Johnhad always been healthy. Although he had health insurance throughhis job, he rarely needed to use it. He smoked half a pack ofcigarettes each day and drank socially a couple oftimesa month.
Oneafternoon, John’s company notified him that it was laying him offalong with more than a hundred other employees. Though he wasdevastated about losing his job, John was grateful that he and hiswife had some savings that they could use for rent and other bills,in addition to the unemployment checks he would receive for a fewmonths.
Johnsearched aggressively for jobs in the newspaper and online, butnothing worked out. He began to have feelings of anger and worrythat led to panic. His self-esteem fell, and he became depressed.When John’s wife was hired to work part-time at the grocery store,the couple felt better about finances. But demoralized by the lossof his job, John started to drink more often.
Twobeers a night steadily increased to a six-pack. John and his wifestarted to argue more often. Then, about six months after losinghis job, John stopped receiving unemployment checks. That week, hewent on a drinking binge that ended in an argument with his wife.In the heat of the fight, he shoved her. The next day, John’s wifetook the children and moved in with her parents. No longer able topay the rent, John was evicted from the apartment.
Johntried to reconcile with his wife, but she said she’dhadenough. Over the next few months, John “couch–surfed”with various family members and friends. At one point, he developeda cold, and when it worsened over a few weeks, he sought care atthe emergency department. Thehospitalstaff told him that he would be billed because hedidn’thaveinsurance. John agreed, and a doctor diagnosed him with a sinusinfection and prescribed antibiotics. With no money to spare, Johncould not get the prescription filled.
Johncontinued to live with family and friends, but his heavy drinkingand anger only got worse, and his hosts always asked him to leave.He went from place to place. Finally, when John ran out of peopleto call, he found himself without a place to stay for the night andstarted sleeping at the park.
Onenight when John was drunk, he fell and got a cut on his shin. Theinjury became red and filled with pus. John was embarrassed abouthis poor hygiene and didn’twanta health care provider to see him. But when he developed a feverand pain, he decided to walk to the nearest emergency department.He saw a provider who diagnosed him with cellulitis, a common butpotentially serious bacterial skin infection, and gave him a copyof the patient instructions that read “discharge to home” and aprescription for antibiotics. John could not afford the entireprescription when he went to pick up the antibiotics, but he wasable to purchase half the tablets.
Winterarrived, and it was too cold for John to sleep outside, so he beganstaying at a shelter run by the church. Each morning, he had toleave the shelter by 6 AM. He walked the streets all day andpanhandled for money to buy alcohol.
Oneevening, some teenage boys jumped John in thepark,stealing his backpack and kicking him repeatedly. An onlookercalled 911, and John was taken to the emergency department. Laterthat evening, the hospital discharged John. He returned many timesto the emergency department for his health care, seeking treatmentfor frequent colds, skin infections, and injuries. Providers neverscreen him for homelessness and always discharge him back to“home.”
Oneday at the park, an outreach team from the Central Margret hospitalfor the Homeless, a hospital that’scelebratingthe 125thanniversary by partnering with the community for free monthlyhealth care services, approachedJohn. The team, including a doctor, nurse, and caseworker,introduced themselves and asked John, “Are you OK?” Johndidn’tengage.They offered him a sandwich and a warm blanket. John took the foodwithout making eye contact. The team visited John for the nextseveral days. John started making eye contact and telling the teamabout his shortness of breath and the cut on his arm. The teambegan seeing John frequently, and he began to trustthem.
Acouple of weeks later, John agreed to go to the healthcare clinicof Central Margret hospital. Upon his arrival, the staff at theclinic registered him and signed him up for health insurancethrough Medicaid and food benefits. John felt comfortable in theclinic, and he saw some of the people who also stayed at theshelter and spent their days in the park. They were happy to seehim and told John about how the clinic staff care and would be ableto help.
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