December is busy: holidays, children on break from school, travel to family functions, year-end duties at work… Our lists lengthen in December and many of us feel burdened by extra responsibilities.
Yet… most of us have clean and dry socks to wear, a roof over our heads and people in our lives who notice if we do not show up for the holiday party. Most of us have abundance in droves compared to people who are living on the streets.
In the latest estimate by the National Alliance to End Homelessness, an estimated 564,708 Americans are homeless. It’s an unhealthy and dangerous existence. Overall, people experiencing homelessness are three times more likely to die than the general population. While most of us can expect to live into our late 70s, the average age of death for a homeless person is about 50 years. People living on the streets are often victims of unprovoked violence and roughly 700 of them die every year from hypothermia, according to the National Coalition for the Homeless.
Since 2010, the Multnomah County Health Department, Oregon State Medical Examiner, Multnomah County Medical Examiner's Office, and Street Roots have worked together to track the number of individuals who have died in the past year and had no known address. Last year, 56 individuals were noted in the County’s report, entitled “Domicile Unknown.” The report goes on to state, “The lack of affordable local housing, the opiate epidemic and the persistent challenges of mental illness and addiction are contributing causes of deaths that could otherwise be prevented.”
Sadly, many of these deaths are of people who have fallen so far out of mainstream society that their absences were barely noticed. Their names were rarely uttered. No one wondered about their well-being.
Since 1990, the National Coalition for the Homeless has sponsored National Homeless Persons’ Memorial Day on today’s date - December 21st. It also happens to be the first day of winter and longest night of the year. In 2014, more than 100 cities in the United States held memorial ceremonies to remember homelessness individuals who have died in the course of the year. In 2005, the National Health Care for the Homeless Council and the National Consumer Advisory Board joined National Coalition for Homeless as co-sponsors of the Day of Remembrance.
At Central City Concern
On a yearly basis at Central City Concern, we provide housing and care to roughly 13,000 people who have been impacted by homelessness. By the time some people come to our door, however, the health effects after years on the streets are irreversible. For such people, our Old Town Clinic staff members are often more than mere health care providers. They are sympathetic ears, inquisitive conversationalists and compassionate souls.
For our 119 staff members working at Central City Concern’s Old Town Clinic, the frantic pace of seeing dozens of patients daily is paused for about an hour on the Wednesday morning before Thanksgiving. Since 2010, staff have taken time to utter names and share stories, laughs and tears about patients, who despite a level of engagement with a medical team, have slipped away. This year’s ceremony recognized 70 patients.
“It started from a need to remember and desire to take a moment to reflect,” says Chuck Sve, Acupuncturist and Education Coordinator. “Noticing what was going on around here which was that some clients were dying, some expected and some unexpected, some violently and some for unknown reasons. Some death was understood and some just wasn’t. It became clear we needed to acknowledge it.”
Ceremonies have varied over the years. “We have used rocks or flowers to symbolize someone who had died and built an altar. Together we remember and honor those who have passed. This develops an increased sense of community and being grateful for what these people have given us. This year’s ceremony had us sitting in concentric circles with singing and sharing, crying and laughter, and just being together in way that is nourishing for our spirit. Staff have always been receptive and appreciated the opportunity to remember those clients who have died. It has been memorable, touching, unusual and intimate,” says Chuck.
(Photo is from 2010 ceremony; at the 2014 ceremony, staff sat in concentric circles, singing and sharing, crying and laughter. The Threshold Choir, a group that sings for people as they crossing life's thresholds, joined the ceremony.)
“For me, working at OTC is all about relationship building with our patients,” say Care Team Manager Carol Weber. “In doing so, there is a lot of dignity, respect, love and care that goes into building that relationship. So, when a patient passes, there is a real sense of loss for us. This time of remembrance helps us in the process of ‘letting go.’ Too many of our patients don’t have good relationships in their lives….we as human beings all deserve to be treated with dignity and respect. The remembrance event that we do is part of that dignity and respect.”
Kerith Hartmann, Health Educator and Project Coordinator at Old Town Clinic, said “In our busy work environment, we often hear about a patient’s death from a co-worker in passing while we are on our way to help another patient. Collectively pausing and sharing stories about individuals is powerful.”
We asked staff to reflect upon how they felt after the ceremony as they rushed down the hallway to their first appointment. Kerith said, “I feel more connected with the patients with whom I interact. It instills in me a sense of making the most of every moment and helps me do my best to support people while they are making changes. I feel more engaged because I am part of an organization that values this tradition.”
Kerith also recalled a particular patient: “It’s a patient I spoke to on the phone frequently when I was a Health Assistant. Whenever this patient was visiting the clinic, I would say hello and check in briefly. When he was physically fragile, I would help him down the hallway and offer some encouraging words. He ultimately died by suicide. I learned about it when I called for outreach and heard the unfamiliar voice of a family member on the phone. This death really impacted me. Sometimes it is easy to feel like we are one step removed from patients, especially due to the necessity of building strong professional boundaries and ensuring privacy. But, these boundaries don’t impede the connection or the impact that patients make on our lives.”
Chuck summed up the ceremony further, adding, “It’s an opportunity to recognize the cycle of life and death. To come together to share the blessings and burdens of working with suffering, being with change, being alive.”