Nothing Left to Lose

Dr. Randy Christensen released his first book, Ask Me Why I Hurt: The Kids Nobody Wants and the Doctor Who Heals Them, in April, 2011. The memoir, which took him two years to write, describes his experiences operating a mobile clinic that services homeless teenagers in Phoenix and his attempts to provide them with necessary medical care. He chronicles everything from the struggles of the clinic's early beginnings, to the support system it became for the kids, and the ultimate recognition it achieved.

Meet the Author - By Bruce Morgan - Fall 2011

Back when he was a medical student, Randy Christensen, M.D./M.P.H. '95, used to pass through Harvard Square and see the Bridge Over Troubled Waters medical van parked there, ready to welcome homeless patients aboard. "That's a neat idea," he thought. Since 2000, Christensen has extended and remade the notion on his own, working with a small team to treat thousands of homeless children and adolescents adrift on the outskirts of Phoenix, Ariz., from his mobile doctor's office in a 38-foot Winnebago.

When he's not on the van, Christensen is busy being chair of medicine at Phoenix Children's Hospital or soliciting funds from philanthropic organizations to support his mission or spending time with his family. He and his wife, Amy, also a pediatrician, have three young children.

Tell me about your patients.
We take care of patients from zero up to 24 years old who are homeless or at high risk of being homeless. When patients come to us we find that, most likely, their problems have been untreated for a while. This means that even though they may be coming in for an earache, it's not the first day of ear pain for them, and they may have a far-advanced ear infection with maybe a rupture of the eardrum. They often haven't taken any medicines. The complexity of the patients jumps up pretty quickly. Mental health issues are abundant. We suspect that when it comes to mental health illnesses, homeless patients have about three times the number of mental health diagnoses as the general population.

How much does all this cost?
We are an expensive program. It's about $1.2 million a year to keep it going. The truth is we're less efficient in a van. We've got to put in gas and cover maintenance. If we get a flat tire, we basically close the clinic. However, with mobile care, we're able to reach a patient population that's on the move.

What has been your biggest surprise?
As medical director, I thought I was going to get my patients off the street by taking care of their unmet medical needs. But really what I began to learn is that there were so many other problems out there. My patients had terrible cavities, or their teeth had all been kicked in, or they had such tragic stories that had led to mental health illnesses. They had a lack of education and just weren't able to deal with many of life's problems that were being thrown at them.

How do you handle all the dark stories you hear every day? The emotional side of things was something I really paid the price for at the beginning. I didn't talk to my wife about it as much as I should have. But the kind of medicine we do affects the whole team. You try to remain objective when you're making medical decisions, but these stories are very difficult. The philosophy we've all come to embrace is that we can't change the past, but we are all hopeful that we can affect the future. That said, there are still terrible things that happen, and some of these affect us dearly.

I tried in the book to talk about that experience. You may come home after a long day where you've just seen a girl who has been raped and tortured, with all kinds of cigarette burns in the genital area, and that's been going on for a long time. What do you say to that? How do you come to terms with that? We sort of watch each other on the team. We might pull somebody aside and say, "Hey, it looks like you're getting too involved with that person. Let me take over for a while."

How big a role does compassion play in what you do?
It's huge. We tell our patients straight out, "We do care about you. We want you to be careful out there." We find it works better than a condescending attitude of "If you do this, then you will get this." That just never seemed to work for our kids. But if we say, "Gee, we think you can get out of homelessness, you can stop using drugs, you can get a job, you can have a happy life, and we care about you," they seem more interested in stopping their behaviors.

So you've had to alter your approach.
That's absolutely right. It's been on-the-job training. But I don't think it has to be on-the-job training for everybody. Some of our experiences can be translated into other models in other cities. People are starting to call me up and say, "Hey, we're thinking about doing this." Some of my time is now being spent helping other programs get started, and I love that idea.

***** TUSM alumnus, Randy Christensen, MD/MPH'95 is currently a staff physician at Phoenix Children's Hospital and medical director of Crews'n Healthmobile, a mobile medical clinic that provides health care to homeless children. He was featured on the Diane Rehm Show WAMU NPR in Washington DC in May 2011.

"More than one million children in the U.S. today are homeless. As a result, many of them lack regular health care. Ten years ago, a pediatrician in Phoenix, Arizona became the first to run his hospital's mobile medical clinic - a doctor's office on wheels. His goal was to help homeless children get the medical attention they need. Their problems - from sexually transmitted diseases to infections from living outdoors - are often very different than those of other children. The converted Winnebago known as 'Big Blue' has now served almost 7,000 children." Listen