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is open from Nov. 1 to May 1), which makes that population different from the one in Springfield, for example, where most stay in shelters year-round. “You’re dealing with a completely different lifestyle that’s much more chaotic and brings a lot more trauma, infection, tick bites — diseases of the
elements — in addition to really poorly managed mental illness,” she told HCN. “These people don’t even know what time it is; they have no running water, no food ... it’s tough living outside.”
Thus, people come to her with all manner of problems and issues, from festering wounds with maggots on them to drug overdoses to bone infec- tions.
“We deal with these issues, and we try to figure out how to keep the patients alive. It takes a lot of creativity, which is OK, because we love doing it.”
By ‘we,’ she referred to a team that she is part of, one that also includes several other doctors and nurse practitioners. Her core team in Northamp- ton includes a registered nurse, Katelyn Wrzesinski, and a community health worker, Jesenia Rodriguez.
“Everything was an algorithm, evidence- based If the patient says this, you do this; if this happens, you do that. I didn’t like that; it was such a machine.”
Together, these individuals work long hours to serve a population with challenging needs and certainly no set hours when it comes to emergencies or phone calls — which come when the callers have enough minutes and when they can get Wi-Fi.
“We do our best to keep order amid the madness,” Bossie said. “‘Orga- nized chaos’ is how I like to describe it.”
In many ways, Bossie prefers this organized chaos to a traditional health setting (she had worked in some previously, during her residency), where, she said, physicians have to see a minimum number of patients a day to meet need quotas and where there is far less creativity than what she finds in her current work.
“Everything was an algorithm, evidence-based,” she explained. “If the patient says this, you do this; if this happens, you do that. I didn’t like that; it was such a machine.”
Her work now is different in a great many ways, including the manner in which success is measured.
Indeed, in more traditional settings, success is measured using numbers, said Bossie, adding that they’re harder to come by in her line of work, and they generally involve an absence of something or a reduction, such as with patient stays in hospitals and visits to the ER, which her team has helped driven downward, thus reducing the cost of healthcare to everyone.
Overall, certainly, the biggest measure is mortality.
“My predecessor made a comment to me one time that shocked me; she said, ‘this work was so sad for me because I think every patient I took care of is dead now,’” she recalled. “That has just not been my experience; I’ve had so few deaths — knock on wood — and vast majority of them were expected.”
Still another measure of success comes in the form of comments from people like Lisa, who came to this region from Florida two years ago. She first met Bossie at the drop-in clinic and was quickly connected to services, including housing, first at a shelter, and later in Miller’s Falls, where she now resides.
She credits Bossie with everything from helping her gain disability benefits to assisting her with both physical and mental issues, including depression, anxiety, and post-traumatic stress disorder, as well as addiction to alcohol.
“The bottom line is she cares so much and is super dedicated,” Lisa told HCN. “She is so attuned to our community and the recovering community as well. She’s just calm and confident; I don’t know how she does it.” v
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