This is a work of fiction. Any resemblance to actual individuals, alive or dead, is coincidental.
Case counts were down; I told the folks delivering vaccinations that I could help. We set up Mobile Outreach Vaccine Events to find homeless people to vaccinate. We gave people twenty bucks worth of gift cards for vaccinating, and offered flu vaccines, booster shots, Johnson and Johnson one-shot-gets-you-done vaccines, and completion doses for Moderna and Pfizer. Our team included a nurse, nursing students, and a registration worker who would handle the complex gift card log and look up the person on the tablet to see if they had been vaxxed previously.
We’d go around to places I knew we might find homeless people and I’d jump out of the white van and ask people if they wanted to vaccinate, tell them about the gift cards. That would usually do it. We had folks who wanted to get re-vaccinated for the incentives even though they had vaxxed before. The winner got dosed four times—she’d changed the spelling of her name so the registration worker missed it. Smart person; too much vaccine, I thought.
We were at 16th and Potrero, about a half a mile away from where I’d grabbed the vaxx team near the hospital when I saw them: a tall woman in a dress with a shorter man, moving slowly in the morning; no spring in their step, pushing shopping carts.. The carts didn’t look well equipped for camping—no rolls of bedding or folded up tent. Just a couple of homeless folks—harvesters of the grapes of wrath—headed down the street. I pointed them out to the nurse riding shotgun, then the light changed and we were gone. We went down to Shotwell Street at 17th, to see if folks there wanted to get vaccinated. Yesterday we’d timed out there, ran out of Johnson and Johnson doses prior to reaching the end of the encampment. We got there, we offered vaccines, no takers. One man wanted to talk to me about how a landlord was murdering people for their Social Security money and raising the rent illegally. “Talk to the Mayor’s Office of Neighborhood Services,” I said, but he wanted police, FBI, phone numbers of the law enforcement here in San Francisco. Numbers that I didn’t have. Disgusted, he turned away from me, pushed his shopping cart somewhere else.
We got to magic alley and I lined up two people for vaccines. The couple appeared—the ones we’d seen on Potrero Avenue. I didn’t see anyone on the street they were camping with. They were visiting, making the morning rounds, maybe looking to set up. I approached the man, asked him if he wanted to vaccinate; he shrugged wordlessly, didn’t make eye contact, looking around, checking out the camps, moving slowly. I asked the woman if she wanted to vaccinate and she said she did. I got her name and date of birth, and gave the information to the registration worker. I talked to her, noticed she was trans—a woman who had started off life assigned as male. I explained that I could offer her a gift card and a self-heating meal. I ask people if they know how to operate the meal: You have to extract the food packet from its pouch, turn it upside down, put it in a bag with heater strips, add water, shake, and return to the box. Ten minutes later it’s hot. Pasta rotini with kielbasa, chicken tandoori with brown rice, Texas three bean chili. Basic. COVID Command had gotten thousands of these things; as the epidemic had calmed down they turned some over to me to use as incentives.
She didn’t know how to prepare the meal. I told her I’d seen her and her partner crossing the street, and we’d thought about stopping. I asked her if she would like me to prepare the meal, and show her how, since she might see them again with other outreach teams. I emphasized that all the street teams are connected, trying to give people a sense of being cared for by a safety net with different faces so that our clients can know and understand that we have communication across teams, care across town. She said yes, and I set about demonstrating the meal. Like a foodie TV show, but in the street.
I looked her over. She was a tall, older woman, wearing a skirt and heavy sweater. Her hands and face were clean; she was taking care of herself, a challenge in the time of COVID with an absence of shelter and hygiene resources. The shopping cart had only usables; she was not storing and traveling around with a bunch of oddball items—something I see a lot, often driven by methamphetamine, a drug that rewards acquisition behaviors. Her voice was low, soft, precise, and she kept to the subject. I made up the meal, put it aside.
She worked with registration while I went over to the man with her and asked if he wanted a vaccine, or a heater meal and gift cards. He turned towards his companion and her face subtly guided him to the right answer. I realized that she was the directing partner and his refusal wasn’t because he had reasons for not vaccinating, but because I wasn’t inside the trust circle he keeps—only his companion is. She gave him permission to vaccinate, to get the heater meal, to get the gift cards. His hands were filthy, and it seemed he hadn’t changed clothes for a long time. I got his name and birthdate from him, though his speech was hesitant and so soft I had to ask him to repeat himself. So I wouldn’t shame him, I pointed to the freeway, saying, “My ears are pretty old, we got the commuter traffic, can you say again? I missed it the first time.” He repeated, and I got his name and date of birth, handed them off to registration, then turned to another gentleman, African-American, doing toe-dips and spins, dance moves, waiting for me to get to him, and I fixed him a meal. The meals bubbled and steamed in the cool morning air as they heated. The man wasn’t in our system so the registration worker created a new patient registration.
She was Georgia Marie. She sat on our portable stool, getting her injection of the vaccine. After she got her gift cards I pulled her aside.
“How long has he been like this?” I asked, indicating her partner.
She looked at me and the light of her intelligence showed through. She was all business, and she’d made a decision to trust me. “Like what?”
“Having a hard time speaking up, not taking action on his own, just moving through, ghosting.” I said.
She said “It’s been a while. Since after the epidemic began.”
“It’s not just an epidemic in people’s bodies,” I said. “Being out here affects people’s minds. He depressed?” She thought about it for a while. Maybe it was the first time she put it together. I think about what it’s been like for her, a trans person doing the direction for the couple, for the survival of both of them, for the third being, the relationship they have together and for how long. All of it, day after day. On the streets, where people beat up trans people.
“Depressed, maybe not sleeping much or sleeping too much, not taking pleasure in anything, or not taking any pleasure in things that he used to.” Diagnostic criteria for depression, the same way that spotty bumps and a fever are diagnostic for chicken pox.
I thought about him, hardly able to speak, gone ghost in camp, moving slow. I thought of how the atmospheric river came through San Francisco, dumping inches of rain on the streets and high winds, thought about what she must have had to do to keep them warm, safe, and dry, how they would have had to dry themselves out after the rain and the wind came through, ripping up tarps and tents. I remember the Sunday the river came through. Even the dogs didn’t want to go out. “It’s mean out there,” I reported to my partner after a potty break for the dogs, and she’d said, “I know.”
The sheer number of the days outside, 18 months, the permissions to stay the night at a housed friend exhausted after 18 months of pandemic, the outreach shower, LavaMae, on hold. “No respite,” said Jennifer Friedenbach, director of the San Francisco Coalition on Homelessness, in a meeting with the city’s Human Services Agency, and if anyone needed respite it was Georgia Marie and her partner. A warm, safe place to sleep that didn’t require a tent, a tarp, spreading out and collecting bedding each morning. What they didn’t have, what they needed. What a lot of people needed and didn’t have.
Georgia spoke up, said, “I have a case manager.” She told me she is with the Umoja team, an intensive mental health case shop, and that she’s talked to her partner about services. I asked her if she was on any housing lists, and she said she had an offer of housing on the table but didn’t know whom to ask if her partner is on that list, if they can cohabit. She said, “I think we get 15 overnights a month. I can’t let him be alone.” She hoped to add him to the lease, and I told her that sometimes that is possible, it just depends on the building. I told her it may make sense to ask her case manager at Umoja if she can help figure out the process. “Your case will be stronger if you guys do domestic partnership,” I said. She didn’t know how to do it, so I told her about the office at City Hall that confers those partnerships, the form you fill out if you are low income that exempts you from the fee. She said, “We’d like to do it, we’ve discussed it,” and I asked how long they have been together. Five years, she said. In her tough experience as a trans person, she’d found The One, the person we all look for, who accepts us no matter what we look like, no matter what we do. There was an unbreakable bond between them. If, as a community, we want them inside, and have a life worth living inside, they’ll need to be together. “I’ve asked him if he wants case management like what I have but he hasn’t decided.” I thought about telling her that one of the diagnostic criteria is not feeling worthwhile enough to get help, but I decided not to. I wasn’t teaching diagnosis that day.
I told her about my friend who works at South of Market Mental Health, rides intake. On Wednesdays, for the past 15 years, you’ve been able to go to Michaela Yasky at 1 pm. She doesn’t judge people because they don’t talk much or their hands are dirty. Michaela’s a good one, I said. I put my name and phone number, Michaela’s address, South of Market Mental Health Services, on a piece of paper.
He was getting his injection. I talked to her about the psychiatric urgent care clinic, Dore Urgent Care, a safe overnight space with meds, for people who might need to be hospitalized but agree not to hurt themselves or others and to take medications. It’s just up the street, and he can go over and walk up, go through the assessment. I didn’t pick up on suicidality, but he was so blank, the bulb burning so dimly, that I couldn’t tell much at all.
Much of what we do is the “good thing” to do, defensive practice, sometimes so we can say, yes, we did it, and sometimes because it might truly come in handy. For Georgia Marie, knowing where the accessible, 24-hour resource is could be helpful in the moment of crisis.
I got the team moving back to the truck. Georgia and the guy were standing together by their shopping cart, ready to depart. I went back over to them, and said, “I’m wishing you luck, and holding hope on both of you,” and that’s it, the goodbye, the close was done. It was time to get the team back to quarters, and I took us back.
I thought about the love that Georgia Marie had for her partner. Reverend Glenda Hope, preacher in the Tenderloin, talks about God’s inclusive love, provided unconditionally to all. Georgia Marie had been through the fire. It toughened her, like tempered steel. Her experience provided her the ability, the skill, the desire to love inclusively. She loves her silent partner. She loves him not because of what he is now, soul-wounded and uncommunicative, but what he was, and what he can yet be. She loves inclusively.
I’m glad that she trusted me to witness that love. We don’t often get to witness love that runs like this. Why should Georgia Marie trust a health care outreach worker who groks her situation quickly? Maybe that is why she trusted me. Maybe she’s a trusting person. It’s hard to know what provokes trust in these street interactions. I know the likely elements: being direct, honest, staying in the role of consultant to the client and not directing, requiring, blaming, guilting. Lots of social work and helping behavior is based on the perception of the deficit narrative. That starts from the idea that people who need help must be deficient in some way. That deficit narrative doesn’t produce trust.
People don’t always show their best self on the street. The risk is too great: People are repeatedly hurt by exploiters, and sanctuary trauma* is frequent. We’ve taught a lot of people that seeking help gets you hurt, by raising hopes and then breaking them. We’ve taught people that the street is the only source of support and understanding. We have a lot of people who provide care for their own satisfaction, versus serving the task or the need presented by the person.
Arthur Diekman, a psychologist, says that to serve others for the purpose of obtaining evidence of gratitude is a trap, because if the gratitude is withheld, for whatever reason, then the risk expressing at the client gets bigger. I see this: Service providers who help others, expect something in return, versus those providing care because it is needed. Diekman’s idea, which he discussed with me just after publishing it, is one that’s stayed with me, more than a quarter century later.
People can tell if you want gratitude. Folks on the street are expert judges of character and behavior. When they know you need gratitude it poisons the relationship, turns it into an exchange of emotional and physical goods.
Georgia Marie has survived, I think, and has retained inclusive love for another despite, or maybe because of living in desperate circumstances. She can teach us how to love unconditionally, starting with how not to be ashamed of who we are in this world. I wish I could elevate her voice. I wish that I had the license and resources to quickly solve her housing problems. She’s done enough time on these streets, in this pandemic.
* Sanctuary trauma occurs when a person who seeks help receives care that is not trauma informed and patient centered. It may include experiences of abusive behavior, demonstrations of not-caring, impersonal care, delayed interactions, power and authoritarian exhibitions and communications failure. It generally results in a person ceasing to seek help.