SCOTT SIMON, host:

This time last year, we introduced you to a man named Donald Cooper. He was living in a homeless shelter near Boston after a long string of bad luck. He had cancer; he'd lost his job; the bank foreclosed on his house; his marriage fell apart; his diabetes went out of control. A doctor who specializes in the care of homeless people helped him overcome his fear of needles and taught him how to inject himself with insulin.

Unidentified Woman #1: Now just pull it straight out fast.

Mr. DONALD COOPER: Oh, OK.

Unidentified Woman #1: You all right?

Mr. COOPER: Yeah.

Unidentified Woman #2: How was it? How was it?

Mr. COOPER: Not bad, but I was afraid.

Unidentified Woman #2: I'm sweating now.

Unidentified Woman #1: Me too.

Mr. COOPER: Afraid--but it wasn't bad.

Unidentified Woman #1: Good.

Mr. COOPER: It was just a little pinch and I could get used to that.

SIMON: But after that, things began to fall apart again. NPR's Richard Knox has this report on what's happened to Donald Cooper in the past year and what it tells us about good medical care.

RICHARD KNOX reporting:

Donald Cooper was glad to move out of Father Bill's shelter in Quincy, Massachusetts, last spring. He'd been there for more than a year. But at the same time, he lost his medical support system and his close relationship with Dr. Jessie McCary. He moved in with his son 90 miles away. McCary didn't see him much. Then this summer, he moved back to Boston. At a clinic visit recently McCary checked his blood pressure.

Dr. JESSIE McCARY: Well, it's not as good as I'd hoped it would be.

Mr. COOPER: What is it?

Dr. McCARY: Your blood pressure: 170 over 104. It's pretty high actually.

Mr. COOPER: 104--that is high.

Dr. McCARY: That is high. That makes me wonder if...

KNOX: His blood sugar is way high too. She asks him if he's filled her latest prescription for insulin.

Dr. McCARY: Don, have you used it yet?

Mr. COOPER: Have I used it yet?

Dr. McCARY: Be honest.

Mr. COOPER: No. (Laughs)

Dr. McCARY: OK.

Mr. COOPER: No. No.

Dr. McCARY: How come?

Mr. COOPER: I told you two years ago that the needle and I don't get along--just I cannot...

Dr. McCARY: Right. We've got a lot of work to do.

KNOX: But Donald and his doctor are hopeful because finally after waiting nearly two years he got into his own place. It's a government-subsidized studio apartment just a few blocks from the Victorian house he used to own.

Dr. McCARY: What's it been like this week being at home on your own?

Mr. COOPER: You know, just--that's the word right there.

Dr. McCARY: Alone?

Mr. COOPER: No. Home. That is the word.

Dr. McCARY: Good.

Mr. COOPER: You know, like, I see my daughter, I go over to my daughter's house, and to say to her, `I'm going home'--that's a feeling that you can't explain to people. That is what it's all about. A home.

KNOX: McCary decides to visit Donald's new home. She wants to poke around in his medicine cabinet and his refrigerator. Not many doctors do that. But McCary knows that patients like Donald need more than clinic visits.

Dr. McCARY: All right. So we'll see you in two days.

Mr. COOPER: Oh, OK.

Dr. McCARY: You might want to clear out the doughnuts before we get there.

Mr. COOPER: Yeah, believe me. If there's anything I'm going to clean 'em out. Believe me. I know you're coming. Believe me. Then I will. Just--but no. No doughnuts.

(Soundbite of music)

Unidentified Man: (Singing) ...I fall in love with you.

KNOX: Two days later, Donald meets McCary in the lobby of his apartment house where the guard has the radio on.

(Soundbite of music)

Unidentified Man: (Singing) ...love you too.

KNOX: She's brought along a team: Sharon Morrison, a diabetes nurse, and Hope Wilson, a nurse at Father Bill's shelter. He takes them upstairs to his apartment.

(Soundbite of door opening)

Mr. COOPER: It's home.

Dr. McCARY: Hey.

Unidentified Nurse: It smells like paint in here.

Unidentified Nurse: As in fresh paint, yes.

Mr. COOPER: This...

Dr. McCARY: Great. You've got it so clean.

Mr. COOPER: ...is home.

Dr. McCARY: This is pretty spacious.

KNOX: Dr. McCary gets right down to business.

Dr. McCARY: Let see you now do an injection of the insulin and maybe we can help with pointers, see how you're doing. It's been awhile.

Mr. COOPER: Yeah, yeah. It's been awhile.

Unidentified Nurse: It's been a long while.

Mr. COOPER: I hope--do you want to do it, then?

Unidentified Nurse: No. You do it.

Mr. COOPER: No, you do it. You want to do it?

Unidentified Nurse: No. Go ahead, Donald.

Mr. COOPER: Don't--no, no, no. You do it.

KNOX: After some fumbles, Donald overcomes his needle phobia and injects the insulin into his belly.

Mr. COOPER: There now.

Unidentified Nurse: Nice job.

Unidentified Nurse: Good job.

Mr. COOPER: Oh, OK.

Unidentified Nurse: Now you need to log it in your book.

KNOX: McCary checks his medicine and says the team will be back to see how he's doing.

Dr. McCARY: All right. Thanks, Don.

Mr. COOPER: Nice...

Dr. McCARY: You've gotta great place.

Mr. COOPER: Thank you. Thank you.

KNOX: After they leave, Donald talks about why the past year's been so hard. He's been severely depressed and he sometimes hears voices.

Mr. COOPER: A lot of the things I wouldn't even repeat what they be saying, but you know, they be saying just like negative things to you, you know, and...

KNOX: Running yourself down or...

Mr. COOPER: Yeah. Yeah. Yeah. But the best thing is to do is to try to keep your mind off 'em and don't even listen to things like that. You know?

KNOX: McCary's got him on antidepressant drugs and the voices aren't bothering him quite so much. A month later, McCary and Nurse Hope Wilson make another house call.

Ms. HOPE WILSON (Nurse): Hello.

Mr. COOPER: Hi. Good morning.

Dr. McCARY: Hi there. Good morning.

Mr. COOPER: Good morning.

Dr. McCARY: What is all this stuff?

Mr. COOPER: Oh, that's my new dining room set. That's a birthday present.

Dr. McCARY: You're kidding?

Mr. COOPER: No.

Ms. WILSON: Nice.

Dr. McCARY: Wow. From your family?

Mr. COOPER: Yeah.

KNOX: McCary perches on a straight chair while Donald sits on the edge of his new fold-away bed. She asks him how he's doing with his insulin injections.

Mr. COOPER: Just--I just fell right into the habit, giving myself the injections. Even when I cheat, you know, like yesterday I had a coffee roll from Dunkin' Donuts. Jessie, even when I cheat I use that insulin and the reading comes out so much lower than what it used to come out.

Dr. McCARY: What kind of readings are you getting now? What range?

Mr. COOPER: I tell you what. The highest one I got was this morning: 134.

Dr. McCARY: Oh, excellent.

Mr. COOPER: 134.

Dr. McCARY: Have you had any low values?

Mr. COOPER: Huh? Oh, yeah: 98...

Dr. McCARY: Great. That's almost normal. That is normal.

Mr. COOPER: I was saying--yeah.

KNOX: Donald says he's trying to eat better, and he's looking for a job.

Mr. COOPER: I've come a long way.

Dr. McCARY: You definitely have.

Mr. COOPER: Now I'm interested in what the future is; as for about the past, there's nothing I can do about the past. But in the future, I got something to say about that, so I'm looking forward to it, you know?

KNOX: Jessie McCary says she's seen this before. To stay healthy and keep chronic diseases like diabetes at bay, homeless people need their own place. You could think of housing as a medical intervention, she says, and perhaps it's the most effective medicine of all. Richard Knox, NPR News, Boston.

SIMON: You're listening to WEEKEND EDITION from NPR News.

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