Burnside Clinic

My shift at the community outreach clinic on Burnside in downtown Portland started Friday. Three other colleagues and myself made it on time to the clinic and began the first shift with a gut full of butterflies. Just getting to the clinic is a lot of extra work. Parking at the Lloyd center, getting on the Max and finding our way to the clinic was quite exhausting.

Dr. Yancy, the attending physician at the Burnside clinic, sat with us explaining the charting they use at the clinic and how it differs in comparison to the other clinics. The first difference I noticed was that the clinic is heavily based in outcome measures that differ from the ones we have used so far. They are very big on endurance tests, disability questionnaires and the use of the patient specific functional scale. Depending on the level of disability, subjective function and physical endurance as well as biomechanical function, we decide how long the person should come in for treatment. It's a great way to track patient progress but it adds a significant amount of paperwork.

The interesting thing about working with the less fortunate folks of society, is how incredibly thankful and generous many of them are. To give them relief from pain and increase their physical function, is a truly gratifying experience. I can't say that I am comfortable doing such work because I have always felt so bad for these people when I see them on the streets. Their lives are so simple but very complex at the same time. I am not the person to give their complex lives the best justice, but I can say, from working with my first patient, not everything is exactly black and white.

Many of these people are living lives that revolve around finding free food and a dry place to sleep each night. Intuition suggests most are addicted to drugs and alcohol, leaving them mentally fogged up and able to live in disregard to conditions of living on the street. I cannot relate to these people at this level and I think that is why I get uncomfortable working with them. We are all human and I believe strongly that we all deserve to live good lives, but when choices made force a person to live on the street in the elements, I tend to get on a soap box. Backing up a bit and realizing that there are thousands of different reasons people end up in these situations, makes the situation look a bit more complex than simply making poor choices in life.

If many of these people quit drinking and doing drugs, they would be able to find a way out of the street life. We are so overburdened in our society with quick fixes for pleasure. Drugs and alcohol provide a level of pleasure that masks the pain these and many socially established people incur each day. Whether it be for musculoskeletal pain, emotional pain or a debilitating disease or a conglomerate of conditions, people self-medicate to make themselves feel better. I think there are a lot of people who don't see a way out of their situation so they stay intoxicated or high all the time. The Burnside Clinic is a place where we get to put to use all the disorders we have studied up to this point. Dr. Yancy made a point to tell us that we will see things that we've only seen in textbooks up to this point.

I would be a lier if I said this all is no big deal. How do you help a person help themselves when they are this low in life? And how do you do it respectfully and authoritatively? Is this even our job? Unfortunately, I have no answers. The thing I can say is that doctors are like parents to the society. They take an oath to look out for the betterment of society and it is their job to hold people accountable for their actions and hopefully guide them to making good decisions.

Unfortunately, my first patient at the clinic turned out to be a suspected heroin addict. It wasn't until I took the person's blood pressure that I saw track marks in the cubital fossa. I then figured this individual had been telling lies to me the whole time. Regardless, the person needed help, I helped out the best I could at that moment and made sure an additional appointment was made before I sent this person back into the wild.

I am trying to figure out how to approach this issue. My plan is to take blood pressure again, and just make a comment on the track marks and suggest that doing intravenous drugs puts you at risk for a multitude of conditions. One of which is osteomyelitis, a bone infection. There are other more important reasons to not do intravenous drugs that I will touch on and hopefully, the seed will be planted for better choices. Ultimately, it is the patients decision to continue using or not. All I know, is that I cannot personally take on the burden of society's poor decisions. To error is human and that's that.

All for now