By Jacob Taylor
In January of 2022, a case manager loads a gold minivan plastered with agency logos full of blankets, water bottles, handwarmers, cotton-free socks, thick gloves, coats, and loaves of bread with peanut butter and jelly. The mismatched plastic bins overflow onto the van’s stained floor. Some of the bins hold matching blankets or gloves, still new in their plastic, while others hold worn quilts and duvets passed down from grandparents, then donated by the unsentimental, the de-clutterers. The pair of outreach workers who normally drive this van left a stack of baby blankets in the trunk because the agency ran out of blankets large enough to cover an adult before the new donation of blankets came in for the state’s annual Point in Time count, a census for the homeless.
The case manager’s team of twenty-something-year-old outreach workers and case managers piles into the minivan—two in the front, two in the back mixed in with the crates of items—census tract in hand. They drive through the blocks of downtown Salt Lake City, stopping each time they see a lump on the grass: a body buried under a blanket, desperate to escape the cold, the frost icing the grass and crawling up the cotton blends that (attempt to) separate skin from biting decay.
After parking, the workers approach one man sleeping under a blanket and say, “Outreach; we have blankets and food!”
The man wakes up and cries out that he’s in pain.
The case manager lays a blanket over his other blankets and tries to give him a pair of socks and gloves, but the man is too cold to take them.
Another worker tells the man he probably has frostbite. “There are little ice crystals forming under your skin that are damaging your body,” she says. “You need to go to the hospital.”
The case manager can see that the thought of going to the hospital terrifies this man in his hesitation. He reminds the case manager of the woman who told them to have the shelter stop calling EMS for her when her seizures went on too long, or when she knocked her head on the way down. He reminds the case manager of the man who refused to go to the doctor to get a medical demographic form, the only document that could help him replace his social security card.
The case manager learns that the frostbitten man doesn’t have health insurance. They crouch down next to him. “Medicaid can cover three months of medical bills retroactively,” they say. He doesn’t think he qualifies. The case manager asks if he has any income. He doesn’t. “You qualify,” they say. “The hospital will help you apply once you’re admitted.”
A worker calls nonemergency dispatch, and a few minutes later, a fire truck, an ambulance, and several other vehicles pull up to the curb. A large fireman walks up, the flashing lights from the fire truck glaring red across his face. The other dozen EMS workers linger near their vehicles and watch. The case manager wonders why dispatch sent so many.
The workers tell the fireman that the man has frostbite.
“Which hospital do you want to go to?” the fireman asks the frostbitten man.
The frostbitten man reconsiders after seeing the fleet of vehicles, after hearing the aggression in the fireman’s voice.
The fireman grabs the man’s blanket, tightly bound around his feet, and tries to pull the blanket off. The frostbitten man cries out in pain, but the fireman just says, “Of course it hurts—your feet are frozen.” The fireman lifts one end of the blanket and tries to shake the frostbitten man’s legs out like a package of frozen burritos.
“Stop!” the frostbitten man says.
The fireman drops the legs. He asks again: “What hospital do you want to go to?”
“I don’t want to go to the hospital.”
“We take people to the hospital,” the fireman says. “That’s what we do. Are you denying medical care?” His annoyance rises into the dark winter air along with his breath.
“Yes!”
The fireman storms back to his truck, as if this whole time, his goal was to get the frostbitten man to say those words.
The team of outreach workers and case managers thank the other EMS workers for coming, and the trucks leave with their flashing lights as quickly as they came. The workers give the frostbitten man a set of supplies and move on to the next section of their census tract. The case manager counts the frostbitten man anonymously on the Point in Time survey, leaving all the questions unanswered except for the one about his living situation: “place not meant for habitation.” They do not know if he will be recounted or eliminated when the administrators (attempt to) weed out duplicates.
The case manager refuses to let the frostbitten man become (just) another number on a survey, so they remember his story.
(Maybe) when the owner of the realty firm the frostbitten man lies in front of arrives at eight in the morning, she finds him under his blankets. He makes her uncomfortable, but she can’t quite accept the fact that he makes her uncomfortable because he’s homeless. The owner thinks she’s a better person than that.
The frostbitten man hears her footsteps like he hears all footsteps: with tension in his neck and anxiety building in his gut. He doesn’t know what her footsteps bring.
The owner watches the frostbitten man while she works, through her window: waiting for the printer to spit out packets of multi-colored information, listening to the coffee drip from the machine she stole from her mother’s garage.
The owner asks her secretary if he’s seen the frostbitten man move.
“If you’re worried, why don’t you call someone?” he asks.
She drinks her coffee and leans against her office door. She knows she shouldn’t worry; she doesn’t feel like she belongs in real estate with this kind of social anxiety, her fear of confrontation. Her mother wonders, when she visits, how the owner made it this far on her own. “I’m not worried,” the owner says.
Her secretary laughs.
The owner shuts her door and stares out her window at the frostbitten man. She’s never called 911 before. She worries that the man might be dead, and she worries that he might just be asleep, and she worries that a customer might see him in front of her realty firm. But most of all, she worries that she’ll waste everyone’s time by calling (he’s probably fine, she thinks), so she doesn’t.
(Maybe) hormones flood the frostbitten man’s bloodstream as his body temperature drops below ninety-five degrees Fahrenheit after the handwarmers the outreach workers gave him die. Blood vessels constrict, and body heat abandons his outer extremities.
The man’s limbs shiver in damp clothing that sucks heat away faster than movement can replace it. His fetal posture stiffens, his muscles tense.
None of the frostbitten man’s bodily functions save him from the cold. His temperature drops to eighty, then sixty. He faints, then dies.
(Maybe) the fireman doesn’t think much about the frostbitten man after their encounter, and the only time he does is not actually spent thinking about the frostbitten man.
I take people to the hospital, he thinks.
He started saying that after the homeless shelter called EMS for a woman who seized but refused to go to the hospital; the staff knew she would refuse, but they called anyway after she hit her head on the way down. He and his team had strapped the seizing woman onto a stretcher and wheeled her out the front door as the staff and residents stared because even though EMTs visited the homeless shelter weekly (daily) it was still a thing to stare at. Halfway down the ramp, the woman stopped seizing and said, “Oh, no thank you—no thank you! Don’t take me to the hospital.” She knew of the thousands of dollars the ambulance, the emergency room, cost and did not trust Medicaid to cover the expense. (She feared the army of debt collectors the medical system employed.)
After he unstrapped her, she shuffled back up the ramp into the shelter. Before the fireman could put the stretcher back into the ambulance, a worker came out and asked if he could just look at her head, talk to her.
“We take people to hospitals,” he said.
Now, when the fireman thinks of the frostbitten man, he really thinks of the seizing woman and workers who call for ambulances and EMTs when no one wants to go to the hospital.
(Maybe) the G eats his triple decker peanut butter and jelly sandwich as he walks down the icy sidewalk in his worn-out tennis shoes. His hot breath glows in the yellow light of the streetlamps. He can see the green-gray toes of his new socks through the hole in the black mesh. The G feels so snazzy with his new coat and hat, but his shoes are throwing off his groove. Shoes are hard to find because if they’re too big or too small, they give a G blisters.
When the G sees the frostbitten man lying on the frosted grass, he notices the blanket on top is the same navy-blue blanket he got from the outreach workers earlier that morning. The G notices the way the food, gloves, and hat are just sitting next to the blanket, untouched. “Hey, G!” he says. “You alright?” The G takes another bite of his triple decker sandwich but stops and stares at the frostbitten man while he chews.
The frostbitten man shifts beneath the blankets but doesn’t answer. He doesn’t want to be awake right now, with the cold gnawing on his nerves.
“Those survey people leave you like this?” the G says. He sits on the curb next to the frostbitten man.
The frostbitten man moves what looks to the G like a head. “It’s so cold.”
“I’ll make you a sandwich,” the G says. He stuffs the rest of his own triple decker sandwich into his mouth and opens the jar of peanut butter the outreach workers left next to the frostbitten man. The nearly frozen peanut butter comes out in hard lumps, and the G worries he might break the plastic knife as he smashes it into the bread. The triple decker sandwich seems to sprout mountains and valleys by the time it’s finished. The puffy white-purple-red fingertips that reach out from underneath the blankets and take the sandwich surprise the G. The skin swells and cracks like a pastry. The G wonders how the fingers still move, if they still feel.
“Thanks,” the frostbitten man says.
“Sure, G.”
(Maybe) the owner of the realty firm asks her secretary where he thinks the frostbitten man came from.
(Maybe) he says, “I read that New York is bussing all of their homeless here, so they don’t have to deal with them.”
(Maybe) he says, “It’s tough out there.”
(Maybe) the owner rethinks her decision not to call 911. (Maybe) she goes outside to offer him some food. (Maybe) she asks him if he’s alright.
(Maybe) the owner’s secretary says, “Probably too lazy to keep a job.”
(Maybe) he says, “I bet he’s high.”
(Maybe) the owner calls the police to have him cited for loitering and removed from the premises, and the frostbitten man warms his flesh in the Salt Lake County jail after the citation goes to warrant.
(Maybe) as jagged ice crystals crawl up the frostbitten man’s feet, piercing his dehydrated cells, the loss of fingers, then hands—toes, then feet—grows surer.
The handwarmers the outreach workers gave the frostbitten man thaw the ice in his hands. Oxygenated blood rushes into his fingers, and they swell and blister with too much life to hold; the tattered cells can’t expand fast enough—and burst. Lipids and amino acids from fractured infrastructure seep into the blood stream, and the blue-gray fingers blister with blood.
Finally, when the handwarmers run out of warm—his fingers freeze again.
The fingers (might) stay attached to his hand for weeks (maybe months), decaying black and brittle like charcoal, before they fall off one by one. The discoloration spreads like infection through his flesh without a doctor to assess and amputate the cells that are already dead.
(Maybe) when the case manager asks (begs) the Bureau of Emergency Medical Services and Preparedness to incorporate trauma-informed care into its training and curriculum for Emergency Medical Technicians in a complaint—describing in detail the fireman’s aggression, how he tried to shake the frostbitten man’s legs out of his blanket, the way the other EMTs just stood back and watched (the way the case manager felt required to stand back and watch)—the administration connects the complaint back to the fireman.
The Bureau requests additional training, not just for the fireman, but for all the EMTs.
(Maybe) the fireman asks permission to examine the next frostbitten man’s body. He patiently, gently unwraps the next frostbitten man’s legs. He inspects the next frostbitten man’s frozen flesh with gloved hands in the light of the ambulance’s harsh LEDs. The fireman explains the next frostbitten man’s condition, the extent of the frostbite, so he can make an informed decision.
(Maybe) the other EMTs help the fireman lift the next frostbitten man onto the stretcher, and they take him to the hospital, where nurses warm his fingers and toes in lukewarm water while saline and painkillers flood his veins.