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Short pieces on a new theme every month
 
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This month...
  Tough Choices
 

No Place Like Home(less)

Josephine Ensign

Recently I had dinner with a friend of mine who, decades ago, had sat on my doctoral dissertation committee. At one point we touched on my dissertation, which covered the health issues of Baltimore's homeless teens.

"You always had an uncanny connection with homeless kids," my friend said. "You really understood them."

I gazed out the window, seeing the homeless people with their shopping carts in the park across the street.

Then I said, "That's probably because I was homeless myself."

I was surprised I'd said this. I'd never before revealed this part of my past to a professional colleague.

He looked shocked, incredulous. "How homeless?"

Thoughts raced through my head. Is he asking me how I became homeless? Is he asking me to prove my degree of homelessness? Or is he hoping that it was minimal, so that he can still respect me, still be my friend?

"Well, I did some couch-surfing and car-living, a couple of decades ago," I said casually, as if describing a nice vacation.

Afterwards, though, I pondered my friend's question--and why I'd answered as I did.

How did I become homeless?

Looking back, I feel a vague sense that I somehow caught homelessness, as a sort of side effect of the work I was then doing as a nurse practitioner.

I was running a clinic for the homeless in Richmond, Virginia. In accordance with the established practice protocols, I worked with a supervising physician--but powerful physician associations asserted that I was practicing too independently. As a result, the Virginia Health Regulatory Board launched an eighteen-month investigation into my scope of practice and temporarily closed the clinic.

Although I was never charged with anything, the clinic closure and the stress of the investigation led to the loss of my job and the dissolution of my marriage. These, in turn, led to poverty and homelessness.

Perhaps if I'd had access to affordable, competent legal advice, I might have found more graceful--and less costly--ways to exit the homeless clinic and my marriage. And if Richmond's low-income housing options had been better, I wouldn't have stayed homeless as long.

But, given the circumstances, losing my job left me without adequate means to support myself. And although homelessness involves individual vulnerabilities, it is fundamentally about poverty.

Paralyzed by a deep depression, and profoundly disillusioned with our healthcare system, I spent six months couch-surfing, living in my car or in an abandoned shed, and picking up day jobs whenever I could.

I was a swimmer and managed to keep a YMCA gym membership that allowed me to shower frequently. I didn't tell my friends or family the extent of my troubles. When asked how I was supporting myself, I wasn't willing to answer, "I wash dishes and scrub toilets, and I sleep in a storage shed or in my car." It was too humiliating. I knew that if others had told me this, I would wonder what was wrong with them.

For me, an even more compelling question is: how did I get out of homelessness?

I had some lucky breaks.

I already had a decent education and career opportunities. Towards the end of my homelessness, I was able to get a full-time nursing job with health insurance.

Then, during a routine exam, my doctor discovered that I had an abdominal tumor. If I hadn't had the insurance to cover the surgery, or if I had needed more extensive treatment, I probably would have fallen more deeply into homelessness.

And if I'd had more severe mental-health issues, or had developed a drug or alcohol addiction, I would have had a much more difficult time getting out.

Even without these problems, I struggled. Homelessness is chaotic, exhausting and soul-sucking.

In fact, it came close to killing me.

One December night, two months after becoming homeless, I realized that I had the means to kill myself. There was an unlocked walk-in freezer attached to the storage shed I was living in, and I had a full bottle of morphine pills that had belonged to a patient now deceased.

The idea drifted into my mind: I can take all the pills, curl up inside the freezer and never wake up....

I was so cold and fatigued that I wasn't thinking clearly. The pills were pain medicine, after all, and I wanted the pain to go away.

As strange as it may seem, what stopped me was a line from the Kierkegaard book I carried with me: "Life can only be understood backwards; but it must be lived forwards."

I longed to be up ahead in the future, looking back, knowing that all this was behind me. So I chose to live.

As alarming as this episode was, it had a bright side: it frightened me into visiting a university women's center that offered free career counseling, so I could get help clarifying my goals and dealing with my depression.

Eventually, hoping to change the healthcare system as well as my life, I decided to move to Baltimore to attend graduate school. There, six years later, I graduated with a doctorate in public health.

It's been twenty-six years since I was homeless, but the scars from the experience still linger, as real as the star-shaped surgical scars on my belly. Homelessness is a "deep illness"--a term coined by sociologist Arthur Frank to describe an illness that casts a shadow over your life. That shadow never completely goes away.  

Several years ago, my shadow suddenly resurfaced.

While working to develop a medical project for homeless youth in Seattle, I'd arranged for our planning group to tour a downtown homeless women's shelter.

I was standing inside the small front lobby waiting for the rest of my group to arrive. I was wearing jeans, having purposely dressed down.

Just as my colleagues were being buzzed in at the front door, a shelter resident walked over to me.

"Did you stay on Aurora last night instead of here?" she asked loudly, naming a Seattle thoroughfare notorious for its prostitution and homelessness.

"I'm sorry--I'm not staying here," I answered in alarm. "I'm just visiting."

Later, my colleagues teased me: "It's so funny that she asked that--you're a university professor!"

But I couldn't shake the feeling that I'd been found out. Nor, despite my best efforts, could I escape a deep feeling of stigma and shame.

"You were homeless? How?" I imagined them asking. "What was wrong with you?"

During graduate school, and afterwards, coming out of the closet about my own homelessness, depression and near-suicide was never an option. It could have derailed my career.

But the shelter incident made me start to think about my past again, and in the months and years that followed, I realized more and more clearly that it was time to come clean--to myself and to others.

That's probably why I revealed this truth to my friend and colleague: it was time to proclaim myself the wounded healer I'd been all along.


About the author:

Josephine Ensign teaches health policy at the University of Washington in Seattle. Her literary nonfiction essays have appeared in The Sun, Oberlin Alumni Magazine, Silk Road, The Examined Life Journal, Johns Hopkins Public Health Magazine, The Intima and the anthology I Wasn't Strong Like This When I Started Out: True Stories of Becoming a Nurse. Her blog Medical Margins covers health policy and nursing. "I write in order to understand and experience things more fully. I also write, as George Orwell says, 'to push the world in a certain direction, to alter other people's idea of the kind of society they should strive for.' "

Story editor:

Diane Guernsey

Comments   

# Zuhra Sarwary 2014-06-23 09:09
Really inspirational!
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# Alexandra T 2014-06-19 20:34
Josephine, It has been an honor to be your student. This story and others you have shared with us are important and powerful. It is a mix of privilege, chance, and action that has lead us to where we are today. We often think of the homeless as other but it is an important reminder that events could have easily steered us down another path altogether. Your story demands that we see the face of each homeless individual and recognize the innate sameness we all share. I hope the country will soon recognize that our society is stronger with all its members and we work to support each person. Community is vital.
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# Sarab Sodhi 2014-06-12 13:43
I'm going into Emergency Medicine and as I look at my patients I've often thought- there but for the grace of chance, luck and fate go I. I have often looked at the old, the young, the destitute, the scared and realized that we are but one degree removed from them.

Your story brought that home to me yet again. All too often as part of our mental armor I think we end up putting up walls and moats around us making us different from those who we take care of. How else do we continue doing it day in and day out?

But in truth- none of us is that far from being one of 'them'. And your story, your marvelous, gutsy, heart wrenching story made me realize that if not for many many lucky breaks over the years I would not be reading this and typing my reply in an upscale coffee shop a few months from graduating to be an MD. Instead I could be the homeless person I crossed on the way here.
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# Dr. Theresa E. McCor 2014-06-02 05:17
Josephine, I'm moved deeply by your courage to share your story of being homeless. How you worked your way through it and found the strength and will to live and contribute so much now to solving the problem of homelessness is inspiring.
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# Judith Gille 2014-06-01 23:53
What courage it took to tell the world your story.
Can't wait to read the full book.
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# vivian foulke 2014-06-01 21:52
Thank you for sharing. Your story really hit home for me. I was not homeless, but witnessed domesitc abuse of my parents my entire childhood. My parents died 17 years ago, the ultimate end to a tragic arranged marraige of 34 years. Murder-Suicide. I burried the memory and thought I had the past in my past. I am presently in an RN to BSN program and we had to do a capstone project. I decided to volunteer at Turning Point of Lehigh Valley. Bad mistake. You stated that the scars from your experience still linger, as real as the star-shaped surgical scars. That is so true. The scars still linger even 17 years later. Anyway, I got a lot out of your story. I applaud your openness.
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# Wendy S. Harpham 2014-06-01 21:09
A courageous essay with valuable lessons that will be shared with respect. With hope, Wendy
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# Flo Keyes 2014-05-31 22:28
I applaud your honesty. When my rental home burned, I was left homeless too, but for a much shorter time. Luckily, I had family in the area and was able to sleep on a mattress on my sister's dining room floor until I found a new place to rent (on an adjunct's salary). As with your experience, being homeless gave me greater empathy, in my case for students who are struggling to maintain housing. They know it's not just talk when I tell them I will help however I can. A college degree and a professional job are not insurance against being homeless, whatever others may think.
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# Marsha Hurst 2014-05-31 22:18
Josephine,
Thank you so much for your powerful personal story. Opening up your own experience enables--perhap s requires--us to attend to homelessness and its partner, ill health, as being part of our own lives, not a condition of otherness from which we can turn away. I am happy to see you are, as ever, a strong practitioner of narrative advocacy.
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# Karen Capucilli 2014-05-31 22:17
This is a powerful, breathtaking piece. It leaves me wondering how many more people like you - formerly homeless - there are. I feel that the shame and stigma are so negative and ultimately unhelpful. Thank you for your willingness to share and for expanding my thinking.
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# Lee Kagan 2014-05-31 20:35
Beautifully and powerfully written story. It bleeds honesty and pathos. My wife, a nurse educator, and I were both moved by the piece. Thank you for sharing this and letting us all inside.

Your openness, I suspect, is a result of "understanding life backwards." I hope the remaining forward part brings you nothing but joy and fulfillment.
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# Mary Oak 2014-05-31 19:48
Thank you for the willingness to share your story in all its complexity and vulnerability. I do believe there is power in being a wounded healer, in sharing the wound from the inside. I find this piece deeply moving. It fulfills your quote by Orwell in pushing the reader forward in understanding. I am tremendously thankful that you followed your hit about living to look back.
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# Karen Donley-Hayes 2014-05-31 14:31
This is a brave and powerful essay - courageous to write, and hopefully Dr. Ensign's courage can help us all look beyond surfaces. Thank you so much for sharing.
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# Dr. Lou Verardo 2014-05-31 08:57
Dr. Ensign, that took a lot of courage to write this piece. It is a very profound act of self-disclosure , and I can only imagine that it brings you closer to patients and injects realism into the health policies you create. Thank you for sharing your story with the rest of us.
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# Elaine Whitman 2014-05-30 23:27
Josephine, I was so very moved by your story. You spoke your truth with strength and grace. I fully understand why you kept your story private for so many years. I hope you do not fault yourself for your choice to keep that part of your life to yourself for as long as you did.

It is always difficult to know the right time to "stand up and be counted." I hope that you will continue to tell your story as part of your public health work. Your story delivers a message people need to hear: if homelessness could happen to you, it could happen to anyone. This is an uncomfortable thought. People like to believe that homeless people are "the other," not one of us. Calmly, quietly, and with enormous compassion, you challenge that myth. Thank you.
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# julia mckechnie 2014-05-30 22:59
What a powerful personal story that Josephine has bravely shared. Her courage in sharing her story whilst working in the health field, leaves me in awe of her. We ,who work in this field, know the cost of disclosing mental health issues or other abberant " social conditions"-( homelessness, domestic violence) to others.
These personal stories humanize those who work in the health systems, and demonstrate the vulnerabilities many of us face.
Thank you for your courage & honesty.
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# Julie Stenger 2014-05-30 19:15
This world is a much better place because you opted not to swallow that Morphine and curl up in a freezer. Your human-ness and beautiful honesty is such a gift.
Thank you for sharing the story of this vulnerable time in your life. So many of us are passing through our days with one lucky break after another and don't even realize it!
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# Lois Gerber 2014-05-30 18:43
Touching story showing the fragile connections between people and the important role of the community health nurse is addressing problems and implementing viable solutions of the homeless and near homeless.
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# Anna Schmidt 2014-05-30 17:39
This is very powerful. I think it is important for people to hear stories like this in order to help dispel some of the myths about poverty and homelessness that continue to get in the way of finding real solutions to these tenacious problems.
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# Paul Rousseau 2014-05-30 17:37
Gut wrenching, raw story. Thank you for having the courage to share. We all have hidden stories, but many of us never have the courage to tell them. Thank you again for your story, your courage, and your dedication.
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# Jessica Bloom-Foster 2014-06-01 22:20
Amazingly rich story, so simply and honestly told. Thank you for sharing this. Reminds me that while I was a family medicine resident in Chicago, I used to think I'd like to make a book telling the stories of homeless people, with photographs. Maybe you should write this book instead. :-)
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