Introduction by John Baden

Bob Flaherty, MD, contributed last week’s FREE Insights, “Pure Medicine”. This was the first half of his Wall Street Journal column on delivering medical care to Bozeman’s homeless. Ramona and I welcome you to join us in supporting Bozeman’s Warming Center through the non-governmental Human Resource Development Council, a 501 C-3 organization. Following is the conclusion to Dr. Flaherty’s article.

Robert Flaherty, MD is a family medicine doc who works at Montana State University and teaches in its WWAMI medical school program. He is also an extremely active and responsible member of our community.  For example, Dr. Bob is the consulting physician for our Warriors and Quiet Waters foundation for wounded warriors.  Bob is also an entrepreneur and a regular presenter in FREE's seminars and policy salons.  In sum, I know Bob very well and respect him immensely.

Dr. Bob has wide intellectual interests and steers by a classical liberal gyroscope.   He is a strong believer in the importance of responsible liberty, community, and creativity.  These values are evident in his Wall Street Journal column in the Weekend Edition of January 17-18.  This week and next week's FREE Insights are the manuscript he submitted to and was published by the Journal. (By the way, only about 1% of submissions are accepted by the Journal.)

Ramona and I had know of the Bozeman Human Resource Development Council (HRDC) Warming Center since its beginning.  Reading our friend's Wall Street Journal article encouraged us to make our first substantial donation to it.  After you read part one, and especially next week's conclusion, you may well want to contribute.  You will also further understand why so many successful people find the Bozeman community such an attractive place to live. HRDC, and especially its Warming Center, demonstrate our sense of community and of responsibility. The address of this private sector 501 C-3 public charity is 32 South Tracy, Bozeman, MT 59715. 

Pure Medicine

From The Wall Street Journal, January 17-18, 2015, Dr. Robert Flaherty

The CHP Dental Clinic and the CHP Medical Clinic are part of Community Health Partners, our local Community Health Center. I was one of several community members involved with starting the Bozeman clinic about 15 years ago and it’s an important resource for Bozeman’s low income individuals and families. It keeps a lot of people out of the ER and the hospital. Angels work there.

Shah is another regular, gregarious and playful, and he has been coughing since I arrived. He says he is from Mumbai and has a mechanical engineering degree from MSU. A mystery. “What’s with that cough, Shah?”

“I have had a cold for a few days, and the cough is getting worse.” I love his clipped and musical accent. “Any hot flashes or chills?” “No.” “Let me take a listen”. Harsh lung noises. Bronchitis, maybe asthma, probably not pneumonia. “I just gave away the last of my cough drops, Shah. Try some honey for the cough. They should have some by the tea at the Community Café.” The Community Café serves free dinners and is run by volunteers. More angels. “If you are not better by Friday, you better go to CHP and let them check you.”

Dan is loudly singing “King of the Road” while dancing a jig. Appropriate choice. I have known Dan for about 10 years, since the homeless clinic in the basement of the Methodist Church. That closed, but Dan abides. Except tonight I think he forgot to take his meds.

Sharon had a big crack in her heel a few weeks ago, which we successfully treated with some antibiotic ointment and a polyethylene dressing. Clearly smart and educated, she armors herself with profanity and holds her own. She describes a professional father and mother, growing up skiing and horseback riding. She speaks proudly of her knee ligament repair, an emblem of her privileged youth. No clues to why she has been a regular here this winter. Another mystery.

I introduce myself to newcomers. Some don’t tell me their names but most do, although even then they offer only their first names, and maybe not their real ones. In the homeless culture, like in some other exotic cultures, if someone knows your name they have power over you. Or, more practically, giving their name may lead to arrest. So they stay safely submerged in anonymity.

I don’t ask about their stories, but with familiarity and trust, bits of history bubble up. Divorce, lost jobs, disappearing husbands or wives, alcohol, drugs, mental illness. Some of their stories might even be true, but it doesn’t really matter. They are who they say they are, and they have become my friends.

These homeless are often different from the homeless you read about in the New Yorker or hear about on NPR. Certainly, many have hit hard times, but just as many prefer to live off the grid, below the surface, avoiding even formal medical care. They want most of all to be left alone to enjoy their liberation from much of what stresses the rest of society. They are not poster children for political assumptions.

“Doc, can you look in my ears. I think I’m goin’ deaf.” Jerry is a sometimes guest. With my otoscope I find both ears packed with wax. Tiffany and I take him into one of the bathrooms and irrigate his ears with my portable kit. Success and gratitude.

Maryn has started to trust me over the last couple of weeks. In her early 30’s, but has seen a lot of miles, mostly with potholes. Her upper front teeth are gone, but some of the other upper teeth remain. Her lower teeth are the inverse, so her lower teeth fit into the space left by her upper teeth. Pretty ineffective dentition, and it is hard not to stare when she talks. She wonders if she should have her few remaining teeth pulled and get dentures. “That sounds reasonable. You should talk to the dentist at the CHP Dental Clinic.” I give her their card.

Maryn’s daughter has been watching her mother and me talk. A few minutes later she walks over, hesitant, ready to bolt. “I’m Trina.” About 14, skinny, fleeting eye contact, almost contracting into a shy shell. Long dark hair worn over her left eye, the opposite of Veronica Lake. “Do you know what this is?” Embarrassed, she pulls the hair away to show a 2cm mass on the left temple. “Can I touch it?” “Yeah, I guess.” It is soft, not inflamed. I shine a light into one side of it and it glows. “How long has it been there, Trina?” “Forever, I guess.” “I bet you hate it.” “Yeah.” “This is a fluid filled sack called a cyst. It can be removed pretty easily.” Sudden eye contact, wide hopeful brown eyes. “Really?” “Sure. CHP might be able to do it, or they could refer you to a doctor who could do it and would take your Medicaid. Give this card to your mom.” She hurries away to whisper to her mother, forgetting to say thanks in her excitement, standing taller. The transformative power of a plan.

I am glad that Tiffany is here with me. She will soon enter the world of 21^st Century medicine:  Electronic Health Records, quality metrics, myriad diagnostic and treatment codes, performance-based reimbursement, insurance exchanges. Medicine as process. Obstructions and impediments where the patient and the purpose can easily get lost.

But on this cold evening, she has seen a doctor helping one patient at a time, doing small things that can make a big difference. In perhaps one of the few places left in America to practice simple care and simple caring.

Pure medicine.

Excerpts of this essay previously appeared in the Wall Street Journal, January 17-18, 2015.

Names have been changed to protect the privacy of my friends.