Lost in the Crowd
This week I find myself in Las Vegas to attend the HIMSS 2021 conference that was postponed from the beginning of the pandemic and it has been an interesting experience. There are so many elements of deja vu in the run-up arriving at the 2020 conference that I had advice to offer for those who were planning on attending (ultimately it was canceled pretty late in the day).
Many things went into my personal decision to attend or not and I must have kept this pretty much to myself as several people were surprised to see me there as they thought I was not coming. I have certainly been on the receiving end of social media wrath in the past as I talked about in my post on Listening and Tolerance and press hard for everyone to try to walk a day in the shoes of others before passing judgment with some talking about the negative commentary and social media shaming they have received for attending.
But here I am, experiencing a very different show that took place right as the country fell under another tide of rising cases driven by the highly transmissible Delta variant. As one attendee put it to me today – there is nothing to complain about, we should all be glad for the opportunity to meet face to face, having lived through a difficult year of isolation. I agree. I’m grateful to have the opportunity to interact with people in person. I’m wearing a mask, which creates a different interaction but we still get to talk and exchange thoughts and ideas with individuals, some of whom I have not seen in many months and in some cases years – what a treat.
Vegas Oh Vegas
Don’t look down
This city is jarring to my sensibilities. I visited it many years before coming to live full time in the United States, at a time when the place was quite different but still filled with the full range of people from the excess to the fully disenfranchised. It is hard to remember if it had always had the level of homelessness and street people but that is a recurring theme from most of my recent visits in the last several years but this year seemed different. There seemed many more, mostly males but some women too. Some appeared to be ‘just’ homeless living on the street with nowhere to go but so many appeared living in a different reality, talking to invisible people, repeating actions, and interacting with an imaginary world that bore no resemblance to the world I was in.
Here we are at a healthcare conference concerned with trying to right the ship of healthcare delivery yet everywhere you look there are people who are clearly being failed by the system. A system that years ago in the United Kingdom elected to close what facilities were available and put these vulnerable individuals on the street. The same took place here in the US and our support services consist of street living with people scratching out an existence in 100-degree weather, fishing out food scraps from trash bins, and begging for money from the waves of people walking by who are so uncomfortable they block their existence out making them appear invisible. Out of one eye, there’s wealth and excess, out of the other are people who are not only down on their luck, lacking lucidity but witnessing their fellow humans walking by seemingly unable to see their plight.
I took my daily exercise heading north on Las Vegas Boulevard and saw a 20 something man shouting into the air in some confrontation. A confrontation taking place in his mind as there was no one nearby. His voice carried and he was filled with anger and resentment. I continued walking expecting him to head to one side, and like others, I had seen many times before to fade into the backdrop of squalor and detritus as his imaginary conversation continued. But this day was different.
Somewhere his reality intersected with mine and he started to focus on me and direct his attention and anger my way. As I watched him all I could think was this was someone’s son. Somewhere there was a mother and father who had raised this young man from a baby. How had he reached this point in life. What happened that put him on the street. What was going on in his world. What was he seeing, who did he think he was talking to?
As I got nearer he continued to bear down towards me and shouting all the while. He never stopped, arrived quicker than I expected, swinging his fists and hitting me in the chest and arms and pushing me backward towards the concrete barrier that was along the sidewalk preventing pedestrians from stepping onto the road which was under repair with resurfacing work.
I stepped back, protecting my face and blocking his wild swings. There were not a lot of places to go. In my mind, I had expected to sidestep him and keep on walking but he had other ideas. Somewhere I was encroaching on his reality and was his enemy to be stopped and pushed back. As I retreated several of the road crew came running from both directions shouting, distracting him and he turned his attention to them screaming at them to get away. With the focus away from me I was able to move back and he screamed at the crowd and then took off in the other direction.
Well-Meaning Help
And just like that, it was over.
The road crew was very helpful and wanted to make sure I was OK. It was nice to see many people jump into action to be helpful. They wanted to call the police but I told them there was no need, all the while thinking that this was the last thing this individual needed. What he required was trained supportive services and help.
But that’s not what we have. I walked back, troubled and sad. He was someone’s son.
How does a country with the resources we have fail people so badly? What opportunities for intervention and support existed before he got to that point. There have been solutions – the Oakland region took a stance, created housing for the homeless with no strings, and created a pathway for people to get back on their feet.
It starts without the judgment of the individual. It starts with seeing the problem and acknowledging it. It starts with refusing to accept the status quo for the current circumstance and a belief that we all need to be part of the solution.
None of this is simple, but the current circumstance is not acceptable. Brain health is declining in this country and the world. COVID19 has made things worse and we need, now more than ever, to take care of our fellow human beings.
Your incremental step is to notice what’s around, soak in the reality of the world around you. Don’t accept the status quo and ask yourself if what you are seeing is OK. If it is not, ask yourself what you can do to change it. Talk with others, together we can find solutions but it starts with speaking the truth to what is happening around you.
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Joseph I Bormel On August 21, 2021 at 8:44 am
Nick,
Thank you for sharing this experience. What started off as a tale of two cities, HIMSS and HOMELESSNESS, evolved to surfacing the existence of mental health.
All of us have experienced effective mental distress in the form of depression and anxiety. We have wonderful language like ‘sub-clinical’ or not interfering with activities of daily living (here including self-care as well as ‘healthy’ amounts of occupational and social activity.)
What you were describing was psychotic, rather than affective mental health, and most commonly manifest in 1 % of the population as chronic paranoid schizophrenia. (https://www.uptodate.com/contents/schizophrenia-in-adults-epidemiology-and-pathogenesis). I was the brother to one such person afflicted with this condition. My dad was able to create and maintain a safe ‘home’ for my sibling, unlike the gentleman in your shared experience.
In terms of incremental changes, I was informed over lunch yesterday that in some places (in this case, Dallas TX), shelter directors have empty beds that, if utilized, could reduce homelessness and improve access to services. Closing that gap starts with Quality Measurement and continues with Quality Improvement. There were a few fantastic presentations at HIMSS, in those air-conditioned meeting rooms as well as virtually, that demonstrated improvements on the Quality Measurement side. Thanks incrementalism in the right direction. It’s still difficult or impossible to measure or conduct surveillance from most healthcare records.