When I think about the Open Door clinic, I think about grand, sweeping gestures of humanity. Thirty-five years ago, its founders had shed their pasts and sacrificed their futures to start a shelter in the heart of Atlanta. From a two-story house hidden in a clump of trees, the community had waged guerilla warfare against hunger and injustice and racism. They even dined in the shadow of giants. The volunteers and the homeless ate every week underneath social justice posters and Biblical murals and worn-out protest t-shirts. It felt like an NBA arena, a memorial to the triumphs and failures of those who dared greatly.

I don’t think of the clinic that often anymore– the shelter was closed in my second year of medical school. When it was open, students like myself volunteered and saw as many patients as we could, to do as much as we could. And we could only do much. Still, the waiting room – a refurbished den lined by a dozen chairs – always filled up. On the quiet nights, you could hear the hopeful silence and the occasional crunch of free popcorn.

Now that I’m in my third year, I have other patients to see in the offices and hotels that rotate through. And even though they now come pre-gowned and pre-roomed, many are still fighting the same fight. Against the same daunting odds.

Those are the days I think back to one of my first nights at Open Door. My first patient had high blood pressure. Not too high – not high enough to jump to medicine. But just high enough for a first-year student to go bug-eyed. He just laughed.

“It’s getting better. They told me to cut down on smoking last time I was here. And it’s actually improving,” he chuckled in disbelief. “I did stop smoking by the way. Hardest thing I’ve ever done.”

That punctuated him buttoning up his sleeves and reassembling his tie as soon as I freed his arm. He had come to the clinic right after his day shift. He was going right back.

“Just take his BP,” I was told, “that’s all he wants.” That’s all I can do for you anyway.

My next patient – a migrant worker – limped into the makeshift office. I felt even worse when I told him that I was just a student and he couldn’t hide his sigh.

“We’ll see the doctor soon, though,” I offered. And he finally indulged me with his story of two days of knifing pain in his foot.  This would be debilitating for anyone. But now, he couldn’t work. And if he couldn’t work… No. I couldn’t afford to look down that road.

I kept my promise and presented him to the clinic physician. The doctor listened. He spoke. He prodded and palpated. And as pondered, I found myself hoping for a “Eureka!” from him – to flourish a medicine or maneuver to figure this out. I prayed that he could fulfill the patient’s faith in my clumsy questioning. In limping after me.  In coming to the clinic at all. But really, I wanted him to fulfill my own faith in deciding to study medicine.

There was nothing we could do. Not there, anyway. The patient was told about an orthopedic clinic.  He was sent out with his hands filled with “hope” – pain medicines in one, referral forms in the other. Deep down, I suspected they would never be filled.

Visits like that crushed me, especially in that first year. They left the heart a little weaker, the tongue a little heavier, the hands a little slower. They left me wanting to dream instead.

As we were cleaning up for the night – David filed the charts and Annie refilled the medicines as she perched on the countertop – we started to vent instead. We proposed. We dreamed. We shoveled up ideas like coal into the boiler. Small changes. Pamphlets? Health classes? Case managers? We picked up speed and barreled ahead. Big Changes. To Medicine and to Attitudes and to Society itself. Pipe dreams. Here, finally, we petered out, our steam fading into fumes, until finally, we were back in a room just bigger than the closet that supplied it.

Before we shut the door, one of our regulars hobbled through. I recognized him from the front stairs, where I always found him lounging in the sticky dusk.

“I’m guarding this Clinic,” he’d cackle toothily, before welcoming us in with a joking complaint.

Tonight, he propped himself against the bed and just showed us his cane. He beckoned to the bottom. The cane was in bad shape, but its rubber foot was worse off.  The wear and tear had left this man’s prosthetic a hazard instead. How much would it cost to get a new foot? How much to get a new cane? To get him better shoes? To treat his diabetes?

David and Annie, remembering a former patient, went rummaging through the closet to find a pair of crutches that he had donated. And after a while, they had found and salvaged the crutches’ pristine rubber feet. Except the new foot was too wide for the end of the cane. So we started fattening it up with layers of duct tape. Add a few layers. Try on the foot. Add a few more. Try it again. Until finally, like a fairy tale…Eureka.

Overshadowed by the promises of religious iconography and the fire of protest placards, a framed, yellow postcard used to hang in the waiting room. On it were the faded words of William James:

“I am done with great things and big things, great institutions and big successes,

and I am for those tiny, invisible, molecular moral forces,

that work from individual to individual, creeping through the crannies of the world

like so many rootlets, or like the capillary oozing of water,

yet which if you give them time,

will rend the hardest monuments of man’s pride.”

When I think of the Open Door clinic, I think about David parading out of the closet with the feet in hand. I think about layers upon layers upon layers upon layers. I think of the triumphant immobility at that last, perfect one.

Fixing his cane was nearly invisible. Nearly nothing. But it was…something. Something concrete. Something real. Sometimes, those tiny, molecular rootlets are all that we can extend, all that we are capable of. And sometimes, that’s enough.


Initially published in The Styloid Process: Literary Journal of Emory University SOM