Monday she told me. She said Dr. Onate was waiting for a medical student and that I must be the one. I was. She led me to his office. Inside Onate was sitting, chatting with a fellow psychiatrist. He smiled and extended his hand, which I shook.

Onate was wearing a dark, Quick-silver button down, untucked, with dark corduroys and black shoes. His skin was bronze and he had a badger-streaked goatee. He was short and well-built. He did not look like a physician. Then again, most psychiatrists don't look like physicians in my book. But Onate had something western about him. I later found out he grew up in Clifton, Eastern Arizona. That explained his mannerisms and look. You can tell if someone is from the copper country.

Onate, like most psychiatrists, enjoys his work. He walked me around the campus, showing me the various buildings and their purpose. We passed through some in-patient units and he stopped occasionally to speak with counselors or nurses about specific patients. Evidently it was a busy weekend. Patients were sneaking benzodiazepines, "cheeking" pills, pretending to use the bathroom to put on hairspray, staying out late at night at the lodge, and upsetting roommates. Nothing unteenager-like there, I supposed.

After the tour we returned to Onate's office. He gave me a seat and I sat. I looked out his window at the blowing queen palms and pines with the clouds passing quickly by under the blue sky. I mentioned he had a better view than any I had seen during medical school. He agreed his location was prime. I wanted to tell him I'd wager his job was probably better than any I'd seen also, but I held that comment in my head and told it to go away. Maybe at the end of my rotation I'd tell him my thoughts on his job.

He showed me his schedule of the day. We were to see three patients and then he had a meeting after lunch. "I'm usually out of here by two," Onate said. That thought I held in my head about his job being the best in medicine almost slipped down to my tongue and out my mouth, but I again held it back. I'd wait and see patients with him first.

We walked out the office together, down the hall to the reception area. We passed your typical office pictures on the wall: An eagle with the word "Dignity" on the top, mountains with the word "Respect" on top, and two ducks necking with the word "Love" on top (they were doing some sort of hugging with their necks, I never really knew what "necking" referred to so I'll just think that's what it means). Onate called for patient 1 and a skinny, young blond guy popped out of the chair he was lounging in. We three walked back to Onate's office.

After introducing patient 1 to me and asking his permission for me to sit in, we all sat down and began the session. Patient 1 wore a blue hoodie, skinny jeans, and converses. He hair was gelled mildly, teepee style. He had aviator sunglasses hanging from the neck of his hoodie. He sat back in the chair and clasped his hands together.

Onate asked how he was doing.

Every day is a struggle, patient 1 said.

Onate: You have the past, the present and the future.

Patient 1: My life is shit, all I do is remember my past. It haunts me, you know what I mean, and all the debt, and survivor's guilt, and pain. It comes back to haunt me and my head does a three-sixty, you know what I mean? Then I think about the future and what's going to happen and my anxiety goes up and I feel like I'm surrounded. He says this while drawing an imaginary circle around himself. And I'm trying to get out, he says, imitating the breast stroke in the air.

Onate: Well, that's why here we are just trying to get you to focus on the present.

Patient 1's story came together a little for me. He's from New York. At his rocky bottom he was living on the street, trying to find a way to his next Heroin fix. His last one was July 4. Out with a bang, he said, smiling at me. I smiled back and looked down at my shoes. Onate said he looked a lot better this week. He was able to talk more--provide more insight into his "present." He was leaving Sunday and wanted to get things ready before his discharge. I wanted to ask patient 1 his plans once out of here. Would he go back to New York? What would he do after his next relapse? Would he end up on the street again? After this session I didn't feel much hope for patient 1. He seemed fragile and unsure. And he was leaving Sunday. After a discussion about his medications, Onate told him thanks and patient 1 got up and left. Onate charted. I looked out the window in wonder of what it would be like to be a patient here.

We gathered patient 2 from the reception area just like patient 1.

Onate: How are you doing?

Patient 2: I've been having more paranoia and acid flashbacks, I presume. I would say flashbacks because it's quite natural to have, coming off drugs.

Onate: Have you tried Seroquel?

Patient 2: It causes me to go crazy, and I'm not exaggerating, it actually makes me crazy. I don't think I'm psychotic, to be honest, and I think that comes from the Seroquel.

Patient 2 is a skinny 17-year-old who has already suffered a heart attack from cocaine use at 15. He's from London. His chart says he studies Fundamental Art. Reviewing his chart before we met patient 2, Onate asked if I knew what Fundamental Art was. Who knows, I said. I wondered if patient 2 knew.

I learned from patient 2 Cottonwood has a liaison set up in London where it's "well-represented." He was targeting two treatment centers: Cottonwood and one in South Africa. Mode of therapy won him over to Cottonwood. Tell me how this sounds to a struggling kid:

Adapted from the Cottonwood brochure:
Cottonwood's compassionate team created an individual plan in which the patient always comes first...a plan that includes these treatment modalities:
Group Therapy
Individual Therapy
Trauma Therapy
EMDR
12-Step Meetings
Equine Assisted Counseling
Expressive Arts Groups
Yoga
Challenge Course
Rocks and Ropes
Psychoeducational Lectures
recreation Therapy
Tai Chi

Sounds like Sedona or Scottsdale for a couple's weekend get-away. And why not? Wouldn't the patient benefit that much more from equine therapy than a stable couple looking for some fun on their stability like a cherry on top?

Patient 2's issue today, other than paranoia, is depression

Patient 2: I don't know, I might be depressed, actually, when does depression start? I might be but I should just give it time. Can I not have something for emergencies, like a benzo--it calms my body.

Now that's Fundamental Art

Onate: You're in a drug treatment facility.

Patient 2: I'm aware of that, he says without sounding britishly snobby (which I didn't think was possible)

Onate: We try and stay away from addictive drugs. Are you open to something else?

Patient 2: Yeah, it won't help, but I'm open to it.

Onate and him agree to start an anti-depressant, a selective serotonin re uptake inhibitor. These are good drugs. Serotonin helps with sleep and a sense of feeling rested and focused. It helps to recognize thoughts for what they are, rational or irrational. I like the choice for patient 2.

I felt some anxiety when patient 2 was complaining about not getting benzos. I imagine he put down a few ten thousand dollars for his month here. As his physician I would feel tempted to make sure he was pleased with his stay--to ensure a good "customer feedback" form was in order. To make sure patient 2 returned home to London and had nothing but good things to say about Tucson. I told Onate after this visit with 2 my thoughts about treating to please and he said no, it wasn't a challenge. Onate asked if I found 2 depressed. I thought not--too talkative, too forward-looking, too engaging. I knew depression to be a black hole for everyone around and 2 didn't leave me feeling drained as some deep depressive patients have.

Patient 3 was talkative. She had long, blond California hair and she wore tight sweats and a hoodie. She could have come straight out of your typical high school pep rally.

Patient 3: I still feel out of body doctor. I feel like my dreams are very, very...I don't feel like I'm sleeping. I dream I'm on a horse with Hulk Hulgan. What is that? I want to change my dosage from night to morning.

Onate: Okay, we don't like to make many changes to your drug regimen. You're very talkative today so let's slow down. We have time.

After some discussion it was agreed to increase 3's Lamictal from 25mg to 50mg. The max dose is 200.

Patient 3: And can I have my razor back?

Onate: You're switching subjects, again.

Patient 3: It's my birthday coming up on the 10th.

Onate: Oh, that's good, he says, smiling

Patient 3: Maybe I'll get a tofu cake, with some recyclable candles. When she says this she smiles, and I think her side profile looks like Joaquim Phoenix, stoned, in Walk the Line. That lazy smile thing going on where the eyes kind of drift aimlessly.

Cottonwood probably hosts many birthdays. The average length-of-stay is 30 days. Some stay 45. And adolescents stay 90. Patients see a psychiatrist once a week and a personal counselor daily. The days are filled up with therapy from the list above. And the final week is "family week." This is what it sounds like, therapy with the family. Another expensive proposition. But Cottonwood, as I'm learning, spares no expense.

After seeing three patients, it was noon. Onate walked me to the cafeteria and we stood in line for food. The cafeteria looked like it belonged in a nice Marriott. The head chef served us--the menu today was top sirloin or fish stir fry. A hot meal, gourmet, cost five dollars. The salad-bar was 4 dollars. The cafeteria served patient and practitioner alike. The patients never sat at the same tables as the staff. But bread was broken together under the same roof. I liked that. I liked the top sirloin.

I spent lunch sitting at a corner table with 5 physicians. Two windows behind me poured the sunlight onto my table. I struck up a conversation with a physician who came out here to work from New York. He is here to stay. We talked a little about religion. He mentioned how one needs to break his heart to find happiness. I couldn't help but ask if he had read The Book of Mormon. He had not. But we both agreed our path to happiness involves focusing less on self and more on others. Any religion that can do this is a good one. I agreed, to a point only. I hope to talk to him about authority next time we share lunch at the same table. He is a good man. And like most staff at Cottonwood, he smiles a lot.

After lunch I was released. I strolled through the campus thinking how nice it would be to bring Anna on a date here. If every treatment center possessed these resources up in the hills where the dove sings every morning, the world would not be so telestial. But we are by design in a telestial world so the stay for patients at Cottonwood is, appropriately, temporary. Pretty soon every patient has to step back out into the unknown future and start that breaststroke, blindly, through the air, trying to find safety.

Maybe Romney Ain't So Bad...

A Presidential Candidate

I have pretty much made up my mind to run for President.
What the country wants is a candidate who cannot be injured
by investigation of his past history, so that the enemies of the
party will be unable to rake up anything against him that
nobody ever heard of before. If you know the worst about
a candidate, to begin with, every attempt to spring things
on him will be checkmated. Now I am going to enter the
field with an open record. I am going to own up in advance
to all the wickedness I have done, and if any Congressional
committee is disposed to prowl around my biography in the
hope of discovering any dark and deadly deed that I have
secreted, why—let it prowl.
In the first place, I admit that I treed a rheumatic grand­
father of mine in the winter of 1850. He was old and inexpert
in climbing trees, but with the heartless brutality that is char­acteristic
of me I ran him out the front door in his night­
of shirt at the point of a shotgun, and caused him to bowl up a
maple tree, where he remained all night, while I emptied shot
into his legs. I did this because he snored. I will do it again if I
ever have another grandfather. I am as inhuman now as I was
in 1850. I candidly acknowledge that I ran away at the battle
of Gettysburg. My friends have tried to smooth over this fact
by asserting that I did so for the purpose of imitating Wash­ington,
who went into the woods at Valley Forge for the
purpose of saying his prayers. It was a miserable subterfuge.
I struck out in a straight line for the Tropic of Cancer because
I was scared. I wanted my country saved, but I preferred to
have somebody else save it. I entertain that preference yet. If
the bubble reputation can be obtained only at the cannon’s
mouth, I am willing to go there for it, provided the cannon
is empty. If it is loaded my immortal and inflexible purpose
is to get over the fence and go home. My invariable practice
in war has been to bring out of every fight two­thirds more
men than when I went in. This seems to me to be Napoleonic
in its grandeur.
My financial views are of the most decided character, but
they are not likely, perhaps, to increase my popularity with
the advocates of inflation. I do not insist upon the special
supremacy of rag money or hard money. The great funda­
mental principle of my life is to take any kind I can get.
The rumor that I buried a dead aunt under my grapevine
was correct. The vine needed fertilizing, my aunt had to
be buried, and I dedicated her to this high purpose. Does
that unfit me for the Presidency? The Constitution of our
country does not say so. No other citizen was ever considered
unworthy of this office because he enriched his grapevines
with his dead relatives. Why should I be selected as the first
victim of an absurd prejudice?
I admit also that I am not a friend of the poor man. I regard
the poor man, in his present condition, as so much wasted
raw material. Cut up and properly canned, he might be
made useful to fatten the natives of the cannibal islands and
to improve our export trade with that region. I shall recom­
mend legislation upon the subject in my first message. My
campaign cry will be: “Desiccate the poor workingman; stuff
him into sausages.”
These are about the worst parts of my record. On them I
come before the country. If my country don’t want me, I will
go back again. But I recommend myself as a safe man—a man
who starts from the basis of total depravity and proposes to
be fiendish to the last.
Mark Twain
[1879]

NBA...Jane Eyre...Moms...Absolutes

Okay, if you enjoy the above as I do then sit back down on your chair to collect yourself and stop looking around for the nearest person to share this spectacle with. I love athletes who work from their core. Blake echoes Rafael Nadal on the court. He's not quite the consistent tiger Nadal is, but close. If you need some more bum-from-the-chair-raising highlights, google last weekend's Australian Open final highlights between the Tiger and Djokovic. Tennis has surpassed the glory of Sampras and Agassi.

But if you need to study, like I do tonight, I need to recommend the soundtrack to the recently released Jane Eyre movie adaptation. It is the right stuff.

For other thoughts, I had a lecture today about medicare reimbursement. For an emergency physician to stop a nosebleed he will apply and bill for a "nasal tampon." This minor procedure nets him $80. So if moms earned more than a nickel for every nosebleed they stopped, they for sure would be millionaires.

Also, I love absolutes, but sharing my thoughts tonight on two absolutes will have to wait until another post because it doesn't fit into the mood of tonight's words...

Life...is...good.

The Lavender Rush

We jogged out of Sabino Canyon, dusty and tired. We switched leads because of the beans we ate for lunch. Blackett's Ridge is wonderful. You can summit the high desert ridge under one hour and jog back down for the completion. It elevates you above the city into deer and bobcat country. You see hikers serious about the hike, not your typical flashy, flesh-showing, lower- elevation hikers who are mad their friends decided on a hike instead of LA Fitness. And you see no trash, which settles your urbanely agitated mind. So within this setting I had another teaching moment from the great head-master, Nature.

On the way out of the canyon Anna noticed the sunset and its colors. I said I love the sage color of the sky. I meant lavender. But that is okay, I justified; lavender is not one of the primary colors. Still, I had a box of many colors in elementary school. I needed to review my colors. Mixing sage for lavender is not elementary for me, my dear Watson.

The sunset's purpose was understood, for me. I was taught humility again. I don't know it all. I won't know it all. And unless I review and practice, I'll forget it all. The problem is, when I learn something I quickly think I know it all. And I stop asking questions. It's easy to know what I see, but what about that I cannot see? Maybe that's why we have seasons; we forget what so recently passed, we need reminders. So here's to a lavender sunset. I'll miss this desert...

Ron Paul

Politics...not my best subject to discuss if I want to pretend I know anything. But I do know one thing, after the republican debate Monday night, which I watched on a comfortable Jet Blue, I would vote for Ron Paul. He is smart. He is efficient. He gives concrete detail. And he is the only one who would conform with the following statement given by the First Presidency of the LDS church during WWII:

“‘. . . the Church is and must be against war. The Church itself cannot wage war, unless and until the Lord shall issue new commands. It cannot regard war as a righteous means of settling international disputes; these should and could be settled—the nations agreeing—by peaceful negotiation and adjustment. "

So while Romney and Gingrich want to make our stick we carry bigger ( I'm not sure where Santorum stands) Ron Paul wants to make our hearts bigger. Sounds cheesy, but I believe him when he says it. And it is that stirring of belief, generated by a politician, that makes me want to vote for him. Looking back, I can't remember ever feeling a "stirring" for any politician I've seen speak. And I guess that's my litmus test of whom to vote for: an inner stirring.

A few thoughts, not out loud

- I enjoyed a particular talk at church yesterday. When I walked up to the stand to thank the speaker I extended my hand and said, "Thanks so much for your talk, I needed to hear that and it meant a lot to me." I saw the two other speakers in the meeting right behind the one I had thanked. Did I need to thank them as well? And if I did not, would I seem ungrateful for their words?

- Sometimes I feel there is a specific mood at church that lingers in every meeting. Yesterday it was a general gloom. Maybe it was the rain outside. Maybe it was the late afternoon and we were all adjusting to new meeting times. I just wanted to stand up and say, "it's not that bad of a life." And maybe it was just me that needed to hear it.

- When I'm turning left from the median of a busy road, I think it should be against the law for opposing traffic in the lane next to the median to yield. The far lane of opposing traffic never seems to catch on quickly enough. But you hate to wave to the good Samaritan who stopped in the near lane and mouth to him: "THANKS, DON'T WORRY, JUST GO AHEAD," while you wave him on. That just seems rude. So under forced gratitude, I always turn left. It's the "white-knuckle" turn of possible death.

- Tucson was re-baptized today. It rained all morning and in the afternoon the clouds cleared. Anna and I drove up to the sweetwater trail head and watched the unfolding of the sunset. The air was clear and crisp. The clouds were huge, with dark undersides and cottony-white tops. The mountains were lavender, sage, purple, red, rust, and blue all at once. And the desert smelled like desert, with the saguaros standing proud over their domain. To top it off, the desert doves were singing the tune of nightfall. Sometimes I hate scenery like this because all I can think about is how it will all be gone in a few minutes.

- The other day at a tumor board meeting in the hospital, a physician was introducing a patient case.
"The patient was a woman. Fairly...rotund."
The pause he gave between "fairly" and "rotund" was more insulting than if he had just said "fat." I committed at that point to use the word "fat" when I present patients who are well-nourished, no stranger to the knife and fork, obese, large, or rotund. "Fat" is the most concise, understandable, and efficient adjective and is also, in my opinion, the least condescending. Plus, I need more of it...

A Short Story

I lie thinking, my right leg propped against the back of the couch. I think about sleep. I whisper the word “rest,” out loud as if he were a friend; a friend arriving with solutions. And before I know it he has arrived. I welcome him inside and fall asleep...

I am awakened by a low rumble. I quickly recognize the sound is my neighbor James opening his front door. Morning. I count the seconds before I hear his door close. James requires seven seconds every morning to close his door. Why does it always take him so long to close his front door? It annoys me. I lift my left arm and weakly twist my wrist to read the time on my watch. 6:32 a.m.

I then hear a window slide open. This would be Alex. She is a quiet, Venezuelan lady, recently divorced. She lives below me. Her domestic noises never annoy me. Alex often leaves a hot plate of arepas on my doorstep. Sometimes I catch her in the act:

“Arepas!” she says, in a commanding tone. “Eat soon while they are warm and put some...um...frijoles on top with, how do you say it...asour cream?”

“Yes Alex! Sour cream. Thank you so much.”

I see few arepas these days. That is okay, Alex is an observant neighbor. She knows something has happened to me and I should be left alone.

After my wedding, I told an old friend from high school my wife and I found “a nice little garret” to rent in a safe neighborhood. He then promptly sent me a copy of A Tale of Two Cities. On the front page he wrote, “To the best of friends, in the best of times, in his little garret with his wife.” I can see that book on the bookshelf right now. Seeing it elicits a painful feeling and I look away. 6:34 a.m.

I stretch out my legs with that wonderful feeling of increased blood flow, and I smile. Like the smile of a tired runner leaning on a friend after a marathon. The smile of survival, curved with pain. 6:35 a.m. I begin to wish it were last night again so I could sleep. Better yet, I wish it were tonight so I could sleep and be one day closer to something, anything.

The morning is bright. The light shines through the shutters and lands in a neat arrangement of parallel lines on the floor. I stare at them for some time. I look at my watch again. 6:44 a.m.
In the past this was my favorite time to go for a run or ride my bike. My shoes have not moved from the closet and my bike has not shifted a gear for many days.

I manage to sit up on the couch. I stare blankly across the front room, bare except for a card table decorated with a half-finished puzzle. I force my arms to push me up off the couch. After the light-headedness of standing clears I walk to the kitchen. I pick the glass Pyrex up off the counter and measure out two cups of water. I place the Pyrex in the microwave for two minutes.

Okay, two minutes to wash my face, brush my teeth, throw off my pajamas, and make sure my backpack has my...wait...no, who am I kidding? I have no where to go today. Or tomorrow.

Today I have no plans. In fact, I have no plans for the next three months when, theoretically, I re-enlist for my last year of medical school.

I let the microwave hum away as I walk back to the couch and sit. I sit and watch again the planks of light on the floor and listen to the soothing hum in the kitchen. But my thoughts are harrassed with memories.

I remember the money wasted in recent days. I think of the time wasted. Addiction is a slave-driver of the worst kind. And I am learning why some men give up family and health in the name of addiction. These men are not selfish. They are imprisoned. I am the latest convict.

The money does not bother me as much as the time. I can always make more money. But I am troubled with time. I heard once after fifty you start counting. I am twenty-eight, and I am counting. Tears well up in my eyes as I look down the hallway of my apartment, forcing myself to remember my wife as she used to look in the morning, fresh after sleep.

“Hey honey. How are you? Did you sleep okay?” she asked every morning.

She was always courteous and positive. Early in our marriage it gave me wonder. How could someone be so nice all the time? And then I learned more about her. Courtesy and optimism were her weapons, forged during a difficult upbringing. She often repeated her favorite motto: “Your future is as bright as your faith.”

I smile as I remember.

Every night I could count on her warm greeting when I arrived home: “Hey honey, did you have a good day? How was it today?” She would then skip up to me and give me a hug. There was little variability is this nightly ritual.

I cannot remember the sound of her voice.

I do remember my hot water in the microwave. I get up off the couch and walk to the kitchen. I open the microwave door, grab the Pyrex and pour my water into a mug. I then get two packets of hot chocolate from the cupboard. I tear them open and empty the powder into the mug, followed by four packets of sweetener and a caramel candy. The caramel was my wife’s idea. And a good one. I take my cup back to the couch and sit down.

I had forgotten to turn the heater on last night and I realize I’m cold. I rest the mug on my lower belly and let the coursing blood warm as it flows near the cup - An old boy scout trick I learned on a camp-out. It feels good.

I sip my chocolate and think over the past few months. Little measurable progress. I attend my counseling sessions and complete the proffered exercises. But addiction remains. I have not touched the guitar. My diary is dusty. The New England Journal accrues, unread, in my mailbox. I no longer enjoy my daily run. And I have stopped attending church. When I look in the mirror these days I force myself to look past my reflection. My eyes sear me with shame.

I sip more chocolate. I prefer it hotter but I have no desire to reheat. The parallel planks of sun on the floor begin to widen. The day is moving on. And I am going nowhere with it.

I feel time pass; literally feel it pass through my chest. In its wake is guilt. I begin to think of my last binge.

Not long ago addiction belonged to my patients. It belonged to those faces on street billboards. It was always compartmentalized safely outside my life. Now it is mine.

As the morning light continues to slide across the carpet, I feel the need to knock myself out. I am tired of the guilt. I gulp down my chocolate. I wipe the corners of my mouth and lay the cup on the floor. I stand up and walk to the kitchen drawer to grab my keys, wallet, and glasses. I can’t see the prices without my glasses.

As I pocket my stuff I make a quick calculation: A few thousand dollars left from student loans and five hundred dollars credit on my charge card - six hundred after last night. I have sufficient. I leave the kitchen, but not before turning on the radio. My wife used to make fun of me for having a radio on that I ignore. “What did that commentator just say?” she would quiz. I never knew. I just like background noise. I walk past the dining table and notice its contents: my phone, a copy of Hunger Games, a Gatorade bottle, some scattered pens, a dirty bowl and a napkin scrunched up in a ball. I think about grabbing my phone, but why bother?

I walk to the front door and my phone rings! What irony in my meaningless life. It vibrates off the table and falls to the floor. That is enough for me to ignore it. I turn back to the front door but as I reach out for the knob, I hesitate. I cannot remember the last time I answered my phone. This morning I will. I quickly rush back to the table and inadvertenly kick my empty cup on the floor. It flies up and crashes into the wall, waist high. The handle breaks into pieces. Agitated at my clumsiness, I look at my phone. Gracie is calling.

“This is Ruben,” I say. I use this introduction to pretend I am too busy to note who is calling.

“Hey Ruben.” she says. “What are you doing now?”

“Just getting stuff ready for the hospital,” I fib.

“Do you work today, Ruben?”

“Always, Gracie. How is the Wii working out for you? Are you past the level you were on when we last spoke?”

“Yeah! I got me a new game. You kill aliens, it’s fun.”

I imagine Gracie saying this with a fat grin on her face. The grin that shoves her cheeks up into her eyes.

“So, what’s up?” I ask impatiently.

“Ruben, I was wondering, can you walk me across street to work today? It’s scary right now. And with cold people are crazy driving.”

Gracie has a habit of forgetting to say “the” in her sentences.

A few months ago I spent three consecutive weeks walking her to work. She fears the walk. Luckily, work is not far; a convenient walk of five minutes even for someone obese like Gracie.

In an odd way I feel glad for her call. Family and friends have since stopped calling and Gracie’s timing is penetratingly encouraging. I agree to walk her to work. “Okay, Gracie. Are you ready?”

“Yeah, I wouldn’t call you if not ready,” she says, chortling.

“Okay, let’s do this, I’ll meet you like last time at your front door?”

“Should we dr..dr...drive Ruben, it’s cold?”

“Let’s walk. It will be good for us.”

With meeting details arranged, I close my flip-phone. Besides receiving a call, it feels good to hear someone say my name, even if it is just Gracie. I walk to the bathroom and grab my hat off the floor. I am not worried about leaving in sweats and a stained jacket. I look at my watch: 7:48 a.m.

I descend the stairs of my apartment. The sun touches my face. The warm sensation is familiar and foreign at the same time. It is cold, but not too cold for Gracie to walk. As if to validate this conclusion I breathe out into the air. No visible breath. Warm enough to walk.

Once downstairs I glance up at my apartment, avoiding eye contact with two people walking past. I walk across the parking lot to the other buildings in the complex. Gracie lives in the far north building with her husband, Steve. Steve’s job begins at 5:00 a.m. He walks two miles to work every weekday. At four miles a day, that is twenty miles of walking in the week. I am impressed.

As I walk to meet Gracie I remember an amusing incident. She found out one evening I was driving my wife to the airport the following day. She asked, “Can I come?”

My wife and I looked at each other; we smiled in meek condescension. I said to Gracie, “sure, but we have to leave by 4:30 in the morning.”

Gracie asked no follow-up questions and we thought she would forget the conversation. The following morning my wife and I both received texts from her at 3:30 a.m.: “Hi, ready to go. Call me now.” She came with us to the airport that morning. Every time we went to the airport after that morning my wife and I jokingly asked each other if we should invite Gracie again.

I hurry past building 900 and 1100 to reach Gracie’s apartment. She has a security alarm sticker on the front door I find amusing because her front porch is full of stuff - easy to steal. Nice stuff too. Cables, satellite dishes, chairs, a dresser, and more.

I knock on the front door and wait twenty seconds. I ring the doorbell, perhaps the only doorbell in the complex. No answer. I am frustrated and slightly angry. Why would Tiffany call me to walk her to work? It’s the easiest thing in the world. She needs to grow up. She needs a life.

These thoughts make me look down at my feet in personal rebuke. “Needs a life, Ruben? Look who is talking.” Tears well up in my eyes. I look up quickly as the doorknob turns and the door swings open revealing a smiling Gracie. She shines through my wet eyes.

“Hey, Ruben, you got here fast.”

“You excited for work?” I ask.

She makes a sound that resembles a starting car. I take that as a “no.” Her sounds confuse me sometimes and I am never quite sure how to proceed with the conversation.

“How’s Steve, Gracie?”

“He’s at work. He has a headache.”

“Is he still on his medication?”

“Yeah, but he don’t do nothing but watch TV all night. Course he has a headache.”

I am pleased Gracie makes the connection between excessive television and headaches. Maybe she will understand her doctor’s advice to learn about diabetic-friendly diets.

She steps outside and turns around to close the door. After the door is shut she looks down into her handbag. She pauses for five seconds. I ask if everything is okay.

“Yeah,” she mutters. Then she opens the door and steps back inside her dark apartment. She reemerges five seconds later and closes the door. “The alarm,” she says, “forgot to set it.”

We walk side by side through the complex out to the main street. We chat about a few things. Mostly I ask about the Wii. She seems to enjoy it more than anything right now. She is also reading a mystery book, she says.

“You like to read Gracie? That’s great.” I hate how condescending I sound. “Does Steve read as well?”

“No, he don’t. He just watches TV all night like I told ya.”

We reach the main street and turn north on the sidewalk. We pass a bus stop where two men are waiting for the bus. One is sitting with his head down, staring at the side-walk. The other is standing beside the bench with both hands in his pockets, trying to keep warm. Maybe it is a little cold outside. Neither one looks up as we pass.

We reach the cross-walk and I look over at Gracie. I sense her anxiety. But with me by her side she presses forward once the signal shows the blue man. Half-way across the street the orange hand begins to flash and Tiffany picks up her pace. I easily keep up with her and we reach the other side with time to spare.

“You don’t have to go on. I’m okay now,” she says. Her work is just across the parking lot.

“Oh, I don’t mind I’ve come this far.”

We continue on together cutting a diagonal path across the parking lot. Behind us the shallow winter sun is rising at its southern angle. The light from it hits our backs, casting tall shadows from our bodies. There I am, slim and tall. And there is Gracie, next to me, her shadow resembling a pumpkin with legs. As we walk I look at our northwest-pointing shadows.

“What if we could trade places with our shadows, Gracie?”

“That’d be cool! But why would you want to do that?” she asks.

“Because then we would all be the same. We wouldn’t have to worry about putting on a happy face for anyone. We could simply exist and function efficiently. And it would equalize all of us. One people, one color.”

I don’t expect Gracie to respond. We walk on for a few moments in silence before she suddenly stops. She swings around, her abdomen striking my thigh, and then extends her arms up and out. Her head is bowed. She looks like a three-year-old waiting for a hug from Father.

“Thanks for walking me, dude!” Gracie then gives me a hug. I can see her saliva-stained shirt come up into my neck. I look up and away and hold my breath.

“Great!,” I say. “Have a good time at work and thanks for calling.”

“No problem. Same time tomorrow?”

I think for a few seconds before responding. “You bet Lauren, best way to start the day.” As the words leave my mouth I realize I mean it.

We part ways. I turn around into the sun to walk back home. I notice my heart feels warm. My shadow is gone. And for a moment, I forget my addiction.