A Case Management Day

Sitting at my desk making my way through the tasks of a case management day – check on someone’s benefit application, send a referral for trans friendly shelter, send a request to an organization that donates shoes, I pause to grab the ringing phone. It’s a gentle sounding woman who tells me her name, and then when she says she’s from NYU Hospital, I immediately know what this is about. “You’re calling about J.,” I say. She tells me that our Very Sick Client is there in the ICU with a serious blood infection. I ask her if it’s coming from his port again. She tells me they’re not sure, that they are waiting for cultures to grow and that they’re going to do a CT to try to locate the source of the infection. She asks me a few questions, and I explain that he has an apartment in the Bronx but struggles to manage on his own there and that he doesn’t have home care because the home care agencies look at his extensive record, his outbursts and his non-compliance, and they won’t take his case. She asks me if he’s been going to dialysis and I explain that he didn’t go in the snow because they won’t come out to get him from the car and he was afraid of falling. She tells me he’s on pressors to maintain his blood pressure, and I tell her about the time he got stuck in the ICU because he couldn’t leave on pressors, and they didn’t know what would happen if they stopped them. As his proxy, I made the decision to stop them and it wound up being OK. She says “I talked to him, and you’re the person he trusts more than anyone. It’s nice to hear him talk about you,” and Misty grabs the Kleenex as the first tears start to fall onto my notes, blurring the ink. I would go see him but I have been coughing for days and extra germs are the last thing he needs. I hang up but I can’t linger in the sadness, I have clients waiting. The next person to come in is the Nicaraguan Political Prisoner. They have a meeting with someone at the UN tomorrow, and they ask me to write, in English, a detailed account of why they came here, what has happened since they got here, how the government switched their case from an affirmative asylum application to a defensive removal/deportation proceeding. I write about what could happen to them if they are deported – incarceration, torture, death. We go back and forth, tweaking the details. By the time we’re done, it’s after closing. The staff has finished cleaning up and left and the darkness outside the stained glass windows makes it feel like midnight. As I clear my desk which has disappeared in an avalanche of paperwork, it dawns on me that nobody has checked the messages on our office phone. I grab it and press play, and the first message is a trans woman. “I’ve been trying to avoid homelessness and I don’t know what to do.” I can hear the desperation in her voice, “I don’t have anywhere to go,” she says. I pick up the phone and she tells me her story about how she was illegally renting from someone for two years until he wound up on Riker’s, how the electricity was turned off and she has been living in the dark for nine months. Now she has been formally evicted and has 24 hours to leave. Her voice is drowned out by her sobs. Once they ease up a little, I say “here is what you can do,” and explain the adult shelter process. “You have to start at the adult women’s intake, and then request a transfer to the transgender shelter.” She’s so frazzled she’s not absorbing the information. “I’ll text it to you,” I tell her and I send it. Once she has the information in writing in front of her, she seems to focus. She thanks me, and I tell her this is what I’m here for and to let me know if she runs into problems. The system is light years more trans friendly than it was when I started doing this work, but it still has a long way to go. I hang up, stare into space for a few minutes, and start gathering my stuff. This day is done.