I t’s Monday night in Isla Vista and St. Athanasius Orthodox Church is serving up its weekly dinner for the homeless. A dozen or so bedraggled-looking souls wander onto the tidy, concrete patio for what will likely be their first and only square meal of the day.
Tonight the crowd consists only of men, and they largely keep to themselves, carrying plates piled with food to the picnic tables and eating quietly. Milling about in his clerical blacks and white collar is the church’s rector, Father Jon-Stephen Hedges, a broad-shouldered, distinguished-looking man in his late fifties. There is also a dark-eyed social worker named Jennifer Ferraez, who surreptitiously gauges the well-being of each guest.
Fifteen minutes into the meal, 46-year-old Mimi Doohan drives her minivan into the church’s parking lot. Ferraez walks over to greet her and, after talking a minute, they approach a pair of men sitting on the grass.
Doohan is a family practice physician with gray-brown Shirley Temple curls and piercing light green eyes. Wearing jeans and a pink cotton sweatshirt, she crouches to greet the men at their eye level; Ferraez stands a few feet away.
“Hi, I’m Dr. Mimi,” she says with simple, authentic warmth. “What’s going on?” Hiking up his right pant leg, a blue-eyed man from Lompoc describes a problem with his leg, which is swollen and has a pussy sore the size of a quarter. Doohan examines it. “Looks like staph,” she says. “How long have you had that?” “Five days.” “Do you have any other health problems?” “Yeah, lots. I’m HIV-positive, and I have chronic pancreatitis,” replies the man, whose name is Vincent. Doohan — the mother of two teenagers and the wife of City College math professor James Doohan — finished her residency training in 2005 and now has a growing family practice in Goleta, just a few miles from her home. She has privileges at both hospitals in town and just began delivering babies at Cottage in association with obstetrician Ayesha Shaikh. Her career is on the rise.
So why, you might ask, is she squatting on an Isla Vista sidewalk after hours to examine the leg of a former drug addict who lives in a tent near Costco? After speaking with her and observing her work, I discovered Mimi Doohan is a soccer mom with personal insight into the soul-sapping nature of homelessness. She has a history that could have permanently damaged her psyche. Instead, perhaps miraculously, she made it to adulthood with ambition, intelligence, and a need to create a system for providing care to people at the very edge. That vehicle materialized two years ago in Santa Barbara as the nonprofit Doctors Without Walls (DWW). Tonight, it is Vincent and his companion Rick who have fallen into the DWW bailiwick, teetering on the edge of serious, potentially fatal illness.
Having determined that Vincent needs antibiotics and evaluation at the emergency room and having secured a volunteer to take him there, Doohan turns her attention to Rick. He is a physically small man in his sixties with a dark beard and forest-green eyes. Though it’s 59 degrees out, he wears a heavy winter coat with the hood up.
“I understand you’re having chest pain,” Doohan says in a soft voice. Rick stares into the distance and doesn’t answer. Doohan tries again. “Vincent here has to go to the emergency room. Maybe you can go together,” she suggests. He pulls deeply on the last eighth of his cigarette, bringing the burn line perilously close to his lips. “Do you ever feel it in your jaw?” Doohan asks about his chest pain. He nods. Finally. “Do you ever feel it here?” she asks, pointing to his heart. Again, he nods. Then he stands, turns, and retrieves his shopping cart and begins walking toward Embarcadero del Mar. Hedges notices and intercepts him. Ferraez and Doohan catch up. It’s a huddle now, all hands on deck to keep Rick from disappearing into the night with unstable angina and, as they soon discover, suicidal depression. “We can’t let you do this, Rick,” says Ferraez. “I’ve got my own life,” he says. “I’m tired of living.” “Didn’t you just say you would go to the hospital?” “I don’t like hospitals,” he replies. Then, recognizing the inevitable, Hedges pats him on the back and says, “Just get through the night healthy, okay, Rick? We’ve got something to talk about tomorrow.” Rick stares into the distance with tearful eyes, then continues on his way. “Remember we have to talk tomorrow, okay?” Hedges calls after him.
A Trip to Hell and Back
Doohan isn’t a saint, nor is she trying to be. But she understands better than most the humiliation and fear that are the accessories of homelessness. When she was eight, her mother, a Holocaust survivor, began descending into a slow-motion but devastating mental breakdown. After divorcing Doohan’s dad, the prominent Bay Area psychologist Claude Steiner, she moved the kids — Mimi and her younger brother — into the house he bought her off Berkeley’s Telegraph Avenue. It was the late 1960s, when women almost always got full custody of the kids in divorce cases. Jobless and living in a house paid for by her ex-husband, she began to let anyone who wanted a roof over their head move in with her family. Doohan recalls having to step over a span of sleeping bodies sprawled across the living room on her way to school. Her mother had essentially given up the daily tasks of mothering, so Doohan’s thick, curly hair was perpetually matted. Her clothes were dirty and torn in places. When one of the female house inhabitants was given money to take Mimi shopping for clothes, she pocketed the cash and told Mimi to wear several dresses on top of each other and walk out of the store. These were the clothes she wore every day.
After about a year, Doohan’s mother became convinced the house was inhabited by witches and put the children in the family’s Volkswagen bus and began to drive. Without any clear destination, they hooked up with other wanderers and formed a caravan, ultimately landing in Colorado. But along the way, Doohan and her brother were briefly abandoned. The car they were riding in pulled up to a Boulder street corner and the driver ordered them out. Then he drove away. Standing on the corner, Mimi’s brother began to cry. She tried to comfort him while figuring out what to do. Hearing the happy voices of young people nearby, she began walking toward them and quickly encountered a group of college students. They gave the children food and called police, who put them in an emergency foster care home. Doohan still remembers that family and the home they offered her and her brother, however briefly; the cupboards were stocked with food. There had been a plan to buy them new shoes. “Throughout all this, what I remember was people being kind to us,” Doohan recalled. “And I wanted to grow up and be one of those people.”
The following day, her mother retrieved them and resumed their trek to nowhere. Soon, she joined a Colorado cult of faux farm workers called “the Bear Tribe.” Together, the family picked fruit with other cult members during the day and slept in a small shack at night. Then Doohan’s mom disappeared. The children, aged 9 and 6, were now penniless orphans living with strangers under a tin roof. “This was definitely all my fault,” Doohan recalled feeling at the time. “I felt like a dirty, worthless kid.” It wasn’t until she cut her foot and was taken to an emergency room that Doohan remembered her dad had given her a method for reaching him. If you ever need me, he had told her, “Call information and ask for Dr. Feelgood in Berkeley.” It was a special line set up specifically for Doohan and her brother. Right away, he retrieved them and took them home to live with him. With her dad, a semblance of normalcy resumed, although, given the time period — the late ’60s — and the location — Berkeley — no one’s life was truly normal.
Doohan loved academics, especially math and science. When she was an undergraduate at UC Berkeley, she met her husband Jim, a Santa Barbara native who had a dream of living here as an adult and teaching at City College. Both super-smart, the couple pursued and achieved simultaneous Ph.D’s in molecular biology from UCSB. After their children were born, Doohan was accepted at Stanford University Medical School and commuted between Santa Barbara and the Bay Area for years while she finished her training.
When the Student Is Ready, the Teacher Appears
Doohan has a knack for finding loyal mentors and hanging onto them like precious gemstones. One of them is her residency professor from Contra Costa Regional Medical Center, Mark Stinson. Stinson is a family practice physician known internationally for his expertise in disaster relief. He flew into New Orleans as everyone else was trying to get out. When the 2004 tsunami hit Southeast Asia, he hopped a plane to Sri Lanka as the rest of us were standing around our television sets, slack-jawed and horrified. And when Doohan was ready to launch a medical nonprofit, Stinson flew here to help brainstorm its structure and mission. They decided it would provide outreach not only to the homeless but also to victims of natural and manmade disasters. Street medicine, field medicine, and wilderness medicine are the same, Doohan said. “It’s life support in all settings.”
Her other mentor is Jim Withers, the internist who is pioneering the practice of street medicine in America. Withers began treating the homeless on the streets of Pittsburgh 15 years ago, and his work has become a model for doctors in cities and towns across America. Doohan learned about his organization, Operation Safety Net, at a conference in medical school. His approach to caring for the homeless cut through the layers of her adult mother/wife/physician self and spoke to the girl who’d been abandoned to a bunch of strangers pretending to be Indians. Accompanying him on his midnight rounds beneath Pittsburgh’s bridges, Doohan discovered her calling. Withers is DWW’s unofficial mentor too.
The central idea behind DWW is to establish a bank of Santa Barbara physicians willing to volunteer their services either at Casa Esperanza or on street rounds to the unsheltered homeless; in the process, they will learn how to practice field medicine and how to jump in if a disaster were to occur. The organization’s board of directors now includes some of Santa Barbara’s most accomplished physicians and attorneys. They’ve even managed to secure malpractice insurance for the group’s physicians. Santa Barbara internist Dennis Baker, who was one of the first DWW volunteers and is a dedicated board member, provides care every Tuesday night at Casa Esperanza.
Last November, Mark Stinson led a three-day DWW-sponsored training in field medicine for Santa Barbara doctors, nurses, and social workers. So far, though, Doohan is the only DWW physician doing medical street outreach. For decades, social worker Ken Williams had been the main advocate for the homeless going to the hidden places where Santa Barbara homeless actually live to offer them care and support services. Now there is someone else. But for the time being, she is limiting herself to the comparatively small homeless community in Isla Vista. As her team has grown, they have started going out into the nearby parks and fields — places where homeless too sick or too frightened to venture out can be found.
The Isla Vista Team
Since she first began attending the St. Athanasius dinners on Monday nights, Doohan has formed a tight-knit team with Ferraez and Hedges. Their system works like this: During the week, Hedges and Ferraez keep an eye on the various homeless individuals they know, often the same people who show up for the Monday night dinner. They’re always on alert for a signal that someone might be willing to accept help, to transition to another way of life. When they notice someone has a medical need, they call Doohan on her cell phone, and together they decide what action to take.
No one knows exactly how many homeless people live in Isla Vista, but a rough estimate put it at about 100. Four of the regular dinner guests have required hospitalization. One person, Tom Turner, recently died of lung cancer at Sarah House. (Ferraez was there at the end, holding his hand and singing to him.) Another one is still receiving hospice care there. And Rick, the man with chest pain who walked away from Doohan and Ferraez, recently managed not to lose his left eye, thanks to the diligent networking of Hedges, Ferraez, and Doohan.
After Rick was assaulted by a fellow homeless person — someone who has since been arrested — Hedges noticed that Rick’s left eye was covered with an opaque film. The eye was weepy, red, and painful. Hedges called Doohan, who said Rick needed to get to the ER immediately. Eye infections can spread to the brain. Hedges offered to drive Rick to Cottage, but Rick refused again. Still, he did check in with Hedges every day at the church and several days later agreed to go.
Doohan suggested calling ophthalmologist Mark Silverberg and asked the specialist to meet Rick in the ER. As soon as Silverberg saw Rick, he admitted him to the hospital. During his brief stay, Rick’s condition was stabilized with antibiotics, rest, and regular meals. But two days was apparently all Rick could take of civilized, albeit hospital, living, and on the third day, he left against medical advice (AMA). Ironically, after Rick left Cottage, he accepted help from an Isla Vista community member and volunteer, Jenny Jett. Jett drove him to a follow-up appointment and convinced him to stay at her house, where he continues to recover. His eye hasn’t healed and may never totally heal. But Rick is alive, and he still has some vision in the injured eye. And he’s off the streets. People who work with the homeless understand that victories must be measured in tiny increments. As far as Rick is concerned, this was a home run. Both Doohan and Baker understand the worst thing an idealistic doctor can do is treat a sick homeless person once and never see that patient again; knowing where to send them for follow-up is critical if a program like DWW is to provide quality care. The same applies to keeping good medical records. “We need to be integrated into the system, not antagonistic and independent,” Doohan said of the organization’s work. “And we have good systems in Santa Barbara. What we don’t have is medical street outreach.”
There have been other interventions on behalf of Isla Vista’s homeless that Doohan has spearheaded with her team as well. There was the case of Alan, the wrangler forced into retirement when a horse kick fractured his skull and ribs. He lives in a storage shed without windows or running water. He struggled with gastritis for over a year. When Hedges introduced Doohan to him last September, he’d lost 30 pounds in three months, was vomiting regularly, and had no appetite. Doohan admitted him to the hospital and cared for him for a week. He is now recovering in his storage shed from pneumonia and complications of surgery to remove his gallbladder. Doohan asked a group of UCSB pre-med students interested in street medicine if they would look in on him three times a day and bring him food and water. “It’s not just about the pills you take,” Doohan said of the healing process. ”Sometimes it’s about comfort, regular meals, and security.”
Many elements of DWW are still being developed. There are financing questions, questions of administration, and even some philosophical debates. What is clear is that Doohan will never be satisfied to bask in her successes and simply relish the life she and Jim have created. There is the voice of an 8-year-old girl inside her — a little barefoot girl with matted hair, wearing a ratty, shoplifted dress. This girl, this Mimi Steiner, will never forget how horrible it felt to be alone and cold with no place to go. And she won’t let Doohan forget either.