Not All of Us Are Saints: A Doctor's Journey with the Poor

by David Hilfiker

In 1983, Dr. David Hilfiker left his practice in rural Minnesota and began to practice poverty medicine in a ravaged community not far from the White House. Fascinating and deeply affecting, this is his elegantly written true story of that time. Previously published by Hill and Wang.

Genres: Memoir, Nonfiction, Medicine, Medical

272 pages, Paperback

First published August 1, 1994

Reviews

[Jeet · Rating 5 out of 5]

Hope and Despair

By depicting a doctor's battles with and for the poor in Washington D.C., this novel is unabashed in its honesty. Not only does it bring to light the many injustices that society has placed on the homeless, but it exposes the demons we all have in ourselves. Many say they want to help, but what will they say when their help seems to change nothing? When it seems as though the world does not care about the poor and chooses the least painful narrative, that poor "brought it upon themselves," or they could just "go get a job?" This book shows that reality is not that simple, yet even among mountains of despair there is reason to hope.

[Erin Cowen · Rating 5 out of 5]

“‘Religious’ or not, conscious of it or not, safely ensconced in the suburbs or not, each of us is inextricably bound to—indeed, tangled up with— the pain of the poor”.

Dr. Hilfiker took an unconventional path in his medical career in choosing to serve, and even live with, the homeless and marginalized in DC. The patient stories he told were powerful, but his reflections on the broader societal issues at hand and his own perceived shortcomings were even more compelling for me. Clearly a compassionate and humble man, Dr. Hilfiker is readily willing to acknowledge his own weaknesses and internal struggles.

This is definitely a heavy read, but a good reminder of the importance of being close to the poor. Also, I’d say the writing wasn’t half bad for an MD! If I have time when I am in DC next week I would love to stop by the shelter he established.

Here are some other bangers:
“The poverty of the inner city is evil, and we betray those caught in its web by romanticizing it or imagining that we—by divesting ourselves of some bits of our privilege—can choose to enter it. The landscape of poverty is inaccessible to most of us. We can barely imagine the scenery”.

“It seems to me that it is precisely in those institutions charged with serving the poor that one finds the highest proportion of workers who are no longer responsive to the real needs of their clients… when the administrator no longer believes that one can run a clinic to truly serve the needs of the indigent, the ultimate result is another institution that encumbers the poor, another strand in the web that binds them so tightly to deprivation”.

“Since resources are finite, the collective wealth of the middle and upper classes is necessarily built on the collective deprivation of the poor”.

“When poor persons become people we know as individuals, when they are people we care about, ‘sacrifice’ is not the terrible thing it may otherwise seem”.

“Rare is the individual who is able (much less willing) to yoke himself for the long haul to an abstract morality opposed to his or her day-to-day well-being and pleasure”.

“When we isolate ourselves from the poor, we do so at our own considerable risk”.

“When we ‘protect’ our children from the ‘undesirable’ elements of society, we render comparison, and thus compassion, almost impossible”.

“Though rarely stated, the hazards of the affluent neighborhood, while certainly different, are equally real: a covetous sense of entitlement, blindness to one’s privilege, numbness to the pain of the poor, and estrangement from one’s own vulnerability”.

“The poverty that confronts me daily…results from a society that collectively agrees it is acceptable that some people remain poor”.

“Numbness and cynicism, I suspect, are more often the products of frustrated compassion than of evil intentions”.

“Not all of us who work with the poor are saints, but maybe we don’t have to be. Perhaps sainthood isn’t a prerequisite for the job”.

[Rachel]

Read in 1996, my review from then: After the author wrote Healing the Wounds, A Physician Looks at His Work, he quit his GP job and went to work as part of a Christian community providing medical care to the poor of Washington, D.C. Gives a devastating look at how hard a time poor people have, in getting medical care and otherwise, and the problems this causes and is caused by. His constant self-examination can be a little tiresome, but it is relevant.

[Price Profitt · Rating 4 out of 5]

Bluebell knows books. Hannah recommended this to me. An eye-opener for the reality of poverty and attempts at alleviation, especially from an outsider's perspective. Even if you aren't wanting to pursue healthcare, and all the more if you do, please read this book. It gives such a somber perspective on what living out 1 John 3:16-18 looks like. Although I wish he had more of a Biblical integration into his work, Dr. Hilfiker clearly articulates the ups and downs, mostly the downs, of providing healthcare to the poor.

[Samantha Draves · Rating 4 out of 5]

This book explores the divide between those who have access to healthcare and those who do not. Dr. Hilfiker describes his lived struggle to be a physician caring for and living in solidarity with the poor. He tells real patient stories about factors that society has allowed to make healthcare continuously inaccessible to people who need it. He describes how having a heart for the poor is not enough but our heart posture shows hope for a change and better healthcare from those society has left behind.

[Jenni Jex · Rating 5 out of 5]

This was an eye opening account of a doctor's experience working with the poor in the inner city of Washington DC. I had no idea of the health and medical injustices suffered by those in poverty in the USA. While this doctor claims not to be a saint, he has a huge heart for those he serves, and his life of compassionate care is one I want to follow.

[Ben · Rating 5 out of 5]

A very moving read about poverty medicine. Up to this point my experience with poverty medicine has only been a snapshot of each life rather than a continuous narrative. A great read for all, necessary for anyone in or going into healthcare to understand a vulnerable population that is usually undertreated as a result of multiple controllable and uncontrollable factors.

[sue paul · Rating 5 out of 5]

Enjoyable and eye opening

Working in an urban health care clinic, I can see similarities , but the plight of the homeless in DC seems overwhelmingly worse. This book makes me realize how great we have it to be able to get the care our patients need

[Alicia Zellmer · Rating 5 out of 5]

As excellent as it is devastating.

[Gabriel Sims · Rating 5 out of 5]

Speak for yourself broh 😤😤😤

[Katie Lynch · Rating 4 out of 5]

A little outdated with the concrete issues he raises(electronic health records now exist), but the moral questions are still relevant. Interesting and thoughtful read.

[James Klagge · Rating 5 out of 5]

This book is a memoir by a doctor who moved with his family to inner-city Washington DC to care for and work with the poor. He was part of a medical mission, Christ House, which is itself part of a far larger collection of missions that go under the banner of the Church of the Saviour. The Church of the Saviour was started about 65 years ago by Gordon and Mary Cosby. A week ago today I was in the very building and ministry that this book is about, visiting with Gordon and Mary, whom Kathy has known for 35 years. They are at the end of their lives, but the flame burns brightly in them, their vision, and the ministries it has spawned. Those familiar with Elizabeth O'Connor's "Eighth Day of Creation" know another manifestation of that Church.
The fact that Christ House has continued now for over 30 years is a testament to the faith and work of folks like the author, Hilfiker. The book was written almost 20 years ago, about experiences reaching back 30 years. It is a sobering book for anyone unfamiliar with urban poverty. And it is sobering to think that things can only have gotten far worse in the intervening 20 years. But it is an extremely honest and revealing book about the personal challenges of trying to do something positive in those circumstances. Of the many stories of individuals in this book, it was revealing that only the last full chapter was a story with a genuinely positive ending. And the epilogue suggested some other positive outcomes. But perhaps the moral of the stories was that outcomes and consequences are not the appropriate currency of ministry. What Hilfiker learned was the importance of being with and accompanying people on their journeys, and the realization that we are all children of God who try the best we can...and still fail. But that is ok, and that is the message of Jesus. About 35 years ago I was dipping my toes into similar challenges in Chicago, and took another direction. But the challenges are ones that I still can hear and feel.
Mary Cosby was a delight to talk with, finding relief in her condition which required others to look after her and being unable to look after numerous ministries. Her ministry was now one of friendship and encouragement. Gordon, on the other hand, almost literally on his deathbed, continues to minister in any way he can. He told us he is focussing on deepening his prayer life (which is really saying something). He talks with God, and spent some time wondering about how he can distinguish between God's voice and his own inner voice. A voice in prayer recently told him that the needs in Anacostia are so great that he needs to begin a ministry there and raise $300,000 to do it. He could hardly believe he was being told to do this, being unable to visit people anymore--but he has persevered. He asked God whom he should ask, and God told him to ask three people-the first being himself. Suffice it to say that Gordon raised $250,000 in short order. Because what he still has is a prophetic authority that he can bring to the better-off among us, and so he continues to do that. I am told that Gordon once preached a sermon on a Sunday morning and when, the following Sunday morning, he preached the very same sermon, he was asked why--had he not had time to prepare another? No, he said, he could have prepared another, but as far as he could tell no one had done anything he called for the last Sunday, so he decided they needed to hear the call again! Gordon is the closest living thing we have to an Old Testament prophet.
Dr. Hilfiker went on to found a new medical mission, Joseph's House, for those dying of AIDS, bringing him even closer to the poor he struggled to understand and love. This mission was oriented more toward the journey and less toward the outcome. This mission continues, and we have visited there as well, meeting with a friend who volunteers and lives there. Dr. Hilfiker has recently been diagnosed with Alzheimer's, but continues to share his journey: http://www.davidhilfiker.com .
Words like "God" and "Jesus" hardly appear in this book, but if you want to know what it is to live in Christ, read this book, and other books that have come out of the Church of the Saviour community, including Gordon's collection of sermons: "By Grace Transformed."
March 20, 2013: Gordon Cosby passed away into the fullness of God this morning.
March 1, 2021: 8 years later Gordon's vision in Anacostia has come to fruition: https://inwardoutward.org/PDFs/Callin...

[Sugy · Rating 3 out of 5]

book started shaky, got better, but then he started diving into prejudices that made it clear he wasnt doing the work for the goodness of his heart, he was doing it because of some ulterior motive. this is the second book i've read by hilfiker and was hoping it would be better than the last. i would use this and his other book as examples of why medicine can learn a lot from public health - everything is a social issue and we must take into account social and cultural issues when improving the health of a nation. while i can appreciate the book dealing with dr hilfiker's internal workings and predjudices which acknowledges to an extent and he writes about extensively in the second half, i felt like he still missed much of the point and the ills of "the poor" which doesnt mean necessarily that someone is homeless or almost homeless or that the ills of slavery (as opposed to the more recent double standards of law that unjustly disadvantage people of color) have a great deal to do with the condition of those he works with.

[Kristina · Rating 4 out of 5]

While the health desparities in America may be hard to read about, they pale in comparision to the systemic corruption that happens in poor, urban neighborhood that is discussed as a first hand account in this book by a physician who lives with and serves the poor. One example that should get anyone thinking about whether we start on the same "playing field" is that Dr. Hilfiker talks about repeatedly treating a 3 YEAR OLD little girl for chlamydia. He had called child protective services each time to try to protect this little innocent child from sexual abuse and they were unresponsive! Social services, like police and social workers in these neighborhoods are over-worked, understaffed and worn out and ineffeciency is rampant. He speaks very frankly about his work with the poor and the institutional system and it's challenges.

[Mom · Rating 3 out of 5]

David Hilfiker is a doctor who moved with his family to inner city Washington DC in order to work in "poverty medicine." This is a compelling but depressing account of the homeless people he cares for and his personal doubts and struggles. Hilfiker's work is important, courageous, and difficult, as are the lives of the people he serves.

One of the most positive aspects of this book is how Hilfiker personalizes the homeless, helping us to see that they are just like us and worthy of respect. His compassion and deep understanding are incredible, as is his searingly honest assessment of his spiritual limitations. I could not give the book a higher rating, however, because it was so depressing. The personal problems of his patients, the societal problems, the endless hurdles, the destroyed neighborhoods.... it was all just too much for me.

[J]

One reason I like this book enough to grant five stars is because of Hilfiker's candor when writing about his inner struggles and limitations. He doesn't take the tough topics and tough questions that he tackles and give nicely-packaged, end-of-discussion answers to the reader. Instead, his discussions freely expose his limitations in understanding social justice and the world of the poor, highlighting times when he hypocritically contradicted himself, for example. It gives the sense that he is genuinely concerned about issues larger than himself and trying hard to figure them out.

I recommend this book to anybody interested in poverty, social justice or charity. He writes from his perspective as a doctor but expands the discussion beyond medicine.

[Julie C · Rating 4 out of 5]

this book really spoke to me because i had gone through many of the same struggles as this doctor who practices "poverty medicine". working in health care in any capacity in medically underserved communities requires special skills and perspectives that are vastly different from practicing medicine in a privileged community. it was helpful to read this book because hilfiker did a nice job of putting words to some of the feelings that i had had working as a health educator on chicago's west side. definitely an important read for anyone who wants to understand more about the link between health care and socioeconomic status.

[Makayla · Rating 5 out of 5]

This book was incredibly touching. Dr. Hilfiker made me feel disappointed, annoyed, angry, and hopeful- in him, in myself, and in the “system”. After reading this book, I am eager (and a bit terrified) to begin my own work at Christ House. The stories and processing of emotions made Dr. Hilfiker extremely relatable, and I’m happy to have read this book. Questions of justice, race, poverty, medicine, and more were asked of me and challenged my way of thinking. Chapters 9 and 12 were especially touching to me.

[Megan · Rating 4 out of 5]

this book opened my eyes to what a hard, unjust society we live in here in America. Dr. Hilfiker chose to take the path less traveled, and brought his family along for the struggles and triumphs of working in a health clinic in one of the nation's poorest neighborhoods...which happens to be within a 5-mile radius of our nation's capital. shocking, and not one to sugar-coat, Hilfiker's journey will give you a different perspective.

[Lily · Rating 5 out of 5]

I'm so glad this book was recommended to me. I underlined at least 5 or 6 passages that verbalized some of the thoughts I've been having about my work over the past months. Granted, I'm not a doctor, but the "poverty medicine" Dr. Hilfiker writes about is something that many people in the "helping professions" end up practicing. It's a pretty personal book about this particular doctor's experiences, but there are definitely some universal lessons to be learned -- I may have to buy my own copy.

[Joel · Rating 5 out of 5]

Amazing book on the care of homeless persons and the work of one doctor in doing this in Washington DC. Phenomenal and sentinel book in this field. An absolute must read for anyone remotely involved in poverty medicine, homeless medicine, or street medicine.

[Esther · Rating 5 out of 5]

Set in the 1980's, the author Doctor works at a clinic for the poor and homeless of Washington DC. The author is open about his struggles to remain emotionally healthy in the midst of despair. The stories and discussion clarify the power of poverty to break and warp the human spirit.

[Mary · Rating 4 out of 5]

A doctor in the ghetto in D.C., some thoughtful insights into poverty.

[Rebecca]

Personal deconstruction of privelege of being white physician working with urban underserved communities of color. Written preAIDS epidemic, in like 1982 or something.

[Sps · Rating 4 out of 5]

Thoughtful.

[Margo · Rating 5 out of 5]

Excellent, fascinating

[Lindsay · Rating 4 out of 5]

A beautiful, painful, real-life memoir of a burnt-out do-gooder who wants desperately to make a difference in the world. Bless you, brother, for your faithful efforts.

[Lucy · Rating 2 out of 5]

20 years old so a bit outdated but a good reminder that poverty is a trap.