From the outside of the building, it might have felt like an unusual night, but inside it was a fairly typical scene. The ER was humming with the electric air of urgency: hospital stretchers and their inhabitants filled the available curtained-off bays; patients in better condition slept on stretchers lining the hallways. Several patients in the waiting room–triaged as the least sick in the building–sat waiting in various stages of boredom.
I reviewed the chart of a patient I had seen recently, a man who just couldn’t seem to keep his diabetes under control. He had been in last month, and three other times last year, for treatment of a potentially life-threatening complication of his high blood sugar. When I asked how things had been going, he made a disgusted face. “I hate it, man.” Frankly, it had surprised me to see him again so soon after his last discharge. He had seemed to understand the details of how and when to take his insulin the last time he left the hospital—and the gravity of what would happen if he didn’t. “Can’t keep no needles around at the shelter,” he said simply, when I asked what went wrong. For him, and for many homeless people with diabetes, the challenges of managing a chronic illness on the streets—finding secure storage for medications, reliably obtaining nutritious food, appropriately dosing and timing injections—can be insurmountable.
Later, I checked in on another patient of mine, a man who had come in several nights prior wearing a pair of tattered, sopping-wet socks and an old dirt-encrusted pair of jeans. His feet were the same color as the socks, a not-quite-biologic shade of grey. The jeans had essentially eroded into his shins, to the point they had to be cut away from his skin. He was diagnosed with trenchfoot, a condition caused by prolonged exposure to cold and dampness; over time, the damp skin can progress to maceration, ulceration, and gangrene. Prevention is simple: clean, dry socks and shoes that can be removed when necessary; the ability to elevate extremities; and access to basic medical supplies like gauze and tape.
But for homeless patients—even those who are able to access temporary living situations—this can be a daily struggle. Many shelters require residents to vacate in the hours of the morning and line up again for reentry around dusk. In the meantime, individuals often pass the time on wet, dirty streets—a situation not conducive to the elevation, rest, and frequent wound care required for healing extremities. This particular patient’s case was especially severe and required amputation of the irreversibly injured tissue. He told me a bit about his life on the streets, including some time passing through “the jungle” over the last few years. “I knew it was turning into a real bad place,” he said. And then, echoing a line that Seattle’s mayor, Ed Murray, had told reporters following the shooting: “People are dying out there.”