No one knew just how long Freddy had been homeless nor what circumstances had brought him to the doorstep of the Baltimore Rescue Mission shelter. As far as Dr. Dalton – our physician supervisor – and his students knew, Freddy had been there forever. Residents of the shelter were required to help out, sweeping floors or cooking for the other residents. Freddy always volunteered for clinic duty and was charged with making the list of patients to be seen that night, assigning patients to student clinicians, keeping the endless folders of medical records in order, and distributing supplies: stethoscopes and blood pressure cuffs to students, socks and toothpaste to patients.
Freddy was also a patient himself; he was profoundly obese and suffered from type 2 diabetes. Every week, he took a few minutes away from his clinic duties to allow someone to take and read his blood sugar. Freddy spoke to few students and trusted even fewer to stick him with the lancet. Despite his stern and tough exterior, he winced and looked away each time the needle stuck his finger. Only the most dedicated and competent students, of Freddy’s choosing, took his sugars.
I had been volunteering at the clinic since I started college in 2007, and in the fall of 2009 my visits became more frequent, until I was there every week, taking blood pressures and joking with the men about the Orioles. On a particularly cold night in November of that year, Freddy pointed at me and said, “You’ll be taking my sugars today, miss.” I simply nodded and turned away to fetch his chart, but inside I was ecstatic. Over the previous two years, I had helped patients fill out Maryland’s tortuous Medicaid application, weaned them off of methadone, and treated massive foot ulcers, but winning Freddy’s trust was the most difficult thing I had done at the clinic.
From then on, I was the only one who treated Freddy, week after week. It was a little routine we had: as soon as I arrived, I’d get the chart while he fished out his list of last week’s sugars; I’d stick his finger, and I’d check his feet and weight. I’d tell him about my sisters, school, the Red Sox score, and he’d tell me about his brother in Texas and his mother’s poor health. Then I would see my next patient, and he would go on with his clinic duties. I watched Freddy’s sugars drop from 700 to the mid-200s, and he watched me learn how to distinguish a bacterial sinusitis from a viral upper respiratory infection. Months went by.
In May of that year, I arrived to clinic to find another man at Freddy’s desk. He stood up and smiled, and introduced himself as “Quentin, but the guys call me Q.” I shook his hand and smiled back, but I couldn’t shake a nagging worry: when patients didn’t come back to the clinic for follow-up, it typically meant that they were in the hospital, sick or beaten or both. I had trouble focusing on my patients that night. In my head, I saw all sorts of terrible things happening to Freddy: hypoglycemic shock, or a mugging gone wrong, or an infection.
At the end of clinic that night, I asked Dr. Dalton about Freddy, afraid to hear the answer. Dr. Dalton smiled and said, “He’s gone. He’s been working for a few months and he saved up enough for the rent on an apartment. He’s not homeless anymore.” Then Dr. Dalton took off his white coat and left the room.
Of course I wanted Freddy to have a home and a job, to be out of the shelter and out of East Baltimore. I wanted him to be happy and well, but I wasn’t ready to let him go. I wish I had had the chance to say goodbye, congratulations, I’ll miss you. And thank you. Freddy was the first person that truly felt like my patient. I loved the months I spent following up on him. I wanted to thank him for giving me the chance to be his health care provider and for trusting me to come through for him. Freddy taught me the value of the longitudinal patient-doctor relationship, and it’s the prospect of building more relationships like this that draws me to primary care.
Diana Wohler is a medical student who blogs at Primary Care Progress.