In the Gaps by Brian Klausner, MD Book Review

When you write a book review for someone you don't know, it's relatively straightforward and simple. You read the book, you feel the feelings (or don't), you articulate your reaction(s) and experience(s) reading the book, make a recommendation or not, and move on. Sometimes, there's an email or tag thanking the author. However, when someone you know or know of writes a book (please understand; I'm not claiming to "know," Brian) and it is incredibly moving, and you mark the whole thing up, dog-ear the pages, underline and star things, you find it difficult to articulate the gravity and impact of their words. Okay, okay back to the book...

First of all, I am a lover of books, obviously. I love words, and I love using a lot of them in broken sentences and fragments, imposing periods so that the reader must pause. I'm sure most people who read my reviews or blogposts find this annoying, but it's the way I write and think. I finished Brian's book months ago and still cannot put the words and feelings it stirred into complete sentences.

I first "met" Brian at Wakemed a few years ago (okay, many years ago) at a conference I attended for Nursing continuing education credits. It was a Social Determinants of Care conference, and Brian was one of the speakers. It should be noted that he didn't want or seek the limelight for the new and impactful small things his team was doing. In fact, most of the presentations and speakers at the conference were people who were working alongside him, finding tents for those without shelter and trying to find ways to keep insulin cold for patients who were diabetic and didn't have a refrigerator in the middle of a NC summer. I recently saw he had a book out and could not wait to get my hands on post-it notes on it.  

Brian starts at the beginning—his beginning—which is vulnerable, humble, and refreshing. And then, he builds. One by one, he paints a human face on the term "homelessness." He does it in such a way that it forces you to humanize a term that our society dehumanizes based on his interactions, observations, and assessments as both a person and a Provider. 

The next time you pull up to the stoplight and see the man begging for money, your thoughts will go right to Brian's book. You'll find yourself wondering about the little boy or little girl that still lives within that grown man or woman. You'll find yourself wondering about the difficult trials and trauma that led this grown man or woman to this cold corner, standing alone and reaching out with their eyes and hands. 

Brian dances between the very poignant challenges facing the homeless population today and the very murky and often hidden challenges they also carry. He does not shy away from the financial toll and burden this part of our community bears on the healthcare organizations caring for them, when they have literally nowhere else to turn. He doesn't shy away from sharing how complex and multi-faceted caring for them is when they allow themselves to be cared for. He doesn't shy away from the burnout and psychological impact these types of patients have on their Providers and Care Teams. He doesn't shy away from the human side of them. No, Brian is a Provider, a human, a writer, a believer in the significance of seeing people. Face to face. Right in their eyes. Right in their struggles. Present.

As a result of being close to the suffering of those experiencing and enduring chronic homelessness, Brian does a compelling job of sharing his thoughts, feelings, and experiences. He is also able to take the 30,000ft view of the issue buried under layers and layers of complexity and identify variables, data points, points of impact, and overarching themes that run deep and affect outcomes.

Brian offers an unbiased view of the multiple overarching and cross-functional, complex challenges that make this vulnerable and often hidden population difficult to reach. He provides details of specific programs, efforts, and initiatives that have proven successful in the past, while gently reminding his readers that every person is unique despite having multiple similarities and indicators that raise concerns that continue after patients leave the building. He provides information, including specific evaluations/assessments and questions used that may help identify a patient as higher risk or needing earlier intervention in words a non-medical professional can understand. He talks about the impacts of legislation, policies, and programs in a way that isn't caustic or offensive. He does a good job of sticking to the facts and not trying to convince anyone of anything. Well, besides being a voice for the voiceless. Brian discusses the financial costs associated with these patients who fall through the cracks, who are not able to be compliant, trying to gain momentum with leaders and organizations to understand that even though addressing these issues is costly, the cost of not addressing them and helping them is far greater. 

I'm still sitting with this book and these words. I'm sure that I could pick the book up again in a year and glean different insights and feelings from it. If there were a required reading list for humans, I would advocate for Brian's book to be on it. 

I could say that I strongly urge you to read Brian's book if you live in NC. But the truth is, human suffering as it relates to chronic homelessness is an evergreen issue. It crosses county lines, state lines, and country lines. It affects every community. Furthermore, homelessness has a name. Many names. Many faces. Brian does an incredible job conveying that homelessness has so very many stories. Stories of good people losing it all, losing spouses, childhood trauma, grief, and pain. Many stories, many people unnoticed. Unseen. Hidden. Carrying burdens and shouldering the weight of the world in ways many of us cannot begin to imagine.  

I dare you to read In the Gaps and not feel a stirring in your own soul. A stirring to see others. To do the difficult thing and acknowledge someone who has a lot stacked against them. To have compassion instead of fear. To have respect and kindness instead of disgust. To know the name of the man on the corner. To leave your judgment on page 1 forever. Because, when I say that In the Gaps is a gift to those of us who have no idea what homelessness is like, I really mean it is a Light in the dark, showing the impact that a small group of dedicated people can have on one person at a time. 

Maybe success for the book (sorry, Brian) isn't me, the reader, or you, the reader, doing some grand gesture or making a million-dollar donation to an organization because we feel so led (but please do, I'm sure Brian would put it to good use). Maybe success for this book is you and I, making eye contact with the person on the street and seeing them. Acknowledging. Noticing. Remembering. Feeling compassion for them. Surely that's something all of us need and yearn for from one another. Surely in this difficult time with so much struggle and division, we can agree on that. We all deserve to be acknowledged. Noticed. Seen. Remembered.  #inthegaps #brianklausner #readingchangesthings #openyourmind #lovedoes #homelessness #bethelight #humanity #loveoneanother #dosomething

Planting Seeds

4/14/25

I was reading about planting seeds of faith this weekend. It was freeing to read about how it isn't really our job to save people, convince them, or secure their place in eternity. It's our job to plant the seeds. I have felt torn and disappointed over the last few years, that I haven't been in a God-focused relationship with a God-fearing and God-loving man, with a surrendered heart. I have churned and beat myself up over the way the faith of my children have been shaped and impacted by the relationship I have had with their father while they have had so many formidable years. It feels like the greatest failure that they haven't all verbalized they have personal relationships with God and that I do not see Him working in their daily lives.

Then, this weekend, I read a perspective-shifting devotional, and it was beautiful. My grandfather planted his seeds of faith in me. I saw how he lived, loved, and served. I saw how he studied the Bible in quiet stillness and how he bowed his head when no one was looking. Consistently. Day after day. Alone and with others. His faith and relationship with God have been the single most impactful thing on my faith—and the faith of everyone who knew him, honestly. There's a huge lift in the mindset of planting seeds versus the pressure of convincing, the pressure of the outcome. The tulips I planted last year came up this Spring, in their own time. When I planted them, they were brown, peeling bulbs. Nothing green, no signs of the flowers that would emerge unannounced this Spring. I didn’t remember to water them. In fact, I didn’t remember them at all.

The seeds of all the vegetables I planted a few weeks ago were teeny, tiny little things. They weren’t green. In fact, they were all mostly colorless shades of white or cream. There were no signs of roots to be found among them in their paper envelopes as I dumped them into my hands. But, I planted them with faith and God is doing the rest. It reminds me of my Papa's response when I would ask him how in the world he would continue to bring in 5 gallon bucket after 5 gallon bucket of tomatoes, cucumbers, beans, and corn all summer long. His response was predictable because it was the same every single time. He would always say, "I just planted the seeds, God did the rest." I feel that’s what I’m called to do as well. And, I'm really thankful for this realization.

I believe there is a purpose and there are gifts that are part of God's plan in my failings as well. Even more, His plan is beautiful, powerful, and believable because He said so. He can mend a broken heart. He can turn a lifeless little seed into a green, rooted, force that has been forgotten under inches of dirt. So, I choose to keep planting seeds. I choose to plant them in my children's hearts, in the dirt, and in my own heart using my hands and bowed head. I'm leaving it up to God to do the watering and sunshining, the storming, and the rooting, knowing I cannot control anything other than the planting. 

4/8/2025 Uncovered Wounds

Today's devotional is about the courage of the Shunammite woman who has a pain and wound bigger than anything else- her desire for a child. The devotional says, "This wound is so painful that she dare not allow it to be uncovered." Oh, I feel that so bigly. Although I don't feel the pain of a woman unable to or trying to conceive, the pain in my heart does feel like a gaping wound that if I uncover it, surely will have the power to overtake me because it is so great and deep. Fear lives in that vulnerability and I've been asking God to heal my heart and let me receive love again. I feel that this wound of mine being covered and hidden, keeps me from hurting but also keeps me from feeling and receiving, believing in love. I know that fear is not from the Light. I know that fear is the opposite of faith. I wrestle with them both. I know and do not want to live a life in fear or because of fear. I want to live a life of faith. I know that we suffer because we love and have loved. We grieve, we mourn, we cry, we reason, we protect and guard our hearts because we have loved. 

The devotional goes on to provide more details about the story from 2 Kings 4. It says that nevertheless, God faithfully fulfills His plan for her. Nevertheless. I love that word right there. Nevertheless. Despite, in spite of, regardless of her wound and her pain, and perhaps with her mustard-seed faith...He faithfully fulfills his plan for her. That God has his own plan and she knows it, takes courage, and seeks His plan for her life with hope and faith. She knows God will act to fulfill His plan in her life. He doesn't do anything about the pain. He doesn't change it. He doesn't make it go away. And, she carries on, regardless. She is hospitable and has a serving heart and hands, despite her uncovered wound. I love that part of the story, too. 

Here I am. I've been praying, praying for a mended heart. A gaping wound. One that is too painful to uncover. I've been praying that God would fix it so that I can one day, receive love and trust it. This story gives me strength today, trusting that God has a plan for me. I need only to be courageous, faithful, to have hope, and believe that He will fulfill his promises and plans for me. I say "only," as if it's nothing. It's difficult. But maybe those are the key ingredients that will turn my wound into a strong scar. By shining love on the broken place. 

So, I will wait. And, I will continue to seek Him in His word, people, His creation, in new things, to remind me that He has my little broken heart in His hands and I can trust that He will fulfill His promises and plans for me, in His time. In His time. 

Not without thanks, of course I pause to acknowledge the wonderfully flawed, imperfect, striving, caring, hurting, brave, and kind people He has put in my path that point me to Him. And, I find myself asking Him that, while he is fixing things or choosing not to, while He is asking me to get up, get out, and do all of the things with my broken little heart and mustard seed faith, I am begging Him to please let me keep the people He has sent. To let me keep the people that love me like He does, without knowing. To let me keep the people who are all shining love on my uncovered pain. 

And, finally, I pray that He doesn't let me forget or become numb to the uncovered pain of others all around me. The unspoken pain. The unseen and covered kind. 

Love Lessons

 2/14/2025

Today the world seems to be on fire with love. Commercialized, dipped in chocolate, flowery, and fragrant love. Loud and noisy love. On fire love. Shiny. Polished. Expensive. Calculated.  

I'm thankful for the love that is none of those things. Because I stopped settling for that top and most outer layer of it, the love from a distance kind of love. 

Instead, I look to the love of the friends I'm so fortunate to have. The ones who show up for me when things are messy, emotional, tired, sweaty, stinky, sticky, unprepared, scared, and brave.  The friends who can get sassy and dressy and go out to a nice ticketed event but know the real me is happy in jeans and a t-shirt, with fake pearls and mismatched ribbon shoelaces. The ones who love me and show up for me despite what an inconvenience it is for them to do so. For friends who have shown me what it means to show up. To be present. The ones who make me feel like my broken heart is perfect in a world hellbent on making me feel the opposite. I'm reminded that there isn't "one person," who can "make," me feel anything. It's a lot of people, walking some paths with us when they can and others who walk the rest with us. Sometimes all together. Sometimes separately. And sometimes, sustaining me to walk specific paths and adventures alone. I'm thankful for those friends who endure my driving, music, last minute adventures, messy hair, and mismatched forks, spoons, cups, plates, and furniture. My mismatched life. The friends who love me in my winters and remind me that they have winters too. The friends who allow me to sit with them in their winters. Who call me because they just need someone to listen sometimes, too. The friends who tell me about the little and big things that break their hearts. The friends that text back when I send a "tell me something good," text. The friends who share 1/2 of their sticky peanut butter and jelly sandwich in the middle of nowhere and think of me when they see a new kind of gummy bears on the shelf. The friends who listen to me whine about the same things and believe in my ability to face difficult things. I'm thankful for the friends who show up for me when I am toeing hard things in my life because they can't imagine me failing or finishing such a big thing alone. They don't want me to call and tell them about it, they want to be IN it. I'm thankful for the ones that show up, in spite of what it may mean for them to do so. To stay when the world and other things also call them away. 

I look at my children for love. Each one, a sprout of love. Bright green with newness and each with love languages of their own. They give me something important to pour my love into and receive it back in a million different ways. Like helping me pull my cowboy boots off, laughing at me when I use words like, "Rizz," and "Aura," wrong. They give me honest feedback when I ask for outfit/shoe combo advice and share their heated blanket on the couch. They don't whine when I steal a bite of their cereal in the morning with groggy eyes. They offer to share the batter when they finish whipping up some cookies and quietly come up and hug me after dinner and tell me that they loved it. It's bringing the groceries in and suffering in the back of the car sitting closer to one another than they'd like for 4 hours just to go and hike some miles with me. They endure my playlists and send me, "Goodnight, I love you and miss you mama," texts in the middle of the week. They laugh at me when I cry about JJ dying on the Outer Banks and settle for tuna sandwiches or oven pizza for dinner when it's been a long day for me. They make me necklaces and earrings and mow the lawn. They find pretty rocks for me on hikes and send me reels of puppies and seals. 

Regardless of the WHO, whether I'm thinking about the love of my friends or the love of my children, what makes it true, authentic, palpable and resonating love for me is that they all demonstrate these qualities: Presence, Time, Proximity, Thoughtfulness, and Plans. They are all relatively quiet and somewhat bland to the world's eye. And, if I blinked it would be easy to miss them. But, when I take a minute to truly think about the "LOVE," I need in my life, it's all of those things mismatched. Woven together into a tapestry of a meaningful and connected life. A healthy life. A soul-feeding, nourishing one. 

Bouquets of flowers on a special holiday for love are beautiful and nice. But, so is a "Look at this 4-leaf clover I found in the yard, you can have it." And, "These chocolate brownies are the best you've ever made," with chocolate teeth and sticky fingers. On an ordinary day. Doing ordinary things. Nothing grand or loud. Not showy. Real. Pure.Together. Right beside me. Because love DOES. And my favorite kind appears dull. Mundane. Ordinary. Mismatched. So today and tomorrow and next week..that's all I'm willing to settle for. 

 

Words From One Squishy Broken Heart

2/12/2025

When I was 14, my mom made me volunteer all summer at the hospital. Most kids volunteered 1 day/week. We couldn't afford summer camp or family vacations and she worked all week. I was too young for a job. She signed me up to volunteer at the hospital 5 days/week all day. All summer long. 

I delivered flowers and cards to patients. I sat with patients in the cancer center and kept them company while they were getting chemo. I helped people sit up to eat, and I took family members from the lobby to patient rooms and back again. 

It was the summer between middle school and high school for me. I was overweight, lacked self-confidence, didn't play sports, read a lot of books, and spent a lot of time in my room by myself drawing, reading, listening to music, and dreaming. 

I came home crying every day about the patients I saw. Every single day broke my heart. I will always remember what my mom said to me one day after being a little annoyed with me for crying again. She said, "Kim, this experience is so good for you. You have always had such a tender heart and one day, the world will harden it, and you won't be so sensitive anymore."

I went to nursing school and the world didn't harden my heart. As a new RN, I remember going into the rooms of my pediatric patients in the middle of the night and picking up the babies that were awake. Many of them wouldn't have parents with them because they had to work the next day, or they couldn't get a ride to the hospital. Or, they had more children at home. Regardless, I would go in and pick them up and sing to them in their rooms. 

I still cry at the thought of the first pediatric patient I lost. When I came back to work and heard he had passed away after he had been getting chemo for months for osteosarcoma. When I would take him a popsicle for his mouth sores from the chemo and radiation, I remember he looked at me and told me I was an angel. It still wrecks me. 

I remember the first patient we couldn't save in the Children's ED who came in unresponsive after choking at home on a hotdog. I will never forget him. Or his mama. 

I cry for strangers. At sappy songs, when I hear people talk about someone they love, or hear them talk unfiltered and honestly about what is hard for them, the circumstances they have overcome. 

I went into 9th grade and started high school a slimmer version of myself, with confidence that was somehow different than the kind my peers had. Still a nerd. Still introverted. Still not athletic. Timid. Hopeful. Looking around and seeing others. Smiling. Accepting. Driven. 

Looking back on that summer, and that specific conversation with my mama, I'd say it was a pretty life-altering experience for me. I saw the power of my squishy heart. The power of sitting with someone in the most scary moments of their lives, just being present. I delivered the cards and saw the impact of such a small and seemingly insignificant thing for a patient alone, in an empty room. I saw their eyes light up when I brought the flowers in and read the card so they wouldn't have to squint. 

It's difficult to have such a squishy heart. People take advantage of people with squishy hearts. But, at 41, I don't know any other way to be. I don't have any control over my squishy heart and the connection it has to the water in my eyes. 

I'm happiest when I can do the giving, the serving, the helping, connecting, the seeing and being present. And, my writing always seems to carry me to a prayer. 

Dear God, when you send me someone this time, could you just please send them with a squishy heart that the world never hardened? Could you send me a man that's strong enough and confident enough to show it? Someone who values the little things? Presence? Words? Handmade cards? Someone who sees me and has been hoping and praying you made a woman with a squishy heart too? There's a lot of darkness, sadness, sickness, trouble, doubt, and fear in this world. I pray for someone who doesn't want wealth and riches. I pray for a man with a squishy heart that leads him with purpose, passion, and is restless and stirring to get busy helping. Then, I pray that you send US. Until then, I will continue to show up, to seek others in ordinary moments that need a little light. And, I pray, having faith that you are going before me and lining all the things, moments, people, places, and circumstances up just as they should be. You know who needs my squishy heart the most. Meanwhile, I will look to the left and the right and see who is on my path now. In ordinary places. Needing little tiny extraordinary things. Because the one thing I know, is what it feels like to use a squishy heart. Give me patience. Strengthen my heart but please, keep it squishy so I can see, feel, and be moved by connection, strangers, words, music, and moments. I now know it's a divine gift of mine, this broken and squishy heart. And so, I just want to say thank you. A squishy heart makes a full life and I know the hard times have led me right here. In prayer. On my knees. Looking up. Having faith. Understanding the assignment. It's your move, God. 

Amen.