The March. The Trudge. The Hustle.

The last several weeks in American history will certainly be remembered. The inauguration of Donald Trump. Women’s March which attracted strong convictions for people on all seven continents. And for me personally the visit of two dear Street Medicine colleagues from Nashville Tennessee who have pioneered a street psychiatry program of formidable sophistication. Taking extraordinarily brave steps to deliver psychiatric care at Vanderbilt university to patients who are commonly deemed as untreatable, unrehabable and prone to recidivism of the use of all civil services including a prison systems, the challenge is insurmountable but the conviction of their leader isundeniable.
As I read through commentaries about the inauguration, the women’s march and their aftermath, I can’t help but think of the parallel playing out in Street medicine before my eyes. The country stands divided as to its identify identity both nationally and internationally, The healthcare system in many ways is limping along trying to find its own identity. It’s trying to determine how do we take care of all of the patients not just some. Still charge enough to keep the doors open but not too much that it seems like we are using the ability to charge for such a necessary need to get rich. Street medicine for me has represented a glimmer of hope as teams of concerned healthcare providers, outreach worker’s, case managers and citizens march every day on their streets looking for those people who are not found anywhere else in our waiting rooms or perhaps in our society. On the Women’s March Saturday, while the world was preparing to march through their streets, Brett and I along with Dr. Fleisch and Her resident, Laura (the street medicine nurse) and Bob Rapp (outreach awesomeness worker) gathered supplies and trudged through soggy debris, muddy embankments and tired worn out train trusses looking for patients that we knew were in need. When people use the phrase American ingenuity I am always reminded of a lecture that I heard from Dr. Jim Withers several years ago. He points out that if someone took our funding away tomorrow we would not need to close the doors of our programs but rather we would hustle. We would hustle to save our programs in the same way that our patients hustle every day for survival and in doing so the hustle creates the solidarity between us and our patients. Our patients know that we would hustle for them and in return they hustle for us. They put themselves out there in ways that they never would otherwise for somebody that they didn’t identify as having their back. The Vanderbilt visit concluded with a street medicine grand rounds at Lehigh Valley Hospital. The panel of speakers included Dr. Fleisch as well as a local county judge a psychiatrist family have Valley Hospital who has served the homeless. And a patient, Tim, who has survived by hustling since being since a very young age when he was put into foster care system and then lived on the streets for many years. In so many ways, Tim represents the reciprocated hustle. He has found more success in the last several months of his life by completing a life recovery program at a local shelter and graduating with a certificate of completion. He’s the kind a guy who feels so grateful for this accomplishment that he took pictures with the street medicine team holding up his certificate. He also has an ornery sense of humor and took pictures with Santa Claus this year (his first picture with Santa ever) which he also shared with the Street team. While expressing that he was nervous to sit on this panel in front of a large crowd, he persistently reiterate that he will do anything to help the street medicine team who he feels has helped him so much. So whatever your cause may be, understand that it really has three components. The March. The Trudge. The Hustle. One without the other two is an unbalanced triangle. Imperfect, incomplete and likely unsustainable. As Napoleon Bonaparte said, “The most important qualification of a soldier is fortitude under fatigue.”