Archive for July, 2014

41 years and an umbrella

Posted: July 31, 2014 in Uncategorized

I am certain they never thought they would end up right here. In an empty church parking lot huddled under a tree praying the forecast was wrong. Storms were coming and the local forecast was calling for high winds, thunder, lightening and flash flooding. Things were uncertain and it must have seemed like a cruel end to a difficult few days.

Earlier that day, Brett had met this couple during his weekly clinic hours at the soup kitchen.  From across the room, he could see that they were worried. They had slept on a park bench in front of the church the previous night but their tattered clothing and unkempt appearance did not look to be purely from last nights rough sleeping. The husband was nearly frantic about where they would sleep tonight. They had braved a mild storm last night and  had taken turns holding the one umbrella they had over themselves. Now, they came to the soup kitchen in search of a meal, and more importantly, a plan. It was learned that the day before, this married couple of 41 years had been evicted from their apartment. They said there was a bed bug problem that the landlord had blamed on them. While the couple disputed whose fault the bed bug problem really was, the end result was the same: eviction.

Of particular concern was the health of his wife, a wheelchair bound woman with multiple medical issues. Her husband was her sole caregiver and because she traveled only by motorized scooter, simple taxi vouchers were of no help to them. A variety of idea were tossed out. Because the Lehigh Valley does not have any shelters that accept couples, it was suggested that the couple split up into the men’s and women’s shelter. The pair wouldn’t hear of it. He worried that no one else would know how to care for her like he did. In a nutshell, they would rather sleep on the street but be together than be sheltered and be apart. This may sound crazy, and maybe it is, but this is not an isolated story. We often see couples or even just close friends who refuse shelter because there is only room for one of them. When you have few possessions, you will do anything to preserve a relationship that has never shown you abandonment. Last winter, on a particularly icy evening, two of my patients had nowhere to sleep. They had wondered the streets together during the day ducking into businesses for a few minutes before going back outside. When one of the men was offered a bed for the evening, he refused saying he could never sleep that night knowing his friend was alone and cold. Instead, they spent the night huddled up against the back of the local YMCA.

The question was then raised, should the wife be sent to the hospital? While there may not have been anything obviously medical necessitating an admission, there was a chance that someone would recognize the situation an admit her for social reasons. But the couple was worried that someone would try to put her in a nursing home (frankly, not a bad idea looking at the situation) and then they would be separated forever.   While the Area Agency on Aging was unable to help , there was a sympathetic employee there who stepped up to try to find a hotel as an anonymous person volunteered to pay for a hotel for a few days to buy some time. She called several places but the only motel with a vacancy was miles away. Without transportation that could accommodate a scooter and no batteries left in the scooter, the couple wasn’t able to get to the motel.

That evening, they were last seen sitting under the tree, this time with two umbrellas.

One days like this, the stark contrast between lives is almost enough to make you cry (or scream). On this same day, our daughter was turning six.  Birthdays to children are like winning the lottery. The excitement about being a year older was rampant in our house and she could hardly wait for today to come. As we were sitting at the Chinese buffet, filling our bellies and singing happy birthday I couldn’t help but notice the sharp contrast in scenarios. Guilt swept over me. But as the rain pounded down and the thunder crashed, I comforted my two older children who felt scared and vulnerable with the passing storm. Just like the couple sitting under the tree. Suddenly I realized the similarity-  Unconditional love.

As a good country song says “Love’s the only house big enough for all the pain in the world.”

 

The first clinic that Brett and I worked to open was the DeSales Free Clinic (check the Where Are We page for more information) in 2007. To the credit of the DeSales University faculty (long before I was a member), they made attending the Clinic a required part of the curriculum. This is no small feat and did not come without it’s share of controversy. In fact, many medical institutions who offer a homeless clinic experience do not require it but rather just make it available. There are a million reasons stated to take this approach- it is better to have people who really want to be there, the students are already so busy, it is really more of a club-type activity and the list goes on. However, academic research has shown that in the medical school and residency model, the greatest impact on the attitudes of students and fledgling practitioners about this population is seen in programs that require participation in the experience.

Early on in the life of the DeSales Free Clinic, I was going about my business of coaching students and seeing patients. One student in particular looked very uncomfortable. At first I thought it was just nerves. The clinic requires a team of first and second year PA students to see a patient as a team. This expectation is both exciting and obnoxiously intimidating for the students. This usually causes GI distress for 48 hours before the Clinic night in anticipation and 48 hours after the Clinic night as they ponder if they know anything at all. I assumed that student was panicking about repeatedly putting their stethoscope in their ears backwards.

I was wrong.

After the student continued to sweat uncontrollably for over an hour and looked as if they were on the verge of passing out, I pulled them aside and asked them if they were ok. Reluctantly, they told me they were terrified of being at the clinic with ‘these’ patients and had no idea how to relate to “them”.  They wanted to be helpful and they wanted to connect but in the students eyes, there was no common ground. They didn’t look the same, they didn’t act the same, they seemed to share no common experiences. Even their dentition was different. As the night had progressed, this young student had generalized this experience to mean they could never relate to any patient. Ever. The whole night was on the verge of catastrophe.

In my experience working with the homeless (and talking the ear off about homelessness of anyone who doesn’t have the good sense to stop me) I think this is a common feeling that becomes a barrier for getting involved at any level.  I have asked myself the question before too.

I grew up mostly in Kansas and Indiana. I am more familiar with tornados, farm land and suburbia than the inner city. I listen mostly to country music.  I don’t have a history of addiction or incarceration or abandonment. I say ya’ll and when I am tired, tend to sound more like a hillbilly than a college professor. I have parents that are still married after 41 years and always had plenty of love. It is not to say that there were never hardships and difficult times but a big difference is those struggles were conquered with the support of a loving environment. So, simply put, how do I relate? Where is the ‘street cred’?

Respect. Dignity. Humility. Authenticity.

It is really very simple.  When we treat people with respect and dignity, they appreciate it. They may not show it right away but they see it, they hear it and they feel it.  Often, in medicine we are told that the homeless are a ‘difficult population’ who never follow up and never follow through (usually accompanied by an eye roll or heavy sigh). This has not been our experience. In fact, one way our patients show us that they have felt the respect and have been treated with dignity is that they either come back to the Clinic or invite us back to their encampment- their home.

There are certain things in life that are exceedingly difficult to fake. Humility and authenticity are two of them. Most of my patients have experienced things that are unspeakable. I don’t know how they have walked on this Earth for all these years bearing these burdens of emotional (and often physical) trauma. And certainly, sometimes they are suffering the consequences of their own actions. But often, no one listens to them. They don’t listen to how they ended up sleeping on a friends couch. They don’t listen to how they ended up sleeping in their car, the woods or in a shelter. They don’t ask why they never took any of the medications they were discharged home on. They simply determine- by way of a sideways glance- that a persons homelessness is the rightful consequence of a mistake and simply cannot be helped.

Dr. Jim Withers (seriously, if you don’t know how he is- Google him) always says that we have to suspend our reality and step into our patients reality in order to truly understand how to help them.  Suspending reality takes some courage. Once you see the world through different glasses, it can be hard to ever see it any other way. Like the former lifeguard in me that cannot go to a swimming pool without constantly scanning the water for someone in trouble. However, if you are willing to take a journey into someone else’s life, you will be enlightened and only the can you really know how to help.

-C

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It Only Took One

Posted: July 22, 2014 in Uncategorized

When I was a physician assistant student at Midwestern University, I met the One.

And I don’t mean my husband (truth be told, I already had him hook, line and sinker).

I mean the one patient that changes how you look at all patients. This happens all the time in medicine. If used for the worst, it is how stereotypes are born. You have a patient who behaves a certain way, who has a certain illness and somewhere in the recesses of your subconscious, you are cataloging your experience and will draw on it for future guidance.

I had been around the homeless or those at risk for being homeless many times growing up. The daughter of two hard working parents, I was taught the value of understanding that many people go without. We volunteered at soup kitchens and shelters. My mother, a pediatric physical therapist, has spent her career working with families who are often just one misstep away from losing their roof. But this was different. Now I wasn’t just a volunteer serving food, I was providing health care.

It was a very cold night and the waiting room of a small free homeless clinic just outside of Chicago was full.  I could not wait to start seeing some patients that night. However, before I could really start, I caught wind of a conversation taking place in the waiting room. Three or four of the patients seemed intensely concerned about John, a rather robust man sitting in the corner chair. Being a nosy PA student, I asked them if everything was alright. Before they could answer, I looked at John. He was sweaty, pale and seemed agitated. As I approached him, he and I locked eyes. And in that instant, I knew something was terribly wrong with him.

Chest pain. A history of uncontrolled hypertension because he could never afford the $10 copay. Claudication. Even though in hindsight, my depth of medical knowledge matched that of my children’s kiddie pool in the backyard, I knew that he could be having a heart attack. A quick hook up to the EKG machine and our suspicions were confirmed. Off he went in an ambulance.  But this is not what made him the One.

Rather, it was the reaction of the waiting room. People were crying, pacing, tense. They were extremely concerned about John. I thought it was sweet.  They thought I was naïve (they were right). John wasn’t just another one of Chicago’s nameless faceless homeless. He was a leader in chronically homeless subculture of this Chicago neighborhood.  Everyone knew John. And John knew everyone. They told me how John had been chronically homeless in Chicago for 27 years. He always knew when there was a new street sleeper and he tried to help them. He would tell the newbies where the soup kitchens were, how to avoid the cops, where to get a free mammogram.

John was the keeper of the knowledge.

It was in this moment that I realized the superficial nature of most peoples understanding (at the time, self included) of the homeless. They were faceless and nameless to us, the outsiders. But to each other, they were bonded brethren. They trusted each other and they worked together to survive.

This epiphany changed everything. It was enlightening and fascinating. It was a world that I wanted to know all about – not so that I could be a prying nosey neighborhood watchdog but rather I realized that I could never really help these people if I didn’t understand their reality. This was the start of the journey.