Dr. Susan Partovi is not supposed to drive patients to the emergency room, but it happens. The “Skid Row Doctor,” as colleagues know her, has an award in her office praising the “boundless compassion” she has demonstrated over what is now nearly 15 years of caring for thousands of the sickest of the sick in the homeless capital of America. Sometimes, however, Partovi’s boundless compassion gets her into trouble.
It was late on a Thursday in February, one of those deceptively gray winter days in Los Angeles that turn sunny and hot in an instant. Partovi and a homeless man with a heroin addiction were in the front seat of her Toyota RAV4, speeding southward on the 110 freeway, destined for the UCLA-Harbor Medical Center in Torrance.
A short time earlier, the patient, Melvin (who gave me permission to use his first name), had broken down sobbing in Partovi’s office, holding up a left hand freshly wrapped in a surgical bandage and crying out in pain that he couldn’t move his fingers. He was a patient of hers who lives out of a wheeled suitcase and sleeps at night on a sidewalk down the street from the free clinic where Partovi is the medical director.
Using shears to gently cut away the dressing from the back of Melvin’s hand, Partovi saw four incisions packed with gauze that told her surgeons had operated to treat a deep infection. The degree of swelling was normal, but the unbearable pain he complained of made her fear that pressure was building within the muscles, which could decrease blood flow and prevent oxygen from reaching nerve and muscle cells. She feared that without treatment there was a chance Melvin could lose the hand. For Partovi, it was a case study that encapsulated much of what she strongly disapproves of when it comes to the way mainstream doctors mistreat patients who inject drugs.
Partovi worked as an attending physician in the family medicine department at Harbor for ten years. She knew the hospital staff usually doesn’t give medicine to patients to control the symptoms of heroin withdrawal. “To me it’s kind of cruel,” she says. She strongly suspected this was the reason why the patient left the hospital against medical advice so quickly after surgery. She had seen so many addicts do the same. “They’d rather leave a hospital with their hand hanging off than be dope sick,” she says.
Partovi jokingly refers to herself as “the abscess queen.” She has a video up on YouTube in which she slices open and squeezes an abscess the size of a grapefruit on a man’s rear end. Most of the wounds she treats at the nonprofit Homeless Health Care Los Angeles clinic start as soft-tissue infections of patients who slam drugs like crystal meth or the low-grade tar heroin sold to desperate addicts on Skid Row.
Partovi had the presence of mind to use the drive-thru at McDonald’s before she got on the freeway. She ordered a Quarter Pounder with bacon and cheese and a side of fries for Melvin and a Shamrock shake for herself. As she merged at the interchange, he stared out the window, absently eating fries from the take-out bag.
With the freeway sign for the Los Angeles Coliseum approaching in the distance, Partovi phoned ahead to the attending physician on duty in the department of family medicine at Harbor. Family medicine, she said, does better at dealing with social situations and seeing the whole picture. She needed someone in family medicine to attend to Melvin. The operator put her on hold. Alan O’Day’s “Undercover Angel” was playing on the radio, and Partovi sang along softly to the part of the chorus that goes, “Love me, love me, love me.”
The young woman on duty who answered the phone knew Partovi from a community medicine rotation the two had done at a needle exchange program. “It’s supposed to go to plastics, but this is not the usual thing,” Partovi was saying, and the young doctor seemed to agree. She told Partovi to call the attending physician on duty at the emergency department. The chipper young man who answered the phone there said he would see what he could do. “You’re going way out of your way,” Melvin said, sounding as if he had come out of a trance. “Just be sure to check in,” she said.
With light traffic, we’d be at Harbor in 20 minutes. Beyond Birth and Death, a slim volume by A.C. Bhaktivedanta Swami Prabhupada, the founder of the International Society for Krishna Consciousness, was sticking out of the passenger seat’s back pocket. Partovi took a long sip on the straw of her shake and emitted a sound like mild shock. “I think I just gave myself diabetes,” she said.
From the street, the Skid Row needle exchange of Homeless Health Care Los Angeles has the discreet charm of a cannabis dispensary. Its frontage is all tinted glass, featuring a large cartoonlike illustration of a syringe, and there’s a security guard who unlocks the front door and admits visitors one at a time. But the interior decor is almost industrial chic, like a tech start-up or an architecture firm: spacious with high ceilings, whitewashed brick, and lots of repurposed metal.
The door of Partovi’s office was open, and the clack-tap noise that broke up the businesslike hush of the exchange was coming from the heels of her black cowboy boots striking the concrete floor. Partovi was scouring the room for something, which she found in a narrow space on the floor between the desk and a filing cabinet. “Aha!” she said jubilantly, retrieving a small pouch made from what appeared to be Alpaca wool, pink-dyed and hand-knit, the sort of thing one might find at a village market in the Andes. Partovi has high, arched eyebrows, freckled cheeks, a fine elongated nose, and dark eyes whose heavy lids she had striped with royal-blue eye shadow to match her turquoise earrings.
The pouch, as she affably demonstrated, is a size that fits snugly around her travel mug of tea (“I can’t even handle coffee”). It has a long cross-body strap that lets the cup dangle at her waist and keeps her hands free. Useful to have, she said, since the temperature outside was in the 40s and we were going out for a walk.
Partovi is the kind of doctor who wears a jean jacket, not a white coat, carries her medical gear in a backpack, and makes home visits to patients who reside outdoors. She has pioneered the practice of street medicine in Los Angeles, having created successful programs for the homeless in Venice and Skid Row that became models for today’s multiagency mobile outreach teams that are run collaboratively by the city and Los Angeles County.
She has developed a knack for for irking certain types of higher-ups. “I’m pushy,” she says. “It definitely pisses people off.
But today Partovi wasn’t carrying her usual backpack, which bears the basics like foot cream, socks, Band-Aids, and antibiotics, and even collars and leashes for dogs. She doesn’t do outreach on Skid Row like she used to. She directs a clinic here once a week. It’s more of a wound care clinic for heroin addicts, run by the Homeless Health Care Los Angeles. It provides sterilized hypodermic needles to people who inject drugs and prescribes medication and treatment for those who wish to stop. Her patients are the lepers of the American public health system, dually stigmatized for homelessness and addiction, for whom illness is inextricable from shame, and they adore her because she treats them without judgment.
Partovi lives in a two-bedroom bungalow in Venice with several dogs, two of which—Cookie and Ray Ray—she adopted from Skid Row. She took Cookie in after the white terrier mix was hit by a car and paralyzed at the waist. Partovi paid thousands of dollars for operations, had one rear leg amputated, a metal rod inserted in the other, and put the dog in diapers for a month, until she recovered and could walk again. Partovi once took in nine cats as a condition for a homeless woman to enter treatment for cancer. The patient later died of her illness, and Partovi kept the pets at home for two years. “How you doing, lady doctor?” asked a man running past with a blanket draped behind him like a cape.
Partovi’s path to homeless medicine had an unlikely start in Brentwood and, later, Malibu, where she grew up the daughter of prosperous Jewish-Iranian parents. Her father, an aerospace engineer from Iran, immigrated to Los Angeles in the 1960s, earned his master’s degree, married her mother (a Jewish schoolteacher from upstate New York), and fell in love with the classic notion of the American dream. When a revolution toppled the shah of Iran in 1979, her father’s relatives joined the exodus of Iranians seeking refuge in and around a burgeoning ethnic enclave of Westwood that came to be known as “Tehrangeles.” Partovi was 12 years old, the only member of the extended family born in Los Angeles and the only one who didn’t speak Farsi. She was the black sheep of the family, she says good-humoredly, and has been ever since.
By high school, the dream of money, two cars, and a house left the precocious teenager seeking a higher sense of purpose. With her parents’ marriage on the rocks and drifting toward divorce—“Lots of yelling and fighting,” she recalled, “a pretty dysfunctional family”—she delivered a shock to her mostly secular parents with the news that she had become a born-again Christian. “I remember my grandma in her broken English saying to me, ‘You’re a Christian now? That’s OK. God still loves you.’ ”
She went to Bible study at a Presbyterian church in Brentwood and joined a youth group on a mission to Tijuana, Mexico. She met a physician’s assistant in the group and went with him to provide medical care to children in a poor village on a hill that overlooked a city dump. She remembers the children were barefoot, filthy, and suffering illnesses like leprosy that stemmed from overwhelming poverty and medical neglect. After graduating from Santa Monica High School, she was accepted to UCLA and then enrolled at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia.
She stopped calling herself a Christian after medical school because of a falling out with the religion based on what she calls intolerance. She has since forgotten any Bible passages she used to know but has retained the “Jesus-like” principles of empathy and being of service to others less fortunate. It can be something as simple as giving away one of her little dogs to a depressed patient and writing him an emotional support dog letter.
Partovi’s father died of cancer when she was in her residency. Her mother suffers from Alzheimer’s; her older half-sister from early onset dementia; and she provides round-the-clock care for both. She has never married. Black sheep or not, she remains close with her father’s family, especially the cousins closest to her in age; many of them, like her, are doctors.
Partovi created the Homeless Street Medicine program at Venice Family Clinic way back in 2007, an achievement that landed her on L.A. Weekly’s list of Most Influential People in Los Angeles. She was the medical field director for the county Department of Health Services’ Housing for Health in 2014 and led a push for the Board of Supervisors to expand the powers of health officials to forcibly stabilize and treat the severely mentally ill—people whose mental disorders are so severe they cannot provide for their own basic life-sustaining needs. She was involved in creating the first and only Suboxone detox regimen at the county’s women’s jail in 2017, treating dozens of incarcerated women for opiate addiction.
Like many a passionate employee with a high degree of competence and independent streak, Partovi has clashed with bosses and been let go from jobs she loved. Four times in 11 years, to be precise, and always, she says, stemming from her advocacy for patients. She has developed a knack for sensing when a patient’s illness is life-threatening and acting fast, along with a proclivity for irking certain types of higher-ups who, she says, tend to hew too cautiously to protocol. “I’m pushy,” she says. “This guy’s gonna die. They’re not in the field. They don’t see what I see. They feel pressured to comply. It definitely pisses people off. But when it works, it’s great.”
The Venice program still exists; the jail’s Suboxone regimen has been curtailed. Meanwhile, Partovi’s clinical duties on Skid Row are down to one day a week at Homeless Health Care, where she directs the needle exchange, runs the Suboxone detox program, and tends to the wounds of intravenous drug users.
Travel to Maui and Mammoth is Partovi’s first love, and she also loves eating at gourmet restaurants—“I like nice things. I host Botox parties. I’m no saint”—but she is happiest as a doctor when she is treating the homeless where they live. “I want to find the sickest of the sick, the worst of the worst,” she said. “Mediating barriers, building trust, that’s for me.”
Her recent job history is a sensitive subject, and she is careful with her words. “I’ll say this,” she told me, “I’ve never been fired for my patient care.” She has deep respect for HHCLA “because they push the envelope, too.” She is working with its CEO, Mark Casanova, to expand her involvement to homeless outreach beyond Skid Row. To make ends meet in the meantime, she sees patients four days a week at the Martin Luther King Jr. Outpatient Center in Willowbrook.
Earlier that morning when I was alone, I had met a homeless man in front of Homeless Health Care who had arrived early and was waiting for the needle exchange to open. When he learned I was writing about Partovi, he told me: “Write that she’s not judgmental like doctors can be. She gets people with addictions. She’s very caring and she’s got a good heart and a lot of people like her.”
At Harbor-UCLA Medical Center, Partovi stopped in the traffic circle near the entrance to the emergency department. She handed Melvin a handwritten doctor’s note and two tablets of Suboxone in case he started withdrawing in the waiting room. “Wait until you’re sick,” she instructed, “take it under your tongue, and it works in 10 minutes.” Melvin sat stock-still and appeared petrified.
The doctor said she wasn’t going inside with him. He got out a bit unsteadily, removed his wheeled suitcase from the rear of the car, and seemed to work up an effort to demonstrate his appreciation. “Melvin,” she interrupted, “they’re not going to let you bring your outfits in.” She used a word common to the argot of Skid Row for the tools in Melvin’s travel bag used to prepare and inject heroin. He rested his good hand on the lowered window and stared blankly back at her. “They make you run your bags through an X-ray belt,” she said.
He nodded, turned, and walked toward the sliding glass door of the ER, and Partovi asked me to go with him. Inside the lobby, a small gray-haired man in the white uniform of a private security company stood behind the aforementioned X-ray belt. The hospital had one of those old metal detectors like the Transportation Security Administration uses when the line is extra long at the airport. The guard was waiting patiently for the only man in line to finish emptying the metal objects from his pockets into a plastic dish.
The guard seemed not to notice Melvin’s presence. It all seemed like standard operating procedure to me. But Melvin stood behind me, frozen in place, directly in the path of the automatic sliding door, which, because it couldn’t close, remained wide open. For some reason, he had pulled a white paper bag from the needle exchange out of his suitcase and was hugging it close to his chest. “Can I talk to you outside for a minute?” he whispered.
The point of going the extra mile for a patient, Partovi had told me when we walked around Skid Row, is for the patient to know that she cares enough about them to go the extra mile, and that maybe one day they’ll care that much about themselves. She glanced up from her smartphone with a bemused expression when she saw that he and I had returned. Melvin’s face was ashen, his expression that of a scolded child. He said something to her about finding a place to hide the outfits somewhere he could pick them up later. “I’m gonna need these after,” he said sadly. He patted the breast pocket of his jacket where he had put the doctor’s note and thanked her for going to all the trouble.
Melvin asked Partovi to call his mother for him, and the doctor agreed. She gave a serene sigh as she watched him pull his wheeled suitcase in the direction of a strip mall across the street, still hugging the bag to his chest with his bandaged hand.
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