Primary Care Profiles

Camden, New Jersey. 

No one is ever on the right side of up here. “Rock bottom” is something people hit time and time again. 

If you watched ‘Stranger Things’ and struggle to picture the “upside down – Camden comes pretty close. There are entire blocks with vacant, abandos (abandoned properties) where my patients tell me they will go to get high. There are no grocery stores – just tiny bodega shops that feature snacks, soda, kitty litter, and Santeria candles but no fresh food. Trash is stirred up by passing cars and the wind. Glossy wrappers get tangled in bushes or create garish contrast against freshly fallen snow. A lone figure drops their pants to defecate in a vacant lot when they think the coast is clear.  

Yet, our oasis stands two stories tall admist the fray. Extraordinary things happen within our walls. I’ve been privileged to be introduced to an ever evolving cast of wonderful human beings. 

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Reggie* is exactly who you might imagine when you think of a chronically homeless individual. He has a long-standing mental illness that may or may not be schizophrenia. He is suspicious of me. He was last in for a doctor visit in 2012 – well before I was a provider there. He smells stale – of soil, of dried urine, and of the tang that develops from sweat never washed away. The fruity aroma that makes my nose twitch  is from the venous stasis ulcers on his legs that have swollen to 2-3 times their usual size. It is a smell that reminds me of my 5 years of hospital nursing. It’s the smell of things dying. I can see the pink-white layers of his skin. Reggie is a large man but he sits hunched in the wheelchair, observing my as I examine him. 

Reggie tells me that he only needs bandage supplies and pills to “make me pee”. He means Lasix – a rather strong diuretic we give to pull fluid from extracellular spaces back into the circulatory system so the kidneys can excrete the excess. I know that Reggie is chronically homeless but he spins me a yarn about having bought a 3 bedroom house behind one of the local hospitals. He goes into such detail about the property that I almost forget to question the verity of the whole thing. In all likelihood, he will go back to loitering around places like local food banks or the McDonald’s and get arrested for such because of the state of his skin but more so for the state of his mind. 

When caring for the homeless, the focus is on keeping the patient out of the ER, so I push the thought of IV antibiotics to the bottom of my list of therapies.  We clean and dress the wounds. I prescribe a strong oral antibiotic and a few days of Lasix. I beg him to let me draw his labs to check for signs of systemic infection and injury to his kidneys. He begrudgingly agrees. In a stern tone, one that I recognize as my mother’s voice, I tell him to return in a week for reevaluation. He leaves laden with a bag brimming full of bandage supplies, pedaling the wheelchair with his swollen feet. 

It has been two weeks, maybe three. No sign of Reggie. I search the streets for his face as I drive around the city on my way to and from work. I check the local news outlets for death notices. I imagine he’ll pop up again. Hopefully, I get to him before his infection does. 

*Name changed.