Even if I had asked, there was little I could have done for one homeless patient

Boston Globe

20 hours ago

He was a 10-year-old who had arrived at the emergency room with a severe sore throat and trouble swallowing. Imaging showed he might have an infection deep in his throat. He was admitted to the hospital that night and received intravenous antibiotics and more tests.
When I examined him in the morning, he was standing next to his grandma, playing with his hospital gown. They were Spanish-speaking, and we communicated with the aid of a medical interpreter.
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After a day on the antibiotics, he had improved and was ready to leave the hospital. He would have to continue on the antibiotics and have a follow-up appointment with his pediatrician within two days, which we discussed. His grandmother nodded that she understood.
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The next night, I called his grandmother to see how he was doing. She told me that he wasn't eating, and his throat was hurting more, not less. I asked about the follow-up appointment we had planned for, and she responded, confused. 'What appointment?' That was when I learned that they lived in a homeless shelter.
I was filled with dread as I imagined his throat closing up and seeing him back in the hospital in even worse shape.
His grandmother then told me that she was not sure whether the boy had a pediatrician. She had called his mom, who said that he was scheduled to see one in August, three months away. His pediatrician's office could not schedule him for an earlier appointment because he had never been seen there before. His only options were to go to an urgent care center or back to the emergency room.
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I wondered what I had been thinking when I discharged him. I certainly would have kept him longer, at least another night, had I known he didn't have a pediatrician or stable housing. How had I forgotten to ask the most basic questions?
I made a mistake, but so have the systems meant to protect our most vulnerable children.
In 2023, homelessness among people with children rose by
Across the country, children's hospitals like mine act as a de facto social safety net. I should have asked my patient and his grandmother where he lived, whether or not he had a pediatrician, and whether he had transportation, all of which affect health and access to health care.
Although I know that what I can do for children experiencing homelessness is limited, that experience changed how I handled the next case. Recently, I treated a child of a Haitian family living in a nearby shelter. The mother asked through an interpreter if her child could stay another night in the hospital to recover. I said yes.
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