Posts Tagged ‘DeSales’

Last week, I was sitting in a leadership training about effective communication. The instructor started off with an explanation of the ladder of inference. This ladder represents stages of thinking that one goes through, often subconsciously, to determine action or inaction after observing a behavior. When we observe something, we often reflect back on the scenario to make sense of it and in doing so, may not remember all of the details (or even have all of the details). Our minds will fill in the blanks, or infer, what is missing to complete the observation so that it makes sense to us.  We determine action or inaction based on this conclusion. The example given to us was an observation of a quiet exchange between two people which concluded with one person abruptly leaving the conversation and exiting the building. We, of course, came up with a variety of colorful, and sometimes even logical, explainations for what we saw and action that should take place as a result. Sometimes this process leads to workplace drama, other times the inference ladder could be applied to whole populations resulting in dehumanizing sterotypes.

As Brett and I were talking with an old friend this week, we realized that the inference ladder had injected it’s influence on our life in a way that we did not realize until now.  I have written before about the influence of an experience Brett and I had during my PA school education at Midwestern University in which both of us spent time at Hesed House in Aurora, Il providing healthcare for the homeless. It was a meaningful experience that lead to the desire to start the DeSales Free Clinic, and eventually, LVHN Street Medicine. In our minds, Hesed House was providing comprehensive care with tons of hours of accessibility from students and volunteers. When we set out a decade ago to open the DeSales Free Clinic, we modeled it after our recollection of Hesed House. In reality, our blueprint for the vision of the DeSales Free Clinic was not Hesed House at all, but rather, the inference ladder at it’s best. A fill-in-the-blank Mad-Libs version of what we had experienced paired with what we thought was needed for the patients. Turns out inference might not always lead to poor communication or office gossip, but maybe every once in a while, a service to a population who is often dismissed as a result of the same thought process. Tricky tricky little ladder, I’m keeping my eye on you!

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In September 2016, Brett and I traveled to Rome for the canonization of Mother Teresa into sainthood. In an effort to save money, we booked a local flat through AirBNB and lodged just two blocks from the Vatican. On our way back one evening, we crossed St. Peter’s square and, after passing two armed guards stationed at a government building, made a turn onto a side street close to home. The area near the Vatican has become a safe space for the homeless to sleep at night without harassment from the police. The local homeless service providers who generously shared their time, experiences and solutions with us tell us that this is a result of Pope Francis declaring that these souls should be left alone and allowed to rest without disruption. And so, to some local surprise, the local police have backed off and allow for some peace and quiet. As such, it was no surprise to see a doorway inhabited by an elaborate cardboard-bag-bottle structure skillfully designed to block light, noise and provide an astonishing amount of concealment for the person who was likely residing somewhere inside the materials. What caught our eye, however, was an inscription scrawled on the marble slab to the left of this construction – LOVE NEVER DIES. We stopped and took a picture of this remarkable image wondering who wrote the message and if the inhabitant of this doorway agreed or disagreed with the statement. We continued onto our flat and retired for the evening. Each night, we saw the same cardboard-bag-bottle construction with the same refreshed inscription, and each night we wondered.

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Three days later, we were walking back from the canonization mass. Anxious to rehydrate (it was about 92 degrees fahrenheit), use a bathroom (400am -2pm is quite a long time!) and to escape humanity for a minute (a sea of 500,000 humans is enough to make anyone need a quiet (padded) room), we nearly missed him. Our doorway dweller was awake, sitting up below the inscription and working on an elaborate drawing. Bathrooms, water and silence would have to wait. We made our way through the crowd and introduced ourselves. George, a man in his 60’s, had primarily inhabited this doorway for the last 6 years. A fisherman from Sweden, he had somehow been land ridden for some ambiguous reason. His drawings were remarkable. He had two completed charcoal drawings and was half finished with another one. All of the completed pictures contained a series of objects that were rearranged or drawn from a different angle. We explained street medicine to George and he engaged us in an interesting conversation about his experiences, affirmed that he had a doctor (however we discovered an access problem- his doctor was in Sweden), and how the heat of this summer had been particularly difficult for him. But it was his explanation of his drawings that moved me the most. The wooden truck was his favorite toy as a little boy, the canoe was his first fishing boat. A child sized fishing rod and small scaling knife were important pieces of his happy place. A pot for smoking fish lead me into a detailed conversation about how to properly prepare and cook fresh fish (fascinating for me considering I generally avoid eating things that originate from under the water). He said he draws to keep himself out of trouble. But I saw something much different. His drawings simply represented the happiest time of his life. A time when he was a young boy, falling in love with fishing and providing for himself. Before he spent 45 years at sea, had broken relationships with his family and had ended up, well, here. We purchased one of George’s drawings which hangs in a place of honor for him in our home. While he never explained why he writes his message next to his doorway everyday,  he really didn’t need to. He retains a sense of hope that one day the tides will shift and he will find his way home again, perhaps to the place in the picture.
He agreed to take a picture with us (which you can see below) and thanked us for keeping him company. As we walked away, George asked us to promise not to forget him. Promise made. Promise kept.

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Four years ago, we attended our first International Street Medicine Symposium in Boston (MA). I was wide eyed, excited and in hindsight- mostly clueless about the real world of street medicine. Street medicine in the Lehigh Valley did not exist yet, I had never been on street rounds and had only read about such legends in this area of medincine such as Dr. Jim Withers and Dr. Jim O’Connell. I met like minded people and heard tales of incredible collaboration between civil services, shelters, providers and consumers. I saw demonstrations of how humility combined with leadership can change an entire city and its citizens. And I do mean all of them – the housed and unhoused, the voting and non-voting, the overachieving students and the retired sunset-riders who directly or indirectly reaped the benefit of the Boston Healthcare for the Homeless Program (BHCHP). In the subsequent years, we travelled to Dublin, Ireland then San Jose, California and most recently- Geneva, Switzerland. Each conference provided new insights, new data, new frameworks, new friendships. As Dr. Pat Perri, chair of the Street Medicine Institute said at the most recent conference in Geneva- it is like meeting aliens from the same planet.

As I sit on my flight returning from Geneva, I am struck by the lecture I had the privilege of hearing yesterday by Nick Maguire (Southampton, UK). He is a psychologist with a brilliant mind and a wicked English sense of humor who has a way of making sense of the behavior chaos that we observe on a regular basis on the streets and in the shelters. His points were so profound to me that I have hardly been able to think of much else. But as he started his lecture, he told us how much this conference means to him. As he says, it is a bucket filler when the world is so often full of bucket emptiers. We come to this conference and are renewed with our sense of purpose and inspired by the brilliant minds from all across the globe that have so committed themselves to such a worthy cause. People who have left lucrative positions in pursuit of a meaningful contribution. People who risk arrest by providing medical care on the street. People who accept that possibility that everyone you know professionally and personally might think that you are crazy for doing this type of work.
As Nick was speaking, I glanced over my right shoulder and saw Jim Withers sitting toward the back of the room as he so often does and thought about how it feels to know that your vision is being shared and LIVED by so many people. Inspiration can be a fickle thing- there one day, and then gone the next. Sometimes people act on their inspiration but, action can also be fleeting. It is inspiration that makes us come back from church camp when we were kids and throw away all of our excess toys, cd’s (back when we used such antiquated objects to listen to music) and other items we deemed unnecessary once we realized that living a simpler life for a week wasn’t so bad after all. But three months later, there we are in our rooms with piles of newly accumulated junk that we forgot we had decided we could live without. Fleeting. But to inspire and then foster inspiration that changes the trajectory of how people LIVE is something quite different. And for me, the International Street Medicine Symposium is like inspiration on Arnold Schwartzeneger dosed steroids.

Thanks Street Medicine Institute. Bucket filled. Lid applied. Pressing on.

“The woman declared that she was all for the building of a drug and alcohol rehab center next to her city apartment except that the proposed height of the building would cast shade on her kale plants and ruin her plants.”

Portland, Oregon was the host of the 2016 National Healthcare for the Homeless Conference and Policy symposium.  I found it to be a fascinating mix of liberal residual hippee mentalities mixed among upscale microbreweries.  A blue city residing in a largely rural red state. The first thing that struck me about Portland was how clean the city was. It’s beautiful to look at with its detailed architecture, Mount Hood peering over you in the background and the Willamette River hugging some of the neatest reformed parts of town. Freshly potted plants sprinkle the windowsills and front door steps of many residential and commercial properties. One afternoon I watched teams of volunteers artistically arrange flowers and potted plants in fancy designs in a local square just for the viewing pleasure of the many young professionals who eat their lunches on the squares surrounding steps. In general there was a sense of calm in the city.

But there was one obvious difference that somewhat shatters the beautiful façade of Portland. Every 6 to 10 feet I encountered a person experiencing homelessness. A man, a woman, a child just sitting on the street. Some of them were clearly high, but many of them were not. One woman sat with a pad of paper and pencil in her hand but was stuck in a catatonic state of waiting for inspiration.  Some of them were panhandling, many of them were not. Children were coloring while their parents made signs displaying their person plight. Many people were laying with their pets. The thing that struck me every day was that for the size of Portland, the number of homeless is unbelievable. Most numbers estimate between 3400-3600 people sleep on the streets of Portland every night. The lack of affordable housing and the lack of enough shelter caused the governor of Oregon to declare a state of emergency which allows homeless to sleep on the street safely without being disrupted by police, business owners or residents. The city has seemed tolerant of this and understanding of the fact that there is simply no where to shelter all of these people.  It does beg the bigger question though.  Why are there so many?

It seems that no part of the city with has been spared by number of visibly a visible homeless. During our travels, we took an informal poll. People working at donut shops. our taxicabs driver, local lifetime residents etc. We simply asked “Why do you think there are so many homeless in Portland?”   Interestingly they all gave the same answer. They thought that because Portland was such an understanding and homeless friendly community, the people (particularly youth) were seeking out Portland as a counterculture experience. There is a pervasive feeling that these that the majority of the homeless in Portland wanted to be homeless for the experience. While many of those that we informally polled recognize that the legalization of recreational marijuana probably his added to the appeal of coming to Portland, none of them could say for certain the size of that effect. The locals seem particularly bothered that there were so many people with seemingly no end in sight. While they admitted that they felt ‘bad for the people’, they were relatively unsympathetic because they felt that this was a situation that has occurred by personal choice. When I attended a breakout session with people representing homelessness from all over the state of Oregon, I told them what the locals told us about the homeless problem in Portland. I asked if they felt that it was true; that there was a counterculture experience occurring and Portland happen to be the perfect place for it to occur. All of those representing Portland on the panel adamantly denied that any of what the common feeling was true. One CEO of a local if you federally qualified health center commented that while the summers are mild, the winters are very cold and rainy and no one would choose to be homeless and stay in Portland. I would say the same for people who are homeless in New England, in Pennsylvania, in Michigan. Many people endure these harsh winters and yet they don’t leave (which has puzzled me for years). There’s no migratory patterns for the homeless to fly south for the winter. While the truth likely lies somewhere in the middle of these two polarized viewpoints, this creates a particularly large problem for philanthropy. People do not donate to a cause in which they feel the misery of poverty is by choice. Frankly, the sympathy factor goes way down and when there’s no sympathy there’s no money. Perhaps some of the most important (and challenging) steps that Portland must take is changing public perception. Porland seems prime for the picking to lead the country in inovative solutions to minimize homelessness.  A combination of finances, a youthful open minded population with well-established social and healthcare services. I look forward to watching this city’s story unfold.  Press on Portland, press on.

The vastness of need can seem endless.  When Brett and I started the DeSales Free Clinic, we had some experience under our collective belts to try to guide the creation of something that would be both meaningful and sustainable.  As it grew, so did our awareness about the larger problems facing the homeless population. Things like personal safety, humiliation, lack of affordable housing and lack of institutional loyalty.  It became easier to figure out reasonable treatment plans that actually had a chance of working because the context of their lives were so much clearer.

At some point, we started to become aware of the needs of other vulnerable and disenfranchised populations that were all around us. Human trafficking victims.  Domestic violence. Veterans. We learned that recently released inmates are 12.7x more likely to die within two weeks of release from prison than someone else living in their same state (Binswanger, NEJM,2007).  I still sometimes feel like a young PA student at Midwestern University all over again learning about the people that we share our world with but know very little about.  It is like standing in a dark room with the door closed. Then, someone turns on the hallway light and you see a small bit of light spread over onto your side of the carpet. Who turned on the light and who is on the other side of the door? Do you crack the door open and peak quickly? Do you fling the door open and boldly shout “Who goes there?”. Or do you retreat from the door and figure whoever turned on the light, didn’t really mean for you to see it anyway.  I think of the door as status quo.  It is always there and it is always accepted both socially and professionally. These populations often give us opportunities to engage them. They flick on the light in the hallway to see what happens to the door.  But all to often, we choose to retreat from the door and maintain the status quo.  The door never opens. Soon enough, the light turns back off and all goes back to the way it was.  But sometimes, someone flings the door wide open and invites the light in. Sometimes the door is opened by a patient. And sometimes the door is opened by a provider.  As it turns out, the light, in fact, is hope. And hope is just about the most powerful thing two people can share. A patient of Brett’s commented that he let the light in for her for the first time. Perhaps it was hope for her but little did she know that her willingness to let the light in  provides an understand that allows the light to be shared with others and the status quo to be challenged.

 

 

Gift giving.  Tis the season for the imagry of Christmas presents under a carefully decorated tree or eight stacked presents to represent the eight nights of Hanukkah. Having small children seems to make the season especially charming. But admittedly, sometimes this season can be challenging for people who work in the homeless community. The contrast between the haves and the have-nots is often stark and blinding.  All providers and advocates have to find that delicate balance in their lives between doing the work and going home to a life that is in such contrast to the life of our friends on the street.

We recently introduced a ‘vulnerable population curriculum’ to the PA students at DeSales. We talked about homelessness (of course!), global health, refugees, human trafficking and spent a lot of time challenging them to think about what it means to be ‘vulnerable’ and how that affects health.  During a series of reflection papers, a student exclaimed that he liked these activities but they were so depressing- who knew of all the things happening in the world. For a moment (or perhaps longer), he wished to live in the world where he eyes were still closed.

His comments though, really made me think.  How is it that there are people who chose jobs in which they take on the burdens of others. A friend who works in Oncology gets asked often – “how can you work in that office! It must be so depressing!”.  Many clinicians have occasional patients who have a story that will stop you in your tracks. Their story tends to haunt you for a few days before enough ‘regular stories from regular people’ wash away the traces of horror you felt a few days before.  But what about people who take on the horrors and traumatic experiences of many individuals at the same time. I think about people like Mother Theresa or Jack Prager ( who has been doing street medicine since the 70s in Calcutta, India) or Jim Withers (father of street medicine in the US).  The things they have seen and heard, the grief they have shared with their patients all while maintaining sanity, faith in humanity and a wicked sense of humor (especially Dr Prager!).  And somehow, seeming to find themselves in the midst of the chaos.

The word compassion derives from com- meaning ‘together’, and pati- meaning ‘to suffer’.  I often interview candidates for PA school admission who describe themselves as ‘compassionate’. When I ask what they mean by this, they usually answer that they are caring or empathetic. It isn’t a completely wrong answer but it isn’t completly right either.  There is a difference between feeling sad for someone and suffering with someone. And frankly, one is more exhausting than the other because it makes us vulnerable too. I think that much of the work we do in street medicine and with vitims of human traficking calls on providers to suffer with another person. And honestly, sometimes it isn’t easy. Often what is spoken about ones experiences have never been said to another soul.  It is a fragile truth that often can begin to free the speaker from the guilt and shame that comes with holding a secret for so long. I think some people, like Jack and Jim and many others, have been given the gift of suffering. An ability to see a world that has been so cruel to people but still resolve in the hope that exists for each them.  It is in these examples that we look to find the gift of suffering within ourselves. Each relationship is an opportunity to do more than just listen and leave, but to share, survive and hope with our friends.

Sitting on a tarmac outside of the Newark NJ airport, I am trying to wait patiently for my plane to take off. I hear mostly white noise as people are shuffling to their seats and stuffing oversized bags into small overhead compartments. I look to my right and see a recent DeSales PA Program graduate sitting a few seats away. In the midst of our boarding process, I hear words being shared about street medicine and homelessness to the unsuspecting middle seat passenger. In 6 hours, Seth could have her convinced to attend the 11th Annual International Street Medicine Conference with us.

 

While I don’t often spend much time reflecting back on progress over time, I find that preparing for conferences like these tends to send me back to a time when I knew less in both knowledge and people. Two years ago, Brett and I attended our first International Street Medicine Symposium in Boston. We had read so much about the world-renowned Boston Health Care for the Homeless Program (BHCHP) founded and flourished by Dr. Jim O’Connell. I had followed their website for years and had a visit to BHCHP on my bucket list for years. (Hey, some people sky dive, I visit homeless programs.) The opportunity presented itself for this visit with just a few weeks notice. Generous support from both of our sponsoring institutions (to let us go) and family (to keep our kids) allowed Brett and I to travel that Fall to Boston. It was the first time we were able to see a mature and robust healthcare for the homeless program and see first hand how something like that is grown and cultivated over time. Each member of BHCHP seemed to share the vision that had begun more than 20 years before. They were motivated, enthusiastic and committed. At a dinner reception after the first day, Brett and I met Dr. Jim O’Connell for the first time. He was genuinely interested in our small but eager programs. I mentioned that the DeSales Free Clinic has an operational budget of about $18,000. I’ll never forget his response. “You do all of that with $18,000? I have a multimillion dollar budget. It sounds like I have something to learn for you.” I was dumbfounded. You? Learn something from me? It sounded laughable ( and still does) but he was sincere. And a reflection of how all Street Medicine Programs are treated by their peers. This type of interaction has been repeated many times over as street medicine programs come from all over the world, once a year, to learn, share, eat, drink and be merry. Dr. Jim Withers of Operation Safety Net (Pittsburgh, PA) once told me that he thinks that people at this conference and his patients sometimes understand him better than his family. (True)

Now, we are heading to San Jose (CA) for this years conference. Our programs have grown exponentially since that first trip to Boston. So many ideas were illuminated, so many seeds planted. We are travelling with 8 other street medicine team members- 2 University of South Florida SELECT medical students, 2 DeSales University physician assistant students, 2 recent graduates of the DeSales PA Program, LVHN Street Medicine’s new case manager and new clinical coordinator. It is hard to imagine the life trajectories that can change when armed with the knowledge that comes from conferences like these. Brett and I sometimes joke that it feels like you are going away to camp. The time is short, the bond is strong.

Caterpillars are not particularly ferocious creatures. Slow and steady and according to my children, very hungry. I am not even sure that they make any noise at all. Or, come to think of it, have any teeth. They do their thing in their unassuming way and eventually make it to butterfly utopia. Silently and without bells or whistles, they make the world a more beautiful place. I have often marveled at the way passion can turn an otherwise quiet and unassuming human into a bull in a china closet. I am certain you have witnessed this phenomenon and it can happen to any of us. Once, while sitting in an ethics lecture some years back, a girl who I had never heard even speak suddenly found her voice and schooled the room about the seemingly double standard in the world regarding when life begins. Looking around, her point had not only been made, but her peers were blown away by the passion that was residing within her.

Advocates for many causes are much like the girl I just described. I remember a neighbor I had who loved animals. She always had a foster animal that she was rehabilitating for adoption. She would spend hours nursing the animal back to health. Once, I got up to go to the bathroom late at night only to glance out the window and see her sitting beneath a porch light picking fleas out of a sad lump of fur. I didn’t understand it then, but I do now. For some people, it is animals or organic food. The environment or breast cancer or autism or homelessness. World hunger, toxic waste or children in Africa. The cause is different but the root is the same. All causes need passion like this. It is what inspires other people to give two rats patooties about something they otherwise couldn’t care less about. I often think that I relate more to people who are passionate about SOMETHING (even if I fall into the rats patootie category about the cause) than those who are indifferent about EVERYTHING.

I am often asked how we do it all. I can see the look in people’s eyes as they ask the question. It is a third happy, a third bewildered and a third concerned. They know we have many clinics and homeless responsibilities. I myself work one full time job and two per diem jobs in addition to my obligations to the homeless. We have three children and other community responsibilities. I know why they are worried and why I am not. The answer is simple. I am compelled. I know that it is not I who is in charge of this master plan. Tenui nec dimmitam- latin for “I have taken hold and I will never let go.” This phrase reminds me to breathe easy, let it go (not the Frozen kind) and have courage.

Caterpillar roar.

Tonight, I was playing mommy referee mediating yet another squabble between by two daughters. They are 23 months apart and like most siblings love and hate each other with 150% effort.  While I am sure repeating myself over and over must sink into their brains somewhere, sometimes I bore myself with the repetition. After the one millionth melt down in the course of 45 minutes, I finally said “Girls! You are a mirror to each other! What one does, the other will also do! If you want to be treated nicely, be nice!” They kind of looked at me like I had three heads. But then started to smile, then giggle, then run off to play pretending to be each other’s mirror and see what they could make the other do in response.

It reminds me of a patient I saw last week for the first time. I am fairly new to one of our local nursing homes so I am sure the staff there hasn’t been notified for my love of homeless patients. That would be the reason for ‘ the warning ‘. I am sure the staff member meant it to be an act of comradery. Give the new girl a heads up. She went on to tell me that my new patient was homeless (followed by an eyeroll) and had AIDS (“of course”) and had the audacity to spend 20 minutes in the shower while she was waiting to start his treatments (sigh, huff, puff). “Good luck with that one!” she said. I thumbed through the 9 million un-useful pieces of paper that had accompanied the patient from the hospital and came across a psychiatric consult that stated the patient lacked the capacity to make his own decisions.  A rather big deal in the medical world that essentially means the patient lacks insight into consequences and can’t be trusted to make their own treatment decisions. It was also particularly relevant to this man since he had tried to sign out of the nursing home against medical advice earlier that day- something that is not allowed if you can’t make your own decisions. Trust me – that only added to his popularity.

I hung out with this patient for over an hour. We talked family, hobbies (a guitar player since age 12), his HIV mode of transmission (not IV drug use as the chart had stated), his medical history (he knew all of his providers names from his previous residence and their phone numbers), wishes and concerns. I asked him about the psychiatric assessment to which he responded “If you’re and asshole to me, I’m an asshole to you.” He went on to describe the interaction with the doctor and how he knew what to say to make ‘that dude disappear’. “It’s really not that hard to be left alone. People don’t want you and so you don’t want then nether.”

His interactions with me were far different than what had been described or documented in his medical chart. There are many reasons for this to have been and I don’t presume that it is all chalked up to my comfort talking about things that, for many providers, are uncomfortable. But I do think that we can become somewhat childish in our interactions. The patient throws up a barrier, then we throw up a barrier. Then the patient pushes our buttons, then we retreat from the interaction. And before you know it, this relationship is going nowhere. And the patient will soon be “non-compliant with a history of multiple no call/no shows”.

Why? Just look in the mirror.

~CF

We have been experiencing extremely cold temperatures over the past week, with the early mornings and evenings below 0 degrees. There is obvious risk of severe injury and death for our patients who choose to stay outside. We always attempt to meet them on their terms and respect the decisions they make, but first try to bring them in to safety. This was the goal when I arrived at Safe Harbor at 8:00AM- we needed to go to the camps by the river and try to get those folks to come in with us for a meal and a warm, safe place. The parking lot around back also serves as a meeting place for the guests to congregate but mostly smoke. After I pulled in, I got out of my truck I was greeted by one of the residence, “Hey, are we doing that homeless thing today?!?” The initial thoughts that rushed through my mind were, “What homeless thing,” and then, “Wait, aren’t you homeless (which of course he was)?” At that moment it occurred to me that the manner in which we carry out street rounds is so inclusive, that the area homeless are beginning to feel a part of it and are making it their own.

The way we perform street rounds varies from day to day based on the locations and the people we are going to visit. At times it’s better to have a small group- usually myself and at least 2 other guides. When we go out around Easton the mood is much different. Tyler, the Director of the large area shelter, Safe Harbor, is extremely well known. Almost all of the people we come across are either known to Tyler or know of Tyler. Because of this familiarity, when we travel around Easton my goal is to be more inclusive. Helping those most in need is difficult and requires full community involvement. Sometimes, the person in need feels alienated from the community. When the situation is right, we’ve found it to be extremely effective to bring the community with us to welcome them. When this happens, the community takes ownership over all of its members, and the previously alienated member feels less that way. There are times when we set out with 4 or 5 people on street rounds. As we visit various camps, we ask the homeless to join us on street rounds culminating in a trip to Safe Harbor for food, shelter, showers and even job assistance. Sometimes we return with 10-15 people. It is this approach that led this resident of Safe Harbor to feel, and rightfully so, that he too was an outreach worker and despite his current situation in life, he is still valuable enough to give back to those less fortunate.

When we set out this morning, I thought I was part of the street medicine program, but as we approached a tent with two very cold people sleeping inside and the same resident yelled from the outside, “We are the homeless posse here to bring you in!” I knew what group I was really working with that day. And we were much stronger than any medication in my backpack.

~BF