By Crystal Vanessa Castaneda
Circa April, 2009 – Washington, DC
We recently discharged Mr. Diaz (name changed for privacy), a Cuban-refugee who was nearly fully recovered from an ankle fracture post assault two months ago. A Cuban refugee, he has struggled to find a job, home, and sense of belonging in the United States for nearly 30 years. His gruff voice intimidated most of our staff, and because he spoke out loud and harshly in Spanish to the voices in his head (as a result of his schizophrenia), my supervisors considered discharging him numerous times, unsure whether or not they could trust him. As someone who understood most of what he was saying, I was continuously advocating for Mr. Diaz, reassuring the staff that what he was saying was nonviolent, even though he spoke so loudly and somewhat aggressively. Recognizing that most did not understand him, he often turned to me to tell me when he was in pain, his grievances, and other information I had little skill or authority to appropriately address; and I would immediately translate the information to the case managers or nurses. Still, on certain occasions, in the hustle and chaos of their days, they forgot about the details I had relayed to them, leading the patient to believe there was a conspiracy amongst the staff to withhold medications and medical attention from him. It took days for me to reassure him, and he thankfully stopped threatening to leave. Though a burden I sometimes felt unprepared to address, I facilitated much of his communication with the staff, other patients, and at a couple orthopedic appointments as his interpreter.
We bonded while he healed in our safe haven, and nearing his discharge, I became more and more apprehensive as I thought about him returning to the real (and “dangerous”) world outside of Christ House. Through conversations with him and introspection, I was able to reassure myself that this grown man did not need me to hold his hand through everything. His ankle was heeling, and his free mobilization had impeccably improved with the boot he was given. I noticed, too, that he was talking to himself less often. One day, we took a walk to the super market down the street where he would buy his groceries after being discharged—he showed me the way on his own. He smiled with pride. Slowly, I began to step away from the over-protective figure I was playing and trust that he would care for himself. This has been one of the greatest challenges for me with many patients as we prepare them to leave our facilities, as I sometimes believe that the patients are still too vulnerable to return to the outside world. Mr. Diaz stayed in the neighborhood after discharge, and I would often run into him limping down the street mumbling to himself. I couldn’t tell if he was safe, eating, or caring for himself. Some days, he remembered who I was and responded to me; other days, he stared right past me. Each time, I resisted against every urge to probe and ask him his living and life conditions. I offered him a quick greeting and a smile, and ached as I watched him go on his way to an unknown destination.
I am learning and continuously reminding myself that one of the most important aspects of the patient-provider relationship is the trust that must extend in both directions: from patient to provider and provider to patient. Just as I hope the Christ House residents will trust us to care for them, I have realized the value in trusting them to take care of themselves upon discharge. The goal is to empower and educate the residents so that they can independently care of themselves, as well as help them break the cycle of homelessness and addiction that many have been trapped in.
Background
I was a clinical unit assistant on the inpatient floor of Christ House. Some people dubbed my position as “The Queen of The [in-patient Unit’s] Universe.” It was a position I poured myself into for the year: I was an advocate for my patients and my peers, a glorified unit clerk, and a girl fresh out of college with energy to change the world. My job description actually read something like this: I was responsible for the coordination of health information for all patients in the medical unit. This included coordinating transportation for our patients, transcribing all orders in the patients’ medical record, ordering labs, and obtaining necessary authorization for patients’ specialty appointments. It was a rewarding challenge to gain greater experience with and understanding of the numerous insurances and protocols necessary for authorizing patients’ medications and referrals. I was especially happy to work with a medical and social work team that demonstrated a high level of commitment to the mission and values of Christ House, preserving the dignity, confidentiality, safety, and most importantly, happiness of all the patients. I am still learning from this experience, especially as I meet each Mr. Diaz of New York City as I take my journey as a student in a short white coat. Reading this is refreshing, because I am incredibly re-inspired by the story. I remember the endless devotion I gave to him– the type of devotion I want to give to the patients I see today. It is also saddening and frustrating, because I know that there are and will continue to be stories like that of Mr. Diaz. This is why I share it with you, so that hopefully you can re-evaluate and re-think the next time you run into a “violent,” “drunk,” or “scary” homeless man in the ER, clinic, or hospital. Look for the real story. Ask for it. Listen, and then share. Talking and listening sometimes helped the men we worked for thousands of times more than the medication and medical care we provided them. Most importantly, be their advocate.
Crystal is currently a third year medical student at Weill Cornell Medical College in Manhattan. Before beginning medical school and after receiving her bachelor’s degree from Yale, she spent a year working in Washington, DC through AmeriCorps at an inpatient medical facility for the homeless as a medical unit assistant and unit clerk.