Posts Tagged ‘Free healthcare’

I was an accountant, I am an RN, I was a doctor, I am a CNA, I was a car sales rep, I am a factory line worker, I was a security officer, I am a cook, I was a teacher, I am a cashier, I was an apartment complex manager, I am a waiter, I was a taxi driver, I was a LPN, I was a legal partner…

This is who “they” are. This is who makes us our homeless population. They are not so different from you and I. Most the them held “respectable” full time jobs. Many hold degrees.

Many of us are living our lives paycheck to paycheck. I am one of them. Many of us are forced to “rob Peter to pay Paul”. In the blink of an eye, any of us could end up in a car accident that leaves us disabled, out of work and stuck with medical debt. An unexpected divorce or death of the family breadwinner. Many of us are more susceptible than others to addiction causing us to falter in our game plans. Or on the other hand, our loves ones become addicted and we lose everything we have trying to “save” them.

These are our friends, family members, neighbors, and co-workers. They were the valedictorians of our classes, the star athletes and the leads of our school plays. In fact, a number of you on my Facebook have been, almost were are currently are homeless. I want those of you reading this to think about THAT…we share many mutual friends.

Remember this as you are driving and walking past them. They are humans too. They deserve respect, love and recognition. Hold your judgement. Share a handshake and smile. Be polite. Take a stand and lend a helping hand.

~ Laura LaCroix, RN, LVHN Street Medicine

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One of the phrases that will send most healthcare for the homeless providers into a hair-on-fire-tizzy is when a justification for allowing the continuation of homelessness in our cities is based on the concept that the homeless just don’t want the help. I can understand how this line of thinking evolves.  It has been said that the United States is the richest country in the world with the most resources to help its citizens. How, then, can we explain that people are still refractory to this wealth of money and resources. The rationalization, for both society and the individual, becomes to accept that some people just don’t want the help.  It is easier for us to go about our morning commute, our jog through town or our walk into work if we work it out this way in our minds.

A few months ago, I read a book by St. Francis DeSales entitled Finding God’s Will for You. St. Francis DeSales was known for his belief that ordinary people could live holy lives in their communities and did not need to be cloistered (as in a nun) or in a monastery, cut off from the rest of the world and it’s many challenges and temptations in order to live holy lives. In this book, he talks about God’s will being the sun and ourselves or our willingness to accept his will for us as a mirror.  At times, the mirror is small and only reflects a small amount of light.  It does not mean that the sun is small but rather it is our mirror that is small.  As we grow in acceptance of God’s will, our mirror grows and is able to accept and reflect more of the sun’s light until we are fully aligned with and accepting of God’s will.  I think of our friends on the street and their willingness to accept help in the same way. When we first meet them, the mirror is small. It may even be impossible to appreciate, made small by pain, suffering, hopelessness and rejection. Feeling unloved and incapable of being loved or loving another. Many times, I have been startled at the depth of shame carried around by our fellow brothers and sisters. But over time, the mirror grows as trust is built so that one day, a full reflection is possible. An acceptance of help, hope and possibility comes into view and value is restored.

We are often impatient with this process, wanting results and success to satisfy our own needs and desires for affirmation. Building a relationship can literally take years. I once watched a brilliant lecture by a colleague from Southampton, England who called it the One-Less-F***-Off. He described a patient who, upon eye contact would yell the magical phrase that sends most people away. No matter what he said, “F*** off” was the response.  Over years, the number for f*** off’s received diminished so that once, when our colleague didn’t visit him but rather visited a nearby street friend, the patient proclaimed “Hey, where the f*** have you been”. Success defined by the most peculiar matrix. But success none-the-less.

At the June 2017 National Health Care for the Homeless Council Conference, Jim O’Connell of the Boston Healthcare for the Homeless Program responded to an audience question with a reminder that we cannot erase the trauma that has happened to our patients prior to meeting them. The growth of the person is not about us, the provider, but rather about the return of this precious individual to their rightful value as they gaze upon and accept their own reflection.

~C

Street Medicine has rapidly spread to become a global movement with over 100 programs worldwide on 6 continents. As the Street Medicine Institute prepares for the 13th Annual Street Medicine Symposium this October in Allentown, PA, it’s right to explore why this movement has taken hold and how this innovative healthcare delivery plan has inspired hundreds of overworked medical providers to put on a backpack and work more long hours for free outside the traditional medical establishment. Although the explanation I put forth is in no way comprehensive, may it serve as an offering to explain the “core” of what those associated with the movement are experiencing by going to the people.
One of the first lessons taught to medical providers in their education is not to get emotionally involved in “cases.” This means not getting too close to patients—no crying, no hugs– and not experiencing what they’re experiencing. It’s become a matter of professionalism, that’s it actually UNPROFESSIONAL to care. When people come to us in the midst of some suffering, they are reduced to becoming a “case” so that we may avoid letting emotion crowd our better medical judgement. Inevitably, we come in contact with suffering and are faced with a choice. Humans without a pathological medical condition can’t meet the face of suffering and feel nothing so the choice is to either engage and take on suffering along with the patient, or disengage as a self-protective mechanism leaving the patient to suffer alone. Since the inception of our training we are taught to be professional and this means not becoming emotionally involved, the tendency is to disengage and leave the patient suffering alone.
There is no point in engaging a suffering patient unless you are suffering with them for a reason, suffering with joy. This can’t be accomplished with the goal of social justice or to fulfill a business plan. Justice depends on giving everyone his or her rightful due. This practiced in excess, especially in certain patients, can have disastrous consequences. In order to practice street medicine correctly, we must rise above justice to give everyone MORE than he is rightfully due. This is done through charity, or love.
Approaching street medicine through the lens of charity is essential because patients experiencing homelessness suffer a lot. This suffering is not just from material poverty which we can cure for a moment by offering food. They also suffer from emotional and spiritual poverty from being discarded by society; of feeling unwanted and unloved. If we are going out to cure, which as medical providers we must, then we also must engage with them in their suffering. This means not just giving medicine to relieve bodily suffering, but to cure means relieving the spiritual and emotional suffering they also carry. To accomplish this, street medicine must be approached through charity and love, not justice.
How or why has this approach to patients experiencing homelessness caught on as a global movement? Street Medicine has caught on because it’s been spread through the joy of suffering and giving through charity. This has turned the light on in traditional healthcare institutions and practitioners. When you turn a light on in a room it doesn’t just shine on the ones you love best, not just our patients, but shines on all in the room, like our colleagues and friends in the community.
Street medicine, at its core, is the light that it gives us permission to share the sufferings of our patients with joy, through charity, with the purpose of healing spiritual, emotional and bodily suffering.

~ Brett Feldman

Last week, I was sitting in a leadership training about effective communication. The instructor started off with an explanation of the ladder of inference. This ladder represents stages of thinking that one goes through, often subconsciously, to determine action or inaction after observing a behavior. When we observe something, we often reflect back on the scenario to make sense of it and in doing so, may not remember all of the details (or even have all of the details). Our minds will fill in the blanks, or infer, what is missing to complete the observation so that it makes sense to us.  We determine action or inaction based on this conclusion. The example given to us was an observation of a quiet exchange between two people which concluded with one person abruptly leaving the conversation and exiting the building. We, of course, came up with a variety of colorful, and sometimes even logical, explainations for what we saw and action that should take place as a result. Sometimes this process leads to workplace drama, other times the inference ladder could be applied to whole populations resulting in dehumanizing sterotypes.

As Brett and I were talking with an old friend this week, we realized that the inference ladder had injected it’s influence on our life in a way that we did not realize until now.  I have written before about the influence of an experience Brett and I had during my PA school education at Midwestern University in which both of us spent time at Hesed House in Aurora, Il providing healthcare for the homeless. It was a meaningful experience that lead to the desire to start the DeSales Free Clinic, and eventually, LVHN Street Medicine. In our minds, Hesed House was providing comprehensive care with tons of hours of accessibility from students and volunteers. When we set out a decade ago to open the DeSales Free Clinic, we modeled it after our recollection of Hesed House. In reality, our blueprint for the vision of the DeSales Free Clinic was not Hesed House at all, but rather, the inference ladder at it’s best. A fill-in-the-blank Mad-Libs version of what we had experienced paired with what we thought was needed for the patients. Turns out inference might not always lead to poor communication or office gossip, but maybe every once in a while, a service to a population who is often dismissed as a result of the same thought process. Tricky tricky little ladder, I’m keeping my eye on you!

In September 2016, Brett and I traveled to Rome for the canonization of Mother Teresa into sainthood. In an effort to save money, we booked a local flat through AirBNB and lodged just two blocks from the Vatican. On our way back one evening, we crossed St. Peter’s square and, after passing two armed guards stationed at a government building, made a turn onto a side street close to home. The area near the Vatican has become a safe space for the homeless to sleep at night without harassment from the police. The local homeless service providers who generously shared their time, experiences and solutions with us tell us that this is a result of Pope Francis declaring that these souls should be left alone and allowed to rest without disruption. And so, to some local surprise, the local police have backed off and allow for some peace and quiet. As such, it was no surprise to see a doorway inhabited by an elaborate cardboard-bag-bottle structure skillfully designed to block light, noise and provide an astonishing amount of concealment for the person who was likely residing somewhere inside the materials. What caught our eye, however, was an inscription scrawled on the marble slab to the left of this construction – LOVE NEVER DIES. We stopped and took a picture of this remarkable image wondering who wrote the message and if the inhabitant of this doorway agreed or disagreed with the statement. We continued onto our flat and retired for the evening. Each night, we saw the same cardboard-bag-bottle construction with the same refreshed inscription, and each night we wondered.

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Three days later, we were walking back from the canonization mass. Anxious to rehydrate (it was about 92 degrees fahrenheit), use a bathroom (400am -2pm is quite a long time!) and to escape humanity for a minute (a sea of 500,000 humans is enough to make anyone need a quiet (padded) room), we nearly missed him. Our doorway dweller was awake, sitting up below the inscription and working on an elaborate drawing. Bathrooms, water and silence would have to wait. We made our way through the crowd and introduced ourselves. George, a man in his 60’s, had primarily inhabited this doorway for the last 6 years. A fisherman from Sweden, he had somehow been land ridden for some ambiguous reason. His drawings were remarkable. He had two completed charcoal drawings and was half finished with another one. All of the completed pictures contained a series of objects that were rearranged or drawn from a different angle. We explained street medicine to George and he engaged us in an interesting conversation about his experiences, affirmed that he had a doctor (however we discovered an access problem- his doctor was in Sweden), and how the heat of this summer had been particularly difficult for him. But it was his explanation of his drawings that moved me the most. The wooden truck was his favorite toy as a little boy, the canoe was his first fishing boat. A child sized fishing rod and small scaling knife were important pieces of his happy place. A pot for smoking fish lead me into a detailed conversation about how to properly prepare and cook fresh fish (fascinating for me considering I generally avoid eating things that originate from under the water). He said he draws to keep himself out of trouble. But I saw something much different. His drawings simply represented the happiest time of his life. A time when he was a young boy, falling in love with fishing and providing for himself. Before he spent 45 years at sea, had broken relationships with his family and had ended up, well, here. We purchased one of George’s drawings which hangs in a place of honor for him in our home. While he never explained why he writes his message next to his doorway everyday,  he really didn’t need to. He retains a sense of hope that one day the tides will shift and he will find his way home again, perhaps to the place in the picture.
He agreed to take a picture with us (which you can see below) and thanked us for keeping him company. As we walked away, George asked us to promise not to forget him. Promise made. Promise kept.

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Four years ago, we attended our first International Street Medicine Symposium in Boston (MA). I was wide eyed, excited and in hindsight- mostly clueless about the real world of street medicine. Street medicine in the Lehigh Valley did not exist yet, I had never been on street rounds and had only read about such legends in this area of medincine such as Dr. Jim Withers and Dr. Jim O’Connell. I met like minded people and heard tales of incredible collaboration between civil services, shelters, providers and consumers. I saw demonstrations of how humility combined with leadership can change an entire city and its citizens. And I do mean all of them – the housed and unhoused, the voting and non-voting, the overachieving students and the retired sunset-riders who directly or indirectly reaped the benefit of the Boston Healthcare for the Homeless Program (BHCHP). In the subsequent years, we travelled to Dublin, Ireland then San Jose, California and most recently- Geneva, Switzerland. Each conference provided new insights, new data, new frameworks, new friendships. As Dr. Pat Perri, chair of the Street Medicine Institute said at the most recent conference in Geneva- it is like meeting aliens from the same planet.

As I sit on my flight returning from Geneva, I am struck by the lecture I had the privilege of hearing yesterday by Nick Maguire (Southampton, UK). He is a psychologist with a brilliant mind and a wicked English sense of humor who has a way of making sense of the behavior chaos that we observe on a regular basis on the streets and in the shelters. His points were so profound to me that I have hardly been able to think of much else. But as he started his lecture, he told us how much this conference means to him. As he says, it is a bucket filler when the world is so often full of bucket emptiers. We come to this conference and are renewed with our sense of purpose and inspired by the brilliant minds from all across the globe that have so committed themselves to such a worthy cause. People who have left lucrative positions in pursuit of a meaningful contribution. People who risk arrest by providing medical care on the street. People who accept that possibility that everyone you know professionally and personally might think that you are crazy for doing this type of work.
As Nick was speaking, I glanced over my right shoulder and saw Jim Withers sitting toward the back of the room as he so often does and thought about how it feels to know that your vision is being shared and LIVED by so many people. Inspiration can be a fickle thing- there one day, and then gone the next. Sometimes people act on their inspiration but, action can also be fleeting. It is inspiration that makes us come back from church camp when we were kids and throw away all of our excess toys, cd’s (back when we used such antiquated objects to listen to music) and other items we deemed unnecessary once we realized that living a simpler life for a week wasn’t so bad after all. But three months later, there we are in our rooms with piles of newly accumulated junk that we forgot we had decided we could live without. Fleeting. But to inspire and then foster inspiration that changes the trajectory of how people LIVE is something quite different. And for me, the International Street Medicine Symposium is like inspiration on Arnold Schwartzeneger dosed steroids.

Thanks Street Medicine Institute. Bucket filled. Lid applied. Pressing on.

A few weeks ago, Lehigh Valley Health Network and the Street Medicine Program hosted two events with Dr. Jim Withers, a pioneer of street medicine in the United States, to raise awareness about homelessness to different groups in the Lehigh Valley. The first night was a small gathering of donors at a local country club with Dr. Withers as the featured panelist along with Brett and Dr. Motley, chair of the Community Health Department at Lehigh Valley Hospital.  It was a fascinating discussion about how street medicine in many cities has uncovered an ugly truth; that healthcare itself is very, very sick.  Often times the Street Medicine provider straddles two worlds. A world of middle class America and a world of extreme poverty and isolation. In terms of Maslow’s hierarchy of needs, we expect all patients to be functioning at the top of the pyramid in a place that Maslow defined as self-actualization. That is the place where people are achieving or are on their way to achieving their highest potential.  Because this is the basic assumption for all of those interacting with the healthcare system, it is no wonder that conscious or unconscious bias seeps in to our everyday patient interactions.  The traditional healthcare systems gets frustrated with those patients who just don’t or can’t follow through. We label them as non-compliant and design policies that allow us to dismiss patients from our practices after two no call no shows or after being late for an appointment a few too many times. Because after all, our clinical time is important and if we allow ‘them’ to be late then we are just enabling them.

Image result for maslow's hierarchy of needs

The homeless population and their interaction with the healthcare system is an example that can be applied to many other vulnerable populations who are expected to be functioning at the tip of Maslow’s pyramid. Domestic violence, gender dysphoria, substance abuse, financial instability and recent prison release are all examples of people are struggling to have their basic needs met. It was interesting to see and talk with the attendees at the conclusion of the panel discussion. Many of them have lived in this area their entire lives and never fully understood how and why this type of human condition was lurking in their own backyards. Perhaps the best part of the evening came from the country club bartender who spoke with me, Brett and Dr. Withers after the room had mostly cleared.  He shook our hands and told us that in his job, he listens to a lot of very boring presentations (and I believe him) but he was so grateful to have listened to this panel discussion.  He felt he had learned so much and went on to tell us about the homeless people he had known in his life and how he thought they may have ended up that way. Of all the people in the room, it seemed that perhaps the unsuspecting bartender had been one of the main benefactors of the event.

The following day, Dr. Withers gave grand rounds at the Hospital. Over 200 people RSVP’d to the event and the crowd was primarily full of short and long white coats.  At the conclusion of Dr. Withers discussion, a panel of currently or formerly homeless Lehigh Valley residents shared their stories of living on the streets, surviving on the streets and in our institutions and candidly shared how things could have been better.  One panelist has been unsheltered for over 9 years and shared that the Street Medicine team are the only people he knows that are not homeless.  This spoke to me particularly as I was reminded of the isolating nature of homelessness and the sense that the world can become ‘us’ and ‘they’ with seemingly very few bridges between. As I sat and listened, I noticed how absolutely silent it was in the room.  There was not a single pager ringing, phone buzzing or hushed side-conversation. Several hundred people who usually conversate all day were hanging on every single word these brave men and women shared.  I thought about how intimidating the room must have looked from the panelist table and that for years, the patients felt like no one listened to them. And yet, here we were, begging in earnest for them to tell us their stories. The power of this paradox is in its irony. Healthcare providers have an opportunity every day to listen to our patients stories. Not just the story of their symptoms. But THEIR story. We feel pressured to rush, to ‘work lean’, to make in through but in the end, that isn’t what anyone wants. Each time I see a room full of such talent hear the message of street medicine and the stories of its patient’s, I can’t help but feel the pull of a tide. That perhaps we are closer than we think to a return to the roots of good medicine and real connections with all of our patients.

Portland, Oregon is a fascinating city situated on the eastern bank of the Willamette River under the watchful eye of Mount Hood.  As with any city that enjoys a river running through it, the bridges that accompany the river become part of the recognizable landscape that defines its character.  Every thursday night, an army of 150 volunteers turn the space under the Burnside Bridge into a hub of activity and services for Portland’s homeless.  I first learned about NightStrike more than 6 months ago as I was interviewing a prospective PA student who was at DeSales for an interview into our 2016 incoming class.  In high school, she had spent time volunteering under the Burnside Bridge with NightStrike and had sited it as a transformational experience that allowed her to see her own city in a different and profound way.  Brett and I were accepted as speakers at the 2016 National Health Care for the Homeless Conference and Policy Symposium in Portland, Oregon and I decided that NightStrike was something I needed to see for myself.

NightStrike is a program run by Bridgetown Inc and was founded by Executive Director Marshall Snider and his wife Lesley Snider (Program Director) 13 years ago. The organization has 5 employees (including Marshall and Lesley) and in addition to NIghtStrike, have developed several programs targeting the marginalized adults and children in the Portland area. NightStrike alone mobilized over 9600 volunteers serving over 20,000 people experiencing homelessness each year. We arrived at a rented church space near the Burnside Bridge around 630pm and immediately upon entering the orientation space, Marshall and Emily (Development Director) welcomed us to the Program. Orienting over 100 volunteers each Thursday is no small task.  I was impressed by the clear and concise message delivered by Marshall to all the volunteers. The purpose of NightStrike is “Because People Matter” and the common denominator that all humans need and desereve love. He pointed out that the volunteer needs the giving experience just as much as the person needs the blanket and encouraged each volunteer to learn the names and stories of the guests being served. To take on an “Oh there you are!”attitude instead of a “Look here I am” attitude. As an organizer of many volunteers, I particularly appreciated this piece because the message of your organization can be inadvertently misrepresented by the volunteers that are so eager to serve. Another staff member performed the reading of the rules (no photography, let religion come up naturally(if at all), show respect) and safety protocols (walk away from anything that makes you feel uncomfortable, three whistle blows means evacuate calmly and immediately etc).  We then broke into smaller orientation groups for our respective jobs. I was assigned to be a hostess while Brett, Laura, Seth and two friends from Ft. Worth were assigned to the clothing cart. After getting the run down, we all walked down to the bridge where, on average, 350 guests await. The path to the bridge cuts through a green spaces with bubble fountains along the river before arriving at the concrete slabs where we would set up shop.  Rows of Home Deopt style 6 ft tables were set up with folding chairs were already occupied by weary men and women. A mobile dental clinic and a separate mobile medical van created part of the perimeter of our space. The Willamette River and four  occupied barber chairs rounded out the perimeter. A food table with hot chili, drinks and coffee was the first stop for most guests. Other services available that night was a clothing table, library table (with new and used books for exchange), pet food table, a sewing table with two sewing machines to repair clothing, sleeping bags, tents and tarps. I even saw one woman repairing a hot dog costume for a dachshund pup that accompanied his owner everywhere.  There was a bike repair stand with everything from air pumps to tire tubes and chains.  5 volunteers carefully washed the feet of travelers while two more gave manicures to the women. A resource table and veterans table provided critical support for people trying to find their way.

My job was to chit chat with guests. I was strangely appreciative of the fact that I was not the health care provider for the night. I walked around with a thermos full of coffee and poured fresh cups for those waiting in line. I struck up a conversation with a larger than life character named George. A 6’3 black man with a large white beard and a fisherman’s hat. He had fashioned a handmade wooden cart to the back of his bicycle that was packed with elaborate handmade birdhouses.  He told me many tales that evening and emphisized the important points by leaning in, raising his eyebrows and pausing dramatically before letting out the most infectious laugh. During our conversation, many ofther guests stopped by to check out the birdhouses. While George didn’t speak to them, it was clear that he took pride in their interest.

Not all guests were like George. As one would imagine, the homeless are as diverse as we are. Some clean, some not. Some with clear responses to hallcuinations, some not. Some sat quietly, some didn’t. Some preached, some didn’t. But one woman struck me. At first glance, she looked slightly out of place with a fairly new looking hot pink fleece jacket, hair styled, and make up applied. I struck up a converstaion with her and on closer look noticed the all to familiar desperate sadeness in her eyes that comes with not really knowing how you ended up here. She did not reveal any of her story to me other than to say that you do what you have to do to survive.  With that, I poured her a cup of coffee and talked to her about the different resources in the city.

Poverty and how a city assists those who are trying to crawl out from a dark place is a fascinating, and often untold tale, of that which makes up the character of a city. Organizations like NightStrike quietly do the necessary not only to empower the guests, but to remind the volunteers that caring about the homeless population is not futile. In fact, a powerful thing happens when people are guided into being part of the solution.  Well done NightStrike. Well done.

Laura, how come you never asked me about Islam?”

I smiled at him. I said because your religion isn’t a factor for me, no one’s deserves to be homeless, especially homeless and blind.

He says to me, “I have been thinking to myself, why is this white Christian woman helping a Muslim black man” he laughs. He then lowers his head and says, “when I came to America, America was asleep. It was a beautiful country, then 9/11 happened and it became so hard for me. ” We sat in silence for less than a minute he turns to me, “Thank you, you are a great communicator and I don’t know how I would ever get here myself. God bless you. ”

Our journey together is not going to be an easy one, we are making small steps every week. Until you have become homeless or ever tried to assist the homeless you will never truly appreciate simple things such as making an appointment with a specialist, getting a pair of glasses, getting unemployment, applying for an apartment….for these people it takes months to obtain any of this. The average individual simply makes a phone call…applies online…gets the information mailed to their house…where does a homeless individual get their mail? What phone number will be called? Who has an email address?

As a nurse I don’t think I have ever felt like such a patient advocate as I do right now in my current career

The vastness of need can seem endless.  When Brett and I started the DeSales Free Clinic, we had some experience under our collective belts to try to guide the creation of something that would be both meaningful and sustainable.  As it grew, so did our awareness about the larger problems facing the homeless population. Things like personal safety, humiliation, lack of affordable housing and lack of institutional loyalty.  It became easier to figure out reasonable treatment plans that actually had a chance of working because the context of their lives were so much clearer.

At some point, we started to become aware of the needs of other vulnerable and disenfranchised populations that were all around us. Human trafficking victims.  Domestic violence. Veterans. We learned that recently released inmates are 12.7x more likely to die within two weeks of release from prison than someone else living in their same state (Binswanger, NEJM,2007).  I still sometimes feel like a young PA student at Midwestern University all over again learning about the people that we share our world with but know very little about.  It is like standing in a dark room with the door closed. Then, someone turns on the hallway light and you see a small bit of light spread over onto your side of the carpet. Who turned on the light and who is on the other side of the door? Do you crack the door open and peak quickly? Do you fling the door open and boldly shout “Who goes there?”. Or do you retreat from the door and figure whoever turned on the light, didn’t really mean for you to see it anyway.  I think of the door as status quo.  It is always there and it is always accepted both socially and professionally. These populations often give us opportunities to engage them. They flick on the light in the hallway to see what happens to the door.  But all to often, we choose to retreat from the door and maintain the status quo.  The door never opens. Soon enough, the light turns back off and all goes back to the way it was.  But sometimes, someone flings the door wide open and invites the light in. Sometimes the door is opened by a patient. And sometimes the door is opened by a provider.  As it turns out, the light, in fact, is hope. And hope is just about the most powerful thing two people can share. A patient of Brett’s commented that he let the light in for her for the first time. Perhaps it was hope for her but little did she know that her willingness to let the light in  provides an understand that allows the light to be shared with others and the status quo to be challenged.