No fixed address
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* Scott Smith

*   © 2008 Canadian Medical Association

We turned the furnace on last week. Still, as I wake up, I feel winter creeping in. I button up my wool coat before settling into the streetcar with my newspaper and coffee.

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/178/1/21/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/178/1/21/F1)

The Addiction Medicine Clinic is located at the Centre for Addiction and Mental Health, a Toronto teaching hospital providing a range of clinical, support and rehabilitation services for people with mental illness or addiction problems.

At the Addiction Medicine Clinic, I find myself in a small room with John, my nose filled with the raw smell of the street, and the human body. Both seep out of John's dirty sweater and jeans. I wonder if my cleanliness is somehow offensive to him.

Black letters near the beginning of the last note — NFA.

“How long have you been without a home?” I ask, not able to begin to imagine that reality.

“Three months now doc,” he answers. Above his beard, his dark eyes dart around the room. His leg swings like a metronome and his hands tremble.

“I think I really messed myself up last night, doc.”

I ask him what he had.

“A mickey of rye and 2 bottles of cooking wine from China Town,” he murmurs. “Now I can't stop shaking.”

He doesn't seem to mind talking. He tells me his father lost his family to alcohol. He tells me his mother would lock herself in her room and cry all day. He tells me about his own depression and how he started drinking — when he was 14.

We sometimes tell patients that predisposition doesn't mean predestination. But I can't help thinking — did this poor guy ever really have a chance?

Near the end of the interview, I ask him casually if he has ever thought of killing himself.

“Sometimes.”

I ask him how he would do it.

He answers.

I scribble down — no active plan. Verbal contract to go to ER if suicidal — and I am satisfied.

John stays at the clinic for a few hours then, refusing further help, heads back to the street. As he leaves, he says “thank-you” — genuinely grateful for those hours of peace.

Leaves swirl around the streetcar on my ride home. I listen to my iPod and try to decide what type of wine to pick up for the dinner party we are hosting.

## Footnotes

*   *CMAJ* invites contributions to Dispatches from the medical front, in which physicians and other health care providers can provide eyewitness glimpses of medical frontiers, whether defined by location or intervention. The frequency of the section will be conditional on submissions, which must run a maximum 350 words or be subject to our ruthless editorial pencils. Forward submissions to: Wayne.Kondro{at}cma.ca