All I could think about as I was transferred from the ambulance gurney to a bed at Harborview Medical Center was how intense the pain in my hand had gotten. Two of my fingers were already swollen to twice their size with pus secreting from the wound sites.
I told the nurse I injured my hand that night during a psychotic episode, which occurred after several sleepless nights protecting my belongings from the other homeless shelter residents. Our conversation was cut short when I mentioned being high on meth, even as I explained to her how that’s one of my few ways of staying awake to guard my things from theft.
The nurse left for about 10 minutes, then returned to my bed with an anti-anxiety medication, applied one Band-Aid over a small part of my wound and handed me my discharge papers. I quickly protested, asking for a closer look at my fingers, as I was unable to move them and they were in significant pain.
The nurse responded by telling me that the hospital is not a hotel and threatened to call security, so I left to avoid escalating the situation. It was clear to me that they didn’t view my concerns as credible in part due to their assumptions about me based on my homelessness and drug use.
After I was discharged from the hospital, I spent the rest of the night on a sidewalk in Pioneer Square until my dad picked me up mid-morning. My dad immediately brought me to a different hospital’s emergency room after he noticed the severity of my infection, and it wasn’t until he directly spoke with the providers that they agreed to investigate my infection further.
Following their assessment, I was quickly admitted and scheduled for an emergency surgery after the nurse told me my fingers might need to be amputated. I was elated to see all of my fingers when I woke up from the anesthesia, but I was still in pain from the work they had to do to save them.
The scars from my surgery serve as a permanent reminder of where my journey in recovery began and exemplify an invisible yet substantial barrier to housing for many of our unhoused neighbors: the prejudices medical providers have against homelessness and substance use disorders.
Stigmatizing beliefs in medical settings, like thinking unhoused people only seek medical care to get drugs or are too lazy to take care of themselves, can lead to health care providers minimizing the severity of symptoms, misdiagnosing problems or dismissing serious health concerns. Being housed or sober could be the difference between surviving a life-threatening infection and entering an early grave.
Research conducted by the Journal of Patient-Centered Research and Reviews revealed that negative health care experiences can also discourage unhoused people from seeking help for future health concerns, resulting in life-threatening infections going untreated. Under the combined burden of multiple physical and mental health conditions, a lack of access to trauma-informed health care significantly hinders unhoused people from improving their overall quality of life.
When, because of bias, trusted services fail to provide the care they promise, especially to under-resourced communities, everyone is harmed.
A study by the Western Journal of Emergency Medicine revealed that, due to lack of access to proper health care, unhoused people are more likely to be readmitted to a hospital within a 30-day period than housed people. This pattern costs the U.S. health care system approximately $320 billion in avoidable expenditures, increasing everyone’s health care costs, according to a 2021 Deloitte report.
Health care bias is a reflection of a broader societal prejudice against unhoused individuals, which is evident in laws that criminalize poverty. These laws restrict access to affordable, supportive housing by further destabilizing people who are already under-resourced. Our collective well-being depends on how we treat each other, regardless of housing status.
We are inextricably tied to both our housed and unhoused neighbors. By addressing our internal biases, we can contribute to building a better health care system and equitable infrastructure for all.
K.W. is a volunteer with Stop the Sweeps.
Read more of the July 3–9, 2024 issue.