[Hpn] How homeless get shunted from hospital to the street

Graeme Bacque gbacque@idirect.com
Sun, 04 Jun 2000 04:45:10 -0400


How homeless get shunted from hospital to the street

By Jack Lakey
Toronto Star City Hall Bureau

Harry Bharat went into surgery not long ago to have his frostbite-ravaged 
fingers amputated.

Five hours later, after doctors cut through the flesh and bones of nine of 
his 10 digits, Bharat - groggy from anesthesia and in agony - was bundled 
into a taxi and sent to a hostel.

Believe it or not, Bharat is lucky. Homeless people who need treatment in a 
hospital usually convalesce in a doorway or over a heating grate after 
they're discharged.

This is the stark face of Ontario's new health care, where the emphasis on 
recuperating at home, to free up hospital beds, is applied to people with 
no home in which to recover.

Doctors and nurses who work with Toronto's homeless are becoming alarmed at 
the willingness of hospitals to push sick patients out the door, knowing 
that they are headed back to the street. At the Seaton House hostel, 
homeless men regularly arrive in taxis and even ambulances from hospitals, 
in no condition to be released without an extensive network of support.

But with unprecedented demand on acute-care beds in Toronto, hospitals 
cannot shelter recovering homeless patients simply because they have 
nowhere else to go.

Most people recovering from surgery have a home to return to and people to 
help them; not Bharat. His succor came from hostel employees and a bottle 
of Tylenol 3.

Seaton House staff fed him, dosed him with painkillers and got him to his 
follow-up medical appointments.
``If it wasn't for you guys, maybe I'd be dead somewhere by now,'' he told 
a hostel worker.

Bharat must adjust to a life with stumps for fingers, without any of the 
after-surgery support most people would take for granted. Even if he stood 
on a corner and panhandled, he would have trouble hanging on to the coins.

Hostel staff and street health nurses tell many horror stories about 
homeless people released from hospital when they still need institutional 
care.

``We are getting people all the time from hospitals who should still be 
there,'' says Jordan Lewis, who manages the Annex program at Seaton House, 
where seriously ill clients such as Bharat end up.

``Sometimes it's so obvious that they need to be in a hospital that we just 
send them back.''

At 46, Harry Bharat is a frail wisp of a man. With most of his teeth 
missing and a Caribbean lilt to his voice, he is so soft-spoken that he is 
almost inaudible. He shuffles around the Annex area of Seaton House with 
his shoes untied,
seemingly unconcerned about his circumstances.

Bharat does not have the will to speak up for himself, and seems not to 
understand the consequences of not doing so. Before his operation, he 
seemed unable to grasp that he was about to lose his fingers.

They were hideously blackened and appeared to be rotting away from the 
bones protruding from their tips, like dry twigs. During a taxi ride back 
from St. Joseph's Health Centre the day before surgery, the driver opened 
the windows to clear the stench.

Bharat would often play with his fingers, absent-mindedly bending them into 
unnatural positions. At times it looked as though they were about to snap off.

He had been told that parts of his fingers had to be amputated, but he 
seemed cheerful, untroubled by the idea.

``They still work, you know,'' he said, holding his hands out in front of 
him. ``The fingers move. I'm hoping that they can clean them up a bit, and 
I'll be able to keep them.''

It took three months for them to become so decayed that they could not be 
saved. The loss began innocuously, with Bharat fumbling to find his house key.

He'd never used a city hostel at that point. He lived in rented rooms in 
Parkdale, paying with his $916 monthly provincial welfare cheque.

Bharat had probably been drinking on a bitterly cold night last January, 
but he can't remember.

About midnight, he headed back to his room at a TV repair shop on Queen St. 
W. But he couldn't get in, either because he lost the key or couldn't get 
it into the lock. He's not sure.

With nowhere else to go, Bharat made the decision that eventually cost him 
his fingers. He chose to wait in an adjoining garage until the man who ran 
the shop, who also lived there, woke and let him in.

By about 4 a.m., Bharat says, he was so cold that he went to an all-night 
store where the staff knew him, to warm up.
``I told the guy I couldn't open the back door,'' Bharat recalled. ``He 
said he was going to get me some help. I thought he meant to open the door, 
but he called an ambulance.''

He was taken to St. Joseph's, where emergency staff thought the frostbite 
serious enough to heavily bandage his hands. They also called his landlord 
and woke him so he could let Bharat in.

``My rent was paid for January, but I couldn't stay because of my hands. I 
couldn't use them,'' he said.

For a while he lived with a friend, but he says that didn't work out. So he 
ended up on the street, with fingers that were deteriorating because he 
wasn't getting treatment.

By early April, a doctor in Parkdale sent him to Seaton House, apparently 
because she knew it was the only way he would get the help he needed.

It was also apparent by then that he would lose most of his fingers.

After he checked in to the Annex, Bharat slept almost continuously for days 
and ate ravenously.

``He was very sick and clearly wore out,'' said Macie Vernhout, a shift 
leader at Seaton House. Bharat told them he'd lost 25 pounds since the 
frostbite, which reduced his weight to about 120 pounds.

``I don't think he could feed himself very well because of his fingers, and 
I guess he was using all his strength to fight off infection. He wouldn't 
have lasted much longer if he hadn't come in here.''

Bharat was told not to eat or drink anything for 12 hours before going to 
St. Joseph's on April 17, for surgery at 2 p.m. By 6 that evening, the 
hospital called Seaton House to send somebody to pick him up.

When Seaton House worker George Carefoot arrived, he found Bharat dopey 
from anesthetic and holding his heavily bandaged hands up in front of his 
face, to keep the bleeding down.

``I feel like I'm in space,'' said Bharat, who needed help to stand up. ``I 
can't do anything. But I can tell you it hurts. It really hurts.''

Nurse Anne Doherty turned Bharat over to Carefoot, along with a 
prescription for Tylenol 3, a codeine-based painkiller. Carefoot wasn't 
sure he could get the prescription filled until the next day and asked 
Doherty if she could give Bharat enough painkillers to get him through 
until the morning. The nurse replied she could give him two.

Carefoot suggested she let Bharat swallow two right away, then give him two 
more to take with him. She reluctantly agreed, but after checking his vital 
signs once more and finding his blood pressure elevated, she called Dr. 
Ronald Levine, who'd done the surgery.

For a minute, it looked as if they were considering keeping him overnight, 
but Doherty hung up and said Levine had told her she could give Bharat two 
extra painkillers on his way out the door.

``Unbelievable,'' said Carefoot, shaking his head. ``It's like nobody cares 
how much it will hurt when he's out of here, in the middle of the night.

``I'm wondering if they would have kicked some nice, middle-class person 
out as quickly, right after cutting off half their hands.''

Bharat was often told before his surgery that many of his fingers would be 
cut off, but medical staff at St. Joseph's didn't explain to him afterward 
just what they'd done.

The morning after, he still thought he had all his fingers. He swore he 
could feel them under the bandages.
``Oh, they're still there,'' he assured a visitor. ``I don't know what they 
did (the day before), but I don't think they finished the job yet.''

He didn't know it, but he was suffering from ``phantom pain,'' a common 
affliction of amputees. The severed nerves were continuing to send pain 
signals.

Seaton House workers who accompany residents to hospital say medical staff 
often do not speak directly to patients who are homeless.

``They'll talk to me about Harry, but not to him, even if he's right beside 
me,'' says Jennifer Urquhart, a Seaton House supervisor. ``It's like they 
just see me, because I'm the person in authority.

``Maybe they think that, because he's homeless, he wouldn't get it, anyway. 
But anyone who's gone through what Harry has should be told what's been 
done to them.''

Levine did not return calls, but his secretary called The Star to say that 
because Bharat's treatment was confidential, he couldn't discuss it.

While the bandages rendered his hands useless, Bharat's right thumb was 
spared the scalpel. The day after surgery he was using it to manoeuvre a 
fork, gingerly lifting food.

``I'm lucky I still got this one,'' he said, gesturing at the thumb.

On April 24, a week after his surgery, Bharat returned to St. Joseph's, 
accompanied by Urquhart. The bandages were removed, revealing a gruesome 
truth apparent to anyone who can count to 10.

On Bharat's left hand, two fingers had been amputated at the second knuckle 
while the middle finger and thumb were cut off at the first knuckle. Only 
the tip of his pinky finger had been nipped off. On the right, his thumb 
was saved, but all four fingers were amputated at the second knuckle.

Bharat was unprepared for what was under the bandages.

``He kept saying, `I have the ugliest hands in the world. I'll have to wear 
gloves to hide them,' '' Urquhart said. ``I don't think he understood how 
much cutting they'd done.''

Other than telling Bharat that he was healing well, Urquhart said, Levine 
never talked to him about his surgery or physiotherapy to help him regain 
some use of his fingers. She said the doctor ``spoke to me briefly and gave 
me a handout sheet on basic maintenance, but he didn't talk to Harry at 
all. Nothing.

``He was still in a lot of pain on the way back. When we got back, I said, 
`Pour this guy a couple stiff drinks. He needs it.' I just felt so bad for 
him.''

Before he lost his fingers, Bharat liked to dream about going back to work. 
The Trinidad native was once an auto-body man, his specialty customizing 
vans. Afterward, he'd run his hands over the smooth surface of his work, 
feeling for imperfections.

Bharat was an average guy with an ordinary life: a wife, decent job, a hot 
car and a taste for a good time.
Things went downhill. His wife left. And Bharat entered a long spiral that 
bottomed out under a surgeon's knife.
But, as is often the case with adversity, some good seems to have come of 
Bharat's situation. He has started physiotherapy to strengthen what's left 
of his fingers.

Seaton House staff think they may have found him assisted housing. , With 
three meals a day, he's regaining some of the 25 pounds he lost.  He's 
hoping for another chance to squeeze the paint gun one day.