“I was afraid I missed you.”

“I was afraid I missed you,” she exclaimed as she quickly caught up to our caravan. “I haven’t been staying here lately, but wanted to see you. You are the only ones I trust to take care of me.” 

Though we had known her for a while, it had taken many weeks for this patient to open up to us. She had a back story like many, including complicated wounds related to substance use. Her previous encounters with the healthcare system had been traumatic, as she faced the typical triad of blame, shame, and stigma. She was a victim of the care provided by a system poorly equipped to deal with those who use drugs.   Experiences like this are just one of the many reasons that our patients avoid seeking care, even when they desperately need it. 

Because of these poor experiences, it takes time for us to build meaningful relationships. While it might seem that patients would be delighted to have medical providers bringing care to them each week, we are often met with skepticism. And justifiably so – many of our patients have not had positive experiences seeing doctors in the past. Then, when we show up on the doorstep of their homes, it would be an afront to ask them to put aside all this historic trauma and just “trust us.”  

For this reason, we try to make our approach intentionally different. We are not there to provide healthcare. We are not there to get anything from our unhoused friends. We just show up to acknowledge the humanity of a segment of our community that is frequently discarded and disregarded. We are there to talk. To bring some food. To share some clothing donations. 

“Oh, and by the way, did we mention we are doctors?”

Relationship is at the center of everything we do. It can take weeks, months, and – for some – years to trust us. But that trust is so invaluable. If affords us the opportunity to help people in significant ways. And for those that do not want or need help, we are there to be a friend, affirming their value and dignity. 

We dressed our patient’s wounds and then shared a hug. “I am glad we got to see you today,” I said, “we’ll be back next week.”

“I wouldn’t miss it,” she said. 

Nathan Nolan is an infectious disease doctor in St. Louis with a passion for serving marginalized communities. He is the founder of Street Med STL. In his little free time, he can be found hanging with his fiancée, Valerie, and their pets.

*Some details related to patient stories may be altered to protect the privacy of those we serve.