Doctor and medical student serve lunch, dignity and more to homeless patient

Christeebella (Bella) Akpala and Allison Ducharme-Smith, M.D.

When a patient experiencing homelessness revealed his favorite meal, Allison Ducharme-Smith, M.D., made a point to deliver it to him for lunch one day. Medical student Christeebella (Bella) Akpala delivered, too, helping connect the patient with a place to call home.

The hospital was somewhere Ben (not his real name) had been before. He didn't like it then. And he didn't like it now.

The middle-aged man had lived with heart failure for years. He'd been homeless most of that time. While living on the street wasn't compatible with managing a chronic health condition, Ben wasn't fond of the hospital experience.

"He is used to independence," says Allison Ducharme-Smith, M.D. "Being in the hospital feels like being in jail to him."

Still, the hospital was often where he needed to be. Which is why he'd been admitted, once again, to Mayo Clinic.

"Ben is on a lot of medications," says Dr. Ducharme-Smith, an internal medicine physician. "Out on the street, he'll run out of his medications, or they'll be stolen. His situation is an example of our broken system."

That's a system Dr. Ducharme-Smith sees up close through her work at Mayo and as medical director of the Good Samaritan Health Clinic, which provides free medical and dental care to people without insurance.

"Discharging Ben back to the streets hasn't been working. But what else can we do?" she says.

Building trust through shared experience — and lunch

That's a question that interested Christeebella (Bella) Akpala, a medical student who met Ben during his most recent hospitalization.

While it might not seem like the two had much in common, Akpala recognized how her story intersected with Ben's. As a new immigrant, she had also once been homeless.

So, after learning about Ben's immediate needs (he was hungry) and asking about his family (he had a brother), Akpala shared her experience with homelessness.

"I told Ben I understood some of what he was feeling," she says. "You feel like everyone is trying to take advantage of you."

The shared experience helped Akpala gain Ben's trust. And that trust grew during the days of his hospitalization, as Akpala continued to do things that let Ben know he mattered.

For example, she and her colleagues ensured he received snacks and drinks each time he requested them.

"We didn't want him to endure the food insecurity he was enduring while on the streets," Akpala says. "It was difficult because he wanted a lot of snacks, but knowing that food insecurity was a potential trigger for him, Dr. Ducharme-Smith gave us the go-ahead to ensure he got whatever snacks he wanted from the floor."

Another worry of Ben's was his mail, which he has delivered to a post office box. During past hospitalizations, the mail had been returned to sender. Akpala also arranged for an indefinite hold on his mail.

And she spent time with a chair pulled up next to Ben's bed, talking.

"I assured him that I was there for him and that the rest of his team was there for him as well," she says. "I was able to assure him that he was safe and that our intentions were good."

Special delivery

When Akpala mentioned Ben's favorite meal — a burger with toppings on the side and a milkshake — to Dr. Ducharme-Smith, she took a step to build his trust, as well, making a trip to a nearby restaurant (a local favorite) over her lunch break to pick up the meal and deliver it to Ben.

And while Dr. Ducharme-Smith and Akpala had hoped to have lunch with Ben that day, he was in no mood for company.

"He was curmudgeonly, so he ate by himself," Dr. Ducharme-Smith says. "Which was perfect because it was what he wanted. But he still knew someone was thinking of him and cared about him."

That caring didn't end with the noontime delivery. Akpala worked with colleagues from Social Work and arranged for Ben to move into a group home when he was discharged.

"In the past, he'd been sent right back to the streets when he left the hospital," she says. "Now, he's in a safe place. He has a room with a door. So we made progress. "

That progress is motivating, says Dr. Ducharme-Smith.

"You see patients like Ben coming in and out, and you feel like you're hitting your head against the wall," she says. "Seeing small changes, seeing a patient cared for in a way that makes him feel seen and heard, is rewarding. And seeing an incredible student like Bella use her determination and persistence to help him find permanent housing is inspiring."

Akpala says that inspiration goes both ways.

"Seeing Dr. Ducharme Smith make the effort to get Ben lunch was humbling," she says. "If you wonder how to raise a new generation of empathetic physicians, it's by showing them how to be empathetic. Consultants like Dr. Ducharme-Smith model that behavior. Making individual efforts for people like Ben is the only way you can change the world."