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\t\t<\/p>\nBOSTON \u2014 Carlton Haynes hugged his left knee, pulling it toward his shoulder as hard as he could. He was desperate to blunt the pain shooting from an open, oozing wound on his right shin. Anahita Dua, a vascular surgeon leading an unusual clinic created by Massachusetts General Hospital that Saturday, told him he was going to the ER and then the OR, where she would remove damaged skin and treat the wound.\u00a0<\/p>\n
Without this stopgap measure, she warned him, he\u2019d almost certainly need amputation.\u00a0OK, he said, but first he wanted a smoke.\u00a0<\/p>\n
So vascular surgery resident Sujin Lee rolled Haynes, 56, in a wheelchair into the elevator down four flights to the street, wondering how far they would need to go in the spitting rain to leave the hospital\u2019s no-smoking zone. In anticipation, Haynes pulled a cigarette from his pack of Winstons.\u00a0<\/p>\n
\u201cDo you have a lighter?\u201d he asked.<\/p>\n
No, she didn\u2019t. Passersby and drivers in parked cars were no help either, as Lee dashed down the street. Then she told Haynes they should head back inside the hospital.<\/p>\n
That last smoke proved elusive, but not for want of trying. Faithful to their ethos of meeting patients where they are, the Mass General team helps bring in people like Haynes \u2014 arranging Uber rides or sending shuttle vans \u2014 so they can see the series of specialists they need in one seamless visit on the hospital campus.<\/p>\n
\t\t\t\t\t<\/p>\n
\t\t\t\t\t\tThe street psychiatrist: Earning trust with vulnerable patients<\/a><\/p>\n Every three months about 30 patients referred by primary care clinics move from a busy waiting room to a triage desk, then down a hallway of exam rooms labeled for the day to render wound care, imaging tests, evaluations, and compression sock fittings. Patients come in with what could be blocked carotid arteries, peripheral artery disease, abdominal aortic aneurysms, or infected sores that could seed sepsis, the overwhelming full-body infection.<\/p>\n \u201cBecause there\u2019s lack of flow to the foot, for example, they\u2019ll get a black toe and they\u2019ll go to the ER,\u201d Dua said about a more typical health care scenario. \u201cIn the American health care system, the model unfortunately is such that there\u2019s a lot of firefighting, but in general, we\u2019re not huge on prevention. So these patients will turn up, and of course they\u2019ll have had no care anywhere previously and certainly no records.\u201d<\/p>\n Working with Boston Health Care for the Homeless Program, the Mass General clinic, believed to be the first and only one of its kind, turns the ER-first model on its head. Primary care professionals at Boston Health Care for the Homeless identify people who could benefit from the hospital\u2019s effort, founded three years ago to treat vascular conditions that threaten life and limbs. The clinic, run by the vascular medicine and surgery group within the Mass General Brigham Heart and Vascular Institute, was created a year after the hospital established the Limb Evaluation and Preservation Program<\/a>, which Dua co-directs and whose mission is to help patients avoid amputation after peripheral artery disease.\u00a0<\/p>\n People can get good care at shelters or clinics for the unhoused, but the middle part between primary care and the emergency department was missing, Dua said. While she and her colleagues do see urgent cases in the quarterly sessions, their hope is to prevent emergencies and overcome reluctance to seek intermediate care. The vascular surgery clinic can be the bridge, Dua said.<\/p>\n \u201cYou do the primary care, you find out someone has an aneurysm in their aorta, and then you say go to the ER? This person\u2019s not going to go to ER, so they die,\u201d she said about patients\u2019 reactions. \u201cThat\u2019s where this idea was born that we would create a clinic where we could do the next step: Send them to us.\u201d\u00a0<\/p>\n David Munson, a primary care physician at Mass General and medical director for Boston Health Care for the Homeless, said building trust has to happen first. He estimates that 125 to 150 people have received care since the clinic began in 2023.<\/p>\n \u201cI think a lot of that is done upstream, where people have done work to either engage people on the street or engage people in shelters or in our respite\u00a0program, and they have a relationship with a provider,\u201d he said.<\/p>\n There is no typical Saturday at the vascular surgery clinic at Mass General, but the mainstays are doctors, nurse practitioners, nurses, and ultrasound technicians assisted by medical students and medical residents. Doctors and trainees like Lee volunteer their time to guide patients through up to five steps that could otherwise require separate appointments on separate days.\u00a0<\/p>\n Four patients, including Haynes, agreed to share their stories with STAT. Most of their care started with Health Care for the Homeless in its Barbara McInnis House, near Boston Medical Center. Many referrals start with a wound that does not heal, a warning signal of an underlying vascular problem.\u00a0<\/p>\n \u2018I\u2019m trying\u2019<\/p>\n Before Haynes bargained with vascular surgeon Dua to have a smoke, Mark Picard, 53, was telling his story to podiatric surgeon Sara Rose-Sauld. Dressed in a black T-shirt and shorts with a New England Patriots hat on his head and shower slippers on his feet, he said he wanted to understand why the sore on his lower left leg wouldn\u2019t heal, eight years after getting a gash from a bike pedal.\u00a0<\/p>\n First Rose-Sauld asked if he\u2019d like to have his long toenails clipped. Yes, he said. Pain from his right hip kept him from doing that himself, and also from putting on socks. He\u2019s due for a hip replacement, but if his leg wound gets infected, that would be a deal-breaker.\u00a0<\/p>\n \u201cI\u2019ve been a drug addict for 30 years, too, so I used to think that that was the reason,\u201d he said about former heroin use and his wound\u2019s failure to heal. \u201cI\u2019ve got a pretty good grip on that now. I\u2019ve gotten some time under my belt and finally, you know, after a lot of years of hard work, I\u2019m trying.\u201d<\/p>\n Finding timely health care has been hard, aggravated by a lack of transportation. This day Picard arrived at the vascular clinic with six other patients via a van from the Barbara McInnis House, where he has received daily dressing changes for his leg. Rose-Sauld cleared the edges, applied a wound-care salve, and emphasized the importance of changing the dressing frequently and elevating the leg when he could.\u00a0<\/p>\n \u201cOnce I get my hip taken care of, then I can get back to doing the things I used to do that I enjoy,\u201d he said. \u201cI love golf. I\u2019ve got nieces and nephews that are golfing. I can\u2019t wait to be able to play with them.\u201d<\/p>\n \u2018They said I\u2019d be dead\u2019<\/p>\n Waiting his turn for an ultrasound exam, Kenneth Bolster, 63, recounted his brushes with death. There was the time in San Antonio, Texas, when a person addicted to meth slammed a steel pipe onto his head, he recalled, causing brain damage that weakened his left side and left his left arm limp. That injury ended his 35-year career as a tattoo artist. He needed that left hand to stretch skin where his right hand would perform his art.<\/p>\n \u201cI raised nine kids on it \u2014 everyone went to college, and I had three new homes,\u201d he said about his tattoo work.<\/p>\n \t\t\t \t\t\t\t\t\t\u2018It\u2019s a universal experience\u2019: Doctor who treats Boston\u2019s homeless population on why community is vital to health<\/a><\/p>\n Ten years ago a tree fell on his right leg, requiring an amputation. He\u2019s also had a quadruple heart bypass, a stomach blockage that required surgery, and a spinal fusion. \u201cThey said I\u2019d be dead in a year and that was six years ago, so I\u2019m not going anywhere,\u201d Bolster said.<\/p>\n This time he was referred to the vascular clinic by the New England Center and Home for Veterans to follow up on CT scan results. He\u2019d had dizzying low blood pressure due to blocked carotid arteries, the large blood vessels on each side of the neck. He felt like he was choking.<\/p>\n Because his right carotid is completely closed, his left one has to work harder to compensate, vascular technologist Lindsey Ferraro explained to him. As the ultrasound swooshed with each pulse and red blobs animated the screen (a good sign), there was no indication he\u2019d need urgent care, unlike fellow patient Haynes, who was heading to the operating room before the clinic\u2019s end at 2 p.m.<\/p>\n Instead, Bolster traveled to the cafeteria with a $15 voucher and a volunteer escort, part of every patient\u2019s visit should they so choose.\u00a0<\/p>\n \u2018I used to be afraid of doctors\u2019<\/p>\n Meanwhile, Emma Chase, a medical assistant in vascular surgery, was helping Francia Echevarria, age 67, stay as comfortable as she could while her two legs were examined for pain that she says keeps her from moving forward. Unlike the open wounds others showed, there were no obvious signs of vascular trouble, but movement hurt due to peripheral artery disease. Turning to the right on the exam table was more difficult than to the left. She sighed a little more loudly, nodding when Chase asked if it felt worse.\u00a0<\/p>\n Originally from Santo Domingo in the Dominican Republic, she now lives with her two daughters in South Boston.<\/p>\n \u201cI take care of two autistic grandchildren. One is 11 years old and the other is 8 years old,\u201d she said through a hospital medical interpreter. \u201cThey were born in my hands.\u201d<\/p>\n While decisions on further steps were being made, the nurse offered knee- and thigh-high compression stockings to ease the pain and improve blood flow to and from the legs.\u00a0<\/p>\n Chase used what looked like a partial plastic brace to widen the stocking to push them up the legs. Kneeling on the floor, Chase brought Echevarria\u2019s ankles to rest on her shoulder so she could bring the stockings up to the hip.<\/p>\n Then Chase demonstrated how this might be done at home. \u201cMake a sock puppet\u201d was the first step.<\/p>\n This was Echevarria\u2019s second visit to the clinic for leg pain. She was smiling behind her mask, which she pulled down at the end.\u00a0<\/p>\n \u201cI used to be afraid of doctors, but when I come here, I feel so confident that I have no fear,\u201d she said. \u201cNot anymore. Here, people are treated wonderfully.\u201d\u00a0<\/p>\n Avoiding us versus them<\/p>\n Moments later, Dua, the vascular surgeon who would see Haynes in the OR,\u00a0heard that he was intubated and would be ready for her soon. Her plan was to clear dead skin from the edges of his wound and then apply a specific treatment: the scaly skin of a fish from Iceland that would promote healing and stave off the need for amputation. Called Kerecis, it\u2019s considered superior to tilapia skin<\/a>, which is used to bandage burns.<\/p>\n Another treatment called Stravix, made from human amniotic tissue, works well but it looks so much like dead skin that well-meaning people might brush it off.<\/p>\n Haynes\u2019 heading into that operating room was a victory for Dua.\u00a0When she first proposed the procedure, he said no, not if he couldn\u2019t smoke while admitted to the hospital.\u00a0<\/p>\n \t\t\t \t\t\t\t\t\tTo fix \u2018spiritual malaise\u2019 behind addiction, Kennedy announces efforts on homelessness and recovery<\/a><\/p>\n Dua\u00a0knows there\u2019s a direct link between his cigarette smoking, vascular damage, and the wound right on his bone that wouldn\u2019t close, but she decided that letting him smoke was a choice that got the job done.\u00a0<\/p>\n \u201cThe minute you make it an us-and-them thing, the patient will immediately reject you,\u201d she said, adding: \u201cThis one cigarette allows him to get the care he needs now. I achieved what I needed to achieve.\u201d<\/p>\n Peripheral artery disease, when narrowed arteries reduce blood flow to the arms or legs, affects up to 12 million Americans. It\u2019s more common among Black Americans, who are three times as likely as other Americans to have their limbs amputated.<\/p>\n It doesn\u2019t have to be that way, Dua said. Screening can begin in primary care with shoes-off exams, when damage from diabetes could be visible; ankle measurements to ascertain swelling, or ultrasounds if warranted. Federal legislation introduced in 2020<\/a> is intended to increase awareness and reduce disparities, but Dua is not hopeful about its passage.\u00a0<\/p>\n With no more patients in the waiting room, Dua excuses herself to see Haynes in the OR, where medical resident Lee has begun the procedure. Dua will return to meet the team for a debriefing on all the patients seen before the clinic\u2019s close at 2 p.m. Their medical charts will be updated to reflect the day\u2019s treatments and decisions.<\/p>\n Staff and volunteers \u2014 critical to the program\u2019s success \u2014 first gather over Indian food. Second-year medical student Shiv Patel arranges Uber rides for patients and he orchestrates takeout for the team\u2019s lunch.<\/p>\n Dua said volunteering reflects the same urge that got them all into medicine. \u201cIt\u2019s just you and that patient,\u201d she said. \u201cThey get to take ownership of the patient fully.\u201d<\/p>\n And go outside with them for a cigarette, if that\u2019s what it takes.<\/p>\n STAT\u2019s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies<\/a>. Our financial supporters<\/a> are not involved in any decisions about our journalism.<\/p>\n","protected":false},"excerpt":{"rendered":"BOSTON \u2014 Carlton Haynes hugged his left knee, pulling it toward his shoulder as hard as he could.…\n","protected":false},"author":2,"featured_media":467057,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[6294,134,527,3274,111,139,69,1675,6290],"class_list":["post-467056","post","type-post","status-publish","format-standard","has-post-thumbnail","category-healthcare","tag-cardiovascular-disease","tag-health","tag-healthcare","tag-hospitals","tag-new-zealand","tag-newzealand","tag-nz","tag-public-health","tag-surgery"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts\/467056","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/comments?post=467056"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts\/467056\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/media\/467057"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/media?parent=467056"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/categories?post=467056"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/tags?post=467056"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}![\"\"](\"https:\/\/www.newsbeep.com\/nz\/wp-content\/uploads\/2026\/06\/LL_DSC5138-1024x1536.jpg\")
Anahita Dua, vascular surgeon and head of the special vascular clinic at Mass General, reviews a list of patients her team is hoping to contact to arrange transportation.Lucy Lu for STAT<\/p>\n![\"\"](\"https:\/\/www.newsbeep.com\/nz\/wp-content\/uploads\/2026\/06\/LL_DSC5183-1024x683.jpg\")
Mark Picard gets seen at the vascular clinic for a persistent leg wound.Lucy Lu for STAT<\/p>\n![\"\"](\"https:\/\/www.newsbeep.com\/nz\/wp-content\/uploads\/2026\/06\/LL_DSC5427-1024x683.jpg\")
Vascular technologist Lindsey Ferraro performs an ultrasound on Francia Echevarria at the vascular clinic.Lucy Lu for STAT<\/p>\n![\"\"](\"https:\/\/www.newsbeep.com\/nz\/wp-content\/uploads\/2026\/06\/SPEECH_BUBBLES_02-768x432.jpg\")
\t\t<\/p>\n![\"\"](\"https:\/\/www.newsbeep.com\/nz\/wp-content\/uploads\/2026\/06\/LL_DSC5394-1024x683.jpg\")
Echevarria speaks with her Spanish interpreter while waiting for an ultrasound at the vascular clinic.Lucy Lu for STAT<\/p>\n![\"\"](\"https:\/\/www.newsbeep.com\/nz\/wp-content\/uploads\/2026\/06\/LL_DSC5582-1024x685.jpg\")
The medical team shares a meal after the vascular clinic sees its last patient, a tradition right before debriefing about the patients they saw that day.Lucy Lu for STAT<\/p>\n![\"\"](\"https:\/\/www.newsbeep.com\/nz\/wp-content\/uploads\/2026\/06\/GettyImages-2259617602-768x432.jpg\")
\t\t<\/p>\n![\"\"](\"https:\/\/www.newsbeep.com\/nz\/wp-content\/uploads\/2026\/06\/LL_DSC5379-1024x706.jpg\")
Bolster gets a snack and drink at the cafeteria after his appointment at the vascular clinic upstairs.Lucy Lu for STAT<\/p>\n