*Disclaimer: client name changed out of respect and confidentiality*

When you are an employee of AIDS Community Services, you acquire an aversion to ECMC for a number of reasons. ECMC’s Immunodeficiency Clinic, also known as “The Tunnel” (due to it’s unbecoming and borderline politically incorrect location in the basement) is the other HIV specialty care provider in town, besides our own Evergreen Health Services. Needless to say, there is no love lost between the two competing providers, and the world of HIV care in Western NY can sometimes feel like the Cold War. EHS/ Immuno Clinic beef aside, ECMC is where fucked up people go to get better or to die, plain and simple. I’m hard pressed to think of a reason why I was ever happy to visit ECMC; each horror I’ve witnessed has steadily been trumped by something even worse. Examples include: my best friend from childhood in a coma in the ICU after a car accident; speaking with a client’s family about hospice options as he lay unconscious and dying of liver failure; going to see a client only to be informed that he died a couple of hours ago and then paying my respects to his still- present corpse; witnessing a client in the Intensive Care Burn Unit because of a freak reaction from chemotherapy and HIV meds that caused his skin to peel off in sheets as he babbled and whimpered deliriously from pain and sedatives; those were the worst of the worst. The experience I want to talk about in this story deals with one of the first times I was ever exposed to something emotionally traumatic at that hospital. I randomly thought about this client today and realized that I’d forgotten all about him and this story; I wanted to write it down before I forgot completely because he’s since passed away and I feel I owe him something for making an impact on me.

We’ll call the main character in this story Phan; I met him while I was still an assistant case manager at ACS. Phan was a diminutive Laotian immigrant; tiny in stature, long wispy hair, heavily accented English, very soft spoken and effeminate. His mental state was a bit…fluid. Sometimes he would present as competent and able to care for himself, but others he was forgetful or confused. He constantly called the case manager that I worked with “Sherry” instead of “Cheryl,” no matter how many times we corrected him. Phan was also an alcoholic, which definitely contributed to a lot of these issues and was a major reason why he needed us in his life, to help him make positive decisions for himself.

The three of us who worked on the caseload: me, the case manager Cheryl, and the other assistant Roz, took turns assisting Phan with his service plan goals. This included badgering him about starting and staying on his HIV medications, occasionally getting him to his check-ups at ECMC, or making sure that his payee (the person who had control over his government checks, due to his diminished mental capacity) kept giving him enough money to pay the rent at the rooming house he lived in. Phan was always happy to see or hear from us and it was not an uncommon occurrence to walk into our waiting room and see him sitting there (most likely without an appointment because he NEVER showed up on the days we actually scheduled to meet with him), wanting to show us some mail or ask a question about his Medicaid. Phan was a little tiresome to deal with at times because of his high level of need but I knew that he honestly required it to stay on track, and he always made sure to thank me for anything I helped him with.

In a city’s poverty culture, Phan unfortunately presented a great target for predation: he was friendly, foreign, and blissfully ignorant to subtle nuances that might indicate trouble to a street-savvy person. The three of us on the CM Team had always feared that with his propensity to drink, Phan would end up putting himself in a vulnerable situation where he ended up getting hurt. One morning, I was in the office by myself when Cheryl came in, visibly flustered, carrying the newspaper. She showed me an article she just read about a robbery/ assault that had taken place the night before, in the same rooming house that Phan stayed in. It stated that during the night, one resident had broken into another’s room and attempted to burglarize it. The person woke up and when they tried to stop the intruder, they were overpowered and had their throat slashed with a box cutter. When the police and ambulances arrived, the victim was rushed to ECMC in critical condition. The article didn’t give any further details. The victim ended up being Phan.

After she showed me the article, Cheryl immediately called ECMC to find out the details; at this point, we didn’t even know if Phan was alive or dead. After a few frantic minutes, Cheryl learned that Phan had been in surgery that night and he was stabilized, but obviously in no condition to talk on the phone. Since I was in the office and Roz was out on another appointment, Cheryl asked if I could go to ECMC that afternoon and get some updates. I was terrified; this guy had literally JUST had his throat cut wide open and put back together! I knew that Phan was fond of me though, and visiting would show that he had the support of his case management team. I knew it was in my job description to do things like this. It was time to see if I had the fortitude to follow through for some one in need of a supporter in the face of a traumatic ordeal.

Armed with Phan’s room number, I rode ECMC’s elevator to the upper floors. The sterile, white walls of a hospital may as well be made of brick and mortar, lit by torches and smeared with human blood because when you step past the nurses station and down the hallway towards the room you’re looking for, you never know what you’ll see or hear from the others you pass. I decided that seeing my own attempted murder victim was enough and kept my eyes facing forward until I got to Phan’s room. I double checked, then triple checked (possibly quadruple checked) the room number and slowly entered. Phan’s small shape lay on the hospital bed, attached to a whirring breathing machine. He looked at me and smiled and waved. Of course, my eyes were immediately drawn to his neck, which for the most part was bandaged up. I peered in closer and realized that he hadn’t been so much stitched back together as clamped shut. A row of surgical staples marched out from beneath the gauze, around Phan’s throat, and up towards his ear; they looked positively savage as they held together pink, shredded pieces of flesh that didn’t quite make it under the wound dressing. I was more enthralled than repulsed, but Phan had another surprise for me. As he tried to greet me, wind whistled through a newly constructed hole in his neck; he grimaced and gently plugged the tracheotomy with his hand and said “hi, good to see you!” As I tried to keep my mind from exploding, I realized the surgeons had given Phan a tracheotomy as an easier way to breath while he was healing, and that in order for his vocal chords to work, he had to physically plug the hole in his neck. We talked slowly and haltingly so as not to tire him out, and I started to piece together what had happened that night: Phan apparently knew his attacker, he was a “friend” that Phan lent money to earlier. Phan then went to bed, but forgot to lock his door. The acquaintance turned out to be a drug addict with significant mental health issues; he barged back into Phan’s room, looking for more money. Phan barely had time to react before he was jumped on by his assailant and stabbed in the neck. I listened to Phan’s tale with morbid curiosity, then tried my best to encourage him and ask if he was comfortable. It was obvious he wasn’t leaving ECMC anytime soon, and I told him that Cheryl or Roz would be back up to see him within a few days. I wasn’t sure what else I could do and frankly, I needed to get out of there so I could process the whole experience. Phan was grateful that some one had come to check up on him; I told him I would see him soon and that I would let him rest. As I walked out of the hospital, I couldn’t keep a sardonic smile off of my face as I thought about what a truly bizarre chain of events had occurred that day.

Phan eventually recovered from his ordeal, but then moved into an assisted living facility that required he drop our case management services to pick up their nursing ones, seeing as though his injuries and HIV would keep him relatively bed-ridden for a good while. We learned through the grape vine over the course of a year that he’d been able to move out of the facility and into his own place on the west side. He surprised us by coming into the building once after that, but I don’t think he ever re-linked with case management . Phan died of a heart attack in winter 2009. He was in his early 50s. I’m glad I was reminded of him because he was a character that I never want to forget. He had a hard life and surely deserves more than a case closure file buried somewhere in a stack of cabinets; I can at least give him this story. I think it helps people who choose this profession to talk about clients who have died; it keeps their memories alive and it makes you reflect on how you made an actual, tangible difference in the life of another human being.