Friday, January 13, 2006

What More Can I Do?, Part II

The patient whom I discussed in this post received an eviction notice this week. It seems he actually missed his court date and will be summarily removed from his home by the Sheriff quite soon. This is not the first time I've encountered such a situation, and though my patients often look to me to somehow magically solve these housing nightmares, the best I can do is point them in the right direction.

For people with HIV, there are specialized housing advocates and programs, replete with housing case managers who go to bat for clients and fight to prevent homelessness and needless evictions. For people without HIV, there are housing advocates and legal aid for the poor, but it is a uphill battle, more so for someone who has little or no command of English, no money for transportation, debilitating illness, and an addiction which often precludes timely and thoughtful action under duress. For as I have seen in so many cases, when the going gets tough, the addict goes copping. You see, stress and seemingly insurmountable circumstances can be a natural trigger for substance abuse---a sad but brutal equation.

If a patient lives in subsidized housing and I have documented in their chart that they are actively abusing substances, I cannot testify for them or sign an affidavit stating that they're clean and sober (as some of my patients have asked me to do over the years). If I testify that a client is clean in my sincere effort to ward off an eviction, and then my notes are subpoenaed, I would be in deep professional and legal doo-doo. That said, a number of my star patients have been in sticky legal situations and I've gone above and beyond to help them, often because they are so proactive in helping themselves and refuse to be victims, and have done their utmost to keep their lives on track.

Sadly, there are a number of people out there who, for one reason or another, just cannot get it together, and cannot pay attention long enough to focus on their well-being and stability. As non-sensical as it may seem to some, learned helplessness and abject hopeless victimhood can be devastating in certain populations, especially where language barriers and cultural differences erect even more roadblocks. It is often just these individuals who come to me and my colleagues: physically broken, emotionally stunted, socioeconomically disengaged, and weighed down by poverty, mental illness, or as previously stated, substance abuse. These are the "train-wrecks" of the community health centers, and their care---often ignored and disavowed by most of the system---becomes our rallying cry. While that cry may at times feel more like a whimper for mercy, none of us are in it for the glamour or the glory and we choose our work quite knowingly. Compassion fatigue is real, but one needs huge stores of patient compassion (and compassionate patience) in this business.

Will this particular gentleman be out on the street next week? Perhaps. Did I connect him with just the right people in an attempt to assuage this dire situation? Oh, yes. Am I powerless to do more? In my mind, yes, unless I choose to take him home with me (an impossible, improbable, and altogether inappropriate idea).

Will another gentleman be incarcerated for something he swears he did not do? Maybe. Did I write a heart-felt letter to the judge, declaring my patient's poor health, poor immune status, and sincere attempts to better himself? Absolutely.

Did I come home to my cozy home and leave them all to their own lives and battles as I enjoy my weekend with family and friends? You bet. If the caregiver does not care for himself, there will be no more care left to give.

What more can I do? For now, I err on the side of self-care, and the pieces will simply fall where they may. I cannot fix it all and I never will.
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