It's 9 a.m. in Hamilton's lower city, and Dr. Christian Kraeker starts his day with a medical bag in his trunk and a car stereo full of tunes.
Kraeker and Tim O'Shea, another McMaster University doctor, have started HamSmart (Hamilton Social Medicine Response Team), a program where they visit the elderly, the immobile, the addicted, the homeless and others who have fallen through the cracks of the health-care system.
They spend the day visiting people wherever they are, whether at a shelter, a coffee shop or darkened apartments in Hamilton's lower city. In essence, they are Hamilton's street doctors.
"We'll basically see anybody, anywhere," says O'Shea as he rides shotgun.
"The idea is to try this for a year and see how it goes."
It's a departure for the doctors, who are learned specialists at the top of their game. Kraeker is an internist at Juravinski Hospital and an assistant professor in McMaster University's general internal medicine division. He also does internal medicine education in Namibia. O'Shea is an associate professor. specializes in internal medicine and infectious disease, and has been an outspoken advocate of newcomer health services.
Doing clinic rounds, they saw patients with the same issues — people with no family doctors and no idea how to find one, addicts afraid to get help for fear of judgment, elderly patients who couldn't leave the house.
HamSmart patients come from various places. They're referred by social workers, or homeless shelters, or family doctors. Sometimes they're referrals by paramedics or police officers.
"There's a lack of family doctors," Kraeker says. "A lack of quick followup. Just lack of access to health care. It's shocking how many people don't know how to access the health-care system beyond going to the emergency room."
This particular morning, their first patient is Hank, a double amputee with cardiopulmonary disorder. Hank's scooter is broken, so he spends most days parked in front of the TV. His ex-wife brings him cigarettes and food.
Kraeker and O'Shea enter to find Hank sitting shirtless in front of the TV. He hasn't been sleeping well, he tells them. Kraeker worries sleeping pills will conflict with Hank's multiple other health issues. Try melatonin to start, Kraeker tells him, and offers to write it down for him.
As the pair check his lungs, Hank tells them he might skip an interview today with a potential family doctor. Kraeker tries to keep it casual.
"Aww, come on," he says. "You have to go."
Getting there is hard, and Hank is uncertain about the interview process. When he agrees to reschedule, Kraeker is happy.
"It's super important that you get a family doctor," he says.
The next stop is in a Park Avenue highrise. The two of them quietly talk directions on the way. To help raise money for HamSmart, Kraeker jokes, "we could run an Uber service."
'My whole world now'
Kraeker gets his trusty medical bag from the trunk, and they head to the eighth floor, where they visit 73-year-old Freddy Devine.
Devine was in prison for 28 years.
"I was in the drug business years ago, in the 70s and 80s," he says. "All I can say is that people got killed and I was responsible."
In prison, Devine says, he at least had a community. A picture of that community hangs above his living room chair now. Devine with five other men, all of them young, robust and tattooed, wear prison-issue green pants. "Collins Bay Pen," the inscription reads. "Used Car Salesmen. 3 Block."
When Devine was released three years ago, the world was different than he remembered — and so was he. He doesn't like being immobile. "My diabetes is real bad, and I have congestive heart failure," he says.
Kraeker and O'Shea, he adds, are "my whole world now."
What really makes people sick
Back in the car, Kraeker and O'Shea talk about why they do HamSmart, even though it means a pay cut and living out of their cars. They need help too. They hope to find some sponsors. They'd like other health practitioners to join them.
O'Shea thinks about it more after he leaves, and emails his response several hours later.
"I thought a bit about your question of why I enjoy this job," he writes.
Doctors are good at identifying illnesses, he says. They're good at telling people to eat well, and exercise, and not smoke.
"What we miss often are the bigger picture items that make and keep people sick. Things like isolation, poverty, homelessness.
"This job gives us the opportunity to see this reality up close and hopefully begin to do something about it."
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