What do you do as a physician when you have all of the best medicines in the world, but can’t treat a patient’s disease simply because they don’t have a place to call home?
This was the question I struggled with as I entered Ms. Anderson’s hospital room. Ms. Anderson was a San Francisco native and shipyard worker for the majority of her adult life before she was laid off over thirty years ago. Due to a work injury, she couldn’t find another job and lost her home, living on the streets for the past three decades. Like the overwhelming majority of homeless in San Franciscans, she was formerly housed in San Francisco.
I had met Ms. Anderson two weeks earlier when she came into the Emergency Department with a broken hip. We admitted her into the hospital for a work-up and ultimately found that she had a new diagnosis of a cancer called lymphoma. Because of her memory impairment, we had the same heartbreaking conversation multiple times, with her desperately asking for treatment for her potentially curable cancer, because without it she would surely die.