On the Front Line – A Case Manager’s Perspective

by Michael Gause on May 25, 2004

(Ed. Note: This is the first of a regular series on the inner workings of “supportive housing,” the chief strategy used by San Francisco and other cities to reduce homelessness)

Though I had only just begun working with Teddy, I was more than a little shocked and saddened when the hotel’s Property Manager came to my office on the first floor to report she had found Teddy dead. Almost fifteen minutes later, you can imagine my bewilderment (and my subsequent elation) when one of our maintenance men rushed to the front desk with a shout of, “Teddy’s alive, man! He ain’t dead!”

Such, I have learned, is the curious and always interesting nature of my job as a Case Manager for the Tenderloin Housing Clinic. A relative newbie to the field, I had been working a little more than two months onsite in the Seneca Hotel near the ever-eventful corner of Sixth Street and Market when Teddy (whose name I have changed for privacy reasons) had his resurrection. The bizarre twists and turns Teddy’s life took in just a few minutes are a great example of the interesting and rewarding aspects of a Case Manager’s daily work. You could say we’re on the front line of the battle with poverty and homelessness. You could also say we are witnesses to some of the more amazing and resourceful people you could meet.

Teddy, an African-American man in his late thirties, is a reflection of the general populace I encounter and work with each day. He came to San Francisco, like me, from the Carolinas. He spent time working on fishing boats in varying locales before ending up here. He still speaks with a slow, Southern drawl, and he carries an easy gentility that comes out when he smiles. Like any person transplanted from the South, he beamed instantly when he found out that we shared a common birthplace. “Well,” he said, “if you’re from the Carolinas, you’re all right with me.”

Teddy, like many others living in the SRO hotels in the Central City area, had a severe drinking problem. He is a quiet man who keeps to himself and could best be described as a functioning alcoholic. Teddy’s near-death experience occurred when he tried to stop drinking. The resulting withdrawal, and an infection, left Teddy in the comatose state our Property Manager found him in. After our maintenance man double-checked Teddy, he found that Teddy’s eyes, though rolled back in his head, were fluttering. The ensuing scene of myself, several other staff members, and firefighters all trying to get Teddy out of his room was partly absurd and partly nerve-wracking.

I’m glad to report that after several weeks in the hospital, Teddy is alive and well. I jokingly told him that he’s our own version of “Miracle on Sixth Street.” But it’s no miracle that Teddy is alive. He’s a prime of example of why supportive housing can sometimes work so well. Teddy’s support system in the hotel is like a trapeze artist’s net with a few extra layers added on the bottom. He has me, his case manager, whom he can come to with problems. If I’m not available, there are our building managers and desk clerks. In this case, no one had seen him for a few days, and several of us checked up on him before finding him unconscious.

Teddy is just one colorful character out of over two hundred in the hotel. There’s “Doc,” who alternately likes to be called The Prophet and who likes to regale me and the other case manager Colin with tales about Louis Farrakhan. There are people like one tenant who, if he is to be believed, has almost every city official on his cell phone. There are poets, hustlers, and flirts, and in just a few months, I feel as if I’ve only scratched the surface. Every hour or so in the building, Colin and I sit down for a few minutes to strategize and trade the most interesting stories we’ve heard in the last half hour. On the slow days, we visit the units of tenants we’re concerned about, but we’re rarely bored.

As another case manager told me, you can’t expect to change the world. A good part of the job is working to make sure people are stable. Every now and then, someone makes a major breakthrough with a new job, which is great. But the bottom line remains this: most of the people in these hotels have just had a few bad breaks. For Teddy, his bad break may end up being a good break. Either way, I’m only a few floors downstairs if he needs me.

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