"No ray of sunshine is ever lost but the green that it awakens takes time to sprout, and it is not always given the sower to see the harvest."

By: Kristin Tang
Quote: Albert Schweitzer

Growing up and attending college in Houston, I wasn’t unaccustomed to seeing the occasional panhandler on the corner or seeing people sleeping on the streets of downtown. My first real encounter with homelessness was at a downtown pizza joint the year before I started medical school. A girl my age placed a crumpled dollar bill and several coins on the counter. She asked the cook if she had enough for a slice of pepperoni pizza. After visibly trying to ignore her, he finally looked up with disdain and said, “Wait in line until you get to the cashier. We deal with money there.” “But do I have enough for a pepperoni?” she repeated. “I can’t count. I’m having a hard time getting something to eat today.” The man, irritated, looked at the coins and said gruffly, “No. You can only get cheese. There’s only $2.50 there. Pepperoni is $2.75.” He walked away. Realizing this girl was homeless, I volunteered to buy her slice. Her name was Mary, and she asked if she could eat with me. Hesitantly, I said yes.

As we swapped stories, Mary’s mood changed every few minutes, going from deep gratitude for my good deed to borderline ecstasy upon learning that I could read, to crying in despair at her living situation, to anger at social workers for putting her in foster care, to irrational paranoia that shelters were scamming her, and finally to hopeful, saying she too would become a doctor. Meanwhile, there I was, thinking all I wanted out of this was to do a good deed. As I observed her, I was surprised at how sobered I felt by Mary’s reality. I felt guilty and helpless, feelings I had never before experienced after aiding others. These feelings kept me up that night. Was I prepared to deal with this in my future career?

During my first week of medical school, I learned of the HOMES Clinic and jumped at the opportunity to make a difference and explore a new side of homelessness. Fate must have played a part on my first day as a volunteer, because sitting there in the waiting room was Mary. Upon recognizing each other, we shared a warm embrace. This time our encounter was only a few short minutes, because Mary wasn’t my patient and I had others to attend to. I learned that Mary had come to clinic because a dog bit her leg. She told me she was living in the woods. Her demeanor was still a little off the mark. After clinic, I learned that Mary often came to HOMES Clinic thinking she was pregnant. I left the clinic wondering if she would be okay on her own.

I let the thought of Mary slip away as I got further into my medical studies. Early one morning during surgery rounds, as I was deeply entrenched in my patient’s chart, my vision was suddenly obscured by a piece of notebook paper held out by a patient. On the paper, a couple of flowers and the following message were drawn in crayon: “This is to say thank you to all the doctors and nurses taking care of me!” The patient holding the card was a young, disheveled woman in a gown. She was walking unsteadily with her IV tower, grinning from ear to ear, and ranting about how great the hospital was. I took the card and thanked her, commenting on how beautiful it was, while a nurse quickly ushered the woman back to her room. I heard the patient objecting down the hall as I continued rounding with my team. It was strange; she looked so familiar, yet I could not match a name or situation to her face. Twenty minutes later, I realized the woman was Mary. It had been over two years since our last meeting. Now I was left with even more questions and that same lingering feeling of helplessness. What was her situation now? Why is she in the hospital? Why, with so many services available to and being utilized by her, does Mary still seem to be struggling with the same predicament after all this time? Have we failed her?

Because my team wasn’t taking care of Mary, I thought it would be unethical to search for her and meddle in her services at the hospital. The brief encounter in the hospital hall was the last I heard from her. Although most of my experiences treating the homeless have had positive and rewarding outcomes, my encounters with Mary bring to light the stark reality of homelessness. According to a report from Houston’s Coalition for the Homeless, 1 in 5 homeless individuals identify as chronically homeless, and 1 in 4 have mental health issues. People like Mary are falling through the cracks, and there’s no reliable safety net for them. It’s evident that our medical system is flawed in many ways. Often, we don’t even know what happens to our patients after they walk out the door. We succeed with some patients and fail with others. One can easily become overwhelmed with all the imperfections that we see. But like many things in life, it’s the little things that count—the small areas in which we can help, the kind gestures we offer to those we care for. I’m not sure what more we can do as healthcare providers or how to turn things around for our homeless. I’ve since come to terms that perhaps a slice of pepperoni pizza and a sympathetic ear is a good place to start. Maybe people like Mary will make their way back to health and social services because they know they will find our smiling faces and giving hearts.

Kristin is a fourth year medical student at UT Houston. Last year, she co-led a project at HOMES Clinic through the Albert Schweitzer Fellowship. She and former HOMES Clinic Executive Director, Winnie Zou, worked to introduce preventative medicine and social work aspects of healthcare using a community-based participatory approach.