Learning to Slow Down and Make Medicine Human

By Jacob Watson, MS2 at McGovern Medical School

Growing up in a small town, and then attending undergraduate in a college town at Texas A&M, I had little exposure to the homeless population. Like most of you, I had been approached and asked, “excuse me sir, could you spare a dollar?” but I could probably count the number of times that had happened before I moved to Houston on my 2 hands. I tried to talk to these people and help when I could but being young with no income I felt like there was only so much I could offer. When I moved here in July I hadn’t even been in town for a week when I was approached outside a restaurant and asked for $5 by a man on the street. I told him that I could give him $1 because I didn’t have any money on me just my credit cards and quarters for the parking meter. I wasn’t expecting the response “No I saw inside your wallet, I know you have more in there just give me $5!”. I had to explain to him that I genuinely did not have any extra money on me at which point he stormed off yelling at me in anger. I remember feeling confused in that moment as to why someone would become so angry with me so quickly when I had offered to help, and it made me not want to talk to anyone I met on the street thereafter. Although it was one encounter it started to form an idea in my head of what would happen if I interacted with more of the homeless population, anger and confusion.

Over the next few months I didn’t attempt to investigate these feelings any further, I became acquainted to Houston, made new friends, and began my studies. I attended a Thanksgiving dinner with a group of friends where I met an older medical student who talked to me about her passion for global health, underserved populations, community outreach, and social determinants of health. She told me that she had been working with the homeless population in Houston for almost a year now, and that it was one of the most rewarding experiences she ever had. She told me that her passion really blossomed when she began working at he HOMES clinic at the end of her first year of medical school. Seeing her excitement when she spoke about her passion and plans inspired me to think about my own and ask myself “What do I want to accomplish in medicine?”.

The following Thursday I saw a post on Facebook by a friend of mine “Emergency! I had a last-minute conflict come up and can’t make my HOMES clinic spot this Sunday at 9 AM, can anyone take my spot??”. I thought about it for a minute, and I decided that this would be a great time to practice my full physical exam I had just learned and get some volunteer hours while I was there. I took the spot. I remember being so nervous that morning about how the day was going to go. I checked the address three times and still ended up driving past the parking garage before looping back and finding a spot. I walked down the sidewalk and saw 15-20 people sleeping or laying down against the iron fence around the Beacon. I began to walk down the sidewalk and I remember thinking “are these people going to yell at me too like the first day? There’s the gate let me just get inside quickly”. Of course, the gate I approached was locked. I stood there trying to figure out how to get inside the fence to the clinic for a few seconds when the man on the ground next to me stood up “excuse me sir, are you trying to get to the clinic?’ “Yes” I replied. “Follow me inside, the doors are just over here”. We walked together for a minute, he asked me how my day was, and then he thanked me for coming that morning. I asked him if he was going to come to the clinic today and he told me no, but that everyone there appreciated what we did. That conversation made me feel proud to be there that morning, but more importantly when I look back this is where the trust between the homeless population and myself started to rebuild.

When I walked into HOMES clinic I sat down and began to talk to the other students in the waiting room. “So how does this work, when do we start seeing patients”. I expected to see at least 10-12 patients in the six hours that we were there. “Well we are going to have a quick orientation in a minute, and then we will go out into the beacon for 30-45 minutes to talk to everyone. After that we will split up into teams and probably see 2 patients each. Just ask them how their day is, get to know them, and see if they have any medical problems that they want to be seen for today in the clinic.”. I don’t remember every conversation from my first day at HOMES, but I remember them going something like “Good morning, have you heard about the medical clinic next door, is there anything you would like to be seen for today? Yes? Great go talk to the people in the white coats. No? Okay, have a nice day”. I remember being nervous and feeling like these people did not want to talk to me and I mostly kept to this script.

We returned to our exam rooms where I saw my first patient for the day with my team, a middle-aged man who said that he just needed a medication refill and that he would like a new cane. After talking to him for a few minutes I quickly began to realize that he was quite a complex case and my 4 months of medical knowledge would not be able to handle it. Uncontrolled Diabetes, Neuropathy, a recent significant blow to the head with vertigo for 3 weeks since the blow, a recent fall, and all his medications had been stolen in the past week. I watched eagerly as my clinical student began to engage the patient, waiting to glean any medical knowledge or interviewing skills that I could from him. “Sir I am so sorry that you had your medication stolen and that you lost your cane, I want to do everything that I can today to try and help you”. I watched as the clinical student continued to show patience when listening to our patient’s problem, empathy when he worked to relate and build a relationship with him, and professionalism in how he prioritized this patient as if he was a VIP. What I remember most when I look back on my first day in HOMES clinic is that I could start to answer that question “What do I want to accomplish in medicine?”, and that was to prioritize and make a human connection with every patient as I had just seen done.

Today I have finished my first year of medical school, and just volunteered at HOMES clinic for the 4th time this last weekend. When I look back at the experiences I have had there were some interesting cases, but the most joy I had was talking to the people in the beacon in the morning before we went to clinic. When I approach someone, it is no longer the scripted speech about the clinic next door, but instead a “Good morning sir/mam”, a warm smile, and a handshake before I ask for their name and if I can sit down to start a conversation. I have met some of the most interesting people: military veterans, construction workers who helped build NRG stadium, people who love sports, people who love to garden, and people who probably grew up just like you and me. I have had the opportunity to sit down and pray with a group of people at the Beacon in the morning, and I have sat down and been asked about my passion and goals. Taking the time to slow down and get to know your patients no matter if you are at the homeless clinic or the private hospital in a large medical center not only helps you form relationships, but I believe will also lead to a more fulfilling career in medicine.