My pager buzzed: “The patient in 757 wants to see a chaplain ASAP.” Damon, in his early 20s, is undergoing withdrawal from multiple street drugs. A nursing note, just posted, says he got a distressing call and now wants to leave AMA (against medical advice) to go OD and kill himself. Deep breath …

I find Damon sitting cross-legged on his bed, a nurse seated beside him. She looks at me with relief; I take her seat and she departs. Damon glances at me through disheveled hair.

“Greetings, Damon. I heard you wanted to speak to me. I’m here to listen.”

“Yeah. I heard you might have an iPad I can use. I need something to distract myself. I just found out that my girlfriend—ex-girlfriend, now—has taken my phone and money and disappeared.”

“I’m sorry, Damon—that’s rough. We have two iPads people use to attend online 12-step meetings or worship services. I can see if one is available.”

Just then a lab tech comes in to draw blood. Damon asks me to stay.

“Can I find out my blood type from this test?” he asks the tech. She says no, not unless there’s a reason to run that specific test.

“If you donate blood at the Red Cross you find out automatically,” I blurt out before catching myself, “… provided you pass their screening checks.”

“I’ve donated before, when I’ve been clean. It makes me feel good to help someone who needs it.”

The lab tech leaves, but this exchange has broken the ice.

“Everything is just so shitty right now,” he begins. “I’d been doing OK—stayed clean for nine months, got off the streets and into transitional housing. My girlfriend—ex-girlfriend—helped me stay clean, but then my mom died and I relapsed, and she dumped me and took my things. Now I have nothing.”

“That’s a ton of hard stuff coming at you all at once—no wonder you’re upset.”

“I just don’t know where to go from here.”

“Are there other people in your life who are helpful to you?”

Damon launches into his life story, filled with loss at every turn. Born to an alcoholic mother, removed from her custody soon after by his father, a recovering IV drug user. Taken to be raised by his father’s parents, who were abusive and forbade him to speak of his mother. Lost his father to Hepatitis C in his early teens. Moved to Portland when he graduated high school, fell into drug use and homelessness. Sought out and reunited with his mother in Ohio, who’d gotten sober and remarried but had never stopped looking for Damon. Inspired by his mom he got clean but then she died and his world fell apart.

“Now it’s just my stepdad, but he’s dealing with his own grief from my mom dying, and we’re struggling to get along. So, really, nobody.”

◊

At the time of this encounter I’d been reading Demon Copperhead, the prize-winning novel by Barbara Kingsolver. It is closely patterned on Charles Dickens’s David Copperfield, but set in a world she knows well: contemporary Appalachia. I couldn’t help noting the similarities between my patient’s tale and that of Damon, the protagonist of Demon Copperhead, so I chose that as my patient’s pseudonym. Whether in 19th century England or 21st century America, these stories are all too common.

The moral challenge posed by patients like Damon is “What is my responsibility to help?” It’s the question each of us faces when we encounter people on the streets suffering from mental illness, substance use, and/or homelessness—or simply driving past tents by the side of the road. This question must have tormented Kingsolver as well as Dickens—David Copperfield was semi-autobiographical. Their response was to write these novels, perhaps hoping that enlightening readers to the conditions they experienced might open their hearts and spur them to support social reforms.

I don’t have a good answer to this question for myself. I have no illusion I can solve the problems on the streets of Portland, any more than these novels could fix the places in which they were set. At the most basic level, I simply try to encounter people where they are, in their full humanity, as fellow children of God. It often scares the shit out of me—“Deep breath …” in my first paragraph is an understatement—but I’m usually rewarded by the person transcending any stereotype I may have formed in my head.

I don’t think this question will ever stop challenging me, and I hope it doesn’t. The calling to “comfort the afflicted and afflict the comfortable” resonates deeply for me. It forces me to acknowledge my own comforts and it spurs me to comfort others any way I can. I don’t have the gift to write great novels, so I do this. All that most of us can do is try to enlarge our comfort zones bit by bit to encompass an ever-larger swath of humanity. They all need what we can offer—and we need what they can offer us.

◊

Damon and I talk about places where he might be able to build supportive relationships. He says there are a couple of good people in his transitional housing situation that he might be able to look to for peer support. We also talk about work.

“It’s so frustrating. I’m getting interviews, even second interviews, but still nothing. I’m a good worker and I have a good resume. I’ve just got to keep trying.”

I offer words of encouragement without minimizing the difficulty of the place in which he finds himself.

“Don’t worry,” he responds, “I haven’t given up hope. I know what that looks like, I’ve seen it in people on the street. You just look in their eyes and see there’s nothing there, they’ve given up. That’s not me.”

◊

As I write this I still haven’t finished reading Kingsolver’s novel, so I don’t know how things work out for Demon Copperhead. I don’t know how things will work out for Damon, either. I do know that, when I saw him, he was being kept safe and was receiving medical and psychiatric care as well as social services, so that encourages me. When our eyes met before parting, I saw a determination, however fragile, to get better, to do better, and to serve others like himself.

I’d like to think my conversation with Damon helped him pull back from despair to a place where he could get better and emerge stronger. I don’t know that, though, and the odds are against him. I feel the same way about so many patients I see. But, as Damon said, I haven’t given up hope—that’s not me.