I still do.

But I’ve been wondering lately about physicians who take a broader-than-average view of their responsibilities toward patients, who take “doing good” to a different level than most of their colleagues. What motivates and sustains them? How do they avoid burning out?

I decided to visit Dr. Roseanna Means, a Brigham and Women’s internist who’s spent much of the last 30 years caring for homeless women and children.

Over cans of Diet Coke at the Wellesley headquarters of Women of Means, the nonprofit she founded in 1999, Means, a small, intense red-haired woman in her late 50s, told me the story of her life, both personal and professional — though the distinction between the two has always been blurry.

Divorce and alcoholism dominated her childhood, but so did a call to activism, personified by the Kennedys. Robert F. Kennedy was her mother’s classmate at Milton Academy, and Joseph P. Kennedy II was Means’s. As a teenager, she organized Milton’s first Earth Day.

Though Means entered medical school intent on healing the poor, it soon became clear to her that this was not the school’s mission. She recalls stepping over the homeless on the street as she hurried to class to learn how to care for people.

In the 1980s, she moved her family to Costa Rica for a year, concerned that her young sons were getting too narrow a view of the world from suburban Boston.

During her residency — a job most find plenty self-sacrificing — she spent three months providing medical care to Khmer refugees on the Cambodian-Thai border.

“That was the defining moment for me,” she recalled. With limited access to medication and diagnostic testing, she told me, “you had to be a doctor on your feet,” improvising, addressing anything that affects quality of life. Further, in Asia she began to think of physicians not simply as healers, but as agents of social justice.

In the next few years, she brought both of these ideas to her work with the homeless. A manual she’s written for medical students and others new to this population covers foot care, nutrition, frostbite, subsidized housing, and domestic violence — issues about which doctors and nurses usually learn little.

Early on, Means noticed that women were much less likely than men to use medical and other services offered to the homeless. Shame and fear of being found by an abusive partner and of being beaten, raped, or robbed, all deter women from accepting government care programs. She founded Women of Means to meet the medical needs of homeless and impoverished women and children. Her team of paid nurse case managers, volunteer physicians, and mental health professionals, now provides 10,000 medical visits a year in seven shelters. Funded by donations and grants, not by taxpayer money, Means estimates that her organization has saved the Commonwealth about $15 million annually in acute and preventive care.

I visited the Newbury Street women’s shelter where Means sees patients every Tuesday. The shelter is housed in a church with some pretty upscale neighbors — Brooks Brothers and Armani to name two — and I imagined a grimly contrasting scene within. But Roseanna Means’s clinic, like her office, isn’t what you’d expect.

In the church’s brightly lit basement cafe, women of all ages ate breakfast.

Some scanned laptops or flipped through magazines. Two chatted over ceramic mugs of coffee. I spotted a young woman in crisp blue scrubs with a stethoscope slung around her neck and told her I was there to see Dr. Means. She looked puzzled, and I realized she was not a staff member but a guest, eating breakfast on her way to school or work.

The homeless and poor, Means later told me, don’t always look the way you’d think. Some work, some (but by no means most) have mental illness, many are educated. What they have in common is a history of trauma. Means says that nearly all of her patients have been victims of abuse or violence. These experiences make it difficult for women to trust anyone, including doctors. Some of the women at the shelter actually have doctors elsewhere, but don’t trust them and rely on Means as a liaison and advocate. The fact that she’s also experienced trauma — divorce, violence, cancer, the loss of a child, and financial hardship — helps Means create alliances with her patients.

Women arriving for breakfast or lunch can sign up for a medical appointment. Means escorts them up to her fourth floor clinic one by one, first come first served. There are no co- pays, no insurance forms, and minimal medical records.

No one looks at the clock — she spends as long with her patients as they need.

This is, as she says wryly, “concierge care for the homeless,” and it satisfies the caregivers as much as the patients. Means has a waiting list of doctors and nurses eager to volunteer.

One of the patients Means saw the morning I visited was Rochelle.

In the past, Rochelle had been homeless and supported herself through prostitution. She now has a place to live and, with Means’s encouragement, recently completed training to be a medical assistant.

Rochelle is undergoing treatment for breast cancer. Means checks her mastectomy scar, congratulates her on finishing her degree, and asks about job prospects and her chemotherapy-induced nausea. At the end of the visit, Means hugs Rochelle and Rochelle hugs her back. Rochelle hugs me, too, and even offers me advice on what to write in this column. “Just say,” she tells me, “that here, they do health care right.”

For more information about Dr. Means and her work visit: www.womenofmeans.org.

–

By Dr. Suzanne Koven
Globe Correspondent / April 23, 2012

Thanks to Daisy Troop #75296 from Wellesley for their generous donations! WoM received help from throughout our community. Children, students, professional volunteers and incredibly generous donors make our work possible…

Read, “The 2011 Champions of Health and Fitness”, Fitness Magazine, January, 2011.

Dr. Roseanna Means and a beloved patient.

December 2010
 
They come in, our beloved ladies, in worn jeans and faded sweatshirts, in long skirts and scarves that they would wear in their native countries, in tattered blazers that they were lucky to pluck from the pile of second-hand clothes. They sit in the rocking chair knitting.  They sip their coffee and do crossword puzzles.  They chat with others.  They bicker about the other women.  One woman arrives after her radiation treatments for breast cancer.   Her cheeks are gray.  She is depleted, but she put her lipstick on in defiance.  Another collapses in the chair beside me to tell me about her husband, the same story I have heard twenty times.   She misses him. They were together for 52 years.
    
The Kenyan grandmother is making scarves; a jumble of yarn peeks out from her cloth bag.  Her face bears the map of African wisdom and patience.  She calls me “my daughter”. The woman with AIDS asks me to listen to her cough. It began over the summer and isn’t responding to antibiotics. Lines crease her forehead while I put my stethoscope on her chest.  I help her make an appointment at the hospital for a chest X-ray.  A younger woman shares with me that when “the deaf lady” died, she stayed with her at the hospital and held her hand until the end, and the spiritual connection that was forged by those shared moments inspired the younger woman to go to nursing school to become a hospice nurse.
   
 My heart both lifts and breaks when I see one tiny woman: I know she has liver cancer and that it is only a matter of time before it will claim her, so her arrival fills me with joy.  She carries herself with grace and more energy than is possible to imagine under the circumstances.  She is cachetic, a wisp hidden under a hat to hide her nearly bald head.  She comes to pick up the cans of liquid protein drink that we buy for her.

So many women, so many stories.

Each one gets a hug and a kiss from us.  We love them.  They could be our mothers, our grandmothers.  They should be sitting in their living rooms, talking about their day with their families, reading notes from their grandchildren, taking cookies out of the oven, decorating the front door for the holidays.
    
But these women are homeless and poor.  They sleep outside or in crowded shelters. They have to ask for everything, eat what is being served, walk the streets to pass the time until the doors open in the evening for a bed for the night, wear someone else’s old clothes.  They are alone.  Sometimes they pull out old wrinkled photographs from happier times, younger days, pictures of relatives that used to care about them but who aren’t around anymore.
    
Nearly 8% of the women we care for in the shelters are over 70 years old.  These are the least, the lost and the last.

Please help us continue to give them the medical care, the supplies, but mostly the love that is missing from their lives.
 
Sincerely,
 
Roseanna H. Means, MD
Founder and President

After being named as a 2010 Community Health Leader by the Robert Wood Johnson Foundation, Dr. Means and the invaluable services provided by Women of Means have been highlighted in local media.

Read “A Dose Of Compassion,” The Boston Globe, Monday, September 6, 2010

Read, “Treating Homeless Women in Boston: Six Questions for Dr. Roseanna Means” by WBUR reporter Rachel Zimmerman