5 minute read

When People You Don't See, Disappear

I have owed Matt an apology, about the bike, for a decade. On the day I met him, he was sitting on a bench, outside a grocery store. His sister had bought him a black and white Schwinn, but at the time, I didn’t know about his sister, or why she bought him bicycles. I just saw an intoxicated, homeless man. We waited outside the ambulance, while a police officer ran the serial number, because I was in no hurry to sit with Matt in a small, enclosed space. People stared as they came and went from the store. When the bike didn’t turn up stolen, to make amends, I agreed to transport it in my ambulance – a bike, a walker, sometimes a wheelchair, are as important to a homeless person as a car is to a commuter.

Over the years, Matt and I got to know each other. It turned out that I started and ended my shifts at the corners where he stood with a sign. I had seen him day after day, shift after shift, without noticing –look ahead, don’t make eye contact, wait for the light to change. For two summers we rode together, me commuting to work on a twenty-dollar bike I bought at a yard sale, and him on the Schwinn purchased by his sister. My shift started at 9:30 am and I would see him trundling down the railroad tracks, from his campsite, as I rode to work. Twelve hours later, summer twilight settled toward dark, as I pedaled home and he rode back to camp, with five-gallon water jugs hanging from each handlebar – “enough for the guys.” Our snippets of conversation, riding beside each other or through the window of my ambulance, while I waited for a light to change, strung together into a disjointed tapestry. On cold days I encouraged him to stay warm and he told me that, after years living in Southeast Asia, he liked the cold better than the heat. On hot days, he would say, “At least I’m not working construction,” which had been his profession. When it rained and I told him that I hoped he’d stay dry, he’d remind me, “Rain is good for my sister’s garden.”

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When I started working part-time, so that I could attend medical school, I saw less of Matt. The COVID-19 pandemic highlighted the shifting value of my life. As a medical student, I arrived at a clinical site and was assigned to a care provider who did not have COVID-19 patients. I worked with residents and physicians, seeing a patient for a few minutes and then retreating to a relatively safe space, to discuss diagnoses and treatments, in preparation for rounds. I followed nurses and spent the morning with patients – stand-pivot-adjust – ordered them breakfast, sometimes fed them breakfast, if a tech wasn’t available, while the nurse hurried to distribute morning medications, before rounds. Then I picked up a shift on an ambulance and listened to dispatchers repeat warnings – Priority 1, cardiac, COVID positive, airborne precautions – 3 on a fall, COVID positive, airborne precautions – Priority 1 on a diff-breather, airborne precautions. Local hospitals diverted the most severe cases, forcing us to spend thirty or forty minutes, in a confined space, with COVID-19 positive patients who were breathing forty times a minute. During the first wave, in West Michigan, call volumes dropped to almost nothing, as people avoided hospitals, for fear of contracting the disease. During the second or third wave, whichever this was, the number of infected patients grew at an exponential rate. As hospitals transferred patients to subacute rehabilitation facilities, ambulance services were inundated, first with transfers to the facilities and then, if the patient’s health declined, emergency calls for readmission.

For the last six months, I haven’t seen Matt. I look for him at the start and end of each shift, when I pass the corners that he used to frequent. In emergency medicine, we see people on bad days. Some people we see more than others and for some, the frequency increases until you stop seeing them. If they die on your shift, you know, but if not, no one calls, no one hangs banners on buildings or takes out ads on billboards or even writes an obituary. You just keep looking at the houses or the street corners where you picked them up, hoping that you’ll see them. The day I met Matt, I made him sit outside the grocery store, while people stared and a policeman confirmed that his bicycle was not stolen, because I didn’t want to smell him. Ten years ago, the thought of putting on an N-95 didn’t occur to me and I’m sure that Matt would have been offended, if I had. Now, I wear a mask and walk into the street, rather than pass someone on the sidewalk. COVID-19 has changed many things, but the pandemic has not shifted the bedrock of our deepest biases. We protect ourselves with masks and face shields, but still look away, don’t make eye contact, wait for the light to change, as the disease spreads through so called susceptible populations – recent immigrants, minorities, homeless men, who sit on benches, outside grocery stores.

The terror of this pandemic is not the R-naught or the mortality rate, or even the lack of herd-immunity, but rather that anyone can catch the disease. I rode to work with a desperately ill man, chatted with him through the open window of my ambulance, without fearing that I would contract his addiction. I drove past Matt for years, without noticing and still would – look ahead, don’t make eye contact, wait for the light to change – if I hadn’t met him. During a pandemic it makes sense to limit exposure –doctors shouldn’t spend more time in patient’s rooms because nurses and techs have to. Smaller hospitals divert critical patients, forcing paramedics to endure extended exposures and as you step out of your truck, sweating beneath layers of PPE, you are likely to see people strolling by on the sidewalk, with no masks. As health care providers, we are trained to limit exposure, but as a society, we have trained ourselves to ignore a litany of pandemics. We look away from addiction, don’t make eye contact with the mentally ill, and wait for the homeless to change. Now, we find ourselves confronted by a pandemic that we cannot ignore, because we are all susceptible. A cough, a sneeze, a breath, but rather than waking with a sore throat or malaise that passes in a few days, it is as though we suddenly risk waking to find ourselves sitting outside a grocery store, homeless, intoxicated, and trying to convince a paramedic that we didn’t steal a bicycle. As a society, if we do not force ourselves to turn, make eye contact and change the trajectory of the COVID-19 pandemic, by wearing masks, socially distancing, and getting vaccinated, we will owe far more than an apology to the millions who have suffered, died, lost loved ones or friends.

- Jacob Guiser, MS-II, MSUCHM

Tranquility Among Chaos (2020)

- Medium: Acrylic on Canvas

As clinicians, we must find balance. Specifically, we must find tranquility among the chaos in order to provide the best possible patient care.

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