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In the dull fluorescent lights of the hospital John appears an old man. He's tall and spare, with half a head of hair, a wide, furrowed brow, and sunken eyes edged in dark rims. A thick mustache wraps around grimaced lips skewered by a toothpick.

"Doctor..." His eyes pivot to the bathroom. "Doctor..."


"Do you mind if..." He grabs the bedrails and pulls himself up, slowly, like a fly on a cold morning. He throws his swollen legs over the edge of the bed and stands, his arms outstretched, balancing. I reach to keep him from falling. "Do you mind if we go into the bathroom?"

"Do you have to use the bathroom?" I ask.


"You don't have to use the bathroom?"


My eyes narrow in a puzzled squint. "I'm not sure what you're asking then."

"I'd feel more comfortable talking to you in the bathroom."

"Are you worried someone will hear our conversation?"

"No, it's just..." He stares at the floor.

Beads of sweat collect on his forehead. "Can we just sit in the bathroom? Please? The nurses said you would."

I nod. I'm bewildered of the purpose of sitting in the bathroom, but it's clearly important to John. So I help him pull a long, coiled oxygen tube and a metal pole with a half-empty bag of intravenous fluid into the tight constraints of an old hospital bathroom with gloomy green tile and a small shower. He sits in a hard slant on the toilet breathing short puffs of breath, I sit on the stiffness of a bedside commode. We're so close I can smell tobacco on his breath. He glares into the mirror, touches his cheeks, and wipes bubbled spittle from the corners of his mouth. Then he turns his head side to side, as if to be sure he still exists. I look around and wonder if the small room seems confining to him since he's homeless and accustomed to open spaces, but he relaxes once the door shuts.

"Is there a lock?" he asks. "I haven't been able to find one."

"No, no locks allowed on hospital bathrooms. But I can ask that we not be disturbed if that would make you feel more comfortable."

"No, no need to do that." He puckers his lips and gulps several shallow breaths.

"Doctor, I'm not quite sure why you're seeing me, but I was told you could get me on hospice, is that right?"

"Yes, that's right. But hospice may be hesitant to see you if you're homeless. Do you have any family or friends who could take you in?"

"I don't have anyone doctor, at least no one who has four walls, a door, and a roof. All my friends are street people, and all my family's dead. I'm what you call dirt poor, been that way my whole life. I'm from the sticks of West Virginia, you know, Appalachia. When I was a kid, there was never enough money; we lived paycheck to paycheck. Sometimes we didn't even make it to the next paycheck. But we kids didn't know we were poor until we went to school. I remember a boy in my class--I must have been in ninth, maybe tenth grade--said I was white trash, and the pants and shirt I was wearing were ones his parents had donated to the Goodwill store. I told my mother. She said, 'Don't pay him no mind, we may be money poor, but we're love rich.' And she was right, but that boy's words changed my life. I never went back to school. Been drifting ever since, working odd jobs and begging on the streets."

I sit there, unsettled, my shoulders slumped in sadness. His story is one of social sparseness, and the scathing injustice of poverty. Yet he has a humble dignity that transcends his daily struggles. "I admire your perseverance. You've had a hard life."

"No harder than some," he says, "but this lung cancer's a hard one. I can tell from what the cancer doctor says there's not much they can do."

"I know the social worker applied for Medicaid, but that might take a while. Let me see if I can find a hospice that will admit you to their inpatient unit. You could stay there..." I forgo the words "until you die;" they're not necessary.

His face eases as he swerves the toothpick around in his mouth. "That would be great doctor. Thank you so much."

I hesitate a moment, then ask, "Do the other doctors sit in the bathroom with you?"

"No, the cancer doctor refused. He's in and out in five minutes anyways. He doesn't want to know anything about me other than my cancer."

We sit in a shared silence, the hissing of oxygen the only sound. Finally, he scratches the sandpaper stubble on his chin and says, "I suppose you're wondering why I want to sit in the bathroom."

"I am," I say, "but I figured you'd tell me when you were ready."

He pulls the toothpick from his mouth and heaves a rattled, phlegmy breath. "Doctor, I'm homeless. The streets are violent and uncertain, especially for older men. We're easy prey; you never know if you're going to be robbed or beaten or killed." Ragged sobs rise from his throat. "Why do I want to sit in the bathroom? Because when you're homeless, when you don't have anywhere to go, the only safe place is a locked bathroom."

Name and certain details have been changed to protect individual privacy.

Received March 11, 2019

Revision received July 6, 2019

Accepted July 30, 2019

Paul Rousseau, MD

Charleston, South Carolina

Correspondence concerning this article should be addressed to Paul Rousseau, MD, Independent Practice, 1531 Wakendaw Road, Mount Pleasant, SC 29464. E-mail:
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Author:Rousseau, Paul
Publication:Families, Systems & Health
Date:Dec 1, 2019
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