Sylvia is a 58 year old marginally-housed woman who I became familiar with today for the first time. She was second on the sign-up sheet for the shelter clinic, and when we sit down to talk, she appears collected, sharp, and witty. Sylvia is knowledgeable about her extensive past medical history, which includes asthma, osteoporosis, hypertension, high cholesterol, diabetes, carpal tunnel syndrome of both hands, depression, and anxiety. More impressive is her ability to name all of her daily medications: albuterol and Advair inhalers for her asthma, metformin for her diabetes, lisinopril for her hypertension, sinvastatin for her hyprelipidemia, Zoloft for her depression, Klonapin for her anxiety, gabapentin for her chronic pain. She sought care today because she is feeling short of breath increased from her baseline that is not responding to her daily inhalers. She also describes some low back pain for which she would like some ibuprofen.
Despite Sylvia’s initial composure, she seems surprised when I deviate from the traditional medical interview and ask her, “How have you been doing recently?” It is almost as if this additional expression of personal concern tore down Sylvia’s wall, and she reveals to me that she has actually been under a lot of personal distress. Her best friend who is also battling depression recently gave birth to a baby boy, to whom Sylvia was the godmother. Just four days ago, her best friend locked herself and her baby in the car and attempted suicide by taking “a bottle of pills.” Worried family members called the police, who were able to reach the mother, but unfortunately not the baby, on time. Sylvia spent all weekend in the hospital with her friend and mourning the loss of her godson. Today was the first time she was able to take a little break to take care of her own health.
To address her immediate issue of Sylvia’s difficulty breathing, I examine her and find that she does not have significant wheezing. However, she does have has reduced peak flows (150-200 on three attempts) consistent with her an asthma exacerbation, so we give her a nebulizer treatment. She is provided ibuprofen for her back pain, and given that it is an unusually cold day, we also offered her a hat. She feels better and one of our staff members escorts her to the elevator.
An hour or so later, I run into Sylvia in the dining room where I notice that she has changed into a bathrobe. I comment that she looks comfortable and cute, but Sylvia nearly bursts into tears while telling me that she “wet” herself in the elevator because it was taking too long. Turns out, Sylvia suffers from urinary incontinence, a condition quite common among women but understandably embarrassing. Seeing her shame, I quietly offer to grab her some Depends adult diapers. I return with them concealed in a plain brown bag, and Sylvia gives me a small smile full of immense gratitude.
Sylvia exemplifies the great efforts that many homeless/marginally-housed women take to maintain facades of control and strength. Behind her strong exterior was significant personal loss and embarrassment about her common female condition (urinary incontinence). In a world of constant uncertainty, most women in unstable housing situations find that keeping their guards up is the best way to survive, both physically and emotionally. However, behind those walls is often immense insecurity and heartbreaking stories that want to be shared…
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