by Tilda Shalof
Before we press on, Kathy opens her knapsack to show me what she carries: bus tokens, a few pairs of wool socks and gloves, vitamins, alcohol swabs, sterile syringes, lubricant, and condoms, including some flavoured ones, for oral sex. Condoms have huge currency on the street. The pimps control the number of condoms they give out and count them carefully so they know how many “jobs” each woman has done. Some girls are tempted to re-use them to keep some cash back for themselves and not have to hand over everything to their pimps.
With her kind, honest, concerned face, in jeans and a plain sweatshirt, and her beat-up purple knapsack patched together by duct tape and hanging from her shoulder, Kathy is easy to trust, easy to like, easy to learn from, and I find myself doing all of these things every step of this walk. I marvel at the respect she conveys to a panhandler we encounter. She’s a dishevelled woman with blackened teeth who comes up to us with grimy outstretched hands. Kathy digs into her pocket and hands her a loonie. She introduces herself and asks, “What’s your name?”
“Sam. Got anymore? Got a toonie?” Sam gives forth a loud, wet, hacking cough.
Kathy has another loonie and hands it to Sam. “Here you go.”
Sam gives them back. “D’ya have a toonie instead? I like them better than loonies.”
“That’s all I have for you today,” Kathy says cheerfully.
I try to help. “Two loonies or one toonie – they both equal two dollars,” I tell Sam. She doesn’t think much of my arithmetic, but I try again. “They have the same value.”
“Not to me,” Sam says as she ambles off, coughing and spluttering as she goes.
We go where they are.
Just then, we’re stopped by two high-school girly-girls in matching berets, candy-coloured gloves, and scarves. With their rosy cheeks, huge, pink, breathless smiles, and springy ringlets, they look like they’re from another era. (Who wears ringlets, anymore?) Melissa and Jenny, it says on their “Jesus Christ of Latter-day Saints” name tags.
“Does faith play a role in your life?” Melissa and Jenny ask in unison, eager to save our souls.
I look up from my notes. “I’ll let you field that one, Kathy.”
Kathy is nicer than me. “Faith is definitely a part of my life, but I’m sorry, we don’t have time to stop and talk with you now.” Her rebuff is gentle but firm, in keeping with the peaceable way Kathy lives. She is in touch with nature, respectful of the wild. She and her husband kill the meat they eat so they know it’s fresh, with no additives, hormones, or antibiotics and, most importantly, that it’s been treated and killed ethically. “I want to know that it lived wild and free. I am going to honour it by having a say in how it’s killed.”
We walk on, stopping now and then to chat with various people who live on these streets, some Kathy knows and others she wants to get to know.
“What’s a typical day like for you?” I ask.
“First, knowing there’s no typical day. How can I itemize what I do? I’m investing in relationships that I don’t know if I’ll have or not. Sometimes you think you’re doing one thing and it turns out you’re doing another.”
“I can feel how much you love your work.”
“I like homeless people and people dealing with mental illness or substance abuse.”
“Why?”
“Because no one else does. They’re hungry, broke, confused, scared. Who would live this way if they had a choice? Who would be a drug addict if they had an alternative? That’s why we start with, ‘Okay, so you’re a user. Let’s start there. Are you using safely? Do you have clean needles? Are you rotating your veins? Are you injecting with the bevel of the needle facing up to preserve your veins? Are you heating the heroin adequately to dissolve the particulate matter, which can damage your veins? Are you doing what you can to avoid abscesses? Our clinic is your oasis of safety. We are your allies.’
“I meet people where they’re at. If I hand you a clean needle, I’m telling you, ‘You’re important. I care about your health. If you don’t care about your health, I will care about you until you are ready to care for yourself. When you want help, come and talk to me. I’ll be there. Even if you’re not ready to stop using there are other ways to treat your anxiety.’ I’ll do whatever it takes to start building a relationship. I want to convey the message that you’re not a piece of shit. One guy told me, ‘I’m a waste of skin.’ ‘Yes, you have problems,’ I said, ‘but you’re worth investing in.’ I told him he is like a one-hundred-dollar bill, torn and soiled, crumpled and tattered, but a hundred-dollar bill still has intrinsic value. ‘That’s you.’ ”
I can’t imagine trying to get off a physiologically addictive substance like alcohol, cocaine, heroin, or cigarettes. I’m dealing with my own addictions – coffee, chocolate cake, for example. “Is meth a problem in this town?” I ask Kathy. (Clearly, I’ve been watching too much Breaking Bad, another of my addictions.)
“Not here. It’s too expensive a drug for this population.”
We arrive at a church drop-in centre and just before we go in, Kathy points out something across the street. There’s a park with a gently sloping toboggan hill. At the bottom of the dip, at the base of each tree is a bale of hay, tied with a rope. “Put there to protect the kids, lessen the impact,” Kathy notes dryly. “When I was a kid we learned to roll off in time.”
The current trend of hovering parents and overprotected kids seems especially misplaced; I’m now meeting a lot of people who need more protection than our privileged children. I guess the bales of hay are a form of harm reduction, too.
As we enter the drop-in centre, we’re hit with the smell of mashed potatoes and gravy. It would be a pleasant aroma if it were a homemade Thanksgiving dinner enjoyed with one’s loving family around the dining room table; however, in this context, the smell is revolting. It doesn’t help that it’s mixed with the smell of cigarette smoke, body odour, and resignation.
The meal is being served in a crowded basement room, noisy with chatter, expletives, hoots of laughter, and the occasional loud exchange of harsh words. Hungry, dirty people sit at long metal tables, hunched over plates of food. We’ve just arrived and already I feel closed in. I’m sweating. Looking around the room, I see one exit. If I need it, I’ll have to plow through this group of rowdy, sullen, or dejected-looking individuals to escape. They wear tattered or ill-fitting clothes and many have painful-looking piercings and scary tattoos like snakes or guns or barbed wire. Others just look down and out, angry or depressed. I swallow down my fear and copy Kathy’s confident stride. Following after her, I enter the room boldly. In fact, I move past her, right into the midst of the people at the tables and those milling around the perimeter. I find a chair in the corner of the room and take out my notebook and pen; it’s my standard retreat when I need to think, when I’m wondering about something and trying to understand it. In seconds, a man with spiders tattooed all over his face, a nose ring, and a black baseball cap clamped to his head comes over and leers at me.
“What are you doing? Are you writing something about me?”
I hadn’t even considered how my usual activity might seem unusual in these circumstances.
“Why’re you here?” he sneers. “Only retards come here.” He moves in to look down at my notebook. There’s no time to call out to Kathy for help. I tell myself to stay calm – or at least act that way. I look him in the eye, trying to think how I might connect with him, disarm him, bring down the tension.
“Why are you looking at me like that?” he shouts. He comes at me in a fury, his fists clenched. A friend of his jumps up and grabs his arm, saving me in time.
“Don’t pay any attention to Kyle,” the friend says, pulling Kyle away. “He’s just pranking you. It’s just that he’s gone off his meds and is a little antsy.”
I go over to Kathy, keeping my head up, though feeling I’ve failed a test. How could I ever win their trust if I were their nurse? I look too rich, too well fed. I wonder if she saw what happened.
>
She did. “You could waltz in here with a fur coat and diamond tiara. They wouldn’t care.”
The image of myself making an entrance in that attire makes me burst into laughter, releasing tension I’m still feeling from that close encounter with danger. Kathy continues, dead serious. “All they want is to be seen, to be acknowledged. They don’t want you to pretend to know what their lives are like; they only want to know that you are willing to listen. Yes, they’re watching you, checking you out, but it’s not about what you’re wearing or what you look like or what you have. They might tell you to fuck off, but if you stay, they know they can trust you. They want to know you’re not judging them. It was good you made yourself at home and sat down.” She looks at me approvingly. I feel better. Maybe I passed the test, after all.
“Were you frightened when that man lunged at you?”
“Yes, I was. A bit.”
“I’d think you were disingenuous if you said you weren’t.”
We stand off to the side of the room. The way they are huddled together, squished on the benches, gulping down the soft, simple food makes me sadder than I’ve ever felt in the ICU. At least there, patients are being cared for. They have a roof over their heads and are hopefully getting some loving kindness from those of us caring for them. Out here, these people are all on their own.
“Every single person in this room has been hurt, abandoned, abused,” Kathy says. “If you were to hear their stories you would not be able to fathom how they’re still standing. When you see their suffering, and not just their bad behaviour, you feel enormous compassion.”
Kathy points out one young woman who she says is a sex worker who uses crack cocaine. One day she told Kathy that her earliest memory is of her mother hitting her on the head with the stiletto heel of her shoe. She was prostituted by her pimp father, bounced from foster home to foster home, abused by –
“Okay, okay, I get it.” I hold up my hands, cover my ears. I can’t bear to hear anymore. I’ve reached my limit. “But what can you actually offer them?”
“We always want to see the results of our actions, but as a street nurse, you have to see the long-term benefits. You’ve got to be in it for the long haul – and I am.”
As we leave the drop-in centre, she’s pleased to find one of the clients she’s been looking for, sitting outside on the stoop. “Hey, Brent, here you are,” she says to an elderly man with a long white beard, wearing a Vancouver Olympics red-and-white toque. He’s dangling his legs and we see there are no socks on his feet. Kathy hands him a pair of socks and a pair of gloves. “I’m glad I found you.”
We walk on down to the river, where Kathy wants to check places where she thinks there might be more people, especially the other person she’s scouting for. At the shore of the Ottonabee River, there’s an inscription on a plaque that she stops to read: “I love history.” In fact, she’s quite a history buff. She’s written an article about the history of street nursing in Canada, in which VON plays a big part. In addition to numerous “letters to the editor” and scholarly articles, she’s written a report called Under the Radar, which examines the alarming incidence of substance abuse in rural areas and how it’s often invisible and hidden. She tells me about a study that asked 454 homeless adults, “What is the hardest part about staying healthy when you are homeless?” She and her co-investigator hypothesized it would be “staying warm” or “finding food.” They were shocked to discover the number-one response was “maintaining self-esteem” – expressed by one subject as “trying to feel good about myself when I get up in the morning.”
“Powerful stuff, isn’t it?” she asks.
We are walking back to the 360 Clinic now, but Kathy still hasn’t found the person who needs an antibiotic injection; she plans to go out to look for him again later.
“And the woman you gave the loonies to is gone from her post, I see.”
“Yes, Sam. She had a bad cough. I’ll find her tomorrow. I want to listen to her lungs. Maybe I can coax her into the clinic for a checkup. I’ll try to tempt her with a bowl of soup, a warm jacket, and a shower.”
“A toonie might do the trick,” I say. “Sam,” I echo. I’d completely forgotten her name. Earlier, she was just another anonymous, beseeching face. Now I’m wondering where she is too. Does she have pneumonia, as Kathy suspects, and will she get treatment?
Back at the clinic, we sit in the office for a few more minutes to talk, drink coffee. I’m still trying to process all that I’ve seen today. “It’s shocking how even the most terrible suffering can remain hidden,” I say. “Most people can’t even imagine there are people nearby living this way. I certainly didn’t. It’s unspeakably sad.”
“And such unnecessary suffering. It doesn’t have to be this way,” Kathy says. She tells me that on any given night in Toronto alone there are at least five thousand homeless people, including the “hidden homeless,” who are roving around, “couch surfing” from place to place each night. “It’s a disgrace that we do not have a national strategy for poverty and housing.” Shelters are only a temporary solution, she says. For her, the shelters with women and their children are the saddest because they perpetuate this legacy of suffering. Kathy compares homelessness to natural disasters like earthquakes and hurricanes, but homelessness is a serious human rights violation. “To have a home is a basic human right, along with health care, of course. That’s why I couldn’t do work downstream if I didn’t work upstream, too.”
“I’ve never really understood those terms.”
“Downstream is service, upstream is advocacy. Working upstream makes an impact on a greater number of people. It’s fighting for systemic changes through writing letters, signing petitions, lobbying politicians, making phone calls, taking reporters behind the scenes, as I’ve done many times. But I couldn’t do the advocacy work if I wasn’t on the scene, doing actual hands-on nursing care in the field.”
Here’s Judith’s third type of nurse. Nurse Activist, Activist Nurse – consummate nurse.
Kathy wants to tell me a parable, and it’s nice to relax and listen to a good story.
“There’s a nurse who’s tired. She needs a vacation. She goes fishing, enters the river in her hip waders, casts her line. Suddenly, she hears someone calling for help. She sees them struggling. They’re drowning! So she rushes over, grabs the person, picks him up, and helps him clear his lungs. A nurse is never off-duty, as you know. But then, she sees someone else in danger. Another person is drowning … and then another and another. People are falling into the water and they don’t know how to swim. Then the nurse figures if she builds a bridge and teaches water safety, maybe there won’t be so many drowning victims. Instead of mopping up messes, the nurse also works on fixing the underlying problems.”
Upstream, downstream. Now I get it. This fishing story will stick.
“Academics love theories. Here’s my nursing theory: You take what you see in your daily clinical practice and allow that to inform what you do on a policy level or in the political arena. You can’t do one without the other. They can’t be separated.”
When Kathy was living in Toronto, Canada’s richest city, she worked in a men’s shelter. There was an outbreak of tuberculosis that resulted in the death of three men. “We know that a shelter, or any crowded living space, is a breeding ground for infection, but tuberculosis? In this day and age, how can this be happening? TB is so preventable and treatable. We rallied together and called a meeting with the chief coroner. We marshalled our arguments, called for an inquest, and came forward, RNs and NPs, to testify as expert witnesses. That’s an example of how downstream work leads to upstream work. But you’d need to be actually doing the work to know this.”
And even when the challenges are as big as these, and there are so many problems she can’t fix, Kathy stays true to a nurse’s “North Star.”
“We can always bear witness. Bearing witness is an important part of my practice.”
I nod. “That’s one of t
he reasons I write,” I say, coming to this realization as I say it.
“We have access to people’s hidden stories,” Kathy says. “It’s one of the great joys and privileges of being a nurse – to walk with people on their journeys.”
I ask her the questions Judith asked me: “Why don’t more nurses speak out on these issues? Why aren’t they more politically active?”
Her response is more charitable and diplomatic than mine was a few months ago, when I first met Judith and got annoyed by this perfectly legitimate question.
“Most workplaces don’t support nurses’ involvement. They discourage it. Many nurses feel it’s irrelevant or beneath them to get involved in politics to bring about change. They don’t feel empowered to make speeches, to be vocal to politicians, attend rallies. They’ve been told so many times that their voices don’t matter that they’ve begun to believe it. When I meet nurses who are intimidated or not empowered, I tell them to get over it. You are needed. There is so much to be done.”
WORKING LIKE A DOG
I’M JUST ABOUT TO GET ON MY WAY when Krista, 360’s office manager, suggests that, before I leave, I should stop by the adult day program located in the mall. “But I’ve already seen a few ADPs,” I say. If you’ve seen one, you’ve seen ’em all, no? “But they’re expecting you,” she says with a twinkle in her eye. “There’s a special guest today.”
That’s how I get to meet Bryce Balson, a retired forester, and Cody, his constant companion and a professional therapy dog.
“We usually come on Fridays,” Bryce says. “Today’s Thursday but we came to meet you. Cody knew it wasn’t his day to work here.” We look down at Cody, whose expression seems to say, Of course I knew. Cody is an old dog with the face of a young bear cub, and Bryce has the face of a gentle papa bear, covered in a ginger and grey beard. Bryce is a hardy outdoorsman in a flannel plaid shirt, suspenders stretched over a big belly, and a black baseball cap decorated with pins and yellow ribbons, reminders of soldiers stationed far away from home. He gazes down at his brilliant dog, who’s sitting at his feet. “Cody’s a Nova Scotia Duck Toller,” Bryce says. “My granddaughter found him on the Internet. ‘Here’s a dog for you, Grandpa,’ she said. He was scruffy, skinny, and his coat was dirty and matted like a bird’s nest. He’d been running the roads. But there was something about him, even though he wasn’t looking his best that day.”