She taps her foot when she is anxious.
A rhythmic tap, like someone musically challenged trying to tap along to some song, but it does not come out quite so clearly.
The tapping begins about an hour after the procedure was allegedly done, but still no one has come to speak with them – Melody Smits, the daughter, Betty Smits, the wife, and Leroy Smits, the brother. They are in the post-operative waiting room waiting for Jonathan Smits, the surgical patient currently residing somewhere between the operating room and the recovery room, and the reason why the family finds themselves in the waiting room to begin with.
They were told the surgery, a vascular repair of the main blood vessel in the abdomen, the aorta, would take roughly three hours, and they knew the case started thirty minutes late, so after waiting four hours, they begin to wonder how things are going.
Melody stands up to ask the receptionist for any updates, but only receives a perfunctory, “I’m sorry ma’am, I cannot say with certainty how the patient is doing, we don’t have that information”, as a response.
She does this twice in thirty minutes, her anxiety inevitably growing, prompting her to walk back and forth and then again to sit down, until she grows palpably frustrated – and begins to squirm in her padded one-seater.
“We should at least hear something by now. This is highly unprofessional!”, Melody says, using the arm chairs to push herself upright in the seat.
“These things take time. No sense in rushing. Might as well just deal with what we have here”, Leroy responds calmly, looking around the waiting room as he gently taps his fingers together and looks over to Betty, who presses her lips together and nodes in response – a silent gesture of agreement.
“No, we are entitled to know what is going on”, Melody rebuts, now demonstrably curt.
Melody, now sensing the conversation is over, stands up, fidgets with her purse, and says, “I am going to find a vending machine to get a snack – anybody want something?”
After giving a moment for Betty or Leroy to respond, she walks off in silence.
“This will give her some time to cool off”, Leroy murmurs, keen to keep his voice soft.
“Agreed”, Betty responds.
Leroy and Betty go on to reminisce about the holidays of years past, so many years ago, when it was just the four of them together – Jonathan, Leroy, Betty, and Melody – and they laugh about all the silly conflicts, grandstanding, and arguments Jonathan got into over the years. Leroy and Betty were always both the calm ones. But Jonathan, however, was and still is as argumentative as the two are calm, almost like Melody, but without the petulance. The combination of personalities creates no shortage of stories and Leroy and Betty take turns telling their favorite moments. But, inevitably, the conversation turns wistful whenever their stories come to the part about Jonathan smoking.
Smoking was Jonathan’s reflex response to stress, and smoking is the reason Jonathan needed the surgery in the first place – and everybody knows it. So when a story turns to the part where Jonathan came back from smoking, went off to go smoking, or screamed he needed to smoke a square – the tone of the story changes, the story becomes less funny and more remorseful. In those moments, both Leroy and Betty grow silent and let the conversation taper off into the silence – content with allowing the background noise of the waiting room to fill the silence, accentuated all the various buzzing and humming ambient noises – before one of them pushes through the silence to continue the conversation.
It is in one of those moments of silence that the receptionist walks over to say:
“Hello, I want to inform you that patient Jonathan is in post-operative recovery. The surgery went well, without complications, and somebody should be here to speak with you shortly.”
Betty releases a gasp of relief, revealing the tension she silently held. “That’s great news – thank you for telling us.”
“Much appreciated”, Leroy adds.
And with that the receptionist returns to her desk, leaving Leroy and Betty smiling in silence at each other.
“Good, good”, Leroy says quietly. “Now the wait feels easier.
“Feels almost like, light, light-weight – make sense?”
“Makes sense”, Leroy whispers, his face forcing a grin.
“Before it was heavy weight, now it is light weight – weight, wait…”, Betty goes on.
“I get it – it’s not funny if you lay the joke on so thick”, Leroy interrupts, and with that the two erupt in laughter, more at Betty’s attempt at delivering the joke than the joke itself. But for Leroy and Betty, given all that they had to endure of late, the two would have found humor in practically any attempt at comedy.
They see Melody returning from the far end of the hallway, now presumably calmer since the sound of her shoes against the linoleum floor is less harsh, something both Betty and Leroy notice.
“Feeling better?”, Leroy asks.
“A bit, just needed to walk off some stress”, Melody acknowledges as she drops her purse in an empty seat next to the one she collapses into.
“Honey, did you even eat – wait, good news – the surgery went well and he’s recovering now”, Betty clasps her hands in joy and shares a childlike smile, grinning widely.
Melody, in turn, jerks her head squarely at Betty and responds, “Thank god – I am so relieved”, and allows herself to sag lower into the seat, overtly displaying her newfound relief.
“Yes, she told us while you were gone”, Leroy says, gesturing toward the receptionist while looking at Melody.
“Great, sorry I left – bought some chips, took a bite, threw out the rest – I wasn’t really hungry, I was just annoyed at the waiting”, Melody says softly, her eyes looking softly downward.
“Understandable, the wait is hard, especially hard since we don’t know what’s going to happen. Now we at least know things will turn out for the good – so waiting is not so hard now that –“, Leroy continues until Melody abruptly cuts him off. Her eyes darting towards Leroy as she adds.
“Why do we have to wait – still – now what is it?”
“Honey –“, Betty attempts to begin before letting her voice trail off in anticipation of another eruption by Melody.
“No, no – what about our time? Where is the regard for our time? All I know is that he is okay and out of the operating room. Then why didn’t the surgeon come and talk to us? What is he waiting for? So we just sit here assuming his time is more important than our time?”, Melody again grows more tense with each word, her words rising into a crescendo.
“Melody, Melody – listen, for once, listen”, Leroy interjects, in a tone projecting both calmn and authority. “Be patient, you are making yourself and others more tense by the way you are acting. This is a place of healing, not a customer service department. Your wait is your wait time – that’s just how it is. You don’t compare your wait time with other’s wait time or value this or that. You just wait, and you understand, and you appreciate whatever good news you get. Jonathan just went through a major surgery and you’re upset because you feel entitled to see the surgeon on your time? How about you just appreciate the fact that the surgery went well, and think about others here? You get riled up and then I get worried, and then Betty gets worried – and everything just feels worse. Instead just contemplate on the good fortune of a good outcome and count your blessings.”
“You live in an age gone by, this is –“, Melody reflexively reacts without even digesting all that Leroy had to say.
“Oh please”, Betty interrupts, intending for Melody to stop speaking. “Let’s just enjoy some silence”, Betty hisses the last syllable and waves her hand at Melody dismissively, calling for the conversation to end. Melody obliges and begins to straightening her shirt and glossing through her phone while pouting in silent defiance.
In the silence, the three slip into their own worlds. Leroy thinks about the times he and Jonathan would share a morning cigarette on their way to work. He finds it funny how something that the two brothers used to bond over nearly tore them apart. Leroy struggles to parse this fact out of the memories, attempting to maintain the fondness of the conversation – only without the smoking part – selectively distilling the memories, the conversations, the bonding time apart. But no matter how hard he tries, he cannot remove the bittersweet taste, as many of their conversations were punctuated by the exchange of cigarette drags from one lip to the other lip.
Betty’s thoughts take a more guilty turn, as she feels responsible for Jonathan’s smoking habits – or least responsible for not doing enough to stop the habit in the first place. She thinks back to the early years of their marriage, when they fought quite a bit – it seemed every disagreement, no matter how large or small, was resolved with a fight. And when the fight was over, Jonathan would cry that he was leaving to go smoke a cigarette, a signal to Betty that the fight was over – something she would relish over at the time, as it meant she won the fight – but now she sits under the solemn weight of past guilt as she realizes those were the times she was tacitly reinforcing a habit that would eventually lead to his surgery. She sits in mourning, punishing herself through silent insults, that she should have let him win all the arguments, justifying that he would have smoked less if he had won more arguments. A nonsensical argument, that she knows is nonsensical, but when you are consumed in the angst of the unknown, pinned beneath the weight of past guilts, you hold on to the nonsensical if that is all you have.
Melody scrolls through her social media profiles, one after another, judging the quality of a picture, the value of a comment or a hashtag by the number of ‘likes’ or responses it generates. She thinks about starting her own campaign – against excessive wait times for families of surgical patients. She wonders how many ‘likes’ she will get, how many comments will be posted, deeming the value of such an endeavor by the external validation it would engender. She recalls various articles she read on social media campaigns and randomly remembers that posts with pictures garner more attention.
Raising her phone to a level just above her head, she begins to take pictures of the waiting room, attracting the attention of Leroy and Betty. Who look at each other quizzically before Betty signals with a head nod and an eyebrow twitch that Leroy should say something. And with a sigh he makes his attempt.
“Melody, dear, others may not appreciate you taking photographs like that”, Leroy says with a practiced patience.
“I’m not taking pictures of people, just of the place, for my social media campaign”, Melody replies in a matter of fact tone.
“Oh Jesus”, Betty exclaims, with a slow-motion eye roll.
“What will your campaign be about?”, Leroy continues, visibly working to humor her.
“Inappropriate wait times”, Melody boasts.
“I assume you believe it is inappropriate to keep you – you – waiting. And that is the main point of your –“, Leroy asks before again Melody abruptly interrupts.
“Our – okay – our mission, alright? Our mission to inform the public –“, Melody continues until Leroy interrupts Melody in kind.
“Wait – there is no our – this is all you. I’m perfectly fine waiting, and I will wait however long I need to just to make sure Jonathan is okay. You don’t know what is going on in there, what the surgeon is going through, or why he is running late. But you know what I do know – he just saved Jonathan’s life – your Jonathan. And that, in my eyes, earns him some respect, definitely the respect of waiting. So no, I don’t think waiting is inappropriate.”
“So will we get any respect on the medical bills? Any respect on the excess wait time? If you want us to give respect, should we not expect some respect in kind?” Melody asks sarcastically, her hands pantomiming a feigned sense of importance. “Can we say, ‘oh insurance company X, can I pay my premium next month, I hope you don’t mind waiting. So if time is money for the hospital, for the insurance company – why is it not a two way street? Look I am really grateful that Dad is okay, but does that mean we have to just sit here waiting forever?”
Leroy was stunned by the seriousness in Melody’s words. Sure, she may have a point, but for Leroy, the point was in poor taste given the time and place. Leroy just found out that Jonathan was going to pull through, and the gratitude of hearing the good news overwhelms anything else – a sensibility Leroy wishes Melody would understand. But for Melody, being stuck in her ways, sees that she has a point, no matter how distasteful, and will latch onto to it come hell or high water.
Sure, healthcare is a business. Leroy knows all about federal budgets, social security, Medicare, and Medicaid spending in his former life as an accountant. But he always considered healthcare to be a bit different. And through that consideration, he behaved differently when it came to the finances and economics of healthcare. Something he realized Melody never once considered.
For her, time is time, and money is money – context be damned.
Just then the surgeon arrives with his surgical assistant walking a step behind him. She points to where the three are sitting as they continue to walk through the waiting room. Once the surgeon is within a few feet he projects a confident smile, extends his hand, and shakes each person’s hand as he takes time to walk over to each one separately.
Afterwards he centers himself in the middle of the three and begins speaking.
“My apologies for being late, don’t mean to disrespect your time.” Melody catches Leroy shooting her a look. “However, Jonathan asked me to stick by his side until the anesthesia wore off. And soon enough we got to talking. He really loves you guys a lot. He told me all sorts of stories about how he and Leroy” – pointing to Leroy – “would go to work together. How you and Betty” – pointing to Betty with a churlish smile – “would get into silly fights and he would let you win just to be able to leave. And how you and Melody” – pointing to Melody while wagging his finger – “became spitting images of each other, particularly in how you two can lose it off the drop of a dime. Don’t worry, I can relate”, he muses while the nurse nods knowingly but silently in the background.
“I really enjoyed learning about you guys”, he continues. “And I feel like I really got to know all of you, as odd as that sounds.
“Oh and of course, the surgery went well, no complications, and he will be good to go after two to three days of recovery time on the general hospital floor. In those two to three days we will monitor the incision for healing, make sure he is able to eat and drink, and all that fun stuff. Any questions?”
Leroy, Betty, and Melody each maintain a respectful silence, nodding gently side to side, their eyes and smiles fixed upon the surgeon.
The surgeon gives a warm smile in kind and nods at each one individually before taking his leave.
“Thank you for your time”, Leroy calls as the surgeon walks away, prompting a brief hand wave from the surgeon.
“He was nice”, says Betty.
“Agreed – very considerate”, Leroy replies.
He glances over and sees Melody quietly deleting the photos on her phone.
Heatmaps showing opioid sub-epidemics by demography and urbanicity
Total number of deaths in each category from 1999 through 2016 are shown in the upper left corner of each plot. The colors indicate age-adjusted mortality rates per 100,000 people. (Synth Opioids OTM: synthetic opioids other than methadone. This category includes fentanyl and its analogs.)