Observations

I’m supervising Connor’s breakfast when the phone rings. It’s J, my very sick client. I can barely hear him. “Help me,” he says, and I can hear that he is struggling to breathe. “Where are you?” I ask right away in case he loses consciousness. “At home,” he says “my arms and legs feel heavy.” I call 911, explain the situation. Sometimes there is a wait for an ambulance because NYC pays EMTs so little that they flock to jobs in the suburbs but it's not long before I hear them knocking through the phone. He can’t get up to open the door, so I call 911 again and give them his door code, thanking the universe that his door does not require a key. Once they’re in, I continue with my morning- human pills, fill the water bowl, put two cans of food my crew has rejected in my pocket to stick in the free pantry down the street. My mind is still in the Bronx though - I leave my phone sitting on the piano and don’t notice until I am already on the train. Thinking about the sound of...

Odie went home. He had been with me since March while his human, my Very Anxious Client made his way through the seriously broken shelter system. While the client was in the shelter, we put in his application for mental health housing, and crossed our fingers. They bounced it back- “not mentally ill enough.” What??? Trying to keep this client halfway functional was taking a monumental effort from our whole staff. Doug revised the psych eval, elaborating on symptoms and how they affect the client's life. I do the same with the psychosocial and we resubmit. Now the serious mental illness is approved, but they are rejecting him for his housing history. “Not enough documentation of street homelessness.” How the fuck do you document street homelessness? It’s not like the park bench gives you a lease, or you get a receipt every time you sleep on the subway. I tried to explain this to the mental health housing reviewer. "Just document one time you saw him for each of the stree...

Wednesdays are my day off but crisis happens when it happens, so I found myself on messenger with a long ago client, H., who was really upset because her new therapist had just diagnosed her with Bipolar Disorder with psychotic features. I was puzzled by this, since I have known her for twenty or so years and never seen her manic. “How many times has she seen you?” I asked. “Two,” she said. That’s the first problem- when I was in school we were taught that you can’t diagnose bipolar until you have known someone for a while and been able to observe their moods. But since payment is based on submitting a diagnosis, that gets tossed aside and people diagnose based on whatever information they can gather right away. While I try to calm H. by explaining that all these diagnoses are really just categories made up by a bunch of doctors sitting around a table, and are more of a communication shortcut than a scientific truth, I think about what could possibly have triggered this diagnosi...

I took Connor for a chemo check-up yesterday. I know by now that if I bring the carrier into the room where Connor is, he will disappear like the Cheshire cat but without even the smile left behind. Instead, I scoop him up from the pillow he has claimed and carry him to where the carrier is stored and pop him in fast, slam dunk style - back legs first so he doesn’t see it coming. As soon as he gets in the carrier, he starts making a sound beyond meowing – a cat yelling – and he keeps it up all the way to the vet. At the vet he takes one symbolic swipe at Doc, a gesture of resistance, which earns him a four-paw nail trim. I have been worried about keeping his weight up since he doesn’t want to eat much on the days after his chemo pill, so I have been getting up before dawn to give him a second dinner before we both go back to sleep. This is not very good for my “sleep hygiene” but it’s working, the scale shows that he has gained a little bit of weight. I tell Doc about the sniffl...

Between the shoulder surgeon and seeing clients, I didn't get to any of the various observances of World AIDS Day. I missed the march, the hours long reading of the names of the dead, the candlelight vigil. Online however, my feed was flooded with people's remembrances of loved ones lost. The vast majority were in the 80s and 1990s, before the availability of HAART (highly active antiretroviral therapy)in 1996. HAART literally resurrected people, including two close friends of mine, from their death beds. My three years as an undergrad were shadowed by this tidal wave of deaths that preoccupied me to the point where a Southern Writers professor, an older woman who still should have known better, flat out asked me if I had AIDS myself. Not only was this an inappropriate question, but in 1993 it was also unanswerable because the autoantibodies present in people with lupus rendered the early antibody tests useless for me. And then I graduated into a world of sudden, unimagi...

I live in a historically Irish neighborhood, on a block flanked by the huge St Patrick's parish church, rectory and school and by Mclaughlin's Funeral Home. I have seen a lot of police and fire dept funerals, but today was huge. Multiple blocks in the area, including my own, were closed to traffic to make room for FDNY vehicles - including fire engines and their Family Transport Van - to crowd around the funeral home. Dozens of FDNY personnel in their navy uniforms and white hats stood in formation outside the funeral home and when I got to the water, several blocks away, a fireboat was pulled up close to the shore sending huge arcs of water into the sky in tribute. The deceased man, James Riches, was a retired FDNY Deputy Chief who contracted 9/11 related illness after digging through the rubble at ground zero for six months searching for his sonn -also a firefighter - who was killed responding to the attacks. After that, he spent the rest of his life advocating for 9/...