Archive for November, 2014

As I do every Friday, I was rounding at one of our local nursing homes after precepting the night before at the DeSales Free Clinic. Friday mornings like these are always particularly challenging for me as I am often struck not by the differences but by the similarities between the ‘underserved’ unsheltered/sheltered homeless and the ‘underserved’ elderly living out their days in a nursing home. Nursing homes are not all doom and gloom and depressed mental pictures of our loved ones wilting away just as caring for the homeless is not a fruitless effort bound for failure. There is actually a great deal of love taking place in both settings. Don’t believe me? On Friday, a long time patient in the nursing home suddenly took a turn for the worse. I frantically wrote orders for medications that I though would ease her transition out of this world. One hour and fifteen minutes later, my lovely patient left this world to another. She left so quickly that her family was not able to make it to her bedside in time. Instead, she was loved out of this world by a nurses aide and an activites assistant to the hymns of her childhood and recitations of her favorite passages from the Good Book. So often, we in medicine think that our only measure of success is cure. I solomnly object.

Last year, I saw a patient in the Free Clinic with one of my students. The student had done a great job seeing the patient, coming up with a reasonable plan and conveying it to me. The patient essentially had a terrible cold. No need for antibiotics or anything more than some OTC medications that we could provide. From my seat in the presentation area, I could see the patient out of the corner of my eye. He looked terrible. Not the “call an ambulance” terrible, but a weary-feverish-please-just-let-me-rest terrible. As we went into see the patient together, we realized he was in the emergency shelter which clears out no later than 8am. This man would wander the streets and try to find somewhere to rest until the shleter opened back up. Your daily goal of survival is rarely replaced with rest and recooperate. It turned out, this man had a car (eureka!). He also had a brother 1 hour north who was going to be away for the next week and had offered my patient the couch while he was away. The problem? The patient’s car needed antifreeze and he had no money.

As we returned to the waiting room, I asked my student to share a memory about being sick and the things that helped him feel better. Then i asked him to remeber how sick he felt and picture not eating or drinking and then walking around or sitting in 20 degree weather while the wind slaps your face as if to remind you of your worthlessness. Before we learned the patients social situation, we of course knew that we couldnt cure his cold. Most viruses are just a test of our patience since more of the things we give for comfort only work marginally well at best. But we were nonetheless ready to arm him with Mucinex, Robitussin, Motrin and anything else we thought would help. In reality, what he needed more, was rest. And the best way to get him rest, was to get him antifreeze. On the way home from clinic that night, I bought him two large containers of antifreeze and dropped them back off the next morning where a very greatful patient awaited and at last would get a good nights sleep.

In street medicine, as with the nursing homes, we cannot simply cure the root cause that landed our patients in ther current surroundings. It is the complex fabric of their lives and health that have to be carefully understood before real comfort -and perhaps cure – can be achieved. This can be a real challenge to newcomers to these areas of medicine. There is a potential for new providers to become frustrated and overwhelmed and run for the hills while wildly flapping their arms screaming about the unfairness of it all. What we find in street medicine is that often the cure comes from the comfort. The brokenness cannot be cured with pills. It can only be cured with comfort. Comfort doesnt’t take money, doesn’t take insurance (thank God) and doesn’t take a master’s degree. It actually takes something much more valuable. It takes tenacity mixed with vulnerability to go there with your patient. To a place that is raw and uncomfortable and can chalkenge you in ways you never thought possible. To a place where we celebrate the small victories and push on when set backs occur. In many ways, this is what our patients need more than anything else. Belief that they are actually worthy of something better than this.

“Sometimes it’s easy to walk by because we know we can’t change someone’s whole life in a single afternoon. But what we fail to realize is that simple kindness can go a long way toward encouraging someone who is stuck in a desolate place.” – Mike Yankoski

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