Author: Maria Yang, MD

Categories
Education Homelessness NYC

Do All New Yorkers Have a Home?

Before I write about “homeless psychiatry”, let’s talk about homelessness.

In New York City, most people are familiar with the sight of people who are clearly homeless. These men and women, sometimes pushing carts and often saddled with several overflowing bags, are in city parks, on subway cars, and under bridges. People grow so accustomed to the homeless that, after a while, they don’t see them anymore, even if they’re looking directly at them. (Once you are actively looking for them, however, you will see them everywhere—and where they sleep, even if they aren’t there.)

Would you believe that New York City has one of the lowest ratios of street homeless individuals in the country? (Please note that there are differences between people who are homeless on the street and people who are homeless in shelters. More about this below.) In New York City, there is one street homeless person for every 2,688 people in the general population. In Los Angeles, there is one street homeless person for every 154 people. [1. See the last page of the document that compares street homeless populations of different US cities. Briefly, this data comes from volunteers who survey the city on one single night, usually during the coldest month of the year.]

What could explain this? Maybe it’s because of the cold, snowy winters and the sweltering summers. Perhaps people who are homeless leave the city and move to places with temperate climes. Those who have worked in hospitals too long might argue that many of the homeless aren’t on the streets; they’re in the hospitals. Those who work in the correctional system may make the same argument, except they replace the word “hospitals” with “jails”. Or maybe they’re hiding somewhere to avoid encounters with the police.

While those reasons may hold true for some people, one major reason that explains the low ratio of street homeless people in New York is the class action lawsuit Callahan v. Carey. The result of this lawsuit decreed that the City and State of New York must

provide shelter and board to all homeless men [and, later on, women] who met the need standard for welfare or who were homeless “by reason of physical, mental, or social dysfunction.” Thus the decree established a right to shelter for all homeless men in New York City, and also detailed the minimum standards which the City and State must maintain in shelters, including basic health and safety standards. [2. Excellent summary of Callahan v. Carey.]

As far as I know, New York is the only state where people have a legal right to shelter.

Even though New York City has a low ratio of unsheltered homeless individuals, there are many people who are homeless who stay in shelters. The Department of Homeless Services in New York (which also shares the acronym “DHS”) keeps a count of homeless individuals throughout the city.

Take a guess: How many people stay in a New York City shelter on an average night?

Those of you who have witnessed the New York City Marathon can attest to the endless waves of people who are running (plodding, whatever) in the streets. Tens of thousands of people make their way towards the finish line. About 45,000 people finished the marathon in 2010.

New York City’s Department of Homeless Services publishes the shelter census every day. The number has recently been around 37,000 people. While there is a difference between the shelter census number and the marathon finisher number, you now have a sense of the size of the shelter population.

Take another guess: How many of those 37,000 people are children?

About 16,000. [3. Statistics about the population of homeless people and children in New York.]

That’s right: In New York City shelters, there are more homeless children than homeless single adults.

These numbers tell us only about people who are willing and able to go through the process of registering for and staying in shelter beds. There are people who are homeless who either cannot or choose not to stay in shelters. [4. Here is a literary example.] As far as I know, there is no literature that describes the differences between these two populations, though I suspect that the differences are significant.

Furthermore, there are major differences between people who are homeless for a shorter period of time versus those who are “chronically” street homeless.

But before we get into those distinctions, let’s think about the definition of “homeless”. Many scholars, politicians, and advocates have tried to provide an accurate description of this word. How would you define it?

Categories
NYC

5:30am in the Financial District.

Prior to my departure from New York, my boss there granted me permission to freely write about the work I did in Manhattan. Though there are many psychiatrists in New York, very few work literally in the streets of the city. Future (original) posts will describe in greater detail my experiences as a “homeless psychiatrist”. As an introduction, here is a post that I originally wrote the following in December 2009.

The moon still floats in the sky at 5:30am and the wind coming off of the river feels like a cold pickle against the skin.

A parade of vehicles make their way south on Broadway, their tail lights glowing red in the dark ink of the yet unwritten day. Large trucks, the kind with eight or ten large wheels, roaring engines, and rattling cargo, rumble slowly along, their unoiled brakes screeching with each push of the drivers’ brakes. Taxis wander along the road, veering to the right, then to the left, then back to the right, of these large trucks, like flies looking for a place to rest their wings. Impatience overtakes the taxi drivers and intermittent honking ensues.

Underground, the subways are filled with people. Most of them are not Caucasian. Most of them are men. Many of them wear construction belts and boots. When the subway reaches the last stop, most of the people file off. A dozen or so, however, remain in each car. These individuals are wearing multiple layers of clothing, are surrounded by pieces of luggage and plastic bags stuffed with what look like more plastic bags, and are fast asleep in postures that look uncomfortable. These are the homeless who have found shelter, warmth, and relative peace for the night.

Back above ground, the sidewalks are almost empty. A young woman wearing tech clothing on her body and ear buds in her ears jogs past, her exhalations light, wispy, and grey. An older man in a dark suit, a yarmulke on his head, and a beard on his face ambles past, following the lead of his golden retriever. The space in front of the New York Stock Exchange, usually filled with tourists, chain-smoking day traders in bright coats, seemingly important men in three-piece suits, and police officers touting assault weapons, is completely empty.

The tiny trailers filled with pastries, bagels, and coffee are already set up and on site. The men inside, however, are napping, their chins tucked into their chests, their crossed arms resting on their abdomens that gently rise and fall with each breath.

A woman approaches one tiny trailer and giggles when she realizes that the merchant inside is sleeping. The man suddenly awakens upon hearing her and bolts upright.

“I’m sorry,” he sheepishly says. “What would you like?”

A few delivery men hoist boxes onto their hand carts. They swiftly push the cart into motion and easily steer the cargo along the sidewalks. Some of them whistle. Some of them frown.

A man sits on a rolling luggage cart, which is purposely positioned above a heated grate. His tattered clothes gently flap from the heat emitting from the vent. His nails are thick and yellow from growing yeast and grime is packed in the ridges of his fingers. To his left is a shopping cart, packed with plastic bags filled with newspapers, aluminum cans, and styrofoam containers. To his right is a lidless jar of peanut butter. A white plastic spoon or fork sits inside.

He faces the street and large trucks rumble past, their bright white headlights slicing through the darkness. Farther out, the lights along the river glow peach-orange, their reflections wobbling and choppy in the water.

The man’s lips move, though no sound comes forth. He shrugs his shoulders and then reaches over to the jar of peanut butter. He deftly pulls out the spoon, opens his mouth, and puts a glob of peanut butter in. He is missing many teeth.

The moon will set, the sun will rise, and the city will wake up. And the man eating the peanut butter will disappear.

Categories
Uncategorized

BRB.

Niagara Falls

Posting will be sparse for the next week or two as I am currently relocating from New York to Seattle… and marvelling at some sights along the way.

In the meantime, I invite you to browse the archives.

Thank you for your patience and understanding.

Categories
Nonfiction

Stairwell.

Originally posted in 2005:

I lingered in the stairwell for a few moments—just a few—today.

The entire stairwell is composed of concrete. The walls are off-white and the floor is now that dingy copper-grey-brown color from years of feet tromping up and down and up and down again on those tired steps. The ceilings are probably close to fourteen feet high and a slim, scratched, rectangular window starts about six feet from the floor. One has to be standing on step two or three from the ground to actually look out the window.

The liquid orange light of the dying sun—and it dies so early these days!—poured through the small gaps between the thick wall of charcoal clouds surrounding the city. A shiny white ribbon of car headlights rippled far below; to its right was a parallel ribbon of shimmering red tail-lights.

It’s cool in that stairwell; the vents that allow the chilly air flow in aren’t visible. Very few people use that stairwell, partially due to its distant location from the rest of the hospital, partially due to the low temperature of the ambient air. It has been completely empty every single time I have set foot in there.

And those few moments of respite are necessary. The ambient noise of the hospital—the malfunctioning IVs, the flushing toilets, the retching or crying or moaning or snoring or yelling patients, the ringing telephones, the beeping pagers, the tapping of keyboards, the thuds of dropped charts, the clatter of dropped silverware, the weird syncopated tonal rhythms of the ventilators, the sobbing of family members, the murmuring of the teams rounding, the sighs of the housestaff and medical students, the uneven rumbling of the cafeteria carts rolling past, the quiet Christmas music floating from the guitar in the performer’s arms—can be too much.

Sometimes it seems like the suffering that surrounds us all never ends. Even though miracles may be happening in every single room—the birth of a baby, the healing of a wound, the deaths of millions of bacteria in the blood, the sealing of fractured bones, the clotting of a wound in the esophagus…

… and for those few moments in the stairwell, everything is quiet and still.

And when my right hand turns the handle and I fling the door open back into the hospital, I am ready to jump right back into the fray.

Categories
Fiction

Just a Little.

Originally written in 2004.

It’s just a little after five o’ clock in the morning and I’ve come to see you. I ask if I can perform a pelvic exam on you; you reluctantly say yes. I try not to think about it too much as I insert my gloved fingers into your vagina, feeling your body tense with pain as I try to hasten my examination. I withdraw my hand from you, the fingers glistening with millions of particles of HIV.

It’s just a little after five o’ clock in the evening and I’ve come to see you. You’re not in the room, but your vomit is. Bright, chunky, thick red stuff that has splattered all over the white tiles of the floor. You didn’t even have to stick a finger down your throat. You’re 19 with a variant of anorexia and bulimia. All you have to do is think about it and you can make yourself throw up. You’re thin, almost too thin, but you think you’re terribly fat. You’re also terribly lonely, terribly empty, and terribly beautiful, but never beautiful enough.

It’s just a little after one o’clock in the morning and I’ve come to see you. You’re ignoring me but you roar to life when I dig my knuckles into your chest. You shout at me that you f—ing have respiratory problems and that you have a f—ing difficult time breathing and that you f—ing just want me to leave you alone, goddammit, because you’re in the f—ing hospital and why can’t you just f—ing be left alone in the f—ing hospital because you just don’t feel like you can f—ing breathe, goddammit. So why don’t you f—ing just go away, goddammit. And then you ignore me completely, pretending you are asleep.

And then you assault the nurses and we put you in three-point restraints.

It’s just a little after two o’ clock in the afternoon and I’ve come to see you. There is only one thing left to do before we can send you home. You’re doped up on morphine because your back is killing you. Your mother died last year, your wife died this year, and you live alone with your seventeen-year old daughter. Alcohol helps take the pain (which pain?) away. Neither you nor I are pleased about what I need to do, but we get it done quickly: You roll over, I pull down your pants, you shift slightly, I put on the glove, you breathe in, I insert my finger, you tense up, I withdraw my finger, and we both exhale in relief.

No blood in your stool, sir. Now we can send you home.

It’s just a little after two o’ clock in the afternoon and I’ve come to see you. Your feet are purple, your face is red. Chocolate brownie is in your hair and tears stream down your face. You lean forward, I try to sit you up. You keep leaning forward, choking on your tears, drowning in your love for methadone. If you don’t have it, surely your heart will break. You’re acting weird, why? Your body is acting weird, why? I want you to get better now, now, NOW, because I want to go home. I’m tired and I can’t think straight. And yet you look sicker and sicker and sicker.

It’s just a little after four o’clock in the morning and I’ve come to see you. The water reflects the slightly orange lights of the city. Layers of grey clouds coat the horizon. I see the trails of lights of the city streets. It is a different world, a silent world, a world where people aren’t sick. It seems so far away, even though the realms are separated only by a plate of thick glass.