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A few of Tony Patchell's Social Worker Burn Out Stories

Some introductory comments from Tony.

9-26-06 - I worked with homeless people for twelve years. I was based at the Tom Waddell Clinic in the Civic Center in San Francisco. The clinic, part of the Dept of Public Health, serves those who are thrown away by our society - the homeless, the mentally ill, drug users, former (and current) felons, alcoholics, victims of violence & poor people with AIDS. I had various titles - psychotherapist, outreacher, case manager, psychiatric social worker, but the work was always the same. We did what we could; we obtained housing where there was none; we got people into health care, on medication, into shelters, into detox, into the ER, out of jail, off the street. We bought shoes & food & eyeglasses with our own money. We pleaded, sometimes successfully, with cops & parole officers. We sometimes reunited lost souls with their families. We tried to get dying people a room & a bed. We stayed with them so they wouldn't die alone & we all too often called the coroner's office so they could wrap up the loose & final ends of yet another short & painful life.

I worked with homeless 1990-2002. Prior to that I work a year in a low fee community clinic. Plus yrs ago I did all sorts of stuff  in & around my college years. I tend to leave the dates (in the work journal) out since not much has changed for homeless folks except for a few details.

I said this in an interview (I think, for 'Turning Wheel,' which put some of my stuff in an issue in 1995):  "The relationship between this work & Zen practice is something I always think about. It's simple:  there's a terrible amount of suffering, I'm involved in it. I don't have to look for the connection, it slaps me in the face every minute. If someone were to say, Oh, you're such a bodhisattva, I would feel a little odd. I'm not more or less than any of my wonderful co-workers, my team mates, or the people with whom we work. There are numerous bodhisattvas around who have never heard of Buddhism. They may go, 'Huh? Zen? What's that?' then they get on with their work."


Mental health clinic. My least favorite part of the week. I once again spend the entire afternoon saying no to desperate people seeking therapy and/or medications. We donít have enough staff, weíre short on docs, no place to send referrals, on and on. Most mental health facilities in the city have set up rules and stipulations that effectively prevent most of those in need from getting treatment. Be on time. Canít be doing drugs. Have to be psychotic. No organic brain damage allowed. You have this kind of problem and we only deal with that kind of problem. We donít like your attitude. Come back next month, take a bath. Those unfortunate souls who somehow manage to persevere and make appointments on time and hide their drug use may finally get seen, then again they may not.


Howís this for bottom-line scary? I leave my Laguna St apt for work about 8:00AM. 16 yr old, pregnant Kathy Ortega is asleep on my living room floor. My kid has gone to work. My wife is doing exercises in the back room. I open the front door and as I walk into the crisp, sunny morning, a young black voice yells right in my ear, "Hey!" I jump about six feet in the air. It is Ramon, a sometimes friend of my son during his high school years. Ramon has since turned into a projects gangster. He is a low level dealer and a user. He is a very good looking young man who has a reputation for being unpredictably and frequently violent. He is smiling at me, says, "Good morning, sir," half-ass trying to look cool, loose, but he is wired tight and his eyes shine with cocaine and menace. He is in my face and his breath smells like cheap wine. He has a tattoo across the right side of his neck, the name "Deborah" in a smooth and simplified cursive script. Behind him I see an older black man get out of a ratty old sedan. His eyes are flat and he looks bored. He walks up and stands a few feet behind and to the left of Ramon and stares right through me. Iím trying to think, but I donít get very far. It looks like Iím about to get shot. Why, I donít know. Then Ramon asks me how is Ethan, my son, doing and how is that foxy white chick, Deborah, that he hangs with. He stresses, spits out, the words "white chick." Then heís all smiles again. Since he asked a question, I think maybe I can get out of this by having him look at me as a living human being. On the other hand, I know he doesnít give a fuck about human beings, and fear chills me and my arms and legs feel like lead.

I work our med clinic for a couple of hours, plead fatigue, and skip out early. I turn the corner off Polk and start up Geary to the bus stop on Van Ness. Ten or twelve people are piled up in a tangle of blankets and rags in a narrow 4í X 8í alcove set into the side of the shelter. These are some of the folks who didnít make the daily lottery for a space on the floor inside. I see a couple of thin, grimy arms reach out, and a small voice says, "Help me, help me," over and over. It is Sarah, a fifty-something white woman from the South. Iíve known her for a couple of years and she has never told me her last name. She always refused medication because of her religion, and she has been on the run for many years, going from city to city in order to keep away from her ex husband who, she once told me, is the sole heir to the Campbell soup fortune. She shows me her feet and lower legs which are burnt to a deep maroon because she fell asleep in the sun in the park. Her body is trembling and the crotch of her jeans is wet with urine because she could not find a bathroom all day. "Iím so ashamed," she says. "People turn you away and I just canít go behind a bush with people walking around. It is only my faith that keeps me alive." I go back to the shelter clinic and drag Mary Mays out to look at Sarah. Mary gives her some skin cream for her burns. I talk to Tommy and Jean who are still in their blankets next to Sarah. Both of them are young and very thin and pale. They are heroin junkies and have AIDS, and Tommy is going blind. For now they are very solicitous over Sarah and they promise to watch after her and will try talking her into coming to clinic tomorrow. A young black woman is next to them, sitting up against the wall and sipping from a short dog of wine in a paper bag. She asks me if I might have some syringes "for her diabetes." The rest of the crowd in the alcove are now awake and interested: Can you get me into the shelter? Am you a doctor? Do you have any food? Can I get them more blankets? Can I come see you tomorrow? Do I have meds for diarrhea? Can you help me? Can you help me?

I donít know what to do. I am dangling at the end of my rope, so I say come see me in the morning, letís see what happens. I walk on up to the bus stop. In a doorway further on a teen aged white couple are sleeping the sleep of the young, tangled together like puppies, their arms and legs bare and sprawled out onto the sidewalk. Their blond hair is tangled and messed up together. Their faces are peaceful, with eyes closed and mouths half open. I miss the bus; it groans by me, packed with weary people and spreading a rolling black cloud of diesel smoke over the entire street.


Went with Marian to the St. Charles hotel on the corner of Bush and Grant, to clean out Princessí room. She is on her way, finally, to an L (as in locked) facility. The Hindu manager complains long and loud because we stopped her rent checks. Fuck him, she doesnít live here anymore. Besides, weíre doing him a favor by cleaning up her mess. The room is a box: high-ceilinged, about 10' X 12', painted light green but coated with years of greasy dirt. One window that wonít shut looks out onto a brick wall. The room is filled to about knee level with garbage, and old, stiff, piss smelling clothes. The small mattress is covered with blood and piss stains. Rotten food is scattered about the place and happy cockroaches are swarming all over. The stench is so bad that I canít go in even while holding my breath. So I stand outside in the hall and hand Marian big green plastic garbage bags and let her do all the work. "You owe me," she reminds me over and over. "You really owe me."

About 6:00 PM, We take a rainy walk from Larkin down Golden Gate to Jones, a very dangerous corner by reputation, if not always in fact. It is raining, the streets are slick and neon reflections bounce and scatter in the gutters. The corner is crowded, mostly Latino men and women in little clumps of three or four. Everyone is thoroughly stoned or drunk. South of the border music, guitars, trumpets, and high-pitched harmony, comes from a ghetto blaster. The crowd strings out down Jones to the police station on the corner. A number of men are passed out on the sidewalk. They are so out cold, so limp and lifeless looking, that I wonder if, in fact, they are dead. They are sprawled in the middle of the sidewalk, faces up to the sky, arms and legs tossed every which way, their thin filthy clothing soaked by the rain. My guess: a dealer with a particularly potent batch of heroin must have passed this way. Marian and I both feel nervous here. Not because there is any malice or danger in the air, but because the despair is so thick. Hopelessness is not a concept here. It is real and it makes it hard to breathe or put one foot in front of the other. We round the corner onto McAllister by the police station. The street lights are dim and the street is empty of people except for one lone drunk sitting on the steps of Hastings Law School. He is clean and neat, dark haired with a gunslinger mustache. He says something to us in a foreign language as we walk by.

My boss, Christine, says Iím burning out, that I am a crispy critter. She says my perspective is becoming harsh and distant. I tell her itís just that I have a weird sense of humor and a tendency to get lost in the chase. Well, she says, you should take some vacation days, get lost, and be funny and weird somewhere else for a while.


This afternoon, a bright, pale day, Paul, Mary, Marian, myself, take an hour before our meeting to cruise a circular route through part of the TL (Tenderloin). We walk down Golden Gate to Jones, turn right and go down to Market, up Market, then through U.N. Plaza, Civic Center, up Polk to Golden Gate again. Every single person we see appears to be homeless. Most are sick, drunk, stoned, psychotic. On the corner of Golden Gate and Jones we see a white woman with a shopping cart standing at the curb. She is about forty, curly brown hair, red face. Sheís wearing a clean, candy pink sweat shirt. She is crying, bawling like a child at the top of her voice. She is so loud that my ears ring. I can see waves of compressed air emanating outward from her, an aura of misery for all to see and hear. When we turn into the plaza the afternoon sun is straight ahead, right above the horizon, shining horizontally and colorlessly down the street, a giant spotlight. To look ahead is to see the world in black and white. Silhouetted homeless people in slow motion, every single brick in the sidewalk outlined, rows of them in focus, a perfect depth of field, receding toward City Hall. Sounds seem muted and hushed. I have the oddest sensation, that I am a child again and the heavens are opening, clouds turning like pages, and the pearly light from Sunday school hymns is here at last to wrap us up and take us away. But I look around me and see an old black man sitting cross-legged against a building. Heís wearing cut off levis and he has written "DAWN" in heavy black letters on the top of each thigh. He is toothless and talking loudly into the loose handset of a telephone that is entangled in a big, dangling ball of multi-colored wire.

Later, 7PM or so. It is hazy, dark, and very cold. Iím walking down Polk directly in front of city hall. There are no streetlights turned on, no cars, no noise. I wonder if Iíve lost my hearing. I look across the street into the park and see the Food Not Bombs table set up. Two big soup pots, a pile of bread. I see a blurry line of faded silent men & women, one after another after another, all the way back to the corner, each one with a bedroll or a pack or a plastic bag stuffed with belongings. They are waiting without complaint to be served. At first I think Iím seeing ghosts because all is so dark and vague and quiet. A heavy, tight ball of sadness rises up from my center and into my throat, my own blood-red, poison sun. I keep walking and breathe the bone-chilling foggy air, in, out, in, out.


The Serape Lady died last week, someone told me. She was Indian or Latina. She had sat on the sidewalk in front of Merrillís drugstore on Market near Seventh for the better part of last year. I always thought, for no good reason, that she came from Guatemala. She had made that unimaginably terrifying journey all the way up here to die alone. Now her hopes and fears are resolved. She was a big woman with a flat, unexpressive face. She usually wrapped herself in a thick, red, green and black serape. She kept two big, hard-sided suitcases, one on each side of her, and when it rained, she covered herself and her belongings with a wide black umbrella.

I keep thinking, how could she have died like this? A couple hundred outreachers and homeless providers, including me, must have walked past her every day. What are my excuses? My Spanish is for shit? Iíll do it tomorrow? Or that much-used favorite: Iíd better get on it and refer her out. But there is the triage process that is constantly running through oneís mind as everyday events push and crowd and kick in order to get attention. You tell yourself you simply cannot stop every ten feet while youíre hurrying on your way from Point A to Point B, or wherever. So check out the consequences, the ramifications. Almost every time lineworkers get together and bitch and moan about homeless death and suffering, someone will inevitably say, "Well, you canít save everybody, you know." We then stand around, slump shouldered, hands shoved deep into pockets, bobbing our heads up and down like a bunch of fucking pigeons.

Second installment of Tony's Burn Out Stories


I talk with Teresa Black between patients. She sits at her desk and fiddles with her stethoscope. She is depressed and near tears. She feels that weíre slipping with our HIV care, but she cannot point out why or how. I donít know, I canít think it through any more than she can. Weíre both too tired to think. Later, in our HIV meeting , I ask that people think about how we can further expand our services into the hotels and streets. I get a mixed and irritable response: Steve practically flips out. His voice is high & tight. How? With whom? Where would we find the hours? Weíre already overwhelmed, on and on. I finally say, Steve, donít worry, itís just a thought, only a thought. Jesus Christ, let it rest. We all bicker and snap at each other for a few minutes, then go back to work.

I go downtown to the Tenderloin which is vivid with bright sunlight and sharp-edged shadows. It looks like a death carnival, but there are no masks, metaphors, or symbolisms here. More like the real thing, the day after Armageddon: crowds of people roaming the streets, all in various stages of intoxication and/or psychosis. Small packs of young people of all colors and exotic persuasions jaywalk and dance and weave in and out of the slower moving crowds of homeless and immigrants. Loud radios, sirens, shouts, threats, laughter, empty bottles hitting the sidewalk, horns honking, cursing, all melding into a gangsta rap, polysyllabic, multi-cultural exclamation: Here I am, this neighborhood says. What you got? What you want? You donít like it, well, fuck you. Drunks and junkies are passed out everywhere, raggedy bundles sprawled face up in the sun or rolled into tight little fetal balls, sleeping, drugged out, in puddles of piss and shattered wine bottles. Their hands are puffed, the skin stretched and split with cellulitis, fingers like spoiled sausages, edemas, old scars, new lacerations, abscesses, cracked and bloody lips, lice visibly crawling. The corner of Turk and Jones, a young white man and a small blond boy, maybe five years old, sit cross-legged on the sidewalk, jammed up tight against the building. A paper cup sits on the sidewalk in front of them and the little boy strums a toy guitar.


I stop by Marileeís hotel. I have not seen or heard from her for three or four days and sheís been talking suicide. Sometimes she does this just to push my buttons, and other times sheís serious. I donít know what she is doing this time and as I knock on her door and get no response, my subliminal anxiety, suddenly and with no warning, starts slipping and sliding out of control. I feel claustrophobic and extremely paranoid. A TV is blaring top volume Spanish from a closed room down the hall. Air pressure pushes, backs off, pushes, against my eardrums. I knock again and stick close to the wall as passersby, all intent on scoring dope, who pick up on my tension, scurry up and down the hall, in and out of rooms. The dirty green walls, the cracks in the plaster, begin to waver and float. I sniff the space between the door and the frame. If sheís been dead for a couple of days there should be a pretty strong stench, but the only smell is the usual piss, garbage, and mold of old hotels. I keep telling myself that she does this all the time. I am not thinking straight; sheís just fucked up on heroin somewhere, so chill out. I try to stand still. Feel my feet on the floor. Follow my breath. I hear humming wires inside my head, my mind starts wheeling out of my body and I am floating up to the ceiling. I try to think linear and pull my mind back in place. I leave the hotel, walk fast through the noise and activity on the street, down to Sixth and Market, go to the Homeless Pre-Natal office and ask if I can use their phone to call the jail roster number. I get a polite officer who tells me, yes, she is here. Busted on a 647B; i.e., prostitution, three days ago. I sit down and stare out the window at the buildings across the street. Anger, frustration, despair, burn a hot spot in my breast bone. Why should I do this? Why give a fuck? Vivian asks me if I am OK. I say no, I am not.

I try to figure out, once again, what happens to me when I see or hear these things. It is grief, I suppose, that forms like some amorphous, greasy, little cloud in my body, slipping and floating through tissue and bone, rising up eventually to my center, my heart, where it fades and expires, forms again, expires again, and so on, over and over during the day. Collectively, weíre all stretched tight, everyone of us; docs, nurses, clerical folks, social workers, out-reachers. We work, sleep, and have wishful dreams of time off. Lately, we havenít done much else. Most of our friends, families, mates, are pissed off, worried, impatient, and confused. Conscious efforts to slow down are effective only for the short term. I, for one, have absolutely no interest whatsoever in ďprocessingĒ this shit. I do not want to express or define my feelings. I do not want them diluted, I do not want to be thanked. Mostly I want the idiots who are so-called administrators to get the fuck out of my road.

This night I dream that it is the middle of the night and I am riding on a train jam-packed with exhausted and hollow-eyed refugees. Americans of all cultures and races fleeing California. The train rattles and rocks north through the darkness. A bright full moon descending in the west rolls along with us. I am in a passenger car with all the seats taken out in order to make more room. I find a space on the floor and roll up in some blankets and go to sleep listening to the clickety-clack of the wheels on the rails. I am jerked awake and upright by a loud, bone-chilling wail. It is me screaming. There is an Asian teen-age girl kneeling beside me in the dark. She leans over and whispers, ďDo you know why you scream in your sleep?Ē Loving kindness emanates from her and I break into tears. I am so very tired. ďYouíve seen too much,Ē She says, and she continues to sit silently beside me as I let the train rock me once again to sleep.


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