Peter Spiegelman - Dr Knox

Mia shouldve been it for the day. She had bruised ribs and a slash down one long white leg, though not from shaving. She was worried about a scar, and that it might hurt business. She swung her dark hair over her shoulder and fluttered painted eyelids at me. Course, for some guys it might be a draw, she said. Her voice was low and scratchy.

Charge them extra, I suggested.

Her Adams apple bobbed as she laughed. You got a flair for marketing, Dr. Knox. Do I need stitches?

Just a tetanus shot and butterfly strips, I said. Jerome do this? Jerome was Mias boyfriend, her pimp, and her alleged fianc. He said theyd get married after she had the surgery, but I thought he was full of shit. I was pretty sure thatdeep downMia thought the same.

She batted her eyes again. He doesnt mean anything by it.

Jeromes an asshole.

He was pissed cause Azul lost to Tigres last weekend, and he lost a bunch of money.

So hes a degenerate gambler, a sore loser, and an asshole, I said as I ran an alcohol swab over her wiry arm. The trifecta. One day youre going to get hurt for real.

Mia winked, and winced as I stuck the needle in. Ow! You gonna take me away from all that?

Im too old for you.

You got mileage, sure, but you still got it goin on. You got that lean, aging surfer thing workingor maybe its an aging ski-bum thing. Either way, girls notice. Guys too.

Youve got the aging part right, I said, and pressed a Band-Aid over the injection site.

Not to worry, baby, Mia said. I got energy for two. She laughed deeply and waggled a finger. And lookyoure not too old to blush.

I lead a sheltered life.

Bullshit, she said, giggling. Youve got some crazy in you. She touched a fingertip to my tattooa tribal braid that ran around my biceps, just below the short sleeve of my scrubs. You get that in the library?

A momentary lapse in judgment. Keep the leg clean.

I keep it all clean, Mia said, every inch. Then she winked again and glided from the exam room.

I looked at my watch. Nearly 7:00 p.m. Nearly there.

Before Mia, thered been Greggie, an ashen, greasy-haired wraith, shivering, mumbling, and shopping for scrips again. Id offered him B, a sandwich, and a rehab referralwhich I did whenever he came in looking for drugs behind some bullshit symptomsin response to which Greggie had rubbed his hands together over and over and finally said, Fuck yerself. Every two weeks, like clockwork with Greggie.

And before him, lined up since early morning, there had been the bleak parade of the homeless. Beneath sedimentary layers of rotting clothes, Id found three pneumonias, a conjunctivitis, a diarrhea, four staph infections, two cases of lice, knife wounds, contusions, rat bites, and countless varieties of ulcerated skin crudand each patient with a stench so earthy and powerful it was like a suffocating hand over my face.

Lydia Torres, my nurse and the manager of the clinic, called it underpass disease. I thought of it as San Julian syndrome, after the street not far from here whose doorways and curbsides were the closest things many of these folks had to an address. San Julian syndrome: the slow and not-so-slow decay of the luckless, the mad, the addicted, damaged, damned, and forgotten. TB and its complications, diabetes and its complications, hypertension, Hep C, HIV, bipolar disorder, schizophrenia, PTSD, and that most desperate diagnosis of all: poverty.

Id seen many of todays homeless before, several under different names. There was no particular reason for the serial aliases, Id learnedsometimes their old names just didnt suit anymore, or had been forgotten, or simply couldnt bear the weight of more history. And, really, who couldnt understand that.

I peeled off my gloves, tossed them in the can, and took a deep breath. The air in the exam room was used upcrowded with the smells of disinfectant, Mias perfume, the lingering reek of street folks, and traces of my own sweat. I leaned over the steel sink and looked into the steel mirror. Angles, planes, a web of lines about narrow, green eyes, and gray streaks in short, straw-colored hair. Aging surfer, aging ski bum. Aging right before my eyes. I ran the water and sluiced some on my face.

Not a bad day, all in all, and far from the worst. No screamersnot really loud ones, anywayno violence to speak of, no sudden deaths, and, thank God, no kids. No great victories, but Id stopped expecting those a week into my residency. Medicine was by definition a play for time, a holding actionskirmishes fought hand to hand or with small, inadequate armament. But alwaysno matter how long you dragged it outthe outcome was preordained. A rigged game.

I dried my hands and face and thought about the joint upstairs, on my kitchen table. A shower, a change of clothes, a six of Stella from the fridge, the lawn chair on the roof, the joint, and the May twilight over L.A. These private fiestas were something of a ritual on Friday evenings. On other evenings too, of lateperhaps on too many others. I closed my eyes and pictured the view from up there, the low, shabby skyline of the neighborhoodSkid Rowadjacent, one of our hilarious part-timers had called itthe downtown towers looming in the west, and the sunset behind them, the sky banded in acid pinks and reds. I could almost feel the gritty wind.

I went down the hall to what passed for my officea wood-paneled, windowless nook with a three-year-old Real Madrid calendar caught in perpetual February on the wall. The desk was a heap: perilous stacks of forms to be signedstate paper, federal paper, private insurance paperall to chase reimbursements that didnt cover the rent; more bills to be paid, most on second notice, some on the third; and on top of it all another letter from my landlord, Tony Kashmarian.