Posts Tagged ‘DeSales University’

We have been experiencing extremely cold temperatures over the past week, with the early mornings and evenings below 0 degrees. There is obvious risk of severe injury and death for our patients who choose to stay outside. We always attempt to meet them on their terms and respect the decisions they make, but first try to bring them in to safety. This was the goal when I arrived at Safe Harbor at 8:00AM- we needed to go to the camps by the river and try to get those folks to come in with us for a meal and a warm, safe place. The parking lot around back also serves as a meeting place for the guests to congregate but mostly smoke. After I pulled in, I got out of my truck I was greeted by one of the residence, “Hey, are we doing that homeless thing today?!?” The initial thoughts that rushed through my mind were, “What homeless thing,” and then, “Wait, aren’t you homeless (which of course he was)?” At that moment it occurred to me that the manner in which we carry out street rounds is so inclusive, that the area homeless are beginning to feel a part of it and are making it their own.

The way we perform street rounds varies from day to day based on the locations and the people we are going to visit. At times it’s better to have a small group- usually myself and at least 2 other guides. When we go out around Easton the mood is much different. Tyler, the Director of the large area shelter, Safe Harbor, is extremely well known. Almost all of the people we come across are either known to Tyler or know of Tyler. Because of this familiarity, when we travel around Easton my goal is to be more inclusive. Helping those most in need is difficult and requires full community involvement. Sometimes, the person in need feels alienated from the community. When the situation is right, we’ve found it to be extremely effective to bring the community with us to welcome them. When this happens, the community takes ownership over all of its members, and the previously alienated member feels less that way. There are times when we set out with 4 or 5 people on street rounds. As we visit various camps, we ask the homeless to join us on street rounds culminating in a trip to Safe Harbor for food, shelter, showers and even job assistance. Sometimes we return with 10-15 people. It is this approach that led this resident of Safe Harbor to feel, and rightfully so, that he too was an outreach worker and despite his current situation in life, he is still valuable enough to give back to those less fortunate.

When we set out this morning, I thought I was part of the street medicine program, but as we approached a tent with two very cold people sleeping inside and the same resident yelled from the outside, “We are the homeless posse here to bring you in!” I knew what group I was really working with that day. And we were much stronger than any medication in my backpack.

~BF

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Whew.

Remember when you were in middle school and your parents sent you off to camp for two weeks for the first time? Personally, I dreaded that day. Two weeks seemed so long. And. let’s face it,  there were an endless number of spiders that could be encountered in 14 days. But off you went and when you returned, you were different. And suddenly, you had lived more in those 14 days and learned more about life, yourself, spiders, archery and basket weaving than you could ever have imagined. Multiply that by a gazillion, and that is what the first three months of full time street medicine in this household has been like.

As you may remember, Brett became full time street medicine on October 1, 2014 as a result of a grant from the Pennsylvania Department of Health. The support and the rate at which the Program has been growing in 12 short weeks is baffling, even by my standards. At the start of the Program, there was a shelter based clinic (Safe Harbor- Easton, PA) and a soup kitchen based clinic (St. Paul’s- Allentown PA) in addition to the separate (but closely related) DeSales Free Clinic at the Allentown Rescue Mission.  In three months, there are now street rounds twice per week – one day in Allentown, one day in Easton, a new clinic at the 6th and Chew St Winter Shelter, involvement of medical students, internal medicine residents, development of a homelessness screening tool, ground work for the opening of new clinics in the Ecumenical Soup Kitchen (Allentown), Salvation Army Hospitality House (Allentown) and New Bethany Ministries (Bethlehem). Not to mention the training for the new Network wide electronic medical record, meeting quarterly requirements of the grant and endless other tasks. In addition, I and DeSales University have taken to a new project by opening a clinic at the Truth Home for Women (Bethlehem) which provides free medical care to women who are recovering from human/sex trafficking.

I have had some time to reflect on these last few months during a much needed break from my teaching responsibilities. However, all that time I envisioned playing board games with my kids and organizing closets were erased by the passing of my dear uncle, the hospitalization of our 7 month old son (who is back to blowing raspberries and trying endlessly get his toes into his mouth), the declining of my most favorite sassy lady- my 92 year old Nana and a slew of other unforeseen life events. In those wee hour moments while rocking a sick baby back to sleep, I get my clearest visions and thoughts.

Life itself is without protocol. I remember being a PA student desperately trying to grasp the concept of electrolyte replacement and management. I remember begging for a protocol. Yes, I know protocols are really just suggestions. Yes, I know we treat people and not number. Yes, I understand that every case is individual. BUT GIVE ME THE PROTOCOL. Mostly, I thought, so I don’t kill someone out of my own stupidity. I needed place to start. Homeless medicine is an amorphous area of medicine. Most people who start out in this field are drawn to the social justice of it all, the simplicity of the system. But they are nervous, scared even. It is so far outside of how we normally practice medicine. Think of a typical office visit- there are front office staff, there is a scheduled appointment, there are people to room the patient. You see the patient and practice within well defined (mostly) evidence based standards of care. You fill out a bill, maybe write out a prescription that will need a prior authorization. Which will then be denied requiring you to either spend an hour on the phone arguing or change the prescription. It may be a pain in the butt, but traditional medicine has structure. It has protocol.

As we are training new providers to volunteer, open clinics and screen patients, I am reminded that this new way of thinking about medicine can invoke a sense of agoraphobia. There are no walls. No documented peer-reviewed standards of care. No protocol. In fact, it is the very opposite of protocol. It is creative, sprawling, think-outside-the-boxy, just-because-its-never-been-done-doesn’t-mean-you-shouldn’ty. This is the origin of the (my) addiction to street medicine.

Brett and I had an opportunity to give some education about healthcare for the homeless/street medicine to third year University of South Florida medical students. It was a great chance to talk about the unique qualities our patients on the street possess and how they survive. We were incredibly fortunate to have Tyler Rogers, executive director of Safe Harbor (Easton,PA) speak as well. His passion for helping people end their hopelessness is palpable and contagious. The repeating theme in all of our discussion was the concept that everyone matters. Here is a story of a person Brett met today during street rounds with Tyler. It is a testament to why we do what we do and the courage our patients have that we often don’t appreciate.

” I’m incredibly blessed to have the opportunity for service that my job affords. Today was one of those days that reminds me even more than usual the importance of joyful work. I was doing street rounds today in Easton and one of the homeless people we met tipped us off to a young girl sleeping on the street who just arrived from New Jersey. I found her and it was quickly apparent she was pregnant– 28 weeks pregnant– and fleeing domestic violence from her mother who is a crack addict. Her mother has abused her and her brother since they were kids and she always stayed to try to protect her little brother who is now 17 and an addict himself. She felt the time was right to get out of the situation since she feared for the life of her baby because of the abuse. She came to Easton because someone told her she would find help there. I found her and her boyfriend in an alley and told her why we were there and about street medicine. I wish you could’ve seen the look on her face. She has been in Easton for 6 weeks and didn’t know who to call to try to get help or prenatal care. She didn’t have insurance or money to pay so the plan was to go to the ED when she went into labor so she wouldn’t be turned away.

While I was with her we scheduled an appointment for her in the Center for Women’s Medicine. I spoke with the team there myself and she was treated with respect and dignity every step of the way. Now she is very much looking forward to her first appointment next week. Jen, the Case Manager at Safe Harbor, has started the paperwork for her insurance and her boyfriend has enrolled in their job training program. She and her boyfriend were placed in a home affiliated with Safe Harbor today so they can stay together and won’t have to sleep in the streets.”

Sometimes people ask us how we stay encourage. How do we stop from burning out or getting discourage. The answer is simple – Everyone Matters.

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

In the Spring of 2013, Brett came across a conference being held in Washington, DC a few weeks later. We scrambled with our employees and our families to find coverage for the many hats we wear and off we went to the National HealthCare for the Homeless Council conference.  I have been to many, many educational conferences in my professional career and I can say that up until that point, none of them would be described as life changing.  Prior to our attendance, we had been running the DeSales Free Clinic since 2007 but had not really met other people who were doing the same things. Two things happened at that conference that changed the trajectory of our lives.

First, we were able to see that what we had created at the DeSales Free Clinic was as comprehensive and well thought out as many of the programs who were presenting their healthcare models at the conference. We always felt in our hearts that what we were offering was logical and right but we really had nothing to compare ourselves to. The second thing was that we were able to meet all of these people that were offering healthcare to their homeless population in ways we had never even thought of.

It was like a mental explosion.

I remember sitting at a restaurant with Brett after the conference was over.  We made a plan at lunch that day about what we wanted homelessness medicine to look like in our area. It was suddenly blinding that what we were doing was great but there was SO MUCH MORE that needed to be done. More people, more locations, more populations, more awareness. For both of us, a sudden and sharp vision (blessing)was born.

We wanted to start with developing a Street Medicine Program. We don’t really know how to do anything small and so considering starting something in a logical-one-step-at-a-time method is a nice theory but we know we’ll blow it right out of the gate. We knew that the biggest job was two fold- 1) convince important decision makers that the Lehigh Valley has a homelessness problem and 2) Get buy in for this never-heard-of-it-before type of medicine called Street Medicine.

A few months after the NHCHC conference, we attended the International Street Medicine Symposium in Boston, MA. Again- mind blown. The benchmark program- Boston Health Care for the Homeless Program- hosted the conference and I thought our heads were going to explode on the car ride home.

Today, Brett starts as a full time Street Medicine PA in the Lehigh Valley Health Network Street Medicine Program. He has worked tirelessly at the hospital and had more meetings in the last year than I think he ever thought possible. It’s funny but Brett is more of a do-er and less of a talk-er but he knew that he had to get people to see the vision as clearly as it lived in our heads. He met with grants people, finance people, security people, mechanics, community partners, HR, PR, IT, development, department chairs, managers…he learned about departments that we never knew even existed. And amazing people who were willing to help in any way that they could to give this idea legs.  Their eyes were opened and all of a sudden, they couldn’t imagine why we hadn’t thought of this sooner. He did lunch meetings, breakfast meetings, stand in the hall and chat meetings. The goal was to create an idea so big that once your ready to ‘go live’, it would be nearly impossible to stop. Their eyes were opened and all of a sudden, they couldn’t imagine why we hadn’t thought of this sooner.

Everyone has a different dream and I feel like very few get to wake up and do what is living in their heart all day. There is a pure joy that escapes unabashedly out of a person when they are doing what they love. Today is that day for Brett.  Dream big or don’t dream at all.

” It ain’t about the money you make, when a record gets sold, It’s about doin’ it for nothin’, ’cause it lives in your soul.”  – Eric Church

The weather has always baffeled me. In a strange way, weather has a way of forcing you into the next phase of the year, ready or not. Saturday had temps in the 90s with humidity so high that it made my normally very straight hair resemble the before shot of an antifrizz hair product commercial. Heavy rains came Saturday night and just like that, Fall arrived. Football, crisp morning air, windows open.  

Last Fall, Brett and I attended our first Street Medicine Symposium in Boston. The Boston Healthcare for the Homeless Program has been the program that all others compare themselves to. It is a huge, well established program that has the most comprehensive programs, resources and street teams. The tentacles of this program seem to reach into all the parks, shelters, hospitals etc. To say we learned a lot would be a stupid understatement.  I recall having a conversation with Dr. Jim O’Connell, president and founding physician of the Boston program.  We were talking about funding (of course) and I said I was amazed at the multi million dollar budget of his program.  He inquired as to the budget of the DeSales Free Clinic and the scope of services. After I told him our annual operating budget was $15,000 he response was ” jeez, we must be doing something wrong if we need so much money”. We then talked about how we operate on limited funds. This is the attitude in Street Medicine – no matter how big or small your program is, fledgling or benchmark status, we can all learn from each other.

A unique feature of these conferences is participating in street rounds with the hosting institution. We really got to see how the pros get it done. I was rounding with a case manager who was looking for one patient in particular- John. She had not been able to find him for the last two weeks and was worried about him. We checked all the usual places that he hung out. We met his street friends who had much to tell us – except for where John was. And so our search continued.

It was about 6pm and downtown Boston was bustling with people leaving work. The streets and the crosswalks were very crowded, horns blaring, quick feet. At a particularly busy intersection, we began to cross just as we see a large dip form in the sea of humanity. As we approached, we saw that our lost patient- John- was right at our feet.  Wheelchair bound, he had lost his balance and tipped right out of his wheelchair and onto the ground. I was impresssed at the number of busy Bostonians who stopped to help him and make sure traffic would not hit him when the light changed to green. We scooped John back into his chair and moved him to the sidewalk. 

John was a rather imposing figure, both in size and in scowl. When you close your eyes and picture a chronically homeless man on a wheelchair, you are likely picturing John. Standing, he was most likely over 6 feet tall. He was wearing many layers of well worn and tattered clothing. He had on an old navy blue winter hat that was a little lopsided so only one eyebrow was showing. He was missing most of his teeth and had a rosy hue to his deeply wrinkled skin. He was not particularly friendly toward me and answered the case managers questions in a short and gruff tone. Yes he had been drinking. No, he didn’t need anything. No, he wasn’t hurt. Then she asked if he was hungry- and for a second, the fiercly guarded wall came down. He was hungry, and thirsty too.  He hadn’t eaten in several days. 

While the case manager went into a Panera Bread, I had a chance to talk to John (or attempt). I started by trying to figure out if he needed anything else since it seemed the peace offering of food had opened the door just a smidge. He told me part of the reason he had a hard time eating despite the available soup kitchens and food vans was that he had a peanut allergy. A severe peanut allergy. Imagine the great lengths moms across America go to in order protect their childreen from inadvertant peanut ingestion. There is even a service through my children’s daycare to find them a playdate with a child whose allergies match your childs ( think match.com but for kids with allergies). Before John, I had never considered what it would be like to have a food allergy on the street. I asked him a few questions about his peanut allergy and then, apparently, crossed the threshold of number of questions allowed.  

I had squatted down to talk to him. Being at the same eyelevel of someone who is wheelchair bound (homeless or not) is extremely important for leveling the playing field. Suddenly, John looked angry. He was nose to nose with me and yelled with a slurred speech, ” Do you reaaaaaaallllllllyyyyy care?” Pause. ” Well, do ya?!” I told him that I really did care. He looked away and muttered, “Well, I don’t know why.” 

There was they key to this whole interaction. Imagine wanting to be helped but feeling inside that you are so worthless that no one in their right mind should want to help you. Therefore, you prophylactically refuse the help because somewhere inside of you, you believe that you are protecting yourself from the inevitable. The dissapointment you will feel when the person decides you aren’t worth it and that they don’t care. Self preservation is a vital survival tool when living on the streets.

We walked with John to a location across town that he liked to hang out ( we had actually been there earlier that day looking for him). He was greeted warmly by his street brothers. A fleeting smile crossed his eyes (but not his lips). As we walked away, I turned back to see John breaking his sandwhich into four pieces – one for him and one for each of his street friends while they passed the bottle of newly purchased lemonade around. A reminder that the parable of the fishes and the loaves is lived every day on the street. 

 

 

Yesterday afternoon, a few of my co-workers and I were walking to a picnic held on the DeSales University campus. We were admiring the beautiful weather and the beautiful surroundings. Despite my love for the urban and rural homeless population, I have to admit it is a quiet retreat to spend time on this beautiful campus of rolling hills and beautiful fields.We noted a tree that was already changing it’s leaves. This launched a whole discussion about how everything is in a hurry- A.C. Moore already has Christmas decorations for sale and emails are jamming my inbox with taglines reminding me how many Fridays are left until Christmas. I, for one, have never really enjoyed winter. If the weather could stop at late October and blend right into April, I would be happy. The prediction for our area this year is another unbearably cold winter with higher than average snowfall. Putting my own last winter-related, generator-finding-polar-vortex-enduring PTSD aside, I think to the other work in my life.

It was a Sunday at the end of February 2014.   Brett’s cell phone rang and it was Jackie, a parish nurse who works with Brett at the Soup Kitchen Clinic. She was calling because she had a patient with her who was desperate to find someone named Corinne who normally takes care of him. She wanted to know if Brett knew who this Corinne person was. Much to her surprise, he passed the phone to his right and she got her answer. It seemed that Kevin* had been asked to leave the homeless shelter he was previously staying in. He had violated one of their rules and as Kevin said, “That was that.” He was out of medications but more importantly, he was out of shelter . The only other place to find shelter was over full and Kevin had been denied entrance the prior two nights. The temperatures were drastically low and he was scared and cold. He had only been able to take the belongings that he had near his bed. All of his items in storage, he told me, were discarded. Imagine the attachment you would have to your belongings if you could count all of them on your own two hands. More concerning, Kevin suffered from incontinence. Not having a reliable place to use the restroom and clean clothes to change into worsened the situation.

Kevin has been my patient for the last two years. He comes to the Clinic religiously every Tuesday for a blood pressure check. The blood pressure check almost always reveals more information about his week, his life and his other medication conditions. Despite his chronic incontinence, he always smelled like cologne. Kevin was compliant, he was never late for an appointment I had set up for him and he never ran out of his medications. He is talkative, polite and wonderful with the students. He had often told me he liked helping the students get their education. The students felt responsible for Kevin, but Kevin also felt responsible for the students.

Kevin and I agreed to meet on Tuesday. I went to my PA students and explained Kevin’s situation. Most of the students knew him from the Free Clinic and were deeply saddened to think of him sleeping on the street. I could see it in their faces- homelessness just got real.

Being that Kevin is a very tall man, finding clothes for him would be difficult. But the students rallied and came up with clothes, toiletries, snacks and other things they thought he would need. I arrived to meet him a few minutes early. In a strange change in weather, the polar vortex had given way to an unseasonably warm that day with a high of 62. I had not even worn a coat as I walked from my car to the building and I passed a few overzealous locals in shorts and tank tops. A few minutes later, I looked out the double glass doors to see a man dressed like the Abominable Snowman. He was struggling with the heavy doors and as I walked closed to help him, I realized it was Kevin.

Everything he owned was literally layered on his body or crammed into a messenger bag that was ripped down one side. Over the course of 10 minutes, he removed from his body 4 winter hats/hoods, two pairs of gloves (both ripped), a puffy winter coat, a leather jacket, a windbreaker, two sweatshirts, a button up collared dress shirt and a long sleeved t-shirt. He had on three pairs of pants, all of which were soaked with urine. What bothered me more than his layers, was his facial expression. Minimal eye contact, soft voice. No smile, no light hearted upbeat Kevin. The Kevin was lost, buried in the pile of clothes sitting beside him. A sadness filled his eyes. He told me he was so embarrassed for me to see him this way, embarrassed to walk the streets literally wearing everything he owned. He didn’t know what to do, where to go. He was desperate. Then his phone rang and it was his mother. She wanted to talk to me. I could hear it in her voice. She begged. She pleaded. “Find him somewhere to sleep tonight! Please! Why isn’t there anywhere else for him to go? Where are all the other people who are homeless?” Her questions were valid. Her frantic tone of voice was justified. Her disbelief that we have nowhere to put our homeless at night. I apologized, I justified, I rationalized, I validated. But in the end, I had no answers.

Then it was my turn to beg and plead. Could he come home to her? Were there resources for homeless in her town? Could she think of a family member, a friend, anyone who would take him in? All the answers were no. And while she wouldn’t elaborate as to why, I could sense that her answer was non-negotiable. There was no answer for Kevin that night. He had nowhere to stay and nowhere to go. It was gut wrenching. As a health care provider, I felt horrible. As a mom, I cannot imagine laying in my bed at night wondering if my son was sleeping outside in the cold. As a friend, I felt helpless. I could work no miracles that night. He slept outside behind a YMCA and waited for another day.

Eventually, we were able to convince the shelter that had asked him to leave to reconsider their decision. Kevin was permitted to return to the shelter and has been diligently working on filling out government paperwork, attending doctor’s appointments and applying for housing. Last week, he proudly reported that he had work with a local resource to update his resume and had interviewed for three jobs. Progress was being made and I am so proud of his recovery trajectory. As summer fades to fall, I know that Old Man Winter is waiting just around the corner. He lurks and just when you have almost forgotten the bone chilling cold that makes you want to pack up and move South for good, he snaps you back into His frosty world reminding me that “Walking In A Winter Wonderland” could have only been written by a person who was housed.

 

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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