the unwashed masses

I don’t have any of THEM as patients. The unwashed masses. All of my patients are smart.

There aren’t any unwashed masses.

I have a gentleman who is overweight, obese, diabetes. He is not stupid. He is not unwashed. He is not exercising or controlling his blood sugar right now because the temperature is below freezing. He has a hole in his trailer floor and no heat. So he huddles under the electric blanket.

I have a gentlewoman, also diabetic. She too is not stupid. She is not unwashed. She lost her husband to cancer and then everything else and then was homeless for a period. She has a small house but she has no heat. She stays in bed to stay warm. Her contractor quit before he put in the furnace and he’s gone bankrupt. She is cold.

I have veterans. They are not stupid. They are not unwashed. One was homeless for a long period and pooled his resources with another to rent a section 8 house. I am so proud of them. They are having trouble living together, each would rather live alone. Only sometimes they would rather not be alone. It is hard.

I have a massage therapist. She started to train as a counselor. To be a counselor, she needs a certain number of supervised hours and was getting this through the county mental health. “I didn’t know.” she says. “It is taking twice as long as I thought because half the time they don’t show up. They don’t show up because they don’t have gas, they don’t have food, they have been evicted, their son is in jail, they are in jail. I had no idea. My massage clientele is so different, they pay. I thought poverty was in third world countries, but it is here, in my county. I didn’t know.”

I know the people who live in the woods. A schizophrenic who comes once a month for his shot. He was losing weight. “Why are you losing weight?” I demand. “I am only eating once a day.” he says. I nag him to go to the community meals. He is shy, he is afraid of people and he is hungry. He is not stupid. He is not unwashed.

I have opiate addicts. Six years ago one expressed concern. He is 6 foot 5 and big. “I am afraid of some of the other people. You shouldn’t be doing this! It’s too scary and dangerous!” My opiate addicts are not stupid. My opiate addicts are not unwashed. Sometimes they relapse. Sometimes they die, in their 50s, 40s, 30s, 20s.

One in six people in the US is below the poverty level. They are not stupid. They are not unwashed.

And when someone talks about the masses, the people, the stupid people, most people are stupid, the sheep….

….I am beyond angry….

….my heart hurts….

Poverty in the US:


The examples are taken from 25 years of practice, details changed for hipaa, but I can list dozens at any one time. The photograph is during the sunset after clinic, when I walked down town, the view across the sound.


10 thoughts on “the unwashed masses

  1. gpicone says:

    What do you think of the Affordable Care Act? Should it be done away with?

    • drkottaway says:

      If it were replaced with medicare for all, that would be fine. If it is done away with and people buy insurance across state lines, how successful will I be as a small practice trying to collect from 1300 insurance companies in 50 states? Am I expected to attempt to be a preferred provider for all of them? Do I have to learn 1300 passwords and different websites? Do you have to call another state to find out if your appendix removal is covered by this surgeon in this hospital with this anesthesiologist?

  2. MarkOPete086 says:

    What do you mean by “they are not unwashed”?

  3. shoreacres says:

    I appreciate this post, and the one you linked. I could offer some examples of my own, but there’s no need. You’ve done it well, and I agree with what you say.

    • drkottaway says:

      thank you….if everyone would show up and adopt a family who is in the midst of job loss, divorce, cancer…. adopt an elderly person as family….help in a shelter, help at a soup kitchen, show up….

      • shoreacres says:

        Isn’t that the truth? I know far too many who love humanity, but hate having to deal with people.

        • drkottaway says:

          …but all of the people they hate to deal with are ones we make assumptions about. Ones whose story we don’t know. Ones that we have automatically filed into “loser” “addict” “obese” “white trash” “drunk” … dare we do that? What the hell is the matter with our culture? And “poor” means loser, trash, shiftless, single mother, and all the rest of it, in our Not United States.

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