Chapter 07: Discovering Work with Underserved Populations

Chapter 07: Discovering Work with Underserved Populations

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Description

In this chapter, Dr. Holleman talks about a third formative experience that shaped his professional focus. He explains that he decided to volunteer at Ben Taub Hospital, a hospital for the underserved where Baylor medical students and residents were trained, in order to understand what his students in the humanities program were experiencing. He tells some anecdotes to show how his time there opened his eyes to the suffering of both patients and young doctors and led to his conviction that this was the population he should be working with.

Based on this, he explains, he started a home visit training program for residents and eventually added a program for conducting health visits for the homeless. He talks about the evolution of these programs and how they led to his decision to go back to school, as he was effectively running a community health center [the Search Center] and functioning as a coordinator and counselor.

Identifier

HollemanWL_01_20170412_C07

Publication Date

4-12-2017

City

Houston, Texas

Topics Covered

The Interview Subject's Story - The Clinical Provider; Professional Path; Influences from People and Life Experiences; The Clinician; The Administrator; Character, Values, Beliefs, Talents; Ethics; The Researcher; Professional Values, Ethics, Purpose; Experiences of Injustice, Bias; Discovery and Success; Human Stories; Offering Care, Compassion, Help; Patients; Patients, Treatment, Survivors; Formative Experiences; Evolution of Career; Professional Practice; The Professional at Work

Transcript

Warren L. Holleman, PhD:

But then I still—the third formative experience, for sure, I said, well, if I'm going to—well, I started volunteering at Ben Taub Hospital. I had read this book called, The Hospital, by Jan de Hartog.

Tacey A. Rosolowski, PhD:

Don't know it.

Warren L. Holleman, PhD:

And my wife and I both read it, and it really changed our life. He had been a volunteer at Jefferson Davis Hospital, which was the predecessor to Ben Taub. And then he was at Ben Taub when they moved over there in 1962 or '63. And he wrote a book about his experiences as a volunteer nurse, nurse's aide. And I said, I want to do that, because I want to know—I mean, our students and residents were all training at Ben Taub and Jeff Davis, Ben Taub primarily at the time. And I said, how can I teach them if I don't know what it's like there? And that book, it inspired me. So I started volunteering there. And that really exposed me to both the suffering of the indigent patients there—I mean, the suffering because they were sick, and then on top of that because they had limited resources. But also, the suffering and challenges of the young doctors and nurses who worked there. It was a very challenging environment. And—

Tacey A. Rosolowski, PhD:

Tell me a little bit about what it was—

Warren L. Holleman, PhD:

So that made me want to get more clinically involved. So I eventually went back to school. Just, you know...

Tacey A. Rosolowski, PhD:

I was curious, what were some of the things that you witnesses among the patients and among the young doctors that affected you so much?

Warren L. Holleman, PhD:

One memory that I think about often, a 12-year-old boy—okay, so a little back story. When I went there to volunteer, something happened that was exactly what had happened back in 1963, when this group of volunteers tried—when they started wanting to volunteer in the hospital, the head of volunteers refused to let them volunteer, because they did not want to expose the general public to some of the suffering and the problems in the hospital. And they kept trying to push them into administrative roles. So I went there to volunteer, and they said, "Okay, we're going to assign you to work in the little store." So I said, "Okay, I'll start there, but I really would like some patient contact." They said, "We can't do that. Too many legal problems with that." And it turned out, there was a whole lot of politics going on with the volunteer office that I could not believe. But anyway, I started working in the store, and I became friends with the head of volunteers. And I said, "Isn't there something I can do?" And he said, "Well, we have this one thing. We have this room that's full of magazines, because we used to have a "magazine girl," and we stopped having that. And people kept donating magazines. If you'll go in and organize those magazines, I'll let you be the magazine girl." (laughter) I said, "Perfect!" So I have a cart, I go around and I give patients magazines, and I talked to them. That was a godsend. So I think I was the only volunteer at Ben Taub who actually talked to real patients.

Tacey A. Rosolowski, PhD:

My god.

Warren L. Holleman, PhD:

And I was doing my magazine girl routine, and I came across all kinds of things. But one memory was, a 12-year-old boy, and I said, "Could I get you a magazine? And how are you doing?" He said, "I'm so hungry." I said, "Oh, well, let me see if I can get you some food." And he said, "I don't think so." So I went to the nurse's station, finally, I get their attention. "No, he can't eat, he's waiting for surgery." I said, "Okay." I go back to him. He's been waiting for surgery for two days. He had broken his arm, but because he was low priority, he wasn't dying, he kept getting bumped. I thought, when I was 12 years old, not eating for two days? That would have killed me!

Tacey A. Rosolowski, PhD:

Yeah.

Warren L. Holleman, PhD:

I just could not believe it. And they said, "Well, we think we're going to work him in today. So we don't want to—if he eats, then he has to wait another"—whatever the waiting time is. And I just could not believe they were treating this poor kid—and he didn't have any parents there, any family members. He was there by himself. So I kept coming back to him, and he was always there by himself. And I just couldn't believe it. I'm guessing his parents were working, they couldn’t get off work. And he was just sort of lost in the system. So I've always remembered that kid. There were several things like that. But that's a very vivid memory. I'll tell you another memory that I—so I was teaching Medical Ethics, and I'll never forget this. I was pushing my cart down the hallway one day, and I heard this screaming coming from a room. "We're not going to kill you!" And I thought, what? You don't say that in a hospital! "I said, we're not going to kill you or anything." And then he said, "Just sign the piece of paper. That's all it says. It's called a 'consent,' 'informed consent.'" So I had studied informed consent, you know, in the ivory tower.

Tacey A. Rosolowski, PhD:

Right. Sure.

Warren L. Holleman, PhD:

And I knew that informed consent wasn't really signing a piece of paper, it was the conversation that the doctor or nurse had with the patient. And the paper was just the documentation of that conversation. And so he was—this young doctor was breaking every rule in the book. On top of that, so I just stood in the doorway and watched. It was a frail, elderly woman who was scared to death. She was very sick, very scared to death. They wanted to do some procedure, some test, which I'm sure she needed. But instead of sitting down and holding her hand, and doing it the right way, he just crammed this piece of paper in front of her. And she froze. And it was just like that young surgeon and that was trying to stick the needle in the spine of that mentally retarded teenager. He was just—the more she resisted, the harder he pushed. Which is so wrong. So I never forgot that experience. And I thought, this is the way informed consent is done, they shouldn't even have informed consent, if that's what it is. You know? So—

Tacey A. Rosolowski, PhD:

How long did you volunteer there?

Warren L. Holleman, PhD:

It was more than a year, it was less than two years, when I said, this is the population I want to work with. So at the time, Family Medicine department had a requirement that all the trainees do home visits. So I said I want to get more clinically involved, and I want to work with not just private patients. So I volunteered to run the Home Visit Training Program. And the Home Visit Training Program was usually to elderly people, and it was about not only providing better medical care for them, but to help the residents understand how your living situation affects your health. So we developed this psychosocial questionnaire, sort of checklist, of things to discuss with the patient about how they're—everything from their living situation, their culture, their religion, everything affecting their health. And it was the coolest thing. We'd go for two or three hours and just talk with a patient. And the residents would always leave that saying, "I didn't know how important all this stuff was." So that got me out in the community, and that sort of introduced me to community health, and to some of the community health centers around the city where our Baylor doctors worked. From there, one of the residents said, "Instead of doing home visits like this, for my home visit, could I do home visits to the homeless?" So this was around 1988, 1989, when the term "homeless" was really just coming into vogue, and the government was giving grants for healthcare. They started this thing called "Healthcare to the Homeless." So it turned out this resident, her name was Idalyn Cyprus, her mother was Shelly Cyprus, who started the SEARCH Center for the Homeless downtown. She was a social worker; she had just started that. That was the first multi-service program for homeless people that wasn't—other than sort of the traditional gospel missions. It was more of on a social work model. So we started—Idalyn and I went down to that center, and we stuffed our backpacks with medical supplies. Well, initially we just took our questionnaires, and we just wanted to interview them about their health. That was amazing. We started bringing other residents and trainees along; medical students, nurses. These interviews were just—you could have published every one of them, it was just incredible. We learned so much. But then, we couldn't just do that. So we started stuffing medical supplies in our backpacks and taking that down there. And if they'd say, "Look at my foot," and they'd have a big open wound, we would dress it, you know. Then one thing led to another, and we started going on the outreach van around the city. For the next several years, we would go—we literally did home visits to the homeless. We went out to the little communities where they lived; in the woods, under bridges and buildings, with our medical supplies. And we built a relationship with them. And they would let us talk to them and treat them. Eventually, some of them would come indoors to our clinics for more extensive care. So I really got excited about that. So we wound up starting a clinic at the SEARCH Center. It was really—I'm really proud of that. We were caring for thousands of people a year within a very short period of time. And our goal—so I was running a health center now, community health center, with no training or credentials. I found that my role was generally—I was somewhere between a nurse and a psychologist. I was the one who was there all the time. The residents and doctors would rotate through, and nurses and psychiatrists. But I was always there, so the patients knew me. The returning patients. So I was often functioning as the liaison, kind of the coordinator of care. But I was also in a kind of a counseling role, because so many of their issues were relational and psychological. That's when I decided to go back to school and get this master's degree in family therapy. That really opened up a new world for me. I started—I would write grants to pay for our clinic, and I would write into the grant that we needed a marriage and family therapist. Of course, homeless people need a marriage and family therapist, which is kind of funny, because most of them don't have marriages or families. That's the whole reason they're homeless.

Tacey A. Rosolowski, PhD:

Right. Right.

Warren L. Holleman, PhD:

So I had myself working there as a clinician, mental health clinician, but also being the administrator.

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Chapter 07: Discovering Work with Underserved Populations

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