Monday nights are my scheduled “outreach” day. I work 2pm to 10pm, starting in the office getting things ready for the evening, helping with research on a newest project or going on High Risk Rounds. I will tell more about High Risk Rounds later in this post.
Generally I go out with Dr. Whithers and Mike to outreach on walking rounds, but they had a big crowd of first timers last week, so I had the opportunity to help on the medical van. Now we call it a van, but in reality its a large Winnebago that has been converted into a medical clinic on wheels. We park outside The Red Door, a place known to homeless and low income individuals as a spot that has various food handouts throughout the week. Miss Nancy, a mission I spoke of at the beginning of this experience, comes to the Red Door Monday nights. Thus, we meet the people where they are at. Monday Nights, they are at the Red Door, waiting for us or waiting for Miss Nancy. The van is staffed by an outreach worker, a volunteer nurse who does intakes and Dr. Kelly, a volunteer MD who examines the clients and provides preventative and basic medical care. I helped Dr. Kelly listen to heart rhythms, lung sounds and interview the clients. I was surprised at the constant flow of people coming in with needs ranging from needing their toenails clipped to colds to unrelenting nausea. In between clients, Dr. Kelly and I would share what it was like to go to Benedictine schooling as we both had and he told stories of his experience in Vietnam and his training in medicine. I am always moved by the clients we see, but it is just as rewarding to get to know people who care about the same things you do, who strive for social justice and option for the poor.
When a client comes into the van, they first meet the intake nurse who does a basic interview of their demographics, comorbidities and complaints. She then reports off to us in the master bedroom-turned-examination room and we take the client in to sit with us. After introductions, I ask what brings them into the van, the duration and extent of the chief complaint and anything in their lifestyle/environment that might be worsening the condition. Factors like sleeping outside (vast majority of our clients do so), smoking, substance use and poor ventilation/mold buildup in tents can worsen many conditions, especially respiratory symptoms. Most of the people we saw had cold symptoms, not surprising for this time of year and the fluctuating weather conditions here. It is interesting to see who comes to the van, who seeks care and who we have to go find.
The people we have to seek in outreach are obviously harder to engage, less trusting of services and sometimes in deeper throws of addiction. The clients on the van range from young twenties to elderly, all walks of life. We have a gentleman who divorced his wife and ended up homeless. He is employable, without addiction and without mental illness. We met a young woman who has been outside for years, she was kind and softspoken, thrilled to go see a movie with her boyfriend because he got paid that morning. Some may scoff at this, assuming that of course there are better things to spend money on than a movie, but to me it just made sense. Any twenty someodd would look forward to something so normal as going to the movies. Experiences like this connect them to a world to which they barely feel connected. The world of urban homelessness is unlike anything I have ever fathomed. I will never understand it completely, but the counter culture of survival, seeking trust and constant lack of safety is an experience I would wish upon no one. We also see a very fair share of people suffering from mental illness and addiction. These clients are the greatest challenge for obvious reasons, but I cannot help but empathize with them. No one grows up dreaming of becoming an addict, of hearing voices that drive their actions rather than their own consciousness or sleeping under bridges because there is no where left to turn.