The Salvation Army is surprisingly difficult to figure out how to get into. It is one of those buildings where the front isn't really the front and you end up hooking around it along little streets until you see the line for dinner. By the time I got there the dinner line was petering out, but there was a little group of people on folding chairs all lined up like they were going to watch a piano recital, sitting quietly, waiting for me and my vaccines to show up.
They had provided us with a nice, sturdy folding table, chairs to sit in, chairs for the patients to sit in-- two vaccination stations and a charting area. Perfect. As soon as we arrived, they hollered "anyone need a 'flu shot?" down the dinner line. A kid showed up out of nowhere to help, maybe about ten years old, with a bag of candy to give to people who got their shots. We arranged ourselves and flew into action. It was surprisingly smooth. I did right arms, my husband did left arms, our med student kept records, and our kid slid candy at the patients-- quite neatly and with great efficiency and purpose... |
I had started tonight with a couple of items on my agenda. (Okay, clearly to vaccinate as many people as I could, but I had other plans, too.) On my first outreach, everyone was talking about dinner at the Salvation Army; it was clearly a major player in the area and a good place to set up an outreach. I wanted to come back here, every week if possible, but hadn't had much luck over the phone. I wanted to be invited back, which means I needed to find someone in charge.
We all saw the Major darting back and forth across the big hall while we worked, a hundred things on his mind that needed to get done tonight at the very latest. Always someone was with him and always a different someone, following, nodding, and breaking off to do whatever it was he just told them to do. We would have to be swift, alert, and brave to catch him.
It was the kid who made it happen, chasing major Ball almost out into the parking lot before presenting us to him in a clump. I'm doctor toms, um, from Loma Linda? Um, street outreach?
So it was about four years ago and I was applying for a job with homeless health care Los Angeles and I had to meet with the guy who runs the place and at some point he just stopped talking about all the programs they had and said, yeah, you're one of us. I just wanted to meet you and see if you were one of us and you are so welcome aboard! And then he started back up again. But the thing is I know what he meant. I don't know how to explain it, but if I show up at your door with 'flu vaccines and your response is to call out "anybody need a 'flu vaccine?" you're one of us. If you run an underserved clinic and can't wait to show me your dental chairs (your food pantry, your closet full of donated odds and ends...) you're one of us. (if you show up to your very first street outreach with a headlamp and your own pen you are clearly one of us). I think that if you love this population you are one of us and that love shows itself in dental chairs and headlamps and a deep-seated need to get out under the bridges.
I don't know what you were expecting from Major Ball of the Salvation Army but, guys, he's one of us. We're invited back tomorrow with our vaccines. We will be announced in the soup lines, which will help turnout tremendously-- and we've got an in to their men's and their women's and children's shelters! (This is a coup, y'all! Our first shelters...)
But it was about 7 and we still had a lot of outreach left in us. So we're walking across the parking lot trying to decide where we will head out to and I realize here is just fine. There's a playground and a group of people hanging around in it so I figure why not just ask.
Hello? Loma Linda street medicine... Anybody want a doctor?
Five people, five people who want a doctor. Well, five who want a dentist and two who need a doctor, too. We split into two teams joined at the hip, getting H&P's side by side. Tonight, everything is trauma. The stories start out with people waking up in the hospital after a fairly substantial blow to the head. You could say that is too much information and that it could be used to identify my patients but that would be sadly wrong-- homeless people get hit on the head kind of a lot. I was at the homeless health care national meeting last year and heard a presentation on severe head injuries among the homeless, listing at least a 40% prevalence of head trauma with detectable cognitive deficits if you test them-- bad enough to get you disability, which is money, which can help pay for housing. But people don't generally come to you talking about their head trauma, usually something else is also going wrong, but we sort of lucked out tonight. There were three bad car accidents between them and a bad assault, also very common in homeless populations. But let's not do the numbers this time. Let's focus on how welcoming and gentle this beautiful young woman was, how she had combed her hair so her ruined eye didn't show-- how she was blind on the street, sent out to the street from the hospital with a phone number for an eye doctor to call that didn't work. You work on the street long enough it no longer surprises you; EMTALA lets the ER stabilize you but does not require anyone to actually fix you. You get used to seeing crooked people with fractures that set themselves at odd angles on the street. But I will never get used to the gentleness, the welcoming. I will never get used to the kindness and forgiveness. I will never get used to the welcoming, to how gracious she was. She smiled in our general direction-- I was a blur to her in her good eye and nothing at all in the bad one. She knew i couldn't make her see. Where she got the patience I'll never know, but she knew I wanted to help her and she very indulgently, innocently, as though none of what had happened to her had ever happened at all, let me try.
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Then we headed out to a nearby park and checked in on some patients, but that story is "to be continued..." |
