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“For the socially disadvantaged and vulnerable, social isolation might be the blade that cuts the last fiber of the safety net protecting them from the bottom.”

Four men sit in a room playing instruments.
By Nick Christian

Austin, TX
United States

“Vzzzt, vzzzt…” I looked down at my phone. My internal medicine residency program director calling at 9:30 PM? This can’t be good.

“Hey, Nick, sorry to bug you this late at night, but there’s a situation that I think your skills are suited to help with...”

My heart sunk.

“There have been six confirmed coronavirus cases at a local homeless shelter. We are trying to recruit a team to go in and swab everyone for contact tracing. Would you be interested in helping?”

I’m devastated and angered to hear the news. But also not surprised. Of course there’s an outbreak at this shelter; everyone is living so close to one another. One carrier of the virus could easily infect everyone who walks through its doors. I briefly reflected on the residents living there, members of society who already are treated as outcasts, now about to be kicked out of their only shelter.

“Sure, I’ll do it.”

Driving to the shelter the following morning, I couldn’t help but think about my formerly homeless neighbors. I live at a community in Austin, Texas, that has provided affordable, permanent housing and a supportive community for more than 200 people coming out of chronic homelessness. It is also home to more than 30 individuals such as me, called “missionals,” who do not have lived experience with homelessness and live intentionally in support of the community. The people I was about to serve at the shelter could possibly be my neighbor in future months.

I had been feeling downhearted from not spending much time with my neighbors since the pandemic started, trying to limit unnecessary interactions since I work in a hospital treating COVID-19 patients and was self-monitoring myself for symptoms. I missed playing music with my formerly homeless friends, one of whom is my next-door neighbor, a Native American flute player named Donny.

A remarkable individual, Donny suffered a life-threatening car vs. pedestrian accident years ago, fracturing more than 30 bones and rupturing internal organs. Remarkably, he overcame the accident while beating homelessness and alcoholism. I attended his three-year sobriety celebration at a Friday night Alcoholics Anonymous (AA) meeting, where he had an entire speech prepared that was entirely composed of jokes worthy of any popsicle-stick, which he was known to send out weekly to everyone at the village. He abandoned the speech last minute to give a warm-hearted account of his journey to sobriety and express gratitude for those who helped him along the way. Donny’s story is one of the many inspiring stories of my community.

On my way to the homeless shelter, I felt a longing to drive towards my home and visit with my neighbors. But I also knew how proud they would all be of my driving into the trenches of the COVID-19 epidemic in Austin and serving many of their former friends on the streets.

I parked in front of the shelter and walked into a parking-garage-turned-makeshift-health-clinic. Prior to my arrival, I had been nominated to do all the nasopharyngeal swabs for each patient. I donned my personal protective equipment (PPE).

It was an overcast, humid, and hot morning. I started sweating as soon as I put on my robe. Once the N-95 respirator was on, I had to adjust to the perceived lack of oxygen coming through the cloth that would serve as the barrier between myself and potential virus-laden air.

The first couple of swabs went smoothly. There was the usual gag and tears in the eye afterward, but no problems. This is not a comfortable procedure. And despite warning individuals about this, they are always shocked.

My third swab, a woman in her thirties, verbally expressed her understanding of what I was about to do. But as I approached her nostril, she instinctively pushed my hand away. “No, no, no!” she yelled, without any thought. It was obvious: Her history of trauma, both inside and outside the health care system, was certainly being re-lived in this moment. I tried to soothe her, but ultimately had to settle for a non-ideal sample.

Fifty swabs in, and I was a ball of PPE and sweat. I had swabbed everyone that was living or working at the shelter. I got a little break for some water. It was nourishing, but the process to re-don the same mask and face shield felt like playing the childhood game Operation — except that with one wrong move, I could contract a potentially life-threatening illness that I could spread to my loved ones.

I completed around 80 swabs that day, and I was physically broken. Having gone all day without food and sweating profusely left me drained. I carefully doffed all my PPE and looked at my phone. I had multiple missed calls and texts from my neighbors. I swiped on my phone and read the first text. It took away my breath.

“Did you hear that Donny died? :( “

I hear Donny’s flute. I think of his speech at the AA meeting. His jokes. I think about how I had seen him two weeks ago and he looked like he had bruises on his face from where he had fallen, visibly intoxicated. I had felt scared for a while that the social isolation caused by the pandemic might fan the flames of addiction that many of my neighbors fight daily to put out. All these memories and thoughts pulsed in my mind until my mind broke. I had to leave. I walked into the rain that had begun an hour earlier. I wished it could wash away the reality of his death. I got to my car and tried to cry but I must have been too dehydrated for anything to come out.

Many of the individuals living at the homeless shelter that I swabbed that day tested positive. I pray that they are faring well, and the virus has not shortened their time on earth as it did my friend Donny. Even though he wasn’t infected with the virus, the implications of anxiety and reduced social support certainly contributed to his return to alcohol use. I wonder how many individuals will indirectly die of the psychological and emotional consequences of the social isolation caused by this pandemic. It impacts all of us in some way.

Most of us have a strong safety net to catch ourselves when we fall. However, for the socially disadvantaged and vulnerable, social isolation might be the blade that cuts the last fiber of the safety net protecting them from the bottom.

It is unknown exactly what caused Donny’s death, but I would diagnose him with a shattered heart. A true shame given he had one of the purest and most beautiful hearts I have ever met. I wish I could have been there to help him keep the pieces together. Now I’m left here angry, with two adversaries: Addiction and COVID-19. Two current predators of the poor and vulnerable.

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