Fuck it. I'll take a risk.

a case study of American healthcare and homelessness

When I enter the hospital, the street’s piss and gasoline vapors are sealed out by a rotating glass cylinder that looks like a hamster wheel tipped on its side. At the front desk, the shovel-faced security guard emanates a spiky cologne with head notes of licking a nine-volt battery on a dare. He prints my driver’s license on a sticker and hands it over before waving me through what I think is a metal detector, though it’s never turned on. As I apply the sticker to my t-shirt, another security guard points at the elevators. I ride up with two nurses, women I reflexively think of as middle-aged and yet who could easily be in their thirties, like me. They smell both clean and contaminated, as healthcare workers tend to, embowered in bleach, talcum powder, rubbing alcohol, peppermint gum, blue razz vapes. At the sixth floor, the elevator bursts open, sucking like an airlock. In rushes the almost oleaginous odor of the public American medical facility: fried food, farts, and the uncanny lemon-and-lavender tang of Fabuloso.

I’m here to visit my neighbor Robert, who I brought in last week. Robert is a shy but friendly man who lives on the street outside our apartment; Jade and I have gotten to know him since I moved in last year. Lately I’ve been looking forward to summer on his behalf. This past winter, no matter how cold it got—and it got fucking cold, especially for homeless New Yorkers, whose numbers have more than doubled since 2022—Robert politely refused our offer to sleep in the vestibule at the bottom of our stairwell. He didn’t want to impose, and it was clear that experience had taught him that suffering was smarter than trusting. Our compromise was a camping chair that Nes found on Facebook Marketplace and a stack of blankets that we put out at night and took in the next day.

But over the past few weeks, I noticed Robert having more and more difficulty walking. Only a month or so ago, when he joined me while I ran some errands, he kept up easily—though I had to prevent him from walking into traffic sometimes—while we chatted about space travel and how Greenpoint used to be a nice neighborhood¹. Now he wasn’t even leaving the block, sticking to a recently emptied storefront two doors down from ours. His dirty clothes became filthy and his spot was surrounded by garbage, neither of which Robert would normally permit, being painfully aware of what that can mean for someone in his position, especially in a bourgie neighborhood like ours. When I asked him about his legs, he waved me off or started stringing words together in a way I couldn’t understand. While this is how Robert talks most of the time, I’ve learned that he just so happens to become less coherent when he doesn’t want to discuss a given topic. In any case, he insists on not being a burden, especially to those he considers his friends.

On Thursday morning, I came outside to find Robert yelling, in his heavy Brooklyn accent, at nobody, which is something I’ve only seen him do at night, when the street is mostly empty. I went back upstairs and made him some coffee—black, like he likes it—and returned to stand with him for a while. Red in the face, he ranted and raved at a spot a little past my right shoulder, leaning on an iron fence for support. You know I don’t mean you, he once interrupted himself to clarify, before diving back into his tirade. Fuckers think you can do this to me when I tell you the truth and you ask yourselves how is it that a man such as this is looking you in the face from out here, right or wrong, and you lie to yourselves while you lick your knives…

Later that afternoon, after he’d calmed down, I asked Robert if we should go to urgent care. Fuck it, he said, I’ll take a risk. The nearest CityMD is a ten-minute walk away, but he would never make it on foot, so I called a car. He smoked a cigarette while we waited for it to arrive, then asked me to hold onto the rest of his pack and his life savings, a couple of five-dollar bills wetly wadded into the shape of a fist.

At CityMD, the doctor urged us to go to the emergency room, and not just because it’s the only place where Robert, who doesn’t have an ID or anything to pay with, can’t legally be turned away. It turned out that he had a very serious infection in both his feet and needed to be examined by a wound specialist immediately.

I held out as long as I could, Robert kept apologizing. I ordered another car.

After our apartment building burned down when I was seven years old, my mom baked dozens of chocolate-chip cookies for the firefighters, who had done their best². This memory came to me when the ER admitted Robert right away thanks to the CityMD doctor, who had told us how to lie in order to make his condition seem as serious as possible. I wished I could go back in time to hug her. But looking at Robert’s bare feet, which resembled rancid beef jerky that had been crushed by an anvil, I wondered how much we’d really needed to grease the wheels. Did someone light them on fire? Robert asked, peering down at himself from the top of his stretcher.

I stayed with Robert in the ER, translating his story for the intake team and explaining to a series of confused RNs and doctors what I meant when I said neighbor. I didn’t want to overemphasize his homelessness, in case it led to a poorer quality of care, or even to him getting booted before he had gotten the medical attention he needed. But because I had given him a change of clothes, and because I was there with him, it took them a while to figure out what had gone wrong in the first place. Only later did I realize that some of the clinicians had initially assumed they were looking at the results of extreme neglect—which wasn’t true, at least in the sense they were thinking. You know, it might be exposure, one doctor finally muttered to another, using a bare finger press down on the white-rimmed ulcer splashed across Robert’s hairless shin. An unhoused man with a housed companion of indeterminate gender was clearly not on their bingo card³.

It wasn’t on ours, either. Robert was afraid and so was I, although I was also relaxed by the ER’s unceasing movement and by the alert boredom of its young, racially diverse staff—men and women with tense, affectless faces, tight-fitting scrubs, and extreme My parents yelled at/ignored me vibes. Not me getting turned on, I thought, fussing with the strings on Robert’s gown. He asked me to stay with him, but visiting hours were almost over. I assured him I would be back in the morning. You promise? But morphine was already dulling his pleas.

For the past week, I’ve gone to see Robert for an hour or two every day. When we’re not talking, looking at newspapers, or watching TV, I’m trying to piece together the story of his diagnosis, which was delayed by the holiday weekend. A friend connected me with another friend who’s been in a similar situation, and she shared what she knew about medical social workers, housing vouchers, psych evals, healthcare proxies, and ways I could help Robert, who’s leery of going to a rehabilitation and nursing facility to continue healing, without violating his autonomy. I’m trying to change his mind about that. If he gets discharged—or leaves early, against doctor’s orders—how will he heal his infection? After the doctor told Robert he had gangrene, I told him I was worried for his health. Well, I’m worried about freedom, he replied.

While I haven’t spend much time in hospitals and ERs, I feel at home anywhere sick, old, disabled, and mentally ill people are crammed together on the cheap. Robert’s nurses and doctors quickly came to recognize his only visitor. They are kind, or at least professional, calling him baby, bringing him treats, and answering my questions so I can make a plan to support him, whatever happens next. They are also unkind and unprofessional, telling Robert to be grateful that someone is willing to help him, chastising him for doing this to himself, implying that he does street drugs (he isn’t currently using, though this is of course besides the point), making snide jokes about him being “schizo,” and not bothering to hide their frustration when he puts up the least resistance to going to one of the city’s homeless shelters, which are so horrible he would rather die than return. I already know how to maintain a sort of cognitive dissonance about the abusive people that you rely on. This is American healthcare, especially for the sick, old, disabled, and mentally ill: patients who can’t afford better are deprived of almost every livable option except the oversight of overwhelmed, underpaid, and mightily exploited workers shoehorned into circumstances that make abuse inevitable, from doctors to medical assistants to social workers and all the way down to me, the housed acquaintance who could, at any time, invite Robert into their home (and not just their vestibule), but won’t.

When I enter the hospital room, Robert cries out, My friend! and shakes my hand. He can’t seem to believe that I always come back and tells me he prays to god that I will. When I met him, I didn’t want to be his friend. Helpful, sure, but not his friend. Maybe if I had been pushier about his feet, this wouldn’t have gotten out of control and we could have remained neighbors. Now Robert may need more than a neighbor, especially if he’s permanently disabled. (And anyway, if you’ve cried with someone, I think that’s grounds for something like friendship, at least.) I’m alone! I have nobody! This is what Robert yelled on Thursday morning while I stood beside him with his cup of coffee, waiting for him to get it out of his system. I could have contradicted him, but with what? I care about you, but I won’t blow up my life for you. What kind of care is that? I’ve given him cash. I’ve washed his clothes. I’ve helped him pee. I’ve touched his shoulder while doctors told him scary things. I’ve listened, bored and annoyed, as he invents religions and spins out on conspiracy theories (Is someone trying to kill me? he sometimes asks. No, no one here wants to hurt you, I reassure him, though we both know that this isn’t precisely true). I’ve brought him Kinder eggs and orange juice. My girlfriend and boyfriend bring him gifts, my friends ask how he’s feeling. It’s not enough. I’ve offered Robert my help, but I fear he’s not in a reality where he can receive it.

Jade said that I started talking to Robert more when her cat, our beloved Marcus, died in November. You always need a little guy, she said.

I’m ending this newsletter with additional reading on homeless Americans and homelessness in America. It’s hardly exhaustive, just the first few pieces that came to mind. If you have any to recommend—especially if it’s written by someone who is or has been homeless or unhoused, as some of these are—please add it in the comments.

• “The Invisible Man” by Patrick Fealey

• “Four Men” by William T. Vollmann

• “California's homeless crisis could be Gavin Newsom's political albatross” by Alicia Victoria Lozano

• “A Climate Dystopia in Northern California” by Naomi Klein

• “Getting the House” by Cheryl Rivera

• “Forced Alternatives with Tracy Rosenthal” on the Death Panel podcast

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1. I can never tell if Robert is referring to gentrification or to the mysterious street gangs that he believes are around every corner. In terms of the threats they pose, I guess it doesn’t really make much of a difference.

2. I’ve come to realize that this was most likely my mom trying to find herself a man. This fallen apple can hardly blame her.

3. As an androgynous transsexual, I am my context. Everyone in the ER assumed I was a woman, in part, I think, because I was serving as a caretaker for a man.