Dragged down by poverty's undertow

October 27, 1994|By Gerri Kobren | Gerri Kobren,Sun Staff Writer

It's no great secret that many of our nation's inner cities are disaster areas, beset by poverty, homelessness, hopelessness, drugs and crime. Nor is it news that we are remarkably short of the saintly types whose lifelong vocation it is to toil in that hostile soil.

For some lesser mortals, the calling is of limited duration. In 1983, Dr. David Hilfiker, a family physician, decided to join an inner-city Washington clinic staffed by the members of his ecumenical religious community. With his teacher wife, Marja, and their three children, ages 4 to 12, he moved first into an apartment near the clinic, and then into staff quarters at Christ House, a "medical recovery shelter for homeless men . . . dedicated exclusively to the care of those too sick to be on the streets."

The 10-year sojourn is described in this sincere and troubling memoir (subtitled "A Doctor's Journey With the Poor"). It is, Dr. Hilfiker warns, not about medicine except in a peripheral way. Rather, it "is about the nature of poverty and its awful power to break the human spirit."

Look at John Turnell, a name-is-changed-to-protect-his-privacy 44-year-old man. He is alcoholic, homeless and out of work, incontinent, impotent, partially numb and otherwise in pain. He's also depressed, suicidal, resistant to treatment -- when, indeed, the free psychiatric care and detoxification he needs can be found.

Or Joanne Torson, who, at 37, has already lost an arm and a leg to gangrene from repeated heroin injection and subsequent infection. She's been arrested on a drug bust, sent to the hospital, discharged back to jail and released to the street on $10 bond. No one is willing or able to treat her addiction.

Or David Lawson, 37, retarded, alcoholic, hypertensive, with pancreatitis, ulcers and seizure disorder. He's admitted to area hospitals through the emergency room several times a year; but there's no follow-up. Dr. Hilfiker, seeing him in an outpatient clinic, can't get discharge summaries from the hospitals.

This is chaos too deep to bootstrap out of. How is a diabetic to follow a diet and administer insulin when home is on the street, shelter is a one-night-at-a-time arrangement and food is whatever one can scrounge? How are abused children, who are the children of abused and uneducated children, supposed to grow into healthy, hopeful, law-abiding adults?

What happens when tuberculosis patients go back to the streets after brief hospitalizations? "All too often," Dr. Hilfiker answers, "within months the still-infected patients are again coughing up the contagious [TB] bacilli."

Amid the despair, the Hilfikers seem to have lived in a remarkably normal way, untouched by fear or crime (except for a stolen bicycle). On the other hand, they were not exactly living with the Christ House patients; the professional staff had apartments on upper floors, with a separate entrance, locked doors, modern amenities.

But even if they had been more completely in the milieu, they could not really have been a part of it, the author reflects: They have what the poor do not -- education, competence, a history of success in maneuvering through American society. He's got a steady salary besides -- $34,000 a year plus the apartment.

Agonizing over the morality of his luxuries, he puts his older daughter through a wringer over orthodontics: Are the recommended braces truly necessary, or merely cosmetic? Isn't it reprehensible to spend $3,000 for his child's teeth when other children don't have homes?

Or, perhaps he's been wrong in blaming social injustice: Could it be that the poor, with their deranged habits, are themselves responsible for their own destitution?

Or is that just a rationalization, allowing him to blame the victims, when he recognizes that he himself is less than the Good Samaritan?

For those who worked at Christ House -- some of them volunteers -- the journey, he writes, was from optimism to anger at the social system to anger at the patients to anger at themselves for being angry and finally to an acceptance of the limits of what they could do.

There were a few people who managed to pull their lives together. For most, however, the "undertow . . . is overwhelming . . . dragging away almost every chance for what the rest of us might call a normal life." Over time, it's become steadily worse, he says: "Society has given up, and no major figure of either political party as much as suggests plausible steps toward a possible restoration."

In 1993, Dr. Hilfiker gave up, too: Burned out, he took a year off for recovery -- another demonstration of unfairness, he says. People like him, with money, skills and support systems, have the real safety net.


Title: "Not All of Us Are Saints"

Author: David Hilfiker

Publisher: Hill and Wang

Length, price: 259 pages, $20

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