Learning on the Job

I'm taking it as a good sign that during the three hours I spent at the foot clinic in the homeless shelter today, I only looked at the clock once, and that was to make sure I would have time to see another patient.

I was late and frazzled when I arrived. I had just shoved easy mac down my throat after spending 9 hours at school and I had forgotten my keys in my room and had to have an RA unlock my apartment. I was having trust issues with my GPS and really heightened parking anxiety until I pulled into the lot of the men's homeless shelter here in Syracuse, a five minute drive from my building.

A man greeted me in the parking lot. He was very friendly. I assumed he was staying at the shelter, but he told me he was security and would make sure I got in OK. Later, he was talking to someone about recently getting out of jail. He was sweet to me and not inappropriate in any way during the clinic. I figured it was better to have him on my side than not.

On the way to the room where we held the clinic, I passed by two large dormitory rooms. There must have been thirty beds in each, bunked. I passed the "lounge," where the lights had been turned off and some men were sitting around watching tv, presumably. Everyone was in good spirits and greeted us. The medical students come once a month on Thursday evenings and are very well received.

I got introduced to the other students, the podiatrist, and the MD running the clinic. We were all wearing Upstate t shirts and jeans, except for the doctor who wore a white coat. The clinic was a small room with tables and chairs set up, which also doubled as the computer lab. There were inspirational Christian quotes on posters on the walls. At any given time, we had five patients in the clinic room. We all sat on folding chairs.

Patient confidentiality is a little hazy to me at this point, so I'm going to err on the side of caution and not tell you about them. But I will tell you--they lived at the shelter. Some worked, some didn't. Some had hypertension and family history of heart attack, some didn't. They were all self-conscious about their feet. Their feet had fungus in them and on them, and thick, painful callouses. I can't imagine what it is like to walk all day in the same old ill-fitting boots and same old socks.

We took their medical histories and asked them what brought them in. Some wanted toenails clipped, some wanted their fungus treated, some had pain and didn't know why. I worked with a second year med student to take the histories and do the physical exam on the foot. We would put a drape down on our laps and have the men put their feet in our laps on the drape. I was instantly comfortable with this. I loved inspecting the feet, checking for strength and sensation, reflexes, pulse. I was fascinated by the fungus but tried not to get too excited about it. The smell was definitely there but did not affect me in the slightest.

For one man with pain, this was the first time in a very long time he had put his feet up. He said the elevating felt very good. While my second year partner went to go get a razor for the callouses, I had a while to wait with this patient. He was embarrassed about the smell and appearance of his feet and wanted to take them off my lap. I could tell he felt relief from the elevation and human contact though, so I told him I would keep palpating and testing for sensation while we waited. By the time my partner came back with the razor, I had a connection with this patient and he was happy to let me hack away at his thick callouses (which I found quite therapeutic...for myself).

I'm not sure if anyone else feels this at the doctor's office, but I love having my neck checked, my back palpated, being asked to breathe in deeply, the quiet and assuring tone of voice my doctor uses as she narrates the exam...I fell into this pattern with my patients tonight. There was an MD there to treat the fungus and advise in the management of diabetes, but I was able to give these patients attention, a listening ear, and a soothing touch.

Two summers ago, I participated in an experience that made me highly critical and even skeptical of service. I carry those critical thoughts with me whenever I engage in an experience like this, or my weekly "Reading Buddies" program that I have started doing at the elementary school nearby (I read for an hour on Wednesdays with a third grade girl). I try to have a realistic view of what I am able to give to people, what they need from me, and how those two things intersect.

I believe that tonight was a great example of a time when I had something to give, there was a need for it in my community, and there was an outlet for me to safely and effectively deliver that service. Working with a team that included a podiatrist and an MD, as well as in the context of a highly structured and long-standing program, made me feel confident that I was part of a service program that improved the lives of the people it serviced, and not just those who served.

A. E. Housman (1859–1936).  A Shropshire Lad.  1896.

FROM far, from eve and morning   And yon twelve-winded sky, The stuff of life to knit me   Blew hither: here am I.   Now—for a breath I tarry            Nor yet disperse apart— Take my hand quick and tell me,   What have you in your heart.   Speak now, and I will answer;   How shall I help you, say;          Ere to the wind’s twelve quarters   I take my endless way.