Dan has been a patient of mine for several years and remains my most memorable success story. As a nurse practitioner in a Health Care for the Homeless program, I have treated many disenfranchised patients with a variety of medical and mental health issues. Dan came into a homeless shelter several years ago after being discharged from a local hospital with the diagnosis of unexplained syncope – he had been passing out for several months.

Although Dan had been to the ER more than once and was hospitalized twice, he was never diagnosed, and the problem was never resolved.  He was unable to work due to the syncope and had no health insurance, so he turned to a local homeless shelter.  A quiet and shy man, he needed someone to assist him in maneuvering through the complex medical and benefit systems.

Dan’s medical records suggested that the syncope episodes were probably psychosomatic in nature. In reviewing his medical records, I discovered a Holter monitor study that showed moderate bradycardia and cardiac pauses of up to 8 seconds.  He was also morbidly obese, weighing more than 400 lbs.  The Holter monitor results had not been evaluated until after Dan’s discharge, and the hospital had been unable to reach him, as he had no address or phone.  

Continue Reading

I helped Dan apply for disability insurance, and guided and supported him through cardiology visits and surgery for the insertion of a pacemaker.  Once that was resolved we began working on his weight.  As he began to feel better, he started to exercise and watch his eating habits. But this was still not enough, and Dan was referred to a weight management program; three years ago he had gastric bypass surgery.

Through all this, Dan struggled with depression but was able to deal with his medical and psychological issues. He eventually moved out of homelessness with the help of mental health counseling.  He lost almost 200 lbs and has learned to deal with his pacemaker.

Today Dan has his own apartment, a full-time job and a positive and grateful outlook on life. He has not had any syncopal episodes since his pacemaker was inserted and has kept his weight off by eating a healthy diet and going to the gym three to four times a week. He also works weekends as a case manager where he was once a homeless guest.

Dan stops by to see me once and a while and reminds me that I saved his life. I know his hard work and humble, quiet approach to life were the fuel for his miraculous changes, but I am grateful to have known him.

Tell us about your most memorable patient by December 15, 2010, and you’ll be eligible to win an Apple iPad!