A Grave Disease

Tonight as I was riding the subway home after being out with friends, I had an odd experience.  As I was stepping onto the platform for my home stop, I noticed a homeless man with a sign which stated:

"Thyroid disease.  Please help." 

He was holding a plastic cup out for money.  He had severe exophthalmos--the characteristic stigmata of Grave's Disease, which is an autoimmune disease that leads to overactivity of the thyroid gland.  It can be life threatening if not controlled due to a situation called "thyroid storm."  This is exactly what you'd think it is: such an overabundance of thyroid hormone that it revs up the entire body.

To anyone outside of medicine, this man's exophthalmos coupled with his poverty would probably be a source of fear or mockery.  I initially started walking away, remembering my personal policy to not give money to homeless people, and to give of my time and talent when I am done with my training.

But for some reason, I was drawn to this man. 

I found a dollar in my wallet, walked back to him, and put it in his plastic cup. 

He said thank you, and I almost turned and walked away again, but the physician in me stopped.

"Are you getting healthcare?  You have Grave's Disease, right?"

I was surprised by his eloquence.  He told me he went to the county hospital, that he was taking the medication methimazole.  I asked him how much it cost.  He said he was covered under Medicaid, but he was living on the street and he needed money for food and shelter.  He asked me if I was a doctor, how long I had been one, and that it was amazing.  He kept repeating that it was amazing. 

The poverty in this city is heartbreaking.  I wonder if the stigma of this man's physical appearance from a disease he can't control is the source of his poverty.  Call me a bleeding heart but with everything that's going on with the budget in Congress, how can we cut healthcare funding for people like him?

As I have been on research for the past eight months, at times I feel like a small part of my identity has wilted.  The part of me that is a physician first and foremost.  But tonight, this man reminded me why I am here and what I'm trying to do.  He's right, being a physician is something amazing.