As I walk the seven blocks to the hospital each morning, I pass the same faces time and time again: the Vietnam veteran sitting under an awning of subway station asking for money and prayers, the man sleeping on a box across from the hospital, and the double amputee bumming cigarettes while holding all of his belongings in a single black duffle bag. Consistency is a foreign topic when it comes to emergency medicine, and these faces have become the only thing I can expect to see on my way to work. Although this is hard to admit, my interactions with these people involve nothing more than averted eye contact and a quick side-step, followed by my own anger for this instinctive reaction. I have been conditioned by society to ignore and even fear these people. But the moment they step into the hospital, everything changes.
Bellevue Hospital is the oldest public hospital in the United States, steeped in history and medicine. It was the first hospital to treat tuberculosis, open a psych ward, and in recent news, take care of an Ebola patient. With over 100,000 ER visits and 460,000 outpatient visits each year, this hospital sees all sides of New York–the good, the bad, and the ugly. But arguably one of the most impressive things about this hospital are the patients: 80% of the patients in Bellevue are from medically underserved communities, and 25% of the patients are either currently experiencing homelessness or have experienced homelessness in the past twelve months. This hospital treats everyone who walks in their door with the same quality of care from the woman sleeping in a shelter to a visiting diplomat.
Homelessness is truly an invisible epidemic, one that Bellevue works so hard to treat with every IV placed or meal provided. Patients have come to rely on this hospital for primary care, a roof to get out of the rain, or just a familiar face. Bellevue has garnered the reputation around the city as the hospital with all of the crazy people, but what people forget are the hordes of healthcare professionals, social workers, and administrators who are dedicated to providing a level of care no other hospital does. Despite this mission, the emergency department is not immune to societal stigmas and assumptions about the “frequent flyer” experiencing homelessness who comes to the ED (Emergency Department) three times a week for a hot meal. Regardless, these are the patients who I will never forget.
As a volunteer and patient advocate in the Emergency Department, I won’t bore you with the details of the grunt work I perform, but my main role is to speak with patients, listen to their stories, and ensure that they receive the care they deserve. What this means is that I blindly approach patients with a smile and hope that they are not in too much pain to speak with me. I have been used as a punching bag (figuratively), a shoulder to cry on, and a confidant. In fact, as I am writing this blog post, a patient whom I have seen in the ED three times over the past two weeks just walked by the window of the café I am in! But it is these interactions that have changed how I view homelessness.
Remember the Vietnam veteran outside the subway? Well, the moment that he steps into the hospital, he is no longer just a face, he is a story. He is the man I spent three hours with trying to navigate our healthcare system, find the only pharmacy in all of NYC that can fill his prescriptions, and help him obtain a metro card. He is the man who tells me about his travels when he was my age and his first love. He is the man who tells me he would rather be sleeping in a park right now than in this hospital any longer. He is the man who I know I will see again both in and out of the hospital. But in the moment, he is the man to whom I can provide a smile, a conversation, and small moment of clarity in this crazy, complex system.
The intersection between homelessness and emergency medicine is a never-ending cycle that bounces people between the street, the hospital, the shelter and back again. It is well understood that one’s health is dictated by more than just access to healthcare. Ideally, providing someone with stable housing will improve overall quality of life, decrease health costs, and break this cycle. Although this is well understood within the healthcare industry, it is much harder to carry out than providing basic healthcare. Bellevue is working alongside different hospitals and organizations to address this epidemic through housing-first initiatives, which work to find stable housing for patients alongside treating their major health concerns. Working within Bellevue has shown me the impacts of homelessness far beyond the street. I am slowly beginning to understand the system, and hopefully my small contribution to this organization will be just enough to bring joy to one person’s day.