It's early last Monday morning and temperatures are frigid outside. Four homeless men and women sit in the functional yet warm and welcoming outer office of the Healthcare for the Homeless Clinic at God's Love shelter.

When nurse practitioner Lisa Kenny opens the door and steps out of her closet-sized examination room, she greets them with a bright smile that lights her face and eyes.

She remembers them by name.

Some say they are there because Kenny saved their life.

In the four years she's worked at the clinic, Kenny, 43, has found that her patients have profoundly changed her life -- and the way she practices medicine.

"There are a lot of people who don't understand why I do this job, and I don't understand why I wouldn't do it. It's part of who I am," she said.

A typical day?

"People who are really sick just walk in," Kenny said.

Frequently, the clients have upper respiratory problems. And often they face complex combinations of medical and psychological issues.

Kenny, a graduate of Carroll College's nursing program who earned a master's degree in nursing from Gonzaga University, is a certified family nurse practitioner. Her training enables her to make some diagnoses, manage common illnesses and write prescriptions.

At least 30 percent of her time is spent helping people with serious mental illness. And she has sought additional professional training to help them.

A lot of her patients suffer from bipolar disorder, schizophrenia or depression. Some are suicidal.

Frequently they may also be alcoholics or drug addicts, often the result of self-treating their mental illness.

"There's a lot of social work involved in taking care of these patients," she said.

Her clients may have to wait six months to see a psychiatrist and up to a month to get into a drug-treatment center.

Many have multiple, complex medical diagnoses -- combinations of hypertension, coronary artery disease, chronic obstructive pulmonary disease, diabetes, hepatitis C or cirrhosis.

"It's heavy-duty stuff," Kenny said.

The homeless typically live outdoors or in cars, so their first priorities are food and getting a roof over their head, not health care.

And sometimes there is little she can do.

"You can't help someone if they don't want help," Kenny said.

But though successes are few, they do happen.

"I've been coming here for the last two years," said Toby Casey, who was homeless when he moved here from Alabama.

"I got shot in the stomach eight years ago. I'm all messed up," he said, gesturing toward his abdomen. "My daddy shot me with a .25 automatic. It tore my guts up."

He said that he'd had multiple surgeries and that much of his insides are full of plastic tubing.

"She (Kenny) is really good at helping me. She took care of the issues as far as the heartburn and pain," he said.

Kenny and other staff helped Casey apply for Social Security because his health problems prevent him from working.

And he and his wife are no longer homeless.

"This is just a good place. I know God has blessed this place," Casey said. "I just think Miss Lisa is a wonderful person. If it weren't for her, I'd probably be dead. That's the truth."

Kristine Gambucci was also homeless when she moved to Helena in 2003. Now she's an outreach worker for the clinic, helping the homeless get shelter, medical care, warm clothes and food.

"I've pretty much come full circle," she said, sitting at her desk in the outer office of the clinic. "I'm so glad to be here.

"Without the people here, I probably would not have survived my first winter here," she said. "My first year, I was here every week, my asthma was so bad."

As she talked, she coughed hard, and then coughed again, gasping for breath. She pulled two asthma inhalers from her bag and breathed in the medicine. The coughing subsided.

"This is $95," she said pointing to one and then the next. "This is $140.

"She (Kenny) is amazing. She told me she stayed up at night worrying about me. She is extremely compassionate. She pours her heart into this place. She actually listens to you. She never makes snap judgments. It's like talking to a friend."

With the help of Kenny and others at the clinic, Gambucci got on a medical plan that provides her medicines at a lower cost.

Kenny's contributions have also been noticed by her supervisor, physician Will Snider, medical director at the CHC.

"Lisa has a really calming personality. People will seek medical treatment because she is there," he said. "I will typically see her patients and they tend to be the more complex patients in the system because of their lack of finances and lack of understanding of the medical system. Most of them have been burned by the medical profession.

"You don't just write them a prescription. You're going to have to figure out how they're going to pay for it. You're holding people's hands to help them.

"It's really important to me to honor Lisa. It's really easy to overlook a provider who serves the most overlooked population."

But Kenny said it is she who has benefited from working with homeless people.

"This group taught me a lot," she said.

She's had to revise how she typically does treatment.

She recalled prescribing a diuretic for a homeless man working as a roofer. He came back and told her he couldn't take the medicine, which causes frequent urination, because he couldn't keep getting down from the roof to find a bathroom.

Homeless diabetics are also a challenge. They have no refrigerators for storing their insulin.

Some medications must be taken with meals, but the homeless don't eat regular meals.

These situations, Kenny said, forced her to think outside the box.

And her patients make her think of what she and most Americans take for granted -- a home, a paycheck, a savings account, a future.

"It could happen to any of us," she said of homelessness. "We could have a catastrophe that would put us in the same situation."

Some people who have sought help at the clinic became homeless because of Hurricane Katrina, she said. Others lost homes to fires this past summer.

"You could lose it all and have no reserves -- nothing."

In many people, this thought awakens fear, but in her, compassion.

"What would have been my priorities 10 years ago are not my priorities now because I've learned so much from the people I've cared for," she said.

One lesson is "acceptance of people, acceptance of where they are, not where you think they should be."

Kenny also wants her children to learn. The mother of a 4-year-old and an 8-year-old, Kenny brings them to the clinic.

"I try to bring my kids down here, so they understand what I do. I want them to be accepting of all kinds of people. That's important to me."

What would help her clients most?

Affordable, decent housing, Kenny says, and greater access to psychiatric treatment and drug-rehabilitation programs.

Besides working at the homeless clinic, she also works three afternoons per week at the CHC main clinic; one afternoon at Elkhorn Treatment Center, a women's drug-treatment facility in Boulder; and alternate Fridays at Planned Parenthood.

Her work at the homeless clinic takes a toll. Sometimes she can't sleep. She thinks about what she should do to help one of her patients.

But she also knows her work makes a difference.

"I've been able to help people who really need help -- to help people maneuver through the system who otherwise wouldn't get help," she said.

God's Love

The Healthcare for the Homeless Clinic at God's Love Shelter is a nonprofit operated by the Cooperative Health Center. Those interested in donating to the homeless clinic can call the main clinic at 443-2584. The homeless clinic is supported by a federal grant.

Reporter Marga Lincoln: 447-4074 or marga.lincoln@helenair.com