1. Kane, Cheryl MEd, BSN, RN


A cold day on the waterfront, a nurse, a homeless man, and a canary yellow coat.


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Patrick had once been a fisherman, living in Boston's North End, a predominantly Italian neighborhood until the young professionals moved in and many old-timers moved out. He had been married and gainfully employed before his life spiraled out of control and his low self-esteem, gambling, and drinking resulted in divorce and homelessness.

Figure. Illustration... - Click to enlarge in new windowFigure. Illustration by Eric Collins /

Patrick was disheveled, dirty, alcoholic, and feisty, although he could be a real charmer. Seventy years old, he was slight of build with a ruddy complexion, a bushy gray beard, and long, dirty fingernails.


Patrick hung out near the New England Aquarium next to the harbor. He spent his days stemming-street slang for panhandling. In the evening, he slept between Jersey barriers on a busy street that traces the shape of Boston's shoreline. In cold weather, he would wrap himself in the dark gray, felt-like blankets homeless advocates hand out when the temperatures drop.


As a member of the Boston Health Care for the Homeless Program's street team, I had been his nurse for several years. I knew the outlines of his early life: his mother died young; his stepmother rejected him. He often talked about killing himself. I once asked Patrick if he was scared to die and he told me that even God wouldn't want him. He rarely accepted health care from our team, but occasionally would allow us to take him back to one of the shelters for a shower and change of clothes.


One fall day, Patrick had been lying on a wall that ran along Boston Harbor when a friend pushed him into the water. He suffered a massive coronary and was hospitalized. A few weeks later I got a page from the local hospital, saying Patrick had left the hospital against doctor's orders, wearing only a hospital johnny and a vest.


It was an unusually cold Sunday in October. I rushed out to look for him. I wasn't surprised to find him in his usual spot between the Jersey barriers, swathed in blankets. I led him across the street and asked him to wait in front of the Dunkin' Donuts while I went to get him some clothes. When I returned with a set of men's clothes and a canary yellow down jacket, Patrick looked at me, then glanced disdainfully at the jacket and said that if he wore it, he would stick out like a sore thumb. He asked me where in the world I had gotten it.


I told him that it had belonged to my husband, Jim. When he asked me if he no longer wanted it, I told him Jim had died two years ago and would have been very happy for him to use it. Patrick's demeanor softened. "Oh, honey. I'm so sorry. Go into that Dunkin' Donuts, buy yourself a coffee-put it on my tab," he instructed. "Then come back and tell me all about your husband."


I went into Dunkin' Donuts and bought a coffee. I paid for it myself. When I returned, he invited me to sit on a milk crate and tell him about my husband. I told him how we hadn't been married for very long before Jim developed a brain tumor, how sick he had gotten, how he loved to run marathons. What I didn't tell Patrick was that our wedding anniversary was that weekend. It was always a difficult time of year for me. My moments of connection with Patrick made it a little easier.


That encounter with Patrick shaped my nursing practice. Working with long-term homeless people can be very challenging, physically and emotionally. Their lice-infested bodies can disconcert even the most experienced nurse. Cleaning them can take your breath away. They can be rejecting, belligerent, ungrateful.


Yet here was this homeless man who fit every stereotype, reaching out to me at a time when I was very vulnerable. His generous spirit and sensitivity taught me the importance of looking beyond the exterior. The tenderest of souls can be contained within the most unlikely of vessels. You just have to take a moment to look.


Our patients have been victims of emotional, sexual, and physical violence. Their ability to trust is limited. When a patient trusts us enough to tell us who they really are, it is a sacred moment.