ARRIVAL | Jonas Attilus
Before you walk into the room—before I see your face, before you see mine—I read your medical chart. I read the notes left by the physician who regularly visits you in the residential care setting. According to the staff, you have been making suicidal comments. They are worried. They want to know what is wrong. They want my words.
Here you are.
I am new here, to a small town in rural America. I had to cross the Atlantic Ocean for our paths to meet here. Before arriving, I had read about the epidemic of loneliness in the United States, but I hadn’t imagined how much more pronounced it would feel in rural places, where distance stretches between homes and towns, where seeing another person can require miles of driving.
In Haiti, where I am from, grandparents live among us, not apart from us. I carry that with me into the room. It shapes how I listen—what I look for beyond the diagnosis.
When I see someone my age or younger, I ask what brought them here, how they are feeling, and how I might help. But when someone in their seventies or eighties sits across from me, I feel a different pull—one that requires restraint. I ask about their mental health, yes, but also about the evolutions they have witnessed in the world around them. I want to ask about history: the places they have lived, the lives they have known, the worlds they have moved through.
So when you begin to enter my office, it feels a little like watching a sunrise. Something—some fragment of history—is about to be revealed. Light will fall on what was previously unseen. The unknown will begin, gently, to take shape.
You tell me the appointment was made for you. You are not entirely sure why you are here, sitting in my office on a late morning.
I ask about your mood. You shake your head. Depression is not what occupies you. What weighs on you instead is the place where you now live, a place where many residents have lost the ability to speak, to move around independently, where the staff is unaccustomed to someone like you: elders with sharp minds.
You do not guard yourself when you speak. Your eagerness fills the room. I can almost touch it—the urgency to explain what is wrong, what is happening to you, what life has become inside that senior living community.
And you hold complexity with ease. You tell me the staff is good—kind, even—but not prepared for someone like you.
“There is not much to do there other than bingo,” you say. “I cannot do it anymore.”
“It sounds like you want something more mentally stimulating,” I tell you.
“Thank you,” you say, and continue, detailing what you are no longer allowed to do.
Retirement, you tell me, has been difficult. You grieve it because it was never your choice. Your employer decided it was time. Decades ago, you chose your last job and stayed in it. You loved it, you say, because it brought you close to people. Over the years, you built a kind of quiet expertise, giving not just information but connection to those who arrived from elsewhere—their eyes open, their curiosity strong enough to carry them this far north.
And now you live there, and you miss your work.
Your room, you tell me, is tucked away in a part of the building that feels especially isolating, for someone whose life was built on conversation.
As I read between your words and your silences, it becomes apparent that the absence of dialogue seems to you like a kind of premature death.
“You go there to die,” you say. “I have to shrink myself,” you add.
Then another layer of grief surfaces. You are nearing the age at which your parents and older siblings died. At some point, they too lived in a place like this.
“How did they survive?” you ask.
Their absence sits close beside you now. So there is grief—and also fear.
I find myself wondering if the suicidal comments the staff heard were not so much a wish for death, but a language for your fear of it. Because there is still so much life in you. You are not ready to leave behind the possibility that someone, somewhere, might still need what you have to offer. Not ready to miss the milestones you imagine sharing with your grandchildren.
You tell me those words came when you were upset, when frustration rose and spilled over. I cannot tell if you intended to frighten them or simply to make them understand the heaviness of what you are carrying.
So I lean toward you and say, gently, “There will be no medication changes today.”
“What you need,” I add, “is a chance to get out of that place. A chance to meet people. To talk.”
I watch your eyes widen. Your teeth catch the light as you smile.
“I already feel good about this,” you say.
“I’m glad,” I reply. “Let’s meet again in two weeks.”
Not two months—two weeks.
I want to interrupt the loop of fear closing in on your thoughts.
“You and I have so much to learn from each other,” I say.
“It feels good,” you answer. “I’m glad I came to see you.”
Before you leave the room, I ask you a question.
“If someone new arrived here,” I say, “what places should they visit to understand this town?”
I do not need the answer as much as I need you to feel helpful again. I want you to remember what you once did so well: welcoming people, helping them find their way, making strangers feel at home.
You answer with new energy, as if you had been waiting for this, for someone who might need what you still have to offer. You tell me about places worth seeing, roads worth taking. I take out my notebook and begin to write.
“These are for me,” I say.
When it is time to end the visit, to say goodbye and prepare for the next patient, you stand slowly, lingering behind your walker as we continue to talk.
“This is going to be good,” you say. “You are in the right profession,” you add.
“Thank you,” I answer. “I’ll see you in two weeks. And I’d like you to bring anything you want me to know—about your life, about this town, about the years before I arrived here. Next time, we won’t rush. We’ll take an hour.”
I see something changes when you hear those words. Something like recognition.
“See you in two weeks,” you say.
You push your walker with more energy than when you first entered the room, as if you are leaving slightly altered, as if your arms have grown stronger in the time we spent talking.
I watch you disappear down the hallway, then turn toward the lobby to call the next patient.
And none of it required changing your medication.
Jonas Attilus, originally from Haiti, is a psychiatrist working in rural Minnesota. He serves both rural and Native American communities. As a member of the Minnesota Refugee and Immigrant Writers Group, he writes in Haitian Creole, French, Spanish and English. His writing focuses on medicine, collective trauma and migration. His memoir, What the Ground Couldn’t Shake, will be published by Split/Lip Press in Fall 2027. Read more of his work on jonasattilus.com and Substack