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I've rounded this corner a hundred times.
Curving gently in front of a liquor store, it was barely an afterthought in my daily commute. But on this dark winter day, I'm seeing the neighbourhood in a different light.
Set further back from the street is a derelict row of homes, and in one of them, a basement hallway branches into several different rooms. My head is angled downward as I scan around the cramped quarters lit sparingly by a broken table lamp. Small roaches scurry along the stained and mouldy walls. Beer bottles and newspapers are strewn over the floor of broken tile. Smoke swirls from a lit cigarette resting on a pop can filled with ash. And in the corner, a man lies semi-conscious on a mattress no thicker than a pad of paper.
We rush toward him.
Every year, medical students at our university are given the chance to accompany, or "ride out," with the city of Toronto's paramedics. Over a 12-hour shift, students roam with an ambulance crew responding to everything from minor nosebleeds to major car accidents. The program is wildly popular; and with limited spots, fingers are crossed that you are one of the lucky few who get to swap the mundane of morning lectures for blaring sirens and the pedal-to-the-metal thrill of a rescue.
But it's not long before the heroic ideal wears off, revealing a grim reality at each scene.
One call is to a man having trouble breathing. Slouched in a broken plastic chair and clutching his chest, the apartment around him is pitch black except for an old television screen that flickers a faint light through an air thick with smoke and dust. We make our way over to him and his concerned partner the only way we can – single-file between a hoard of shopping carts and floor-to-ceiling stacks of dirt-covered boxes and wares.
"Don't touch anything," my paramedic partner says as we navigate the narrow path. "There are probably bed bugs here, and trust me, you don't want to bring those home with you." (He was later right about the bed bugs.)
After an innocuous case of heartburn and a stubbed toe, we get a call is to a women's shelter. Inside, a young woman is found shaking and crying in the arms of her social worker. "She took too many pills this time," they calmly admit. As we prepare the stretcher, a group of the shelter's residents and staff gather behind a protective window down the hall. Their looks are ones of concern, but also suggestive of some routine – an occurrence for them, that I imagine, is sadly all too familiar.
"Will she be all right?" the social worker asks me.
"I'm sorry, I really don't know," I reply, regretfully.
Yet, soon I will.
I know that when I move into the clinical years of my training, I will likely see these individuals as patients in the sanitized and context-deprived setting of a hospital ward. Donning the standard hospital gown and sitting in the standard hospital bed, their illnesses will be both their distinguishing feature and my academic focus.
I will be taught to tease apart the mysteries of their biology through a medical history and a physical exam; to flip through hospital charts and order lab tests; to formulate diagnoses and decide on treatment plans; and, once they are stable, to discharge them from the hospital with the appropriate follow-ups. Along the way, I might also be pulled into discussions about our health-care system's shortcomings – access to clinics, medication coverage and the like.
But something will be missing in how we care for these patients.
Between calls, my partner and I wait in a parking lot below an overpass. It's a time to decompress and have our lunch, now cold from the noon hour. While one eye is on the computer monitor as I anticipate the flash of our next call, my other scans the area around me. I watch tired commuters spill out from a nearby subway station. As fast as they appear, they disappear into cars or idling buses. Silence surrounds us once again. In that quiet moment, I think about those commuters heading home, and realize how the medical profession falls short. That despite our best efforts, neither the system nor I can give some patients the treatment they truly need: a dose of a healthy home.
Where the perils of drugs, isolation and poverty are replaced instead by the security of a stable income, an education and the support of family and friends. Their effects on our health – discrete and intertwined – are largely taken for granted by those of us fortunate enough to have them. But for the most vulnerable in our communities, the fractured nature of their living environment is often where it all comes apart.
Riding along with the paramedics is an experience like few other in health care. Finding myself in the sights, sounds and smells of these patients' homes shows me a side of medicine that challenged the textbook lessons I'd learned in class. Simply put, the cycle of patients falling ill, doctors finding out why and patients getting better is far from a matter of fact. There isn't always a blue pill to fix this or a red pill to fix that. Many of those who we most want to help are those hardest to reach. And when health goes awry, more than an imbalance of hormones or abnormal blood tests needs our attention.
So as I finished my shift later that night, puzzled and feeling rather powerless, I made myself a promise: that when I'd start to see patients, I would not forget to ask them one simple, yet telling question.
"What is home like?"
Because home is where health begins. I'm reminded of that every time I round that corner.
Arjun Sharma lives in Toronto.