In Memoriam

Dwight and I sat in his small apartment and talked about our memories from Pine Street, the neighborhood we had first become friends and neighbors.  He was grinning in a mischievous way and I knew something good was coming.  “When I first met you, you were juggling outside, and I thought,” he paused to actually chuckle, “Wow, this guy must know kung fu or something if he’s crazy enough to juggle outside in this neighborhood.”  That had been nearly five years ago; we laughed hard which felt really good.  He adjusted his nasal cannula, paused to breathe, and ate another spoonful of the butternut squash soup my wife had made.  He sighed and set it aside. “Dave, this is really good, but I just can’t eat any more.  I can’t eat that much these days.”  He could barely stand from the easy chair, limited both by weakness and the extreme shortness of breath he experienced as his new normal.  I stared at the stains on the carpet and his pants where he had spilled some of the soup earlier.  I remembered wiping it from between his toes and off his swollen legs with the same sense of affection and gentleness I did with my two year old son.  It felt strange because I knew it shamed him to feel so helpless, this man the age of my father who prided himself in his ability to work with his hands, but there wouldn’t be anyone else to come by that night to help.  It was the only thing left I could think of doing to preserve his dignity, something I thought about a lot those days.

There was a pause in the conversation and I asked him a question that I had been meaning to for some time.  “Dwight, I’d like to ask a favor from you.”

“Sure, Dave.  Anything for you.”

“I’ve been thinking of writing a book or something about my experiences from Pine Street, and I was thinking about how much I learned from you and still do about the city and your life and everything.  I was hoping we could write it together, the story of our friendship, or maybe I could interview you.  Would you be interested in something like that?”

He answered quickly.  Yes, he would like that.  Yes, I could make some recordings if I wanted to; he didn’t think he wrote very well but loved to talk and loved to tell stories and we agreed that that might feel more natural.  He had been thinking about writing some things down anyways.

We talked a bit more and then I washed a dish or two and went to leave.  “Love you, Dave,” he said.  I told him I loved him too.  It was an exchange he had taken to ending our conversations with over the past two years; it had taken some time for me to get used to, being naturally hesitant to use the L-word, but it felt both expected and natural by now.

I took the elevator down the high rise and drove home.  I walked up the steps to my house and thought again about how we could build a ramp so Dwight could visit more easily and see the new home and remark on how different it was from the row houses of Pine Street we had first met in.  I thought about what we might cook for him and how much salt to put in it.  I did some looking for a nice voice recorder and ordered it on Amazon exactly two weeks later.

I never got to use it with him.  He died a week after that, but I didn’t find out until this weekend and only did so because I found that his number had been discontinued.  Two months have already passed and I missed the announcement, the interment, the memorial service.  I missed everything.

I first encountered Pine Street while working as a resident in the hospital, described here by one of my earliest posts on this blog:

I moved from a nice, single apartment near the hospital I work at and into a row house in the inner city where my patients live. I moved out of a fully furnished site with laundry and Fios and easy access to every modern convenience into a shared house and a room like my college dorm except smaller, without air conditioning, and with plenty of cockroaches and a gas leak that’s worse every time it rains. I moved away from neighbors I loved who were fellow physicians in training and into a house on a block where the neighbors shrug and freely confess they deal drugs to “make ends meet”, hold vigils in my back parking lot for gangsters who were shot, and are crazy enough to try my home cooking. I moved away from everything that was comfortable and safe into a world of rumors and sensational reputations and risk.

I thought I was going to write this blog to show off how daring and cavalier I am, but it really is just to share my daily struggle to overcome my fear of small things like the dark. I thought I was going to write about thugs and hoodlums, but there are only honest people, funny people, warm and tragic and open hearted people, understandable people here. I thought I came here to embrace the suffering and the lost, but am finding that it was I who needed a home.

When I first met Dwight I might have been juggling for a bunch of kids but he was one of the few adults that greeted me and watched.  It turned out that both of us had moved into the block fairly recently.  He was a separated contractor who had been drifting from house to house (literally staying in the empty places he was working on) that had now settled into a home with his son and other relatives a few doors down.  As I struggled to overcome my fear of violence in the community and figure out my place in the neighborhood, it was Dwight and his son who made things easier by their open, affable, and genuinely friendly conversations.  Thin, vibrant, and energetic, they were the ones who would greet me at the odd and late hours I came home from work, who would ask me how I was doing and what I was feeling.  I began cooking family-sized dinners and inviting neighbors over to eat and they were the friends who came and stayed and talked to me.  Through them I learned about the patterns and forces at work in a neighborhood characterized by urban “poverty” even if I never heard them use that word once.  They taught me about food stamps and the underground economy necessary to survive.  I would drive Dwight places for errands around the city and he would point out bits of its living history as well as his own: what it was like to go to a segregated school, to watch the riot of 1968 unfold and to live under occupation by the National Guard, to escape the city and serve in the military, to return and have friends and family get locked up or shot.  Sometimes on warm nights we would sit out on the stoop and chat with our other neighbors like Dolores or Rob or Ben.

Clubbed fingers and dinners at Pine Street

Then Dwight started wheezing.  He had difficulty keeping up with his work.  He had short hospitalizations here and there.  I knew with fair certainty what it was, as I had watched him and his son chain-smoke freely on those lazy warm nights.  I unofficially became his doctor, answering questions and badgering him about his smoking, driving him to pick up medications.  Eventually I dragged him into the resident clinic and made him my official patient so I could call in the prescriptions when he needed them, trying to prevent his COPD exacerbations from flaring badly and sending him to the Emergency Department.  I would sit at his bedside and feed him nebulizers and teach him how to use his controller medications and watch the pulse oximeter I’d bought on Amazon flash on his clubbed fingers.

Dwight with my father at my wedding

He loved it.  Everywhere we went he would proudly introduce me to everyone as his friend and his doctor while I would laugh nervously.  He invited me to church with him and to his birthday parties, even if it was just sharing a pizza with his two sons in his cramped bedroom.  He came over and helped me reinstall a door.  When I started dating someone he gave me dating advice.  When I married her, he was there at the wedding.  When we were pregnant, he gave us parenting advice.  When he drank too much, he would call me and tell me I was like family to him.

He even stopped smoking cold turkey, although the damage had already been done.  His flares became more frequent despite my careful and literal bedside management.  I sent him to a pulmonologist and he eventually started on chronic oxygen supplementation.  The house they were staying in got foreclosed despite their best efforts.  He couldn’t work any more and food stamps had been cut and disability checks weren’t enough for him to find a place for himself.  Some of the family squatted in the home with him even after that, using kerosene lamps for warmth as the weather got colder which only made his COPD worse.  My wife and I became increasingly alarmed that he would end up homeless… or more accurately, even more homeless than he already was.  He ended up in a motel once or twice on a voucher from the hospital and I worried about him constantly.  When his medication list grew too long for him to afford it, even on Medicaid, he begrudgingly transferred his care to the VA because he could get his meds for free then and they eventually set him up in temporary housing just as winter set in.

Even though the VA took good care of him, he continued to refer to me as his doctor.  He ran medication changes and side effects by me often but eventually came to trust his new medical team.  Our meetings and conversations became less frequent but were still regular.  After a series of close shootings and burglaries in the neighborhood and our unexpected pregnancy, my wife and I finally moved out of Pine Street and into a quieter area of the city.  Even though both of our new living arrangements were smaller, we offered to store his tools with us.  He would talk about taking them back when he was “getting to work again” but I knew it wouldn’t happen.  I did my best to tell him that, and he would say he understood, but I think we both held on to some hope that things would turn out better than we expected.  What else could we do?

Younger days

Eventually temporary housing ran its course and the facility threatened to evict him.  During this time an elderly vet living at the same facility was randomly and viciously beaten on the street outside, ending up in the ICU.  Several shootings and a murder occurred across the street from him.  My wife scoured Trulia and Zillow for new places within the city for him to rent even as we looked to buy a home for ourselves.  Nothing we could find for him, even in areas equally violent and dangerous as the ones we had come from, were even close to affordable, and the only way he was able to avoid becoming homeless again was to move outside the city, away from all the family and friends and support he had known. The miracle social workers at the VA squeezed him into a small apartment on the third floor of a subsidized housing complex.  He had no car and little energy to climb three flights of steps.  He went to church less frequently because his portable oxygen concentrator just didn’t have enough battery to last a full service anymore.  Though I had become a full fledged attending at the hospital, the new distance and a newborn baby made it seem hard to visit and help like we used to.  I think he only lasted as long as he did because a kind young man there befriended him and helped him with groceries.  He called me a lot but I was often too busy to talk at length and he sensed that.

It was hard for him to save money to plan for anything because any new income he received (like the pension from his time in the military) resulted in a reduction to any assistance he already got.  He was literally living on a fixed income and so his only reserves for dealing with new problems was to draw on others.  He hated asking for help; he wanted to be both autonomous and generous as was his nature but could no longer afford to be either in even the small ways… and now, in a setting removed from those he had come to know, he had even fewer people around him to share what he had with.  One day we got a bushel of Maryland crabs for an overdue meal together; he insisted on paying for them himself, planning for a good sized ad hoc celebration.  We steamed them up with Old Bay and beer and he called a dozen different people to see if they were free, but in that apartment outside the city we were only joined by one other person, a friend from the temporary VA housing.  We cracked into them for hours, eating and joking around and telling stories, enjoying a meal together just like we used to.  We both went to bed that night feeling content.

It was a while before we got together again.  I think it was because Dolores, our old neighbor from Pine Street, was hospitalized for metastatic cancer.  I brought Dwight to visit her in the hospital.  He had gained so much weight from his medications he was nearly as difficult to recognize as she was, but we sat and reminisced for a half hour among the three of us about Pine Street and the neighborhood.  We tried to orient her in her medically induced confusion and help her be at peace.  We prayed together at her bedside and as we left, I could see tears running down his cheeks.  Dwight wept, and it was the only time I had ever seen him cry, this man whose cheerfulness had been some of my only encouragements during the hardest times at Pine Street.  He said it was hard to watch her suffer, gasping for air and clearly in pain.  He didn’t want it to happen to him in that way even as he knew his time was coming.  I think that that was Dolores’ last day of consciousness; she died within the week.  The family had a closed funeral and Dwight was bitterly disappointed at not being able to be there.  I think it was because he worried the next funeral would be his own.

My wife and I finally bought a house in a nice, safe part of the city and my young family moved again for the third time in as many years.  Dwight moved too, but this time into a high rise senior home because he could no longer get up the steps to his apartment.  I remember moving day clearly; his family had gotten a moving truck and some friends to help and though I had promised to be there and bring dinner for everyone, ended up stuck late at work taking care of sick patients.  By the time I had arrived it was raining hard; most of the heavy furniture was already inside and the pizzas I’d brought were cold.  I remember watching Dwight struggle to walk across the room, stopping frequently to breathe.  After everyone had left, I spent another hour there organizing his medications to make sure they and his phone were within reach.  If I hadn’t done that, he probably would not have survived the night; even so, I drove to my new home in a stupor, feeling more helpless and useless than I had in a long, long time.

He got along for a little while, but before long became too weak to care for himself and ended up in a hospice short stay unit for a few days.  He had called me in a mild panic when he arrived, more short of breath than usual and unsure of what was going to happen.  He said they had been talking about sending him to a nursing home but even as he said those words I knew it wouldn’t happen; I had seen too many patients in his same situation and knew that not only did he lack the money for it, he was unlikely to survive the 2-3 month waiting period to qualify for long term Medicaid, the one insurance program that could pay for it.  When I visited him in the hospice unit he seemed brighter and a little happier; he was clean and calm and resting well even though something as simple as standing up set off his breathing.  When I talked to the hospice nurses in the hallway they told me he was one of their favorite patients because he was so kind and polite and alert and cheerful… but thought they might have heard him crying at night.

He didn’t want to lose what little independence he had left and eventually went back to the apartment.  We talked over the phone a few times.  I visited him twice more; the first time we talked about life insurance and where he wanted to be buried, the second time we talked about writing a book together.

And then he died.

I was talking to a patient the other night as the first person to deliver to him the news that his symptoms were almost certainly from cancer.  I asked him if there was anyone he wanted to talk to, anyone he could think of as a support or family or friend and he looked at me and said very matter-of-factly, “No, they’re all dead.  I’m the only one left.”  He proceeded to tell me how everyone in his family and his squad of friends had died prematurely: of chronic illness, of cancer, of drug overdoses, of AIDS, etc. etc.  He was in his sixties, and the similarities of their isolation and the contrast in demeanor made me think of my best friend Dwight from the neighborhood of Pine Street.

I am unsure as to why I felt compelled to write all this.  I do not think it is merely because a friend of mine died or even because he necessarily would have wanted me to write it.  I think he would have wanted to be remembered as someone who loved life and friendship, who worked hard with his hands and believed in the Lord.  I do not think he would have told the story of his life in this way, and so I will honor that:

What you read was not the story of Dwight’s life, of which I witnessed relatively little.
What you read was the story of Dwight’s death, of which I witnessed far too much.

It is a story worth telling because he fought death with dignity, with greater fortitude than I can hope to, and with more love than I can bear to remember right now.  But when I thought about him in church yesterday, what came out in prayer was not a song of triumph or celebration but a public weeping in lament.  Because as his doctor and as his neighbor and as his beloved friend, I will tell you that I wept bitterly.  I wept at the injustice of his circumstances in poverty, the effects of systemic sin that made his personal sins that much more painful and cruel.  I wept that though he was loved and loved much he still felt lonely.  I wept that I could have done so much more, had thought so many times about bringing him to live in our home together, but stopped short of both small and radical actions of affection because I simply didn’t have the strength to.  I wept because he had been one of my few friends left from Pine Street, the rest taken by drugs and illness and etc. etc.

And I wept because I knew there were thousands more like him in our city, one of whom I had just met, one whose story of death began long before any cancer was there.

Kyrie eleison: Lord have mercy.



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