Walking With Alejandro | chelseanow.com

Walking With Alejandro

BY JOHN A. MUDD | Alejandro Medina: I try and let the name roll off my tongue with the Latin flair it deserves. Alejandro painstakingly hobbles along, huffing and puffing, and trying to keep pace with my stride. His legs do not carry him well. He is old beyond his years, and has lived a rough life. His life on the street is a secret to his five children — I find this remarkable. Brianna Mankey, Program Director of Breaking Ground (a homeless outreach service; breakingground.org) tells me this is not uncommon. I didn’t disbelieve Alejandro, but I wondered where the inquisitive voice amongst the five grown children. Did they really not know or did they not want to know. He smiles while talking about his one son, and frowns while talking about the severed relationship with his daughter. He’s been living on the streets since 2005; that’s a 12-year stretch.

When we first met, he was taking up residency under construction scaffolding for a vacant building that will eventually become a hotel. I couldn’t ignore him: I passed him often as he sat or slept on my block. Besides, as the president of the Midtown South Community Council, with a mission to better the quality of life for those who live, work, and visit midtown of Manhattan, I was obligated. I wonder how far back his rough past goes, and what steps led him to a life on the streets.

In the 1940s, the Viet Cong built underground tunnels, and by the 1960s they had built them to include hospitals, headquarters, storage, and command centers. The tunnels held numerous threats: enemies, booby traps, rats, spiders, scorpions, snakes, and more. Upon discovery of a tunnel network, a “tunnel rat”— a soldier equipped with a pistol, bayonet, and flashlight — would be sent in to kill any hiding enemies and plant explosives to destroy the tunnel.

From the little I know of Alejandro, my amateur psychoanalytic mind deduces that his experience as a tunnel rat for around eight years could be the root of his troubles. As we walk, he points to where four bullets riddled his body. He points to where shrapnel scarred his left brow; shrapnel sent his way from a mine his buddy stepped on a few paces ahead of him. He spoke of the scarring incidents matter-of-factly, with subtle pride and torment.

Alejandro Medina. | Photo by John A. Mudd

Alejandro is appreciative of the smallest considerations. He thanks me profusely for accompanying him to obtain a New York ID and medical card. It’s unnecessary though, he knew the approximate location — all I did was Google the route and kept him company. Although he loves Pomodoro’s soup, which I turned him on to, he’s happy with little more than a slice of pizza and a Mike’s Hard ale. I’m certain he aches for a soft bed, but we’re finding that is a process. “Yes, I’m to go see Steve [from Urban Pathways] at one o’clock. I promise,” he says. “But in the meantime, can you give me a buck?” Most likely for that Mike’s Hard ale, and possibly a Xanax to help the methadone give him that punch drunk feeling.

I excuse his lack of follow-through and indecisive nature. He’s been dismantled as a human being in many ways. The trick here is to build trust and show that you care. The trust takes considerable time. And if I cannot encourage him to accept hospital care and other services, perhaps his deteriorating health will. He’s 63 and his body is feeling the pangs of his 12 hard years on the streets. His legs are swollen and infected and are likely screaming for help from the marrow of his bones.

Alejandro and I investigate two shelter options together: Urban Pathways’ Antonio Olivieri Center on W. 30th St. and the New York City Rescue Mission at 90 Lafayette St. Both are clean and run by caring people. The first option is a drop-in center. There are tables and chairs, the stairs are not so easy to climb, and there are rules. It’s not a permanent solution. The second option is a large clean room with cots and mattresses allowing up to 150 people to sleep. There are tables and chairs, and they serve coffee and pastries. Showering is mandatory. Alejandro recognizes the Rescue Mission when we arrive and is acquainted with the process of standing in line to register for a cot or mattress. Despite my connection to the center and Scott Hansen, Outreach Leader for NYC Relief, who will secure Alejandro a spot, Alejandro is not interested. He has had his problems in group sleep settings and he’d rather brave the streets than what may come from a crowded room of 150 strangers. We travel back to Midtown to the methadone clinic for his group therapy meeting, after which he’ll sleep at his usual spot, under the dimly lit, green scaffolding midway on my block. Maybe tomorrow he will go to the hospital.

Alejandro Medina: the name is not quite rolling off the tongue yet. He’s flailing a bit. His addictions have gotten the better of him. Any sort of long-term vision toward a more effective end takes a back seat. I can relate: I get overwhelmed looking into the future; I worrying about being an accident away within this wavering insurance market! The notion that we are the “greatest nation on earth” is not so great when you’re looking at it from the homeless perspective. Does society owe you? I dare say, yes, it does… veterans surely included.

“Tomorrow” came and went, as did a few other days; Alejandro never made it to the hospital. Sooner or later his legs would be the boss of him. Well, “sooner” came in a week’s time — coerced by piercing pain — we’re walking to the Ryan/Chelsea-Clinton Community Health Clinic on 10th Ave. (btw. W. 45th & 46th Sts.). Alejandro is barely with me through registration, he mumbles through a haze of what I suspect is a prescribed (or likely, “self-prescribed”) substance, offering only a coherent word or two after much prodding. The nurse and I struggle to extract his medical history. The doctor confirms he needs emergency hospital care. I take him to Mount Sinai West on W. 59th St. After doing a little more than wrapping Alejandro’s ulcerated, bleeding, and swollen legs, the ER doctor sets him free to hobble out of the hospital. The process was less than six hours; I expected an overnight stay. After asking the doctor about such expedient care, he answers, “We’re not running a Holiday Inn here.”

I get it. I would imagine no one takes pleasure in having to treat a homeless man’s scaly legs, in looking at uncut crusty nails with twisted toes, in smelling body odor through dirty clothes… but this is Alejandro. And the care he received at Mount Sinai hospital is merely a Band-Aid (quite literally) on a problem that is sure to worsen, perhaps critically, and will be left for others to deal with down the road. The hospital seems to have missed the definition of healthcare.

A couple of weeks later, with pain and blisters mounting, I call an ambulance to take Alejandro to Mount Sinai Beth Israel on E. 16th St. The staff from this facility reacts differently; the doctors find Alejandro’s problem to be serious enough to keep him. They have a social services department. For seven days and counting, the social worker, Runita, works out Alejandro’s transfer to a rehab center for continuous care, while the doctors are attending to his immediate needs. The caregivers in this hospital seem to know well the definition of healthcare.

Despite the persistent, nagging pain, Alejandro has a sparkle today as he sits on his hospital bed talking through a simple plan for the future. I offer a few suggestions before I leave him for the weekend, promising to return soon. His wants are basic; he wants to survive. My wants are that he helps wrangle others from the streets of this city. This, of course, after he’s settled with a place of his own.

Returning on Monday, my jubilation quells. I need to rethink those suggestions I left Alejandro with last week, I wonder if he is up to the task: he is suffering from CVI (chronic venous insufficiency) stasis. His legs are a puffy black and blue mess — although they are far less swollen than before and expected to heal. But he’s fading in and out of coherency, and he is talking to people who are not in the room. I check with the hospital for any history of schizophrenia. Are they giving him too much or not enough drugs? The thought of people having to live out the rest of their days on prescribed drugs just to remain lucid (in an insane world) just makes me queasy. Excuse me, medication, not drugs… Alejandro insists there is a clear distinction.

Further through his hospital stay, regular rest, meals, medication, and exercise, Alejandro is better, with no hints of psychosis. He’ll stay a few more weeks to improve his health before being transferred to a rehabilitation center.

Alejandro’s new temporary home, the Highland Care & Nursing Center, is a rehabilitation center in Jamaica, Queens. The caregivers have him exercising daily, and his medication is regimented. The front desk people are professional. Alejandro’s nurse manages him with kindness. The on-premise social worker, Patrick Sokhu, seems optimistic about Alejandro’s progress, and about permanent housing placement at Surf Manor (recently renamed as Brooklyn Terrace). I hope Surf Manor isn’t a bloody dump and he will like it. I asked around, looked online, called the place, and mapped its location. It’s near the beach — Coney Island. The place gets points for that! Alejandro’s high expectations of his new digs (Surf Manor) make me sweat.

On Nov. 29, 2017, two days before the transition into housing at Surf Manor, we hit a rough patch regarding Alejandro’s autonomy. He calls a “friend” to pick him up to run an errand. Neither I nor the rehab center know anything about this “friend.” Highland Care Center’s personnel will not allow Alejandro to go. He rants and threatens to leave. “And go where?” I ask him. “Back to the streets,” he says. His outburst is without thought to the consequences, and it worried me. But after a few conversations and a good night’s rest, he settles down and by the time I meet with him the next day (the day before the move to Surf Manor) he is back to his chipper self.

But the day of the transfer doesn’t go well: he’s not able to get the medication he needs, and the only one he does have is his Hepatitis C. His other medications are pending from a nearby pharmacy. Trazodone (used to tread depression), among others. Worse, his methadone (an opioid used to treat addiction to narcotics) is out.

He has no way of getting these vital medications, or the people in charge don’t seem to have the resolve to get it for him. Methadone is a big part of Alejandro’s treatment. He gets a regular dosage, prescribed and monitored by a particular clinic. He visits that clinic in Midtown Manhattan on Mon., Wed., and Fri. Today is Fri., Dec.1, and he needs his dose of methadone. Surf Manor’s responsibility is to assist residents with their medication management. That includes their travel to clinics for their needed methadone supply. Mika, a nurse from Surf Manor says Patrick, Highland Health care’s social worker, told her that Alejandro had enough methadone to carry him through to Dec 13. She definitively tells me a ride is to be requested 48 to 72 hours in advance. I ask Mika about Alejandro’s other medication. She says they are still pending from the pharmacy.

While I work behind the scenes to procure an alternate ride or a pickup of Alejandro’s methadone, unbeknownst to me, he is hobbling his way — on CVI stasis legs — to his methadone clinic. And from the slurring of his voice, it must have been a hazy trek.

I have a later conversation with Mika to ensure Alejandro is set for transportation for his next clinic visit and to see if the pharmacy delivered his other medications. Mika tells me that Alejandro has received and has taken all his medication. Yet he continues to sound drowsy and incoherent. I call the following day; Alejandro is still with slurred speech. Mika is off work. Joseph will be coming in to take over the chore of handing out meds. I call back and am told Joseph will not be in today; so they lied. I am able to connect with Joseph later. He is brief and not very communicative. He does not confirm delivery of Alejandro’s prescriptions from the pharmacy, yet he’s the one dispensing the meds.

Although Alejandro played somewhat of a part in being without his methadone — clarity in communication sometimes lacking, especially when he’s off his medication — I’ll leave him exempt. The burden of responsibility lies between Highland Healthcare and Surf Manor, and my pointed finger is bending towards Surf Manor.

Wanting to confirm Alejandro’s excellence in care and follow through from his previous residency, I called his nurse from Highland Care. Her voice rang with confidence, “All prescription info was sent to Surf Manor.” She said that the Hep C medication and two empty methadone bottles to be refilled traveled with him to his new home. This was consistent with what Alejandro told me. The Hep C medication, used to eradicate the Hepatitis C viral infection, was given to Surf Manor for its daily distribution.

It is quite possible that Alejandro has been without his meds, including his Hep C medication, since his arrival on Dec. 1-6. This came to light on Dec. 9, when I was with him and his doctor discussing his medications and treatment. The doctor is very emphatic that consistent Hep C medication is imperative for a cure. But all is not lost. She alleviates Alejandro’s concerns by telling him that he is near enough to the end of his treatment and likely will not suffer a setback.

I’ve had four conversations with Mika: one attempted to be pleasant, two were unnecessarily combative, and the last lacked clarity. I didn’t bother to push for clarity on that last one due to her combative nature. Questions make her defensive, and her attitude makes me suspicious.

Alejandro paints an unpleasant picture of Surf Manor. He tells me the staff is unruly, residents are left to piss and shit themselves and wander the halls, and people drink and do drugs in front of the building. His meals sound appalling. Cheerios? I ask him to record his meals going forward. These conditions seem barely a trade for access to on-premise pharmaceutical drugs, and for horizontal sleep out of frigid temperatures, although there is some stability in the consistency, even under the conditions. The only other redeemable quality is that Alejandro’s room faces the beach, and he loves looking out at the sea.