* * Anonymous Doc

Tuesday, July 20, 2010

Dear Homeless Person,

Maybe working in the hospital is teaching me the wrong lessons. Maybe it should be teaching me to be more compassionate and more understanding and more willing to give you change from my pocket.

I used to sometimes give homeless people change. Or at least when I didn't, I felt bad about it, like I should. Like I don't know your story and maybe you really will use it for food, or something worthwhile.

But I don't believe that anymore, and it saddens me. Because all I can think about are the homeless people I see every day in the hospital, who are all in and out with alcohol withdrawal, drug withdrawal-- day after day, week after week, often the same people, days later, weeks later, months later. I know what they're spending their money on. I know where they're ending up time after time.

And maybe they're ruining it for the rest of you. Maybe it's just a few homeless people giving the rest of you a bad name, and you really do want a salad, or a piece of chicken. Maybe I was just naive before, and thought that this is actually what someone could possibly be spending my change on. But I don't even ask myself the question anymore, there's just no way I am reaching into my pocket and giving you any of my change, because it just means I'm going to see you that much quicker in the ICU.

Look, clearly doctors should not be solving the policy problems that lead to homelessness. Clearly, the issue is greater than what someone is doing with my change. By the time someone gets to a point where they're homeless and panhandling, we're probably far too late. And my instincts were probably wrong in the first place-- give money to organizations helping people in legitimate ways instead of to homeless people on the street. But just at a purely gut level, being exposed to the patients I see is absolutely making me a less sympathetic person in these cases. And that's sad, and also sort of unexpected. Shouldn't I see that these are medical problems, beyond someone's control? Shouldn't I be more able-- not less able-- to separate the illness from the individual?

But here's the thing-- I feel like I used to think that would absolutely be the case once I became a doctor-- wouldn't it totally bum me out to realize that we're all stricken by these terrible illnesses without deserving it, without doing anything to cause it, and it's a random crapshoot that anyone makes it through life unscathed. And, yeah, I absolutely see terrible things happen to people who didn't do anything to cause it. Cancers and worse.

But I also see a whole lot of things that people helped bring upon themselves, due to smoking, obesity, etc. I don't think I've seen anyone in three weeks without COPD, brought on by smoking. People complaining about their heart conditions and telling me they've been using cocaine off and on for 25 years. People who get injured riding motorcycles without helmets. Come on. If I've learned one lesson from this job-- don't ever, ever, ever, ever, ever get on a motorcycle. Ever. Ever. Never. I can't have that much sympathy for those patients. I have to save it. I have to save it for the ones who *really* didn't do anything to deserve what they have. I have to save it for the ones who I have no idea what they possibly could have done to prevent whatever they have.

And then I sometimes see these bitter attendings, who have no sympathy left for anyone, and it doesn't take a lot to figure out how they got that way. Which sucks and I don't want to be that way and, ugh, I don't know what the point of this post is. But, argh, I'm tired of sick people.


  1. I can relate. We like to joke about how many of our patients were "minding their own business", or "taking out the trash". We see very few people who really are innocent bystanders, or who don't bear at least some responsibility for the situation they've found themselves in.
    I suppose we all fall back on the basic principles, though. Heal what you can, support who you can. You never know who'll take it as a second chance.

  2. When I lived in Toronto, I heard about the "they don't actually want food, they want to pay for their next hit" thing.

    So whenever someone asked money from me, I would originally refuse. Then they might continue, how they just wanted a cup of coffee to stay warm. So I invited them for a cup of cofee on me - but not the money.

    One homeless took me up on this offer, and we had a very interesting talk, as he gave me his entire life story over this one cup of coffee. It was a quite interesting talk, and it completely changed my view on homeless people.