In This State is a syndicated weekly column about Vermont’s innovators, people, ideas and places. Dirk Van Susteren is a freelance writer and editor from Calais.
Tommy is in a troubled medical state. He is homeless and drinks and smokes too much, and he is hurting from weeks of radiation treatment for cancer.
The cigarette habit is especially tough to control, he tells Dr. David Adams and Liz Fehrenbach, a registered nurse, during a recent visit that’s not in the doctor’s office, but in a shelter home where they have come to see Tommy and other patients.
“Tommy, you have a rough cough. … I am glad I am seeing you,” says Adams after entering Tommy’s room. Tommy tells his visitors about a sharp burning sensation “in my lower back” from the radiation, and Adams, concerned, mentions the salve that had been recommended. He and Fehrenbach glance about the room to find it.
There’s another issue: A card game with a friend the previous night got noisy.
Tommy, elf-like, with bushy white beard and wearing a Yankees baseball cap, had been warned by the shelter’s director of housing about the noise. Adams gently suggests he keep things down.
There’s more talk about other ailments, medications, nutrition and social behavior.
And so things went with the half-hour session with Adams and Fehrenbach, on this, one of the caregivers’ visits to housing and daytime centers for Burlington’s homeless.
At a time when almost no doctors make house calls, this pair goes to shelters and to the streets. They were seeing Tommy at the Harbor Place, a former Econo Lodge turned shelter in Shelburne that on this day is jammed with more than 100 people, including many families. Because temperatures hovered near zero the last few days, the state has allowed a larger number of destitute people to obtain state emergency housing. All 55 rooms at Harbor Place are filled.
Having a roof overhead in harsh weather is the most obvious first need for the homeless, but right behind are meals and medical care. The medical part of this equation in Burlington, with its large share of Vermont’s homeless, is being addressed by Safe Harbor Health Center, which employs Adams and Fehrenbach.
Safe Harbor is an affiliate of Community Health Centers of Burlington, which since 1988 has been providing health care to low-income people. But Safe Harbor, located on South Winooski Avenue near the downtown, specifically serves the homeless. As many 900 people a year receive care there — from Adams and Fehrenbach, a physician’s assistant, five social service workers and two part-time dentists.
Adams and Fehrenbach may be primary-care providers, but you could easily consider them specialists in an unusual field, as their patients often have special problems with drug or alcohol abuse, or mental illness.
Fehrenbach notes though that often patients are just down on their luck, just out of money. A tepid economy and the high cost of housing in Burlington can quickly “bounce” someone on the edge into full-blown homelessness, she says.
She believes Burlington, for some reason, also has “this vibe” as a place for to come.
The nurse is talking in her silver Ford Fiesta, with the doctor in the passenger seat, as she makes her way through noontime traffic toward Daystation, a drop-in center in the old Methodist Church parsonage on Buell Street. This is the place where many of the city’s homeless visit on cold winter days after a nighttime stay at one of the city’s shelters.
At Daystation, the medical team talks to one patient about her difficulties breathing and to another about medication. Part of their work, they say, is just being available to remind people — unobtrusively — of the array of medical services offered at Safe Harbor.
The two see homelessness in all its varied permutations. They’ve helped people sleeping in cars, hanging out in parking garages, and living in “camps” in tents or shelters made of cardboard or plywood.
“Some folks just ride the buses, using transfers, until the buses stop at 1:30 in the morning, and then they might sleep in a Laundromat or maybe the stairwell of a church until morning, when they can get back on the bus,” reports Fehrenbach.
This little medical team had started its day four hours earlier at a soup kitchen.
“Will Kommen; Boyei Bolamu; Ter Vetuloa; Welcome,” are the words on a poster that greet them and the diners at 7:45 a.m. the entry of the Chittenden Emergency Food Shelf on North Winooski Avenue.
Another sign promises: “Free Clothing Repairs on Tuesday.”
Visitors are indeed welcome at this breakfast hall. There, those in need get a free meal of oatmeal, eggs, bacon, potatoes and coffee from 6:30 to 9.
Adams and Fehrenbach set up a temporary doctor’s office in a cramped space just off a hallway to see maybe a half-dozen patients, to check blood pressures, make sure patients are taking their medications, and remind them of upcoming appointments.
One patient has an ear problem, another hepatitis C.
Fehrenbach, with a laptop, updates everyone’s records.
Meanwhile, out in the breakfast hall, Stuart Rasmussen, the food shelf’s physical plant coordinator, eagerly gives a testimonial on the medical attention provided to the homeless: “Oh, yeah, they are happy to have this health care!” he says.
“I had the flu this winter and back pain, and they helped me,” says a grateful former patient who happens by. Robert Harris of New York, living in a shelter, says Adams and Safe Harbor’s physician assistant in the past also have found him clothes and provided emergency taxi money.
For a physician, working with the homeless can require a recalibration of goals, given the many social, psychological and economic hurdles faced by patients. Adams says his aim with some is modest: to keep them on a path of “no further harm.” That, hopefully, translates into fewer arrests or maybe fewer hospital emergency-room visits.
“Some patients may not take their shoes off for months at a time, so we see cases of trench foot,” says Adams. He mentions cases of frostbite and hypothermia.
There are small victories to be won in the doctor’s unconventional days of working with the homeless: They range from helping a fellow of the streets sober up just long enough to attend his daughter’s wedding, to finding a refrigerator in a shelter where a patient can store his glaucoma drops.
And big victories. Adams mentions a case in which a bipolar diagnosis resulted in medication that helped a patient leave the streets for gainful employment.
“I don’t want to call it a ‘calling,’ because that sounds highfalutin’,” Fehrenbach says, when pressed to discuss her own motivation. “But since nursing school, I thought that working with people in difficult circumstances was something I could, and maybe had an obligation, to do.”