Whatever it Takes
Lydia Mayer, MD, MPH, FACOG
Health Care Without Walls (formerly Women of Means) is a volunteer-physician based non-profit that provides free medical care to homeless and poor women and families in seven Boston-area shelters. I have been a volunteer with them since August, 2015.
I didn’t expect “opportunity” would describe my volunteer experience at HCWW through the Massachusetts Medical Society’s Committee on Senior Volunteer Physicians. I volunteered to facilitate Board Maintenance of Certification activities and continue clinical practice of generalist obstetrics and gynecology. Having previously worked with a socio-demographically highly diverse patient panel guided by my motto “do whatever it takes” to get a patient whatever help she needs to improve medically, I hadn’t anticipated work with HCWW would require me to refine doctor-patient skills.
I feel fortunate to volunteer at HCWW because the organization values caring for patients, something often lost in other settings to time pressures and productivity concerns. At HCWW, I treasure clinical moments when patients can speak plainly, telling their stories as they wish. These moments, gifts to me personally, occur because I practice medicine. They also provide information essential for success in what interests me most—guiding others towards health.
Overall, my first task seems to be finding the right balance in the shifting sands that we stand in. What requires more skill than I have needed up until now is the ability to define a reality that includes both the homeless woman’s life and health care services. Getting needed medical services poses many challenges. For example, so far I don’t know of a way one homeless woman, who won’t use her real name at HCWW, can circumvent a picture ID as the first requirement of entry into medical care. But I can solve problems like these as they arise with input from other more experienced colleagues at HCWW.
I also think of one, very smart woman, who unfortunately suffers isolation in her paranoid schizophrenia. As I screen her by asking about symptoms of possible medical contributing factors to one of her diagnoses, she engages. Her eyes light up, she smiles, and she temporarily forgets her paranoia. As I approach diagnosis in an old-fashioned, thoughtful, less routine way, I enjoy taking her history with questions that give me insight into her physiology. Those insights will allow me to respect her safety needs and know what diagnostic steps are essential. Diagnosis in her case cannot proceed entirely according to standard protocols. Sadly, the next few times I see her, she appears to be actively suffering. She is absorbed in her thoughts and isolated again by her mental illness. At that moment, I know she is unable or disinterested in pursuing a further work-up. We talk about the pleasure a donated cupcake affords her that day. Sad as this is to see, perhaps future moments will allow us to continue to explore her path to better physical health.
To complete all the steps necessary for a homeless woman to effectively engage in medical care, I will need to become familiar with the culture of homelessness. I will need to use that knowledge to find points of connection between the culture of homelessness and the culture I know well - the health care system. In short, instead of having a cultural broker present during clinical interactions, I am now learning to take on that role. I find this engaging and worthwhile.
And even without the added skill of cultural brokering, I’ve noticed that several of the homeless women appreciate extensive patient education surrounding their particular diagnoses. It seems to give them self-confidence. They use the practical knowledge I respectfully provide to improve their health on their own, sometimes without needing more from health care services. What I offer at HCWW can make small differences.
Reading this, perhaps you understand the pleasure I’ve already taken in finding small ways to join a homeless woman, so she is not completely alone in life and her medical journey. In this way, I can continue to honor my commitment in medicine to lifelong learning.
