Healthcare on the Margins: Rosemary Zimmerman

I am opening a small, independent, and most importantly free home-visit primary care medical practice focused on the needs of the highly medically complicated indigent poor.

Patients who are simultaneously both very ill and also deeply impoverished often struggle with transportation, so I would only make “house calls,” the phrase placed in quotation marks to encompass shelters, long-term-stay hotels, or the street. (This also means I don’t need to fundraise for the significant overhead costs of a clinic space.)

As I have spent most of my career working as a hospitalist (a primary care provider who works only in a hospital, providing general medical care to acutely ill and often very medically complicated hospitalized patients), I have a much more extensive familiarity with medical complexity than many primary care providers.

I often send patients home from the hospital knowing that when they go home they will lose all access to medical care: they are too impoverished, too medically fragile, or too both to be taken care of in any clinic. Sometimes there are other barriers, too. These patients break my heart; my ministry is designed to help them.

A few stories:

  • A quadriplegic who required long-term tube feeds was hospitalized when she lost access to food; her primary care doc left the practice and no one else was willing to take on the management of tube feeds at home. Either they felt uncomfortable with her medical complexity or they thought “she should just be comfort care.”
  • A young man—developmentally disabled, homeless, and illiterate—had a medical condition (diagnosed on biopsy) causing severe, uncontrollable, and near-constant diarrhea. He required adult diapers to manage this, which naturally he could neither afford nor obtain. The predictable results meant that he was tossed out of every living arrangement ever offered him, and that he could not use public transit to get to medical appointments.
  • An elderly Guyanese woman came to America to visit her family and overstayed her visa by at least a decade. She then developed a severe condition requiring complicated medical care, and then—to cap it off—fell and badly broke her leg. She now required specialized medical transport to make it to her many appointments. Her family was devoted to her, but absolutely unable to afford the vast costs of so much out-of-pocket medical care.

What could be done for any of these patients? In each case, we had very little left to give; we discharged them each to a homeless shelter or the cobbled-together care of overwhelmed (or sometimes disinterested) relatives or simply to their own best efforts.

One evening I found myself apologizing to a different patient’s sister. This patient was a young man who had a very severe medical condition which could be more or less directly attributed to some of his own very poor (and very repeated) choices. The evening of this conversation, he had ripped out the various tubes and lines keeping him alive and walked out of the hospital with the obvious intention to go right back to the various activities which had brought him in to us.

I am so sorry, I told his sister, that I couldn’t do more for him. I couldn’t make him stay. I couldn’t make him want to be well.

His sister looked at me and said, ‘you gave him what almost no one else ever has. Most people look at him and only see his mistakes. When you looked at him, I could tell that you saw my brother, my sweet brother I love. He was a person to you. You gave him everything that matters.”

And there it is. That’s why what I do isn’t simply a charitable medical practice—though surely it’s that and practical help matters—but is also a ministry. Because if God has given me one gift of His Spirit, it is the ability to look at the absolute “least of these”—the ones who are “addicts” or “should be on hospice” or “shouldn’t be here in the first place” and see the face of my Beloved — the face of the incarnate Christ.