ON MY WAY TO WORK: A WALK THROUGH SAN FRANCISCO’S TENDERLOIN NEIGHBORHOOD |
Kathryn Taylor
On my way to work, I look for chest rise.
On this day, I crouch by the shoulder of a man who is folded between his wheelchair and a parked car, knees asymmetrically crossed onto his chest, head at a painful angle against the car door. He doesn't respond, and I am shaking him now, "Sir, are you ok, are you ok?" His eyes roll open, and his head falls forward. It takes his pupils too long to land along the same line of sight. Finally, he finds my gaze. "Leave me alone."
Are you ok? Leave me alone. Are you ok? leave me alone, leave me alone, leave me alone, I am trying to sleep here.
On this day, I see a patient of mine. He is sitting on the sidewalk, smoking fentanyl. He sews together bits of thrown-away leather and, every day, wears patchwork leather overalls and a patchwork leather cape. I look to make eye contact, ready to say hello if he chooses to. He doesn’t look up.
I am a doctor at a clinic that sees homeless patients, and on my way to work, I walk five minutes from the Civic Center BART in San Francisco, CA, to the clinic door.
On this day, a homeless man plays the guitar by the automatic ticket dispensers, his dog curled at his feet. I know he is homeless because he told me once after I gave him some change for his heartfelt songs. He told me that he lives out of his storage unit, that he has HIV, and that busking gives him a reason to get up each day.
On my way to work, I am met with the hellos and how are yous of the Urban Alchemy community ambassadors, the wearers of black vests with bright green piping, carriers of Narcan, enforcers of community norms, standing sentry. They are hired by the city to prevent people from, for example, using the sidewalk as a bathroom, and use the portable bathrooms instead, which the city has brought in due to this exact, ongoing civic complaint. Hello ma’am, how are you, hello ma’am, hello.
On this day, as I climb the concrete steps out of the BART’s entrance, a man who appears homeless is screaming full-throated at an ambassador, "You are not a fucking cop, bro–where's your badge, bro? Show me your badge!" The ambassador is being held at the elbows by fellow ambassadors, writhing for a fight. It must be hard to be tasked with compelling and obliging others to follow civic norms when all you have to nudge a fellow human in a direction is your personhood and a vest.
On my way to work, I exit the Market Street BART, its steps overshadowed by the Orpheum Theater and its ornately carved, Spanish Gothic Revival facade. Here, dealers, primarily young men with tattoos and hoodies, flipping through un-ironic wads of cash, cluster on the stairs. Buyers sit directly next to them, for to move would be to wait one unbearable moment too many–the hit must arrive right now, on these cold, stained, concrete steps. These steps are crowded by morning commuters, who bottleneck around the morning users, who soon become limp, folded over their legs, brought to you by the letter C, softened and sprawled across too broad of a span of staircase. Moulin Rouge is playing, and Rent ran before that. A story about consumption and sex work, AIDS, and heroin. Today, the play of fentanyl is followed by its skin abscesses, cellulitis, non-fatal overdoses, and epidural abscesses. Tuberculosis and heroin seem provincial.
On my way to work, I cross through the UN Plaza, where hawkers lay out samplers of stolen goods: a pair of ski boots, a bag of adult diapers, a loaf of bread, and a row of Suave shampoo bottles. The plaza is trash-strewn, and large snow-white seagulls scavenge its length, their bright yellow beaks flecked with red, like vampires after a recent feed. Today, they fight over trampled chips, nipping and winging at one another until the ground has been pecked free of calories. They retreat and land atop granite slabs of the Brutalist UN Plaza fountain.
The fountain hasn't held water in years. Too many homeless were showering, urinating, stooling, and laundering clothes in the fountain, so its benches were removed to prevent lingering, and soon it was permanently barricaded. A petition was floated to remove or alter the whole thing, but no one could agree on any of the plans.
Here in the UN Plaza, the open-air drug trade is at its most brisk. Buyers plainly yell out what they seek; sellers plainly show their stock in hand. In the last few months, this site has housed Tenderloin Linkage Center, opened during Mayor Breed's homeless emergency as a place to link the unhoused to various services. It will be closing this month for reasons not articulated by City Hall but seem to involve complicated politics, an election cycle, the complexity of trying to link the homeless clients to services, and its $1.5 million dollar monthly operating budget.
On my way to work, I walk toward the gilded spires of City Hall and its rows of pollarded mulberry trees, past the Asian Art Museum, the Main Library, towards Bill Graham Auditorium, and its wall of public art: neon-lettered etymological deconstructions of the word “civic” and “center” into its Gaelic and Aramaic roots, past the auditorium’s walk of fame, brass faces embedded into the sidewalk: Jerry Garcia, Bill Graham, Carlos Santana, Janis Joplin, John Lee Hooker, Jefferson Airplane, Metallica, Journey, DJ Steven Seaweed, Sammy Hagar. The walk ends at a steam vent, where a huddle of homeless people has already set up. Like figures around a campfire in a spaghetti Western, they circle up, warming their hands, spreading out bed rolls, and settling in. I hear the thrum of butane lighters and the suck of lungs as they smoke fentanyl off foils.
On this day, someone has smashed the glass of the auditorium’s seven-foot shadow box that houses the posters for upcoming shows. They won’t get new glass in for weeks.
The golden niches of the auditorium are perfect, person-sized camping spots, and the cement there holds the stains of encampments, current and past–blood spilled, shit smeared, ash blackened, as well as the detritus of life on the street: broken pipes, used syringes, empty lighters, wet blankets, crumpled clothes, take-out containers, boxes of cereal, a half-eaten sheet cake–Happy Birthday!
On this day, they are pressure-washing the sidewalk again.
On this day, a man shouts, "I need a doctor!" I stop, my pulse quickens, I recount what useful items I have in my bag: one CPR mask, one Narcan, my cell phone. I look around for the voice. Then, "I need someone to hit my neck." He does not want me; he wants someone who can inject for him, so scarred are his veins he needs to use more difficult-to-reach vessels. Realizing my error, I quicken my step.
On this day, four men surround a single woman with bright red hair. The conversation I overhear consists of the pros and cons of a circumcised penis.
On this day, there is a huge shit across four of the BART steps, onto which a janitor is shaking a powder.
On this day, a woman in a skin-tight dress wanders in and out of traffic.
On this day, a bare-chested man runs a razor over and over his chest. When I ask if he is ok, blood starts to drip down his abdomen. He says he is getting the bugs out.
On this day, a man has his pants lowered to his groin, genitals barely covered, and he injects into his femoral.
On this day, a man stands just off the curb, in the gutter, tilting his head far to his shoulder, and, looking in a car's side mirror, injects into his jugular.
On this day, one man stands over another, injecting drugs into his arm for him. Doctoring.
On this day, agonal breaths, a thready pulse. Narcan from my bag, 911, Narcan again, counting, only six breaths in this full, painful minute. A bystander gives me more Narcan. Finally, finally, sirens, EMTs, bag-mask-valve, a monitor, 68% oxygen, stirring eyes open.
I’m late to work.
Kathryn Taylor is a community doctor who works at a homeless clinic in San Francisco, California.