Life as a specialist homeless GP in London involves a lot more than just practising medicine • Guardian Jobs: see the latest vacancies in healthcare

'My patient was trafficked from Eritrea and raped. She cries, so do I'

Monday

There’s nothing more invigorating than being surrounded by inspiring people. I’m at a conference. There are passionate speeches about the effects of child poverty, and the devastating effects of NHS migrant charging, and workshops about rising homeless deaths. It’s one big crusade against health inequalities. I feel empowered and ready to change the world.

Tuesday

An email from our commissioners points out we’re bottom of the class for diabetes care. I stick a note on my monitor that says: “Sort out diabetes.”

My last patient of the day was trafficked from Eritrea, and gang-raped in the process. She cries because she misses her children and gives me a small gift for my daughter. I hug her, though I’m not sure I’m supposed to. Then I cry too. I’ll never understand how humans can be so cruel to one another. Then I see the note and realise I didn’t sort out her diabetes.

I get my coat to leave and notice that our crumbling and neglected ceiling is leaking again. I hunt for a bucket.

I walk through the bustle of Soho knowing I’ve probably missed my daughter’s bedtime. She’s still awake when I get home. “Were you fixing people mummy?” she asks. “Umm … Yes. No. Sort of,” I say. I spend the rest of my evening asking myself the same question.

'As I take my foster son to school, friends of his parents yell abuse at me' Read more

Wednesday

I stop by the barefoot Romanian begging outside McDonald’s on Oxford Street. I explain I’m a GP for homeless people; he shrugs and hobbles towards our Soho practice, tempted by my offer of socks. I give him a mug of tea, and some socks and shoes. His legs are swollen from sleeping sitting up, and pooling fluid on to the waiting room floor. He sits down to wait his turn.

My first patient has an infected leg wound from trying to remove the “tracking device implanted by the government”. My prescription for antibiotics gets eyed suspiciously. I suspect he won’t take them. The consultation finishes and we’re both left with a sense of unease. I contact the homeless mental health team.

I review an oncologist’s letter saying that my patient with operable cancer won’t be operated on due to his immigration status. As a GP I treat everyone for free. I write to the hospital asking them to reconsider.

My next patient is drunk and tries to urinate in the corner of my consulting room. It’s lunchtime and I haven’t done any proper medicine yet.

Thursday

In the queue of regulars is a woman I know well. She was abused as a child, had her first heroin overdose at age 12 and her first incarceration not long after. A victim of domestic violence and addicted to heroin, crack and alcohol, she has a list of problems I’m unlikely to ever fix. After 45 minutes she sees me glance at the clock. Accusing me of not caring, she storms out. She feels rejected. I feel I’ve failed her. I hope she comes back.

On my way home I pass the barefoot Romanian again. No socks, no shoes, outside McDonald’s.

Friday

At our weekly multidisciplinary team meeting we discuss our most complex patients. It feels good to share the burden.

The day goes downhill when a patient calls me “a fucking bitch”. We ask him to leave. He threatens me. My next patient asks if I’m alright and offers to sort him out. I politely decline. Two fresh-faced medical students look on in horror. I apologise for the chaos, hoping they’re learning something.

As I set the surgery alarm that evening, my mind drifts back to earlier. I peek out into the dark alleyway, am relieved to see no one there, and hurry to the tube station.

Saturday and Sunday

The surgery is closed and I spend time with my family. I save my last reserves of compassion for my daughter, leaving none for my husband. He has a cold, and I’m unsympathetic and guilt-ridden for being a crap wife. On the plus side, I know where to get the cheapest cider in central London.

Dr Natalie Miller works at Great Chapel Street Medical Centre in London.

If you would like to contribute to our My working week series about your job in public services, get in touch by emailing sarah.johnson@theguardian.com