The doctor is in at Seaton House, and Michael John Maloney has enjoyed his visit - until now.
"Ahh!" he shouts, jerking his arm to expose a raw, pus-covered wound the size of a coaster.
Unruffled, Dr. Stephen Hwang holds up the damp gauze he had been pressing on the sore.
"It's just water," he says.
"I know, but it fucking hurts!"
Dr. Hwang has been seeing Mr. Maloney for about two years now, mostly to treat him in the aftermath of a brain aneurysm that robbed the 38-year-old of his job in construction, and some of his mobility, vocabulary and social inhibitions. But on this recent overcast morning, he needs antibiotics because two guys jumped him for his grocery cart full of empties, leaving only this nasty cut.
"Dr. Hwang is good to me," says Mr. Maloney, despite the earlier exchange. "He always treats me just right."
Since Dr. Hwang arrived in Toronto 12 years ago, he has treated a stream of homeless men at Seaton House, a 434-bed, four-storey building on George Street, the city's largest shelter.
But he's also become one of the world's leading researchers on homelessness - and his research questions, he says, are inspired by patients like Mr. Maloney. Questions like: How many men are dying on Toronto Streets? What barriers stop homeless women from getting mammograms? Could a brain injury increase someone's chance of winding up homeless?
His answers - formed through rigorous, careful analysis - have added legitimacy to the cries of activists, shaped social policy, and are cited regularly in the media.
They include one study this month, which showed a disproportionately large number of homeless people have traumatic head injuries.
But here's another question with a nuanced answer: Who is Stephen Hwang?
An American graduate of Harvard and Johns Hopkins University, he has trained in the tallest ivory towers yet built a career studying Toronto's most marginalized citizens.
His work is widely respected - he recently slammed the federal government's opposition to Vancouver's safe injection site in a paper signed by over 130 prominent health officials, including the medical health officer of B.C. and the medical health officer of Montreal - but colleagues at St. Michael's Hospital's Centre for Inner City Research say his modesty and unassuming nature are rare among doctors of his calibre: He's the guy who cleans out the staff fridge when it smells.
Ask what drives him to this work, and he describes an unwavering devotion to two seemingly opposite callings: God and science.
"I'm dancing this line because I think it's important to recognize the limitations of moral philosophy and ideology, and recognize the limitations of science," he says.
"I think they can inform each other, rather than be at war with each other."
CLEARLY A STAR
Stephen Hwang grew up in a comfortable suburb of Los Angeles, the son of Chinese immigrants who docked on American shores carrying what they could in a suitcase. His father went to Stanford and became an aerospace engineer; his mother graduated from university before raising two boys at home.
A natural student, Dr. Hwang spent his childhood playing on the bluffs of southern California, observing tadpoles morphing into frogs. He followed his older brother to Harvard, where he enjoyed the freedom of being away from home but stayed grounded in his Christian faith.
One especially cold Boston winter, Dr. Hwang helped set up an emergency shelter in the basement of a campus church. As he struggled with a mop after a night shift, a homeless man approached and demonstrated how to mop with military precision, just like he had in the navy. "Just the kindness he showed me in trying to help me, and teach me something, was a moment of connection that I'll always remember," Dr. Hwang said.
His biochemistry degree launched him into Johns Hopkins University, whose medical school is considered one of the best in the U.S. But the church basement in Boston had left a lasting impression, and Dr. Hwang remembers telling a professor he planned to serve underprivileged communities as a doctor. "That's a real shame," he remembers being told. "You have a real talent."
Among his classmates was his future wife: Angela Cheung, also a Christian and the daughter of immigrants from Hong Kong who had settled in Toronto. The couple chose to do their residencies in internal medicine there, to be closer to Dr. Cheung's family.
Dr. Hwang rose to chief resident at the University of Toronto's residency program before the couple returned to Boston, where Dr. Cheung pursued her doctoral degree in health policy at Harvard.
At the time, a program that provided hospital and shelter-based health care for Boston's homeless was looking for a doctor. When Dr. Hwang handed in his application, they couldn't believe their luck.
"He was clearly a star," recalls Jim O'Connell, who helped found Boston's Healthcare for the Homeless Program in 1985. "You just didn't find people like that coming and asking to work with the homeless program."
At 30, Dr. Hwang showed remarkable skill as a clinician. Calm, soft-spoken and a good listener, he connected with patients at the chaotic shelters. But he also impressed colleagues with his ability to quickly assess complex symptoms and make a diagnosis, Dr. O'Connell says. His treatment plans were often creative. One time, shelter staff were struggling to work with an elderly man who could barely hear. "I'll never forget Steve just taking his stethoscope off and putting it in the ears of that man, then talking to him through the front of the stethoscope. The guy's eyes just lit up because he could hear everything Stephen was saying."
Soon Dr. Hwang began looking for deeper answers to Boston's homelessness problem. Research, Dr. Hwang says, is in his nature.
"I think it's fun to just have the free range to just say, 'Why is that so? And is it really true what people think? And is there some way that we can test it in a scientific way?' " he says.
"While it's fun to just let your mind wander and wonder about things, what's even more fun is the chance to try and answer that question in a new and rigorous way that sheds some new light on the issue."
He split his time between the clinic - where he became medical director - and the classroom, completing his masters degree in public health at Harvard. He completed several research papers on causes of death in Boston's adult homeless population as part of his studies, but his time in Boston was ending: His wife wanted to go home, and Dr. Hwang had kept in touch with his old mentors in Toronto.
"We owe him big time," says Dr. O'Connell, who keeps in touch with Dr. Hwang at conferences on homelessness around North America. Today the Boston program attracts some of the best and the brightest, Dr. O'Connell says, many of them chief residents at their universities.
"I'm not at all surprised that he goes to Toronto and then becomes one of the world's most renowned researchers in homelessness," Dr. O'Connell says.
"For [four]years he just took care of tons and tons of homeless people. And that's, I think, what grounds his research. He's the real deal. He knows what it's like to be in the trenches."
MAN OF GOD
By the time Dr. Hwang returned to Toronto in 1996, the city was grappling with a growing homeless population and a critical shortage of shelter beds. That winter, three homeless men froze to death on the streets, shocking the city and paving the way for an inquest. Something had to change.
At the same time, St. Michael's Hospital added a research component to its inner-city health program, which until then focused on providing health care. About seven qualified candidates applied for the new research position, but the decision was unanimous. "Stephen just stood out," says Jim O'Neill, a member of the interview committee and now head of the Centre for Research on Inner City Health, which has dozens of research scientists.
Dr. Hwang's arrival was an immediate boon for activists, both because of his research and the respect he showed them. "He's been an incredible breath of fresh air," says Cathy Crowe, a street nurse and a co-founder of the Toronto Disaster Relief Committee. "He obviously does great hands-on clinical care. But he's also developed the bigger picture that supports the long-term solutions."
One of Dr. Hwang's first projects studied 8,938 homeless men in Toronto over 2½ years, concluding they were eight times as likely to die as men in the general population. "It's something we quote all the time now," says Baric German, who works with Street Health, a non-profit agency providing health programs to homeless people in Toronto's core. "Although we might have suspected that for a long time ... he just said, 'Okay, let's find out.' "
Over the years, Dr. Hwang has earned a reputation for doing work that is elegant and rigorous. Whether he's looking at panhandling, bedbugs, or mortality rates, his studies almost all seem to have a direct application to the lives of homeless people.
"He chooses topics that are very pertinent," says Tomislav Svoboda, who became a doctor at Seaton House a year after Dr. Hwang, and is now the shelter's medical director.
Dr. Hwang makes no bones about the fact that he hopes his research helps to improve the lives of marginalized people. But, he says, "there's always a fine line between being a scientist and being an advocate."
A FUNDAMENTAL COMMITMENT
He's just parked his bike in his office on the corner of Richmond and Church streets (his commute is his only chance to exercise, says the father of three) and is sitting behind a round table for an interview. His language is clear and simple, something his students and peers say makes him an effective teacher for University of Toronto medical students. "It's a complex relationship, because why I do the research that I do is tied very closely to my convictions on this," he says. "At the same time, I think it's important for me to be a scientifically credible researcher, who while committed to improving the health of the disadvantaged, also has a fundamental commitment to doing that in a scientifically sound way," he says.
He pauses. "It's an interesting subject. I think about it a lot."
Harm reduction, he says, is the issue that crystallized his thoughts on this balance between faith and science, compassion and balanced inquiry.
Last year, in a forceful letter published in the peer-reviewed journal Open Medicine, Dr. Hwang criticized the federal government for threatening the continuation of Vancouver's supervised safe-injection site, where addicts can inject drugs in a safe, clean place staffed by health professionals.
He wrote: "The fact that a highly promising intervention for the management of substance abuse appears to have been judged by an entirely different standard than interventions for other common chronic health conditions, such as diabetes, suggests that scientific evidence is about to be trumped by ideology."
To those who believe it's immoral to sanction drug or alcohol use, that stance might seem puzzling coming from a devout Christian such as Dr. Hwang. But Dr. Hwang says the issue of harm reduction simply comes down to the evidence. Science can help us determine what programs or policies can help solve problems, he says.
Where science falls short, he says, is in its ability to convince people to care.
"What I can't do as a scientist," he says, "is say that it is important that we do not leave the most marginalized people behind and just abandon them to their fate. And that it makes us better people to care about the poor."
TO AN UNHAPPY STREET
Every Wednesday morning, Dr. Hwang takes a 10-minute walk from his office on Richmond Street to Seaton House. He could drive - he has a parking spot near the shelter. But walking, he says, is the best way to get the feel of a neighbourhood.
"This is not a happy street," he says, as he rounds the corner from Dundas onto George Street, passing a sign for $5 lap dances, abandoned buildings and glassy-eyed pedestrians.
Soon he's through the shelter doors and on his way up to the fourth floor where patients are waiting for the first 9 a.m. appointment.
Dr. Hwang greets a man he's known for a long time.
"How're you doing?" he asks, as the man pushes his wheelchair down the hallway of the third-floor infirmary.
The man grins and responds with a question of his own.
"Still takin' over the world, or what?" he says.
Dr. Hwang, embarrassed, just laughs.