October 4, 2016

People : Safety

At our clinic we have every patient fill out a form called the "Staying Healthy Assessment."  There's a list of thirty-odd yes or no questions that are theoretically designed to help clinicians focus on preventative care.  There are questions about nutrition, exercise, substance use, sexual practices, and so on.  The idea is that if a patient answers "no" to any of the questions,

One of the questions is: "Do you feel safe where you live?"

The problem is that if someone answers no, which is not uncommon, I'm not sure what to do about it. I know that the stresses of feeling unsafe in your neighborhood place a burden on our patients' physical and mental health, contributing to the slow, lifelong development of chronic disease.  I know that being constantly, subconsciously on edge about what could happen makes it difficult to focus on cooking, studying, and exercising.  I know how to lower blood pressures with pills, but I don't know how to alter the stresses that elevate our patients' pressures in the first place.

Growing up, my parents managed a convenience store in a sketchy area of the South Bay, and not infrequently they were robbed at gunpoint.  They moved to an area of the East Bay that they thought would be better, but proved to actually be a little worse, possibly due to its proximity to a bank. So when I was really young, I was never scared of monsters or ghosts--I was scared of robbers.  But once they retired, and I moved to a college dorm, I grew complacent and even while living in New Haven during medical school I never thought consciously much about my own safety.

We hear all the time on the news how globally there are so many people living in unsafe conditions, and I hear all the time from our patients about the dangers of their neighborhoods.  It feels both very palpable, and a little distant from my experience.

More recently, it's come up in my immediate circle, giving me a sense of its prevalence and a small, small glimpse of what it might be like for our patients to always feel its presence.

One Wednesday night I was catching up with a friend over dinner, and as she was filling me in on her life, she mentioned how her elderly grandmother in India had opened her door to a man asking for water and was then robbed.  I felt so bad for her, having this happen far away but close to her heart. That night, I came home and opened an email from my brother whose subject line read: "Please find another apartment!"

My brother has been advising me to move for a long time.  My family sometimes worries about my own safety, as my area of San Francisco isn't the most secure.  As anyone who knows me knows, I've had my car broken into half a dozen times over the past several years.  I've also had another driver throw a large cup of sugary juice straight at my car window while I was in it, after he'd cut me off and not allowed me to get back into my lane.  And the car that we drove for six weeks across country to move here, was crashed into by another car and slammed onto the sidewalk. It was parked, so we weren't there, and the car sped off, leaving us with a non-functioning car with no way to pay for its repairs. Later, someone else stole the battery out of it.

So there's some reason for my brother to have told me to leave, but on this particular night he wrote to me after his home in a very secure neighboorhood was broken into while he was at home.  He advised me more urgently to leave, saying that if this could happen where he is, it would definitely happen where I am.

The next morning after hearing about these incidents, I went to work and one patient assaulted another patient in our waiting room, resulting in an injury that required emergency care.  It occurred in my particular area of practice that morning--our drop-in acupuncture clinic for patients with substance use disorders.  I always love working here, because it's quiet and peaceful. There's light music playing, herbal tea brewed fresh, free organic food donated to the clinic, and patients quietly receiving treatment.  It's designed to be a safe space for these patients who in the rest of their lives face a lot of chaos.  Sometimes, that chaos arrives with them and these things happen.

That night, I went to a birthday party and meet a woman there who lives in a neighborhood adjacent to mine. I mentioned that day's incident to her.  She shared with me that every night for the past week people have been jumping the fence into her backyard and doing drugs on her patio, which leads directly into her bedroom. They didn't do anything beyond use her space, but I can't imagine having to sleep in that kind of environment.

So in the course of two days I'd heard and experienced the encroachment of our physical space in my own confines, from where I live to where I work.  While I realize that these things can happen anywhere, there's also a wide spectrum of probability.  All this made me feel more how little security our patients have, how little reprieve others have from the fear of being violated.

It makes me newly aware of how important it is to ensure our clinic is a place of safety, non-judgment, community, and acceptance.  I know I often forget this when I get impatient or frustrated during patient encounters. Because I get caught up in trying to provide the right medicines, to get the blood sugar under control, to screen for colon and breast and cervical cancer.  Because I can't always understand and shoulder the many demands, anxieties, and needs that are unloaded.  I forget that sometimes the most valuable, and hardest, thing we can offer is just a place for our patients to be in comfort and safety, for fifteen minutes of the day.


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  2. Coincidentally, I'm reading Between the World and Me right now and the topic of safety is heavy on my mind (already heavy on my heart because of the weekly news of yet another young person shot dead and also because of my personal experiences all once removed). I don't know how to respond except to say I love you and be safe and lets get together soon.

    1. Love to you & to community, of all types. Connection will win :) See you very soon!


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