Nursing Notes: Them.

I was an accountant, I am an RN, I was a doctor, I am a CNA, I was a car sales rep, I am a factory line worker, I was a security officer, I am a cook, I was a teacher, I am a cashier, I was an apartment complex manager, I am a waiter, I was a taxi driver, I was a LPN, I was a legal partner…

This is who “they” are. This is who makes us our homeless population. They are not so different from you and I. Most the them held “respectable” full time jobs. Many hold degrees.

Many of us are living our lives paycheck to paycheck. I am one of them. Many of us are forced to “rob Peter to pay Paul”. In the blink of an eye, any of us could end up in a car accident that leaves us disabled, out of work and stuck with medical debt. An unexpected divorce or death of the family breadwinner. Many of us are more susceptible than others to addiction causing us to falter in our game plans. Or on the other hand, our loves ones become addicted and we lose everything we have trying to “save” them.

These are our friends, family members, neighbors, and co-workers. They were the valedictorians of our classes, the star athletes and the leads of our school plays. In fact, a number of you on my Facebook have been, almost were are currently are homeless. I want those of you reading this to think about THAT…we share many mutual friends.

Remember this as you are driving and walking past them. They are humans too. They deserve respect, love and recognition. Hold your judgement. Share a handshake and smile. Be polite. Take a stand and lend a helping hand.

~ Laura LaCroix, RN, LVHN Street Medicine

The Mission Forward

The Street Medicine Institute and I share a vision where all neighbors sleeping on the streets around the world will have access to healthcare in a location and manner acceptable to them. Over the last decade I’ve witnessed this vision inch closer in cities all around the world and I’ve had the honor to serve the most genuine and loving people you could imagine. I’ve witnesses the evolution of reality based medicine in the Lehigh Valley from in front of my backpack.  When the DeSales Free Clinic opened in 2007 it was the only healthcare being provided directly to the homeless in the area but now there are 10 clinics, a sprawling street presence, a medical respite and the ability to enter any hospital in search of our people. The communities as a whole has galvanized support and started a winter shelter in Allentown, Bethlehem and Easton, where before there were none. If a new person is seen panhandling off any freeway within hours we are called with hopes we can provide some help to the person. Most often, the call comes from someone outside of the healthcare field who just wanted to do something to help. There is still much work to do but the community is strong and our team at LVHN is getting stronger every day supported by senior leadership that not only understands the mission, but has allowed our belief that everybody matters to infiltrate ALL patient care to the benefit of so many.

In December 2016 I was asked by Dr. Kevin Lohenry, the Director of the University of Southern California (USC) PA Program, to deliver the Keynote address for their White Coat Ceremony and for the first time in my adult life I witnessed the intense poverty and immense number of people sleeping rough on the streets of Los Angeles.  The streets look like a post-apocalyptic wasteland of humanity. As I stepped over the bodies using the streets as their living room, bedroom and outhouse on the same corner, I felt utterly useless to help them and needed to learn more. Over the subsequent months, Corinne and I met with the dedicated servants of the homeless in LA working for various agencies and FQHCs all sharing a common goal. Although the number of homeless has risen over 20% from the year prior, there was a palpable sense of renewal and drive to push harder. The citizens of LA felt the same way and voted to increase their own taxes with funds going to help the homeless. With the belief that, “an excellent private research university should take on the most intractable, multifaceted problems of our time,” the USC Provost, Michael Quick, announced that USC will play a large role in the effort to solve homelessness in LA. It seemed that the large number of rough sleepers in LA was only outpaced by unwavering desire to help them.

It is on this back drop that Corinne and I have made the decision to join the many incredible and talented servants trying so hard to help our neighbors experiencing homelessness in LA. In April, I will begin as the new Director of Street Medicine at USC.  Corinne will serve as faculty in the USC PA Program and will have time set aside for working with me on the street team and pursuing much needed research on the rough sleeping population. It’s our hope to contribute in our simple way to the complex work needed on the streets of LA. It’s our aim to further an understanding of our friends sleeping rough through research so that we may all better meet not just their needs, but help them renew their dreams as well. If we are to fulfill the vision that all people sleeping on our streets will have access to healthcare then there will need to be many more street medicine programs and providers throughout the world. There is no better training ground than LA, and no University more poised to dissect this issue. With this in mind, we will be working on the creation a pipeline of well-trained providers in the art and clinical acumen needed to practice street medicine properly will be created.

My time at LVHN serving the homeless in the community along-side so many special people has been the honor of a lifetime. I leave behind a team that I have no doubt will take great care of our patients and continue the work much better than I could ever have done.

We begin our work in LA with the blessing of obedience to HIS work. Not on a new mission, but a continuation of the same. He has given us the inspiration and grace to begin. As our mission moves forward, you will be able to follow our journey at streetmedicinela.org. Corinne and I humbly ask for your prayers as we continue our journey of walking with the homeless

Sincerely Yours,

Brett

They Just Don’t Want Help

One of the phrases that will send most healthcare for the homeless providers into a hair-on-fire-tizzy is when a justification for allowing the continuation of homelessness in our cities is based on the concept that the homeless just don’t want the help. I can understand how this line of thinking evolves.  It has been said that the United States is the richest country in the world with the most resources to help its citizens. How, then, can we explain that people are still refractory to this wealth of money and resources. The rationalization, for both society and the individual, becomes to accept that some people just don’t want the help.  It is easier for us to go about our morning commute, our jog through town or our walk into work if we work it out this way in our minds.

A few months ago, I read a book by St. Francis DeSales entitled Finding God’s Will for You. St. Francis DeSales was known for his belief that ordinary people could live holy lives in their communities and did not need to be cloistered (as in a nun) or in a monastery, cut off from the rest of the world and it’s many challenges and temptations in order to live holy lives. In this book, he talks about God’s will being the sun and ourselves or our willingness to accept his will for us as a mirror.  At times, the mirror is small and only reflects a small amount of light.  It does not mean that the sun is small but rather it is our mirror that is small.  As we grow in acceptance of God’s will, our mirror grows and is able to accept and reflect more of the sun’s light until we are fully aligned with and accepting of God’s will.  I think of our friends on the street and their willingness to accept help in the same way. When we first meet them, the mirror is small. It may even be impossible to appreciate, made small by pain, suffering, hopelessness and rejection. Feeling unloved and incapable of being loved or loving another. Many times, I have been startled at the depth of shame carried around by our fellow brothers and sisters. But over time, the mirror grows as trust is built so that one day, a full reflection is possible. An acceptance of help, hope and possibility comes into view and value is restored.

We are often impatient with this process, wanting results and success to satisfy our own needs and desires for affirmation. Building a relationship can literally take years. I once watched a brilliant lecture by a colleague from Southampton, England who called it the One-Less-F***-Off. He described a patient who, upon eye contact would yell the magical phrase that sends most people away. No matter what he said, “F*** off” was the response.  Over years, the number for f*** off’s received diminished so that once, when our colleague didn’t visit him but rather visited a nearby street friend, the patient proclaimed “Hey, where the f*** have you been”. Success defined by the most peculiar matrix. But success none-the-less.

At the June 2017 National Health Care for the Homeless Council Conference, Jim O’Connell of the Boston Healthcare for the Homeless Program responded to an audience question with a reminder that we cannot erase the trauma that has happened to our patients prior to meeting them. The growth of the person is not about us, the provider, but rather about the return of this precious individual to their rightful value as they gaze upon and accept their own reflection.

~C

The Silents

It was only 23 degrees the day when the phone rang that October morning. A familiar name appeared on the screen of a work phone happily charging it’s battery after a long week of being a conduit between those living outside and those living inside. I answered knowing that this was a call from a man who was trying, for many years, to do the right thing. A Saturday morning phone call made me nervous because while he knew we would usually answer, he was respectful to try not to call unless really necessary. I personally had not spoken to him since I was pregnant with my last child. He remembered vividly how I would waddle down the hallway of the facility and call out his name like an old friend.  As often does, our patients transition out of one setting and into another, thus trading one Feldman the other. Resiliency is a word I use frequently (just ask my students) to describe my friends who are living outside. This man is no exception. We talked about the difficulty of sleeping outside with the cold weather creeping in like a prowling lion ready to pounce when you fall asleep. We talked about how his long nights are a mental battle between a will to survive and a will to succumb. Sometimes the best place to shelter in the rain, he tells me, was a porta-potty that was left behind after the summer had ended. While I hold my breath for the minute and thirty seconds it takes me to pee under pressure of the stifling smell of a porta-potty in June, I cannot imagine the June porta-potty in October being my bed for the night.

Then he told me about the Silents. Individuals who have helped him in the most simple and but impactful way. He went on to describe how every outlet in a nearby park is shut off in the winter, except one. A maintenance man who works for the parks knows he sleeps outside and at times, he brings a space heater under the pavilion and plugs it in to stay warm and dry. He believes that this member of the Silents leaves the outlet on for him knowing it keeps him alive. Another member of the Silents walks the food from the food bank out to his tent when the weather is bad, understanding that his health often times limits his ability to walk into town for supplies. He tells me that he recognizes these fellow citizens do these things for him in silence. A simple fellow man helping another fellow man in need. No recognition, no newspaper article, no pat on the back. Perhaps even incurring risk along the way, but doing the right thing all the same. It is a reminder that the smallest things can mean so much. A reminder that true generosity is doing a deed for someone you know can never repay you. A reminder that the human connection that keeps us all alive is the connection that can allow a broken man to dream again. Lost for so many years, he dreams now of working with a street team or the food bank as a peer support. He tells me, “I’m worth something, you know. I think I really am.”

The Core of Street Medicine: Peeling Back Social Justice and the Business Plan

Street Medicine has rapidly spread to become a global movement with over 100 programs worldwide on 6 continents. As the Street Medicine Institute prepares for the 13^th Annual Street Medicine Symposium this October in Allentown, PA, it’s right to explore why this movement has taken hold and how this innovative healthcare delivery plan has inspired hundreds of overworked medical providers to put on a backpack and work more long hours for free outside the traditional medical establishment. Although the explanation I put forth is in no way comprehensive, may it serve as an offering to explain the “core” of what those associated with the movement are experiencing by going to the people.

One of the first lessons taught to medical providers in their education is not to get emotionally involved in “cases.” This means not getting too close to patients—no crying, no hugs– and not experiencing what they’re experiencing. It’s become a matter of professionalism, that’s it actually UNPROFESSIONAL to care. When people come to us in the midst of some suffering, they are reduced to becoming a “case” so that we may avoid letting emotion crowd our better medical judgement. Inevitably, we come in contact with suffering and are faced with a choice. Humans without a pathological medical condition can’t meet the face of suffering and feel nothing so the choice is to either engage and take on suffering along with the patient, or disengage as a self-protective mechanism leaving the patient to suffer alone. Since the inception of our training we are taught to be professional and this means not becoming emotionally involved, the tendency is to disengage and leave the patient suffering alone.

There is no point in engaging a suffering patient unless you are suffering with them for a reason, suffering with joy. This can’t be accomplished with the goal of social justice or to fulfill a business plan. Justice depends on giving everyone his or her rightful due. This practiced in excess, especially in certain patients, can have disastrous consequences. In order to practice street medicine correctly, we must rise above justice to give everyone MORE than he is rightfully due. This is done through charity, or love.

Approaching street medicine through the lens of charity is essential because patients experiencing homelessness suffer a lot. This suffering is not just from material poverty which we can cure for a moment by offering food. They also suffer from emotional and spiritual poverty from being discarded by society; of feeling unwanted and unloved. If we are going out to cure, which as medical providers we must, then we also must engage with them in their suffering. This means not just giving medicine to relieve bodily suffering, but to cure means relieving the spiritual and emotional suffering they also carry. To accomplish this, street medicine must be approached through charity and love, not justice.

How or why has this approach to patients experiencing homelessness caught on as a global movement? Street Medicine has caught on because it’s been spread through the joy of suffering and giving through charity. This has turned the light on in traditional healthcare institutions and practitioners. When you turn a light on in a room it doesn’t just shine on the ones you love best, not just our patients, but shines on all in the room, like our colleagues and friends in the community.

Street medicine, at its core, is the light that it gives us permission to share the sufferings of our patients with joy, through charity, with the purpose of healing spiritual, emotional and bodily suffering.

~ Brett Feldman

Street Code of Friendship: a Paradox

We once knew a man who was sleeping in an encampment in the woods. One day, it was discovered that he had been beat up pretty badly by a good friend of his who also resided in the woods. He was taken to the hospital and was eventually released. His physical elements didn’t hurt him as much as the psychological and emotional pain he felt . However it was not for having been beaten up by someone he considered a friend, but rather, the guilt he felt for saying such terrible things about the friend who had just assaulted him. He went on to be concerned about his friends Health and who would take care of him if they weren’t friends. While the story may sound unique, I can assure you that I can think of at least a dozen other cases where two street friends have a disagreement that turned violent only to declare their friendship as strong as ever in the days that followed. I call it the Street Code of Friendship. It’s unlike any type of friendship structure I have witnessed but the bond seems incredibly strong. This represents for me somewhat of a paradox in which I find myself teaching my own students that many relationships formed on the street are superficial in nature. Friendships in which, when push comes to shove, are often abandoned by temptation, housing, whim, and addiction. But, as I reflect back on that statement, I am left wondering about the origins of such taless I have just told. I think about a pearl of wisdom I received from Dr. Withers (again, I know) when he mentioned that communities who feel that feeding the homeless encourages them to remain homeless is like asking you to think of the best sandwich you’ve ever eaten in your entire life and then choosing to be homeless so that you could continue eating that sandwich rather than be housed and not have the sandwich. For me, it’s not a sandwich but my Grandma Stella’s pot roast. The most delicious thing I’ve ever eaten however I would not give up my house and just so that I can have her pot roast every day. It makes me wonder, what acquaintance do I have or even friend in which I would allow them to physical hurt me and then retain my friendship with them. Or further, we have had cases where one rough sleeper refused housing out of worry about what would happen to the person they share their encampment, their bench or their doorway with. I think about the stress and the trauma of living on the street. Perhaps if you find that one person who understands and who seems to have your back on most occasions, that sense of abandonment that you’ve experienced in your life starts to dissipate in a very small but very real way. Perhaps it’s like when you go away to camp for a week when you are a kid. You are away from home as a child, you’re scared and if you’re me you’re terrified of spiders crawling on your face and in your nose and mouth as your sister promised would happen (thanks Becky for those sweet dreams). The people you meet at camp or strangers to you on the first day but by day seven you are blood brothers and sisters. The bond speaks to the human nature of wanting to be protected and protective. In someway the street cultivates this amongst individuals. Perhaps the lesson for us housed people to learn is one of forgiveness. I am not condoning violence of course by maybe the lesson is one of understanding that impulses are often acted upon carelessly and harmfully but that at the end of the day the impulse represented one second of the emotion that is not able to erase days, months or years of survival on the street.

 

 

Hesed’s Ladder

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!

The March. The Trudge. The Hustle.

The last several weeks in American history will certainly be remembered. The inauguration of Donald Trump. Women’s March which attracted strong convictions for people on all seven continents. And for me personally the visit of two dear Street Medicine colleagues from Nashville Tennessee who have pioneered a street psychiatry program of formidable sophistication. Taking extraordinarily brave steps to deliver psychiatric care at Vanderbilt university to patients who are commonly deemed as untreatable, unrehabable and prone to recidivism of the use of all civil services including a prison systems, the challenge is insurmountable but the conviction of their leader isundeniable.
As I read through commentaries about the inauguration, the women’s march and their aftermath, I can’t help but think of the parallel playing out in Street medicine before my eyes. The country stands divided as to its identify identity both nationally and internationally, The healthcare system in many ways is limping along trying to find its own identity. It’s trying to determine how do we take care of all of the patients not just some. Still charge enough to keep the doors open but not too much that it seems like we are using the ability to charge for such a necessary need to get rich. Street medicine for me has represented a glimmer of hope as teams of concerned healthcare providers, outreach worker’s, case managers and citizens march every day on their streets looking for those people who are not found anywhere else in our waiting rooms or perhaps in our society. On the Women’s March Saturday, while the world was preparing to march through their streets, Brett and I along with Dr. Fleisch and Her resident, Laura (the street medicine nurse) and Bob Rapp (outreach awesomeness worker) gathered supplies and trudged through soggy debris, muddy embankments and tired worn out train trusses looking for patients that we knew were in need. When people use the phrase American ingenuity I am always reminded of a lecture that I heard from Dr. Jim Withers several years ago. He points out that if someone took our funding away tomorrow we would not need to close the doors of our programs but rather we would hustle. We would hustle to save our programs in the same way that our patients hustle every day for survival and in doing so the hustle creates the solidarity between us and our patients. Our patients know that we would hustle for them and in return they hustle for us. They put themselves out there in ways that they never would otherwise for somebody that they didn’t identify as having their back. The Vanderbilt visit concluded with a street medicine grand rounds at Lehigh Valley Hospital. The panel of speakers included Dr. Fleisch as well as a local county judge a psychiatrist family have Valley Hospital who has served the homeless. And a patient, Tim, who has survived by hustling since being since a very young age when he was put into foster care system and then lived on the streets for many years. In so many ways, Tim represents the reciprocated hustle. He has found more success in the last several months of his life by completing a life recovery program at a local shelter and graduating with a certificate of completion. He’s the kind a guy who feels so grateful for this accomplishment that he took pictures with the street medicine team holding up his certificate. He also has an ornery sense of humor and took pictures with Santa Claus this year (his first picture with Santa ever) which he also shared with the Street team. While expressing that he was nervous to sit on this panel in front of a large crowd, he persistently reiterate that he will do anything to help the street medicine team who he feels has helped him so much. So whatever your cause may be, understand that it really has three components. The March. The Trudge. The Hustle. One without the other two is an unbalanced triangle. Imperfect, incomplete and likely unsustainable. As Napoleon Bonaparte said, “The most important qualification of a soldier is fortitude under fatigue.”

(Name)less

Nameless. Faceless. Invisible. It’s estimated that during the life of a homeless individual in the United States, many go up three months without being called by their name. The physical and social barriers between the housed and the unhouse are immense. For the homeless, it can seem to be an endless maze of closed doors. Like the old rat experiment from my Introduction to Psychology course- teach the rat what to do and what not to do by shocking it with a quick zap at deter unwanted behavior. For the homeless, they stand too long in the doorway of a business- zap! They go to a doctor’s office without insurance – zap! They ride the bus for too long- zap! Nowhere to go, nowhere to be and no where to feel safe.
But what happens when these souls pass on from this world? Most of the bodies of our friends who have lived their lives on the streets will remain in the county morgue waiting for someone to claim them. Usually no one comes. Unclaimed and unnoticed even after death. Most are cremated and buried in an unmarked grave, unceremoniously passing from the land of the living to the land of the dead. No memorial service, no sign in book, no slideshow of memories to cherish. Even the cause of death seem somewhat generic. The majority of the time the homeless who die on the street have died of “natural causes”. There’s no family to request an autopsy or discussion as to why or how someone died. They just simply die. The injustice against these souls does not end at the moment in which they take their last breath. Over the last 11 years, I’ve had the privilege of knowing many of our rough sleepers in the Lehigh Valley. Some have resided outside for more than a decade, others have floated between the streets, shelters and single room occupancies that scatter our cities. My experience has taught me their lives are anything but forgettable. Their survival to the moment in which they left this world is nothing short of remarkable. Many of our street friends have endured things that no human should ever experience. Abandonment, untreated mental illness, an astounding amount of physical and psychological trauma. And while each of us, homeless or housed, have undeniable autonomy over our choices, we cannot ignore how previous experiences affected growth, development and decision-making capacity of those who are unsheltered. They have taught me and those who have shared their lives with them the remarkable resilience of a person and how a community of strangers can grow to love one another when they share each other’s burdens. They are some of the funniest, kindest and truest souls I have even known who had a way of sharing their reality with me so I understood their wisdom.
As we ring in the beginning of winter this week, many cities across the United States remember those men and women who have died on our streets with a memorial service. So that their lives, even after death, can attempt to have some humanism attached to it. This year, a memorial wall has been erected in downtown Allentown. Located at 707 Hamilton St so that all who pass by will remember that the Lehigh Valley is not insulated from the harsh realities of homelessness and the fact that some of our own citizens die while struggling with homelessness. It is an attempt to remind us that we are all connected. The seen and unseen. The named and the nameless. So while we gather with those who we hold so dear during this holiday season let us remember those who passed in silence and offer them some compassion, some memory, and some honor.

Love Never Dies

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.

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.