This article by Anne Housholder is featured in our most recent newsletter. You can see the full newsletter here.

Reflections on Being with: Friendship at the Healthcare Margins

This season at Lydia’s House we’re reading Friendship at the Margins by Chris Heuertz and Christine Pohl.  As we’re reading it, we’re asking ourselves questions about what it really means to be friends, particularly friends with those whose lives have often been marked by frequent losses of friendships and frayed family structures.  Serving women transitioning out of homelessness means that Lydia’s house often leads us both intentionally and unintentionally into friendships we don’t expect. How is friendship a unique model of being with those at the margins? For me, as a physician, I’ve found I can offer friendship through medical advocacy and accompaniment, often putting aside the privileges of my credentials to just be with women in some of their hardest moments.

Within a very short time of welcoming guests, the leadership of Lydia’s House began to notice the frequency with which trips to the hospital occurred.  These often late night visits to emergency rooms were exhausting for everyone, but regardless of how short staffed the house was, volunteers committed to going with and staying with guests throughout a hospital visit.  Our volunteers have also accompanied mothers and witnessed the birth of two children born to guests in the last year.  We have all taken the extra duties involved in covering both house duties and regular hospital shifts.  When a baby was born prematurely in June, we filled the NICU log book for the week of his stay.

These trips took a lot out of us, but as I reflect on them, I’m asking myself “Instead of as obligation or sacrifice, how can we look at these experiences through the lens of friendship?” To start this discussion, I’ll  share three important points I’ve learned as I’ve stepped to the other side of my profession and accompanied women, as their friend, through medical crisis:

  1. There is no substitute for time in developing friendships
  2. Emotional involvement is a necessary sign of friendship
  3. Friendships offers us the possibility of persevering towards our goals of wholeness

One of the first things any of us learned about friendship as a child is that time spent together matters—and making friends was basically our job. As adults, the demands of our lives squeeze our friendships in to smaller and smaller timeframes. We let our pre-established friendships coast as best we can on the limited time we have and hope we’ve built up enough goodwill to get by with an infrequent note or call.  Developing friendships, though, still requires a substantial time investment.  Fortunately, in hospitals we end up having a seemingly infinite time to wait.  Waiting with a guest for a medical procedure, I worked on re-twisting a strand of her hair, for which I earned the epithet, OG (original gangster) for the first time from her, which I consider a mark of our deepening friendship.  The trips back and forth to the NICU with another guest allowed for many conversations about dreams and hopes she had for her life and the lives of her children.  By accompanying women through medical encounters, the very slowness of hospitals that we all hate (doctors more than anyone) has offered us the freedom of time to entertain ourselves in ways that lead uniquely to adult friendship.

In describing my work in medical advocacy as friendship, I cannot simply report that I’ve developed simple and mutual relationships. To be honest about this journey, I must also talk about the emotional weight, specifically for me as a physician, of being with marginalized women as they are further degraded by the very system that supports my livelihood.  The encounter that started with light conversation and hairstyling in the waiting room was followed by a shocking confrontation with racism.  I sat in the room in stunned silence as our guest’s anesthesiologist poorly explained her upcoming sedation.  When she responded with appropriate confusion, he became irate and went on a tirade of how inappropriate it was for a patient to have any say in their care. He said he would not listen to anyone who didn’t have an MD.  After he left I listened as our guest questioned what was wrong with her that she had such a bad encounter with a doctor.  In my medical ethics classes I had learned that internalized racism is when mistreated individuals take on the beliefs of the oppressor and begin to assume they themselves must really be the problem.  Years of education and analysis told me how to interpret this degrading event; but it was friendship that made my heart break when I heard this self-doubt coming from our guest.

When we become friends with others, the hurts they experience no longer occur at arm’s distance from us.  After this experience, I wrote a letter to the anesthesiologist outlining what I experienced sitting as both a physician and a friend to the woman he was mistreating.  I believe, even if I never get a response from him, that the emotional involvement that friendship requires enabled me to see and name the systems of oppression that exist in medicine.  I hope this will help me be a better doctor and a better friend to our guest, reassuring her that I was a witness and she did nothing wrong.

The Lydia’s House commitment to being there for medical encounters brings me to my final thought: medical accompaniment is a commitment to friendship.  The guest who had such terrible experience with medical systems failing to offer compassionate care, is nevertheless persevering in seeking the best medical care for herself with great encouragement from me and our community.  After we talked, she had her operation even though she was nervous about her care and shaken by her doctor’s verbal abuse.  She continues her search for a doctor who will provide her with the best medical care for her particular needs, and we continue to support her in that quest.  Friendship showed me the truth of that encounter; it also empowered her to continue forward toward greater health, despite great discouragement. The volunteers of Lydia’s House provide encouragement to each of our guests as they seek wholeness in body, mind and spirit—telling them to seek this elusive treasure which many have told them will never be theirs. It’s common at our table to talk about care of body and spirit, and together we’ve taken on many challenges: seeking a primary care home after only getting care in the ER, diet change, breaking addictions, running a ½ marathon, getting tested for illnesses we fear, continuing to seek medical care even if the system has failed us again and again.  We all- but especially the guests— are persevering in seeking good things for ourselves because we have the support and encouragement of our friends.

Medical accompaniment is just one of the many ways that we are exploring friendship as a model for seeking wholeness.   Over the last year, we at Lydia’s House have not only learned how to do this accompaniment better in terms of our own self-care but also become increasingly aware of why we are willing to make such sacrifices for it.  In medical ethics there’s actually a term “the un-befriended patient,” that describes patients that cannot make choices for themselves and have no one around them to help make decisions for them.  Although this term does not properly apply to where our guests might be without us, it matters that they are unquestioningly befriended every time we are at the hospital with them.  Watching a woman labor in pain in the middle of the night as no family arrives isn’t easy for us.  Listening to a talented, motivated, responsible woman be demeaned by those who are supposed to care for her is even harder.  We do these things because our friendships with the marginalized brings us to places, including hospitals, where we see exactly what that marginalization looks like. When our friendships extend before and after these trips we can all persevere in loving and supporting each other.  Persevering friendship offers a life beyond marginalization, where every community member’s health needs, like all pieces of their whole, are cared and prayed for by us all.