The Little Things

By: Nadia Haj-Ismail

“Does your leg hurt you?” I asked a patient with a bandage on his leg while managing at HOMES Clinic.

“No, not at all. But when I was walking past a few people sitting outside of the Beacon, one of the guys said, ‘What is that awful smell?’ It hurt me right here.” He pointed to his heart with a sad smile on his face.

I felt my own heart shatter into a million pieces. I couldn’t think of what to say to him; no words could encompass the amount of sadness that I felt when I looked at the expression on his face. As I continued to talk to this patient, I realized that in addition to dealing with the daily struggles of homelessness, he was also trying to properly care for chronic ulcers on his leg. For an individual with a home, caring for an ulcer may be as simple as buying some gauze and bandages and changing the dressing on a daily basis. For a homeless individual, however, the process is more complicated when the individual doesn’t have access to a shower, transportation to get to a store, or money to buy the necessary supplies.

Beyond each of these challenges, this patient had also had hip surgery in the past; as a result, he was physically unable to bend his leg to reach his bandages. The only time that he was able to change the dressing was when he had a doctor’s appointment or used some sort of urgent care center such as an emergency room. He told me that on the previous day, he had gone to an ER where the physicians had decided that changing his bandages wasn’t a necessary service. Instead, he was instructed to wait another two days until Monday, when he could be seen in a clinic.

It has been nearly two years since the first time I volunteered at HOMES Clinic. Every time I am at the clinic, I hear another story about the unimaginable struggles that our homeless patients face as they drift along the streets, unsure what each new day will bring. Some of the patients have been homeless for a considerable time, their rugged faces reflective of all they have seen. They know what resources are available to them, where to sleep, and where to get food. Other patients are newly homeless, evident from the uneasy look in their eyes and the flailing optimism in their voices.

The patient was not exaggerating regarding the smell of his bandages. The look on the faces of the other patients in the waiting room made it obvious that the odor was very strong, and anyone who opened the door to the patient’s room was greeted with a powerful gust of the unpleasant smell. Our attending said that there was little to no concern about infection of his leg, and the patient had an appointment to see another doctor the very next day. Regardless, the team decided to address the patient’s concerns and change his bandages.

He was so extremely grateful for our help, thanking everyone for doing such a huge favor for him. However, the reality is that changing his bandages was not much trouble at all. I’m still bothered by the fact that the ER chose not to change his bandages for him. I know that the ER is not supposed to be a place for non-emergent or routine care, but for someone who is homeless like our patient, there aren’t many alternatives. We usually don’t get to learn what happens to patients after they leave our clinic, but hopefully, this patient is able to find himself somewhere stable to live—a home that will enable him to properly care for his chronic wounds and establish long-term care with a primary care physician. In the meantime, hopefully HOMES Clinic can continue to address his and other homeless individual’s needs.

Nadia Haj-Ismail is a third year medical student at UT Houston. She is currently serving as one of the Associate Directors of Operations on the HOMES Clinic leadership team.