Listen to This Article
Laine Goettsch packed her emergency medical bag and drove into downtown San Diego to look for her favorite patient, afraid of what she might find. Sometimes, she saw Abdul Curry cleaning the sidewalks near his tent and dancing to a playlist of Ed Sheeran songs. Other times, she found him hypothermic in a wet sleeping bag and surrounded by people smoking fentanyl. And then there were the days when she couldn’t find him at all, and she continued searching for hours as she braced for a call from the hospital, the police or the medical examiner.
Now she drove into a homeless encampment and saw three people huddled near a camping stove and sharing a bottle of vodka. “Anyone heard from Abdul?” she asked, but they shook their heads and turned back to the fire.
Laine, 29, had spent the last year working as a medic in the forgotten alleyways and parking garages of downtown, trying to help Abdul and dozens of others stay alive during the most dangerous time in modern history to be homeless in America. More people in the country’s biggest cities were becoming homeless, more were living outside instead of in shelters, and a record number of people, from Los Angeles to Denver to New York, were dying in premature and preventable ways on the street. The toll in San Diego County had increased by nearly 10 times in the last decade, from 64 homeless deaths in 2014 to nearly 600 investigated by the medical examiner’s office in the last year.
She drove across a bridge and spotted Abdul slumped over at the entrance of a parking garage. He had an open wound on his forehead and water dripping from his clothes, but when he saw Laine coming, he dusted off one of his old suitcases and offered it to her as a chair. “Sorry about this weather,” he said.
“I’m fine, but you must be freezing,” she said, as she draped a blanket over his shoulders. “It’s been raining for days.”
He shrugged. “My teeth are clattering like piano keys, but we’ve been through worse,” he said.
Abdul had come to rely on their weekly visits as his only semblance of stability during a time in which living on the street in San Diego had become what he called “a daily game of Russian roulette.” His longtime partner, Phasia McKee, had died in November of a suspected fentanyl overdose at 46 years old. Three of his friends had been run over and killed in their tents by an intoxicated driver who swerved onto the sidewalk. In the last year, Abdul had revived six people after fentanyl overdoses by administering CPR and the nasal spray naloxone. He had also overdosed five times himself, including once a few days earlier, when he collapsed on the sidewalk, gashed open his forehead, suffered a minor stroke and spent 36 hours in the emergency room before being released back to the street.
“How’s your recovery going?” Laine asked.
“I’ve got my miracle drug,” he said, holding up a small container of olive oil, pouring some onto his hands and massaging it into his skin.
“What about your medications?”
“They’re either lost, stolen or in here somewhere,” he said, as he began to sift through a grocery cart, a suitcase and two plastic bins that contained all his belongings. Laine knelt next to him to check his vitals. He had a slight fever, and his blood pressure was dangerously high. She gave him aspirin and took out her computer to add another line to his medical chart, which told the story of a life outside: chronic fatigue, malnourishment, alcoholism, blurred vision, schizoaffective disorder, depression, anxiety, paranoia.
For the past several weeks, Laine’s increasing concern about Abdul’s health had extended beyond her workdays with the nonprofit group Healthcare in Action and into her evenings, until she sometimes picked up her son at day care and drove 45 minutes back into San Diego just to make sure Abdul was still there. The average age of death for people who were homeless in San Diego was less than 50, and Abdul was about to turn 64.
“I’m worried something bad could happen to you at any moment,” Laine said.
“From Him we come, and to Him we return,” Abdul said, repeating one of his favorite phrases in Arabic from the Quran.
“But not yet, OK?” Laine said.
“Not yet,” he agreed.
Abdul had spent the last several years bouncing between temporary apartments and being forced by the police to move his sleeping bag from one sidewalk to the next, until the closest thing he had left to permanent shelter was a parking garage on a hill overlooking downtown. The concrete entrance was 15 feet wide and 20 feet deep. He squeezed against the wall every few minutes as cars drove in to park for $45 a day. A sign at the entryway read: “Warning! Breathing the air in this garage can expose you to chemicals which are known to cause cancer and other harm. Do not stay longer than necessary.”
Abdul had managed to stay off and on for 20 months by making himself useful and by charming the private security guards whose job it was to keep the garage clear. He washed and detailed customers’ cars and compulsively cleaned litter off the nearby streets with a broom and a dust pan. He greeted dozens of office workers by name each morning and serenaded them on their way to work. “The homeless mayor of San Diego,” some people called him.
But at night the nearby offices emptied out, the parking garage went dark, and the only people left on the block were the ones with nowhere else to go. A half-dozen people who lived on the street dragged over their belongings to join Abdul in the garage, where they could stay dry under the overhang and look out for one another until daybreak.
“I can’t feel my damn feet,” Eric Thompson, 57, said as he sat down a piece of cardboard near the back of the garage and settled in for another long night during San Diego’s wettest spring in decades. The temperature dropped to 52 degrees, and it started raining again.
“You have to get your blood moving in this cold,” Abdul said. “Start wiggling your toes.”
“I’m trying, but they don’t move,” Eric said. His jeans were soaked, and a decade of alcoholism had left him with poor circulation and chronic numbness in his arms and legs.
“All right, I got you,” Abdul said, as he unlaced Eric’s shoes and started to warm his feet in his hands. Abdul had moved to California two decades earlier to take care of his mother and his brother while they were dying of cancer, and he had nursed his own grief with vodka and heroin until he went to jail on a drug offense, lost his refurbishing business and started a new life on the street, changing his name from Howard to Abdul. He was still a caretaker by nature, testing the safety of his friends’ drugs with fentanyl test strips, bandaging their spider bites and staying awake for most of the night to watch over people who moved between the nearby shelters and the garage. There was Michelle Benitez, 56, who had an abusive ex-boyfriend and a Little League baseball bat she carried for protection; and Pamela Thomas, 51, a former fentanyl addict who collected pieces of burned tinfoil off the sidewalk and folded them into ornate frogs, butterflies and boats that she wore as jewelry; and Henrietta Maes, 38, who was often carrying a portable gas canister and lighting up something to smoke in a pipe, including now, as a private security guard walked by on patrol.
“No way!” the guard shouted. “You’re going to burn this place down. This is private property. Get out.”
Abdul snatched away Henrietta’s pipe and apologized. “You’re right,” he said. “That one’s on us. No more smoking. I give you my word.”
“Good, but you still have to get out,” the security guard said.
“Come on, man,” Abdul pleaded. “It’s raining. It’s cold. How many cigarettes have we smoked together? You know me.”
“Sorry. If I lose this job, I’ll be out here with y’all.”
“OK, OK, I got you,” Abdul said. He packed his belongings, dragged them around a corner and told everyone else to do the same. They waited outside in the rain for 25 minutes until the end of the security guard’s shift and then moved everything back into the garage. Now their clothes and blankets were drenched, and Eric was shaking and starting to slur his words. Abdul covered him in blankets and sleeping bags and piled on a layer of garbage bags to hold in the heat.
“You getting any warmer?” he asked. Eric just groaned. “Hey,” Abdul said, jabbing his finger against the pile of sleeping bags until Eric finally rolled over.
“I can’t stop shivering,” Eric said. “Everything stings.”
“Just don’t fall asleep — keep talking to me,” Abdul said, and finally, with some prodding, Eric started to tell him about how he had lived for a while on a boat in the San Diego harbor, and how one summer he had sailed his 26-foot Marlin all the way from California to Hawaii.
“I bet it was hot over there,” Abdul said. Eric kept reminiscing about his eight months in Hawaii as Abdul listened and searched the garage for a working cellphone, in case he needed to call 9-1-1. The emergency room at the nearest hospital had recorded 10,500 homeless visits in the last year alone. According to the district attorney’s office, people who were homeless in San Diego were 118 times more likely than the general population to die of a drug overdose, 19 times more likely to be murdered, 12 times more likely to be assaulted, and eight times more likely to commit suicide. One of Abdul’s friends had been murdered with a railroad spike. Another had drowned in the San Diego Bay while drunk. Another had died by suicide, overdosing on prescription medication while Abdul, unaware, listened to music 20 feet away. Another had been hit by a semi-truck after wandering into the highway during a psychotic episode. Others had died from outbreaks of Covid-19, shigella and hepatitis A.
Abdul had helped his partner, Phasia, recover from two overdoses before she died at a friend’s apartment, and lately whenever Abdul remembered that night, his mind wandered from the entryway of the garage up to the sixth-story roof, where he sometimes imagined walking up to the edge and falling.
Eric was silent. Everyone else in the garage was asleep or nodding out on drugs. Abdul nudged Eric’s sleeping bag again with his foot.
“You ever go to one of those luaus?” he asked. Eric didn’t respond.
“Hey,” Abdul said. “You alive under there?”
“Let it be,” Eric said. “I’d probably make a better angel anyway.”
“Not on my watch,” Abdul said. “I’ll stay up with you. You’ll be all right.”
Laine arrived at the garage early the next morning to deliver them hot coffee, dry blankets and also some good news. She’d spoken to a colleague on her nonprofit team, and it turned out that since Abdul had served in the Air Force after high school, he was eligible for a subsidized apartment through the Department of Veterans Affairs.
“It’s still not a slam dunk,” Laine explained as she started to write down a list of steps for Abdul’s potential move indoors. He needed to replace his lost Social Security card, but he had already exceeded his lifetime limit of 10 cards, so that would require writing a letter and applying for a special exemption. Then he needed to replace his missing state ID, clear up a warrant for a minor drug offense, establish a working bank account, complete a half-dozen forms and interview with potential landlords.
And before he could do any of those things, he needed a working phone.
“You should have a way to communicate with the outside world,” Laine said, and she emphasized her point again: Abdul’s best chance to survive was to get an apartment, and the first step toward getting an apartment was to have a working phone.
“Consider it done,” Abdul said. “It’ll happen today. Guaranteed.”
He knew a guy named Mike who ran a phone kiosk by the bay, and Mike had once told Abdul that if he brought back his old iPhone in working condition, he could replace it with one that had cell service for just $30. Abdul turned on his portable radio and started humming to himself as he searched for his old phone, emptying his suitcases and his grocery cart across the floor of the garage. He found six rolls of toilet paper, 14 cans of food, three electronic screwdrivers, a half-eaten chocolate cake, eight phone chargers, an unopened pack of underwear — and finally, there it was, an iPhone with a cracked screen. “Big day,” Abdul said, as he turned up the music. “Making moves.”
He hit a button to turn on the phone, but the battery was dead. He tried all eight chargers until he found one that fit and then walked to a convenience store to ask if he could use the outlet. The manager said first he needed to buy something, so Abdul went back to the garage and spent 45 minutes trying to borrow money from friends who didn’t have any, until finally someone agreed to pay him $10 to rent his portable radio.
Abdul ran back to the store, bought a pack of cigarettes, plugged in his phone and waited almost an hour until it powered on. The display screen showed that it was just past noon. Abdul still needed to come up with $30, and he also had to find someone to guard his belongings in the garage while he took the trolley to the phone kiosk.
He spotted Henrietta walking down the street, wearing blush and long lashes. “Can you do me a favor?” Abdul asked. “Will you watch my stuff for an hour so it doesn’t get stolen?”
“Sure,” Henrietta said. “Give me 10 minutes. I’ll be right back.”
Abdul repacked his belongings into a corner of the garage and waited for 10 minutes, 30 minutes, almost an hour. “This is starting to get on my nerves,” he said. He searched through his belongings for his portable radio to play some music and then remembered he had rented it out. He smoked a dab of marijuana. He drank from a pint of vodka. He remembered that Laine wanted him to take his anti-anxiety medications when he could feel himself getting upset, so he unpacked all his belongings to search for his pillbox, found nothing, and repacked everything again. It was almost 3 p.m., and the phone kiosk would close in an hour.
“Hey, can you watch my stuff really quick?” Abdul asked another friend, whom he had revived after an overdose a few months earlier.
“Sorry,” the friend said. “I’m having a rough moment.”
“Who the hell ain’t?” Abdul said. Another dab. Another pull off the vodka. He hadn’t eaten in 12 hours or slept in two days, and he could feel his body getting numb and his thoughts becoming cloudy. He looked around for anyone else he could trust to watch his things. Eric was finally asleep on the sidewalk in the sun. Michelle was crying about her abusive boyfriend and pointing her baseball bat in the direction of cars as they drove by. Twenty yards down the sidewalk, a man was smoking fentanyl and nodding out of consciousness with his pants down at his knees. Abdul watched him fall off the curb into the street, and he went over to check on him. The man’s breathing was shallow and his face was starting to turn purple. Abdul thumped him in the chest several times until he was alert enough to sit up and then helped him back to the sidewalk.
“You all right?” Abdul said. The man looked at him but didn’t respond.
“Should I go get the fire department?” Abdul asked. The man shook his head. “Then get your act together,” Abdul said. “Stand up. Pull up your pants. I’m so sick of fixing all these broken toys.”
“Everything OK?” Michelle asked.
“No, it’s not OK!” Abdul shouted. “I’m nowhere close to feeling stable right now. I spent all day trying to get off this sidewalk and never made it 30 feet. This place is quicksand.”
She sat down next to him on the sidewalk and offered him half of her granola bar. They stayed there together until the kiosk closed and the sun dropped below the skyscrapers of downtown, and then they went back into the garage.
A few days later, Laine pulled up for her next appointment with Abdul and found the garage empty. Abdul’s belongings were piled in a corner, but he was nowhere in sight. “It’s not like him to just leave his stuff,” Laine said, so she started walking through the neighborhood to look for him. He wasn’t in the convenience store where he usually bought vodka or in the soup kitchen where he sometimes ate lunch. She spotted Michelle standing on a corner, smoking a cigarette in her nightgown.
“Any sign of Abdul?” Laine asked.
“Not since last night,” Michelle said. She joined Laine’s search, whistling and shouting Abdul’s name across downtown. He had disappeared from the garage before, and once Michelle had found him crawling in the middle of Fourth Avenue with a dislocated shoulder and a broken sternum after being hit by a car. Now she circled the block and saw an ambulance pulling over to the sidewalk where a man was passed out with his face against the ground. “Oh, no,” she said. She hurried closer and watched the paramedics lift the person onto a stretcher, until she could tell it wasn’t Abdul.
They kept searching until Laine was late for her next appointment. She gave her phone number to Michelle and squeezed her hand. “Call me when you see him,” she said.
“He’ll turn up and be fine, right?” Michelle asked.
“Probably,” Laine said. “I hope so.”
She got into a van with her colleagues and went to check on their other patients, almost all of whom were suffering from mental health conditions and substance abuse disorders. One was recovering from an overdose and said her blood still felt “thick like lavender.” Another was lying under a highway overpass and trying to pick imaginary parasites from her feet with a flat-head screwdriver. Laine called a prescription into the pharmacy and then checked her phone, wondering about Abdul.
She knew from her own family experience that the outcomes for a life on the street could be sudden and unpredictable. Her father had been homeless in San Diego for brief parts of her childhood as he suffered from alcoholism and an oxycodone addiction, but then he had managed to get sober with the help of a church and become the director of a street choir and a soup kitchen. Her uncle had been homeless at the same time, and despite stints in rehab and several family interventions, he had continued drinking until he died alone in a motel room at age 48. “Sometimes peace is knowing there’s an end to suffering,” Laine remembered a pastor saying at his funeral.
She parked the van and tried to help stabilize a patient who was throwing rocks into the freeway during a psychotic episode.
She parked again to treat a man with second-degree burns and open wounds on his feet. “How much are you drinking?” she asked. He thought about it for a moment and took a sip of his beer. “Profusely,” he said. “Nothing else takes away the pain.”
She drove from the East Village to the Second Avenue Bridge, passing row after row of tents. San Diego was building seven new shelters and opening four designated parking lots for people who slept in their cars, but each month more people were being priced out of one of America’s most expensive cities and becoming homeless than the number who were getting off the street. There were more than 1,900 people living on the sidewalks of downtown, triple the number from 2020, but what Laine found even more humbling than the scale of the crisis was the effort required to help just one of them.
Abdul was the first patient she had met when she started working at Healthcare in Action, and he had acted as her guide on the street, teaching her the vocabulary of fentanyl addiction and introducing her to other people who needed help. In return, she had spent hundreds of hours trying to untangle the mess of his daily life, but it was never enough. Her team had worked to secure placement for Abdul in a 90-day rehab program, but he left after three days. They got him an appointment with a specialist to check if he had colon cancer, but he fell asleep in the warmth of the waiting room and missed the appointment.
In the last few days, they had found a landlord who knew Abdul and was willing to overlook some of the paperwork and hand over the keys to a subsidized apartment, but Laine was already wondering how long it would last. Abdul had turned his last temporary shelter into a refuge for his homeless friends, collecting people and junk and then eventually rats in his apartment, until he was back outside again.
Laine parked the van, took out her phone and texted Michelle. “Did you find him yet?” she asked. She was walking into the Salvation Army shelter to see another patient when her phone rang.
“I’m with him,” Michelle said. “It’s not good.”
Abdul was sitting with a blanket over his head in the lobby of a family medical clinic, mumbling to himself, dry heaving and occasionally moaning in pain. Laine knelt beside him to take his blood pressure, and the machine showed a reading of 168 over 153. “That can’t be right,” she said. She had never seen hypertension that severe in any of her patients, so she restarted the machine and checked again: 165 over 152. “Dude, this is seriously not good,” she said. “How are you even managing right now?”
She put her arm around Abdul’s shoulder, and after a few seconds he opened his eyes and started to list off some of his symptoms: nausea, headache, dizziness, blurred vision in his right eye, partial paralysis in his hands, and numbness on the right side of his body. Laine called a physician assistant on her team to see if Abdul needed to go to the hospital, but first they decided to try giving him a series of medications. Laine handed him four aspirin and seven other pills. He chewed them down one at a time, and after a while his blood pressure started to come down.
“There’s something else we need to do while I’m here,” Laine said. She took out a medical form that she’d been thinking about since Abdul went missing. It was an advance directive for his medical care in case of an emergency, and she started reading him the questions.
“If something happened, would you want life support?” she asked. “CPR?”
“I’ve given it to people lots of times,” Abdul said. “So sure, I’d receive it.”
“How about a ventilator if you can’t breathe on your own?”
“Hmm,” he said. He was struggling to keep his eyes open. “If my mind’s still there, then yeah, OK. But give me some drugs.”
“Feeding tube?”
“That’s a hard one,” he said. He closed his eyes and leaned back against the chair. “I don’t know. Let me think about it.”
She waited for a minute as his head dropped toward his chest, and then she put her hand on his knee. “Are you thinking, or are you falling asleep?”
“I’m dreaming,” he said.
“About what?”
“Something nice — something other than dying,” he said. She watched him for another moment as his body relaxed and his breathing slowed, and then she quietly packed up her medical bag and put away the advance directive for another time. She expected that soon he would have a place to sleep inside, and maybe for at least a while, neither of them would have to worry quite as much about the garage, or the cold, or the rain, or the cars swinging by, or the psychotic episodes, or the falls, or the overdoses.
“Get some rest, and we’ll finish this later,” she whispered. She got up to leave, but then Abdul stirred and reached for her arm.
“I thought about it,” he said. “If there’s any way I can still be saved, please save me.”
Audio produced by Tally Abecassis.
