Not All of Us Are Saints: A Doctor's Journey with the Poor.

David Hilfiker's Not All of Us Are Saints provides, in a different vein, another recent North American exemplification of the "preferential option for the poor." Drawn to live in Washington, D.C., in 1983 out of a faith-inspired sense of obligation to help the poor, Hilfiker practiced medicine for ten years at Community of Hope Health Services, a small church-sponsored inner-city clinic, and at Christ House Mission Group, a medical recovery shelter for homeless men and a home for their caregivers.

On one level Hilfiker's narrative develops as a form of social criticism examining the institutional reasons--from substandard education and joblessness to racial discrimination and overly routinized and demoralized social service administration--that make escape from poverty nearly impossible for many people. In a beautifully clear and direct writing style, he provides a riveting account of his experiences with the world of overcrowded, underheated, and rodent-infested public shelters, of hospitals discharging patients with tuberculosis or other infectious diseases into the shelter system, of a city detoxification center which turned people away "because they weren't drunk enough," and of hopelessly understaffed child protective services which refused to investigate blatantly abusive families.

Writing in the vein of Jonathan Kozol and Alex Kotlowitz, Hilfiker's depiction of inner-city misery ought to stir the compassion of middle-class Americans and thereby inspire a deeper commitment to providing minimal health care. Yet he does not write naively or with a simplistic assumption that disclosing the suffering of the urban underclass will prompt immediate action from middle America. First, the personal consequences of the "internalization of poverty" penetrate more deeply than either social engineers or kindhearted voters realize. Second, the problem is not a lack of information but rather "compassion fatigue"--the fact that the wider public has become "numbed" to the deterioration of the inner city and to the suffering of those trapped within it.

On another level, the narrative constitutes a form of introspective analysis that probes with ruthless honesty the author's own complex reactions (including his fears, distress, and episodes of depression) when repeatedly confronted with the chronic physical and mental problems of his patients. His story explores the tensions and ambiguities he felt as a highly educated professional who attempts to be part of a community comprised primarily of people from another class, culture, and race, people utterly lacking in the basic support, opportunities, and hope that middle-class Americans take for granted.

Intense awareness of the disparity of opportunity heightens Hilfiker's sense of the injustice underlying the health problems of poor people and his anger at the unresponsiveness and cynicism found in some public service workers charged with their care. But acute cognizance of his own temptations, lapses, and failures prompts him to accept his own frailties and limitations as one basis for accepting those of his patients

The "preferential option for the poor" takes on a particularly personal character in the author's discussion of the impact of inner-city living on his own children, especially concerning their physical safety and education. Again and again, issues of personal responsibility and social fairness are examined. Living side-by-side with the "wretched of the earth," Hilfiker asks, "in what sense do I deserve my wealth? If I possess these luxuries while they suffer in poverty, can there ever be community between me and my patients at Community of Hope? What happens to my sense of integrity when I live so comfortably while those with whom I would be friends remain--by accident of birth--homeless and marginalized?"

Hilfiker develops a narrative rather than a prophetic mode of moral discourse, recounting his encounters with the innercity poor in a way that is sympathetic, sensitive, and yet entirely devoid of sentimentality. He offers a fascinating "phenomenology" of the "preferential option for the poor" from the perspective of one innercity physician, a man who is introspective without being self-absorbed, intelligent without being pretentious, and hopeful without being naive. Though unmistakably committed to Christian moral ideals, Hilfiker displays a spiritual center of gravity that never collapses religion into mere social activism or compassion. Like Wallis, because Hilfiker lives with the poor, he yearns to communicate "the terrifying discrepancy between the lives we live and our concepts of justice and mercy."

He succeeds.