There is something wonderful when you truly see a person for the first time. I’m not talking about “Hey, we ran into each other and now we’re friends,” but rather I mean the moment when you thought you knew someone or you had an idea about them and you realize you never really knew them at all.
Over the last six months in my Population Health course and while working at the Maybelle Center, this has been my daily experience in Old Town, a community in Portland’s historic Chinatown that is mainly filled with individuals who are marginally housed or living outside. The stark contrast between hospital and home is odd. Getting to know a patient, or even a colleague on an inpatient acute care unit, compared to getting to know them in the community is incredibly polarizing. In the community there is a type of vulnerability and unabashed honesty in seeing the lives of those we care for in the place that is their home.
During the first year and a half of my nursing education the majority of the work has been preparation. Prep the drug list for your patient tomorrow, prep the discharge planning, prep a care plan, prep what you think the priorities of care are (which you are usually wrong), read their notes from three years back in Epic (that probably no one has looked at for quite some time), prep your hand off, prep on the disease process, prep, prep, prep. Is this important? Definitely. Does this fully prepare you to see the patient in front of you and give them the care that they need? Not even close.
Last spring term, my partner and I were placed at the Maybelle Center for Community to care for and learn from individuals who were considered marginally housed. We sat in the community room after being introduced to our first client and exchanged maybe twenty words total, feeling as if we were probably the last people in the world he wanted to be drinking his coffee with.
Awkward would be a perfect word to describe not just the interaction, but how I felt as well. For the first time the weight of my intrusion and how I had left the territory that had been so clearly defined as mine became clear. I realized that I’d become accustomed to the power of authority the hospital gave me, and also began to realize how that authority might have, at times, robbed my patients of their own guiding voice.
For the first time in my seven years of living in Portland, I realized how many individuals lived isolated in S.R.O.s (Single Resident Occupancy) in Old Town/Chinatown. My placement pulled back a layer of ignorance about the reality of many Portland residents, and with that I began to see an almost invisible community and knew I could never un-see them.
This new reality proved challenging because it meant that I needed to change the way I thought about and provided care for this community, before I even began! My times of providing “care management” or “home health care” began to look vastly different from anything I had experienced thus far. My sessions with one client now included walking a lovable and overly excited pup through the streets of Old Town because that got him out of the house, playing Skip-Bo in the community room because that got him talking or making homemade pizza in an attempt to increase his nutritional intake. I had to be understanding when he missed his third appointment, or when he rarely followed through with some of the goals he made for himself, particularly the goal of going into rehab for his alcohol dependency. I also began to see just how unrealistic some of the “prep” I had come to depend on in the hospital had become. My interventions for nutritional deficiency and medication management shifted, my patience expanded and my definition of success changed. Through this experience I realized how incomplete my “assessments” had been and how I had never truly seen the people I cared for.
I feel so grateful to have known so many clients in their own homes, to have met people who challenge the way we provide care and who fight for a community where people are empowered to walk their own journey in life while also being there to travel alongside them. I see now even more than I did before how much I have to learn, and for the first time, how much of that comes from moments that I can’t prepare for, but rather have to remain open to. I hope I always hold onto these experiences. They will be integrated into the way I practice and the way I view health care. I hope I always keep a posture of learning, remembering that even when I think I know, there will always be more to learn.
I worked at the Maybelle Center over the summer which allowed me to visit with some of the past clients I had while in clinical. I walked in to see that first client I had last term who had only a handful of words to say to me in the beginning, and who I never saw during my term complete a single one of his goals. He was smiling from ear to ear, having just been discharged from alcohol detox, being licked by the pup who walked us through our time together, having just completed the most difficult of the goals he set for himself. And in that moment I felt like I really saw him, a man who just needed people to believe in him for him to be able to believe in himself.