Monday, November 14, 2016


I was a neurology resident, doing a rotation at a large county hospital. Like most county hospitals, it served a predominantly indigent population.

I was in my 2nd year of residency, 3 years out from medical school and in my late 20's.

She was the same age. I'd been consulted because she couldn't afford her epilepsy medication and had a seizure. She was also pregnant with her 4th child. So she was in the OB ward of the county hospital.

I had a job, an apartment a few miles away, a 4-year-old car in the parking lot, and a girlfriend (now Mrs. Grumpy).

She was homeless. None of her kids had the same fathers. She bounced between different shelters and whichever guy would take her and her kids in for a few days.

I'd showered that morning. She and her kids smelled awful, and obviously hadn't bathed recently.

I was in a generic shirt, tie, and pants from Target, with the required white coat. She and her kids were in tattered clothes from a donation center.

As I talked to her, scribbling her history down on my note pad, I suddenly realized I knew her.

10 years earlier we'd been in the same year in high school. We took PE, economics, typing, social studies, and chemistry together. We weren't close friends, but knew each other and said "hi" in the halls and local stores when we crossed paths. I suddenly had a vivid memory of her running to third base when I hit a single in a softball game.

I didn't mention it, and if she recognized me she didn't say so. I don't think she did. Her chart was huge, and I was just another in an endless stream of residents she dealt with on her frequent admissions. I restarted her seizure med and folic acid and she was discharged later that day. I went to another rotation the next week and never saw her again.

To this day I think of her. We came from the same upper-middle class backgrounds. We went to high school in American suburbia. Her parents were as successful in their area as were mine. Not wealthy, but comfortable, with expectations for their kids of college and a job and self-sufficiency.

I wondered how she got there. In 10 years we'd landed in very different lives. Had she made bad choices? Drugs? Alcohol? Had she just encountered terrible shit luck that all of us dread happening to us? A marriage gone bad? Domestic violence? A financial catastrophe beyond her control? I remembered seeing her and her parents posing for a picture at graduation. Did they know where she'd landed?

Sometimes, while trying to sleep, I think of her sitting there. I wonder if she's still on the streets. If she got her shit together and was able to move out of poverty. If she's even still alive. I'll probably never know.

Maybe she did something stupid, the kind of thing where all of us living in comfort can say "that would never happen to me, I'd never do something like that." Or maybe the circumstances were entirely beyond her control, the kind of financial clusterfuck nightmare that all of us dread destroying everything we have and work for.

I'll never know the answer. But the encounter always reminds me how much of life can be terrifying random chance, no matter how much we'd like to believe otherwise.


Anonymous said...

It's easy to forget there are people behind the labels that are so callously thrown about. I hope she is in a better spot in life.

Packer said...

Wow, I have these things come upon me all the time. There but for the grace of God, go I is an oft repeated statement in my life. Just yesterday in ahead of line in front of me was a lawyer who lost his license, it was booze that did him in. The pressures of the profession often lead to too much drinking, I stopped drinking anything 35 years ago in response to what it was doing to a relative. This is a hard knock life. As a Catholic, some may think it odd that I believe in the power of Modeh Ani as a way to live.

Anonymous said...

Thanks for remembering, Dr G and choosing to tell.

bobbie said...

As long as you remember her, she will never die ~

Anonymous said...

Her seemingly normal childhood home life may have been anything but, as well; appearances can be deceiving. Those who do well like to think it's their doing, and those who give it all they have but still "fail" are too often blamed. "There but for the grace of God ..." or similar saying is a good one to keep in mind as we go through life. It can all turn on a dime.

Anonymous said...

I wonder if her epilepsy had anything to do with her situation - seizure on the job, unable to get insurance (ACA wasn't around to let her stay on her parents insurance) to get her medications, leading to the downward spiral.

Anonymous said...

My thoughts precisely.

Heidi said...

Thank you for this very moving post. Your concluding sentence is chillingly true.

I know wonderful, good-to-the-bone people who get hammered over and over with "bad luck". They don't deserve it, nor have they done anything to cause it. It just keeps happening, sometimes to a mind-boggling degree.

The random chance thing is very real. And scary as hell.

I have those "There but for the grace of God..." moments all too often.

Moose said...

"If she got her shit together and was able to move out of poverty."

It's not simple to "move out of poverty." There are few programs to help, and those that exist are stretched to their limits.

People bitch about welfare programs "catering to lazy people who don't want to work." The reality is very different and not so simple. Are there cheaters and lazy people? Sure. But they're a tiny minority. The majority of people on food stamps [SNAP], for example, are white single parents with at least one job and/or going to school to improve their lives.

But... it's near impossible to get a job when you're transient. Sure, cellphones today mean you don't need a fixed phone number, but employers want to see some basic sign of stability so that they know you'll come in to work. (Yes, even McDonald's & Wal-Mart.)

The wait for section 8 housing in many places is over a year or longer. She might have been on a waiting list.

How do you get childcare without a job? With a minimum wage job it's still nearly impossible. Without it, what do you do if a child gets sick, when your job will fire you for missing too many shifts? Not everyone has family who can help with childcare.

Poverty is very hard to overcome. I've been there. I don't normally divulge this kind of info publicly. I was homeless for a while in the 80s. Less than 10 years ago, while waiting to qualify for SSDI, I almost became homeless again. (And most homeless shelters are not equipped for the disabled.) I qualified for heating assistance. I qualified for SNAP, but as a single person the amount was just enough to cover cheap and unhealthy foods (especially in the cold, bad-winter northern US) -- and SNAP doesn't cover the things we take for granted, like toilet paper, soap, or feminine plumbing products. I didn't qualify for Medicaid but, thankfully, there is a free medical clinic near me that was able to help me sign up for free insulin programs. I didn't qualify for any kind of cash payments. My cheap apartment complex doesn't take section 8 even if I were to qualify, which I didn't.

I was lucky. After a year of struggling some friends banded together and gave me enough to cover rent and basics until I qualified. But most people aren't that lucky.

Yes, anyone can fall into deep poverty. People can and do recognize that. But it's easy to think that people just need to fix themselves to pull out of it. It's not always that easy.

Moose said...

I also want to apologize for coming on so strong when your post really came from the heart. You recognized that she'd fallen from what we perceive as "normality" and reacted with compassion.

You just hit a strong button for me, and I surely came on too strong. I still like you, Dr. G. :-)

Mage said...

I too once was homeless later my kids came back to live with me. Thank you for remembering her.

Anonymous said...

Some people do not want to be helped. They refuse help. They resent you for trying to help.
They do self destructive things and blame everyone except themselves for their repeated problem behaviors.
They sabotage themselves, I do not know if it is consciously or unconsciously, or even if they understand that they are sabotaging themselves.

I see these behaviors in members of my family. I see them in myself sometimes too.

Other people may not have this fault. I have helped people that were successful when they got that extra boost.
Try to help. Do not be disappointed if you cannot.

Anonymous said...

If I hadn't met my partner when I did and got married, I likely would have been out on the street. Becoming so disabled you can't work when you're young makes it really hard to find someone willing to spend their lives with you. I tell him I don't really understand why he puts up with all the crap that comes with being married to someone with a disability, and he tells me "I got lucky."

He doesn't realize I'm the lucky one, in more ways than one.

clairesmum said...

thanks, Dr G. I second Bobbi's comment above. Moose gives an accurate description of how easy it is to fall into poverty and how hard to climb out. So many of us have been or are vulnerable to falling into that hole...and the randomness is terrifying....
and some become comfortable in that life 'on the dole' as a way to 'settle for' and claim as their own the identity that chance and judgement have thrust upon them. if you see no way to make a change, then you can't change.
i think our fear makes us judgmental, looking for ways to make a poor person 'other than me' as a false reassurance to our own terrors. If there is a substantive difference between myself and 'that person', then I am protected from becoming 'that person.'
Such arrogance we humans have! The fear fills up the heart, leaving no space for compassion or kind action, and then we speak from hate......

tbunni said...

To Anon 11/15 4:05 To me it sounds like you both got lucky - the best kind of marriage there is!

Geno said...

1970 My brother 19 rode on the back of a motorcycle that t-boned a car. He was bruised but his head injury caused severe TBI and removal of part of his left side of his brain. Years of recovery he gets his masters in ABI but because he still does not express himself clearly he never gets work in his field. He works at Fed EX packing trucks. He is lucky, some never recover after even a little fall. You are an exceptional Grumpy! Each day is a gift, not to be taken lightly for we know not tomorrow. We only have today. Keep up the good work.

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