October 18, 2005
There is no such thing as skid row disease. But if there were, Lonnie Whitaker, 49, would have it bad. He hobbles into the office of Dr. Dennis Bleakley, lowers himself onto a chair and goes through the long list of what ails him.
He has seizures, tested positive for TB, had hepatitis that might have been from a used needle, just got out of prison, hears voices and can barely walk.
"From my hips all the way down to my feet, it's like it don't wanna wake up," Whitaker says, telling the doctor he was in a car accident four years ago and was initially diagnosed as paraplegic. Until recently, he used a wheelchair.
It's a grim list, but nothing Bleakley, 63, hasn't heard a hundred times.
He took this job five years ago, his 10th as a doctor. He had experience. He had options. And still he came here to 6th and San Pedro's JWCH Medical Clinic, where the small-town boy from Pennsylvania thinks of himself as a family doctor.
On Monday, he arrives before the rain, but not before his patients. A line forms outside the clinic, at the Weingart Center, as he approaches in a raincoat and sneakers, walking east on 6th Street.
He knows what he's in for. Anyone who's bottomed out on skid row is at high risk of nasty diseases — tuberculosis, hepatitis, HIV to name a few.
And a lot of his patients have been neglected for so long, they're looking for more than just medical attention.
"You know, one of the hardest things for me is to express myself," Whitaker says, telling Bleakley he has spent nearly his entire life — from the age of 10 — in juvenile detention and prison.
"I can't read. Can't write. That's something I just don't tell people. To get a job, at 50 years old, what am I gonna do? I don't wanna go back to prison. But being on the streets, I've got to do something to take care of myself."
The good news is that Whitaker is in a residential recuperation program at JWCH. Bleakley examines him, chats some more and orders a round of lab work. At least the guy's got a place to stay.
Skid row, Bleakley says, is "the lower depths," the place that gives a face to all the problems society has shoved into a dark and seedy corner. Policymakers should be ashamed and good citizens shocked at the amount of preventable disease that festers on the streets and spills into the clinic. And one thing that really bothers Bleakley is that addiction, a killer disease, is treated as a moral choice.
Three-fourths of his clients are addicted, half are mentally ill, the majority are African American. Bleakley doesn't expect a national policy debate any time soon.
He's here in part because nobody cares, and compassion was one of the first principles drilled into him at Case Western Reserve University, his Cleveland medical school.
He's here because he likes the patients. Most of them don't self-diagnose on Google or invent diseases they don't have. They stream in, 100 or so each day, to see Bleakley and two other doctors. They come without insurance or money and often say thanks on the way out.
"He gives them dignity," says Christopher Mack, who walks me out the door of the clinic and into the streets on his daily mission of outreach. "Dr. Bleakley is top of the line," he says, looking dapper in black leather jacket and braids, four sets of beads around his neck. "TOP of the line."
Part of Mack's job is to chase after skid row patients whose tests come back positive or whose meds have come in. He knows what corner to find someone on or what bridge to look under. Today, with rain clouds threatening, Mack is rounding up clients who are high risk for HIV, signing them up for a prevention class.
Mack waves and hugs his way down the street, a long, slow process.
I ask how he knows so many people here.
"I was one of them," he says.
We turn the corner onto San Julian Street, one of skid row's many outdoor drug parlors. At a drop-in center, he finds a shriveled 51-year-old man named Anton "Tony" Montgomery, who appears to be at death's door. He's got AIDS. He can't breathe.
"Right now I'm so weak," he says with eyes that remind me of the woman I watched die just the other day, a woman who was scooped off this very street.
"His T-cells are gone," Mack says, telling Montgomery he's got to take care of himself.
A 23-year-old woman recognizes Mack and rushes toward him, eager to answer his HIV-risk questionnaire. Yes, Nicole says, she's had sex recently, and suicidal tendencies and thoughts, and she smoked crack last night.
Mack asks how much.
"Too much and not enough," she says, drifting into incoherent scats before fluttering away like a frightened butterfly.
Back on the street, a barefoot woman rolls around on the pavement, wrestling demons in a death match. She sits up in mortal agony, her body caked with filth, her breasts exposed.
"It's poison," Mack says of the crack that devours these people. "It's not no cocaine the way it used to be." The way it was when he was hooked. You used to get it in powder form and rock it with baking soda, he says. It wasn't this pre-rocked stuff that's out here now. Who knows where it's from or what it's got in it?
"I smoked cocaine from 1979 to 2000," Mack tells me on 7th Street, and I understand his true value to this mission.
People here don't see just Christopher Mack the outreach worker. He's Christopher Mack the former addict who picked himself up and made it. For everyone out here, he's the hope.
"They had me dead to rights," Mack says of the event that turned him around. He was caught in Inglewood, picked up with cocaine on him. It was a second offense, and he was looking at five years in jail when he had a spiritual reckoning.
He heard a voice: "Someone told me, 'You won't see one day in prison.' I been clean and sober ever since."
It's just people out here, he says, wiping away tears. People who got hooked the way he did.
We make a turn and come upon the place where he last saw his brother, an addict, not too many months ago.
"He had just taken a blast. I hugged him and he called me his angel. He died in MacArthur Park three weeks later."
We walk another block and duck into an Alcoholics Anonymous meeting, 40 people gathered around a table and ready to go cold turkey. Mack introduces a recovering friend who's now helping others out of addiction.
"He's a part of my hope," Mack says.
"How are you?" a woman asks, walking past him.
"Blessed," Mack says. "And you?"
When we get back to the clinic, Bleakley has been through several cases of diabetes and high blood pressure. He's treated a man with a tooth so badly abscessed his face was the size of a pumpkin. I see a tall thin woman leave his office and ask what her condition is.
"Schizophrenic, TB-positive," he says. "The usual."
Lonnie Whitaker, his first patient of the day, has had another setback. He's been asked to leave the residential program. I see him limping toward the street with his belongings in a sack, and he tells me he was kicked out for accidentally lighting a piece of tissue with a cigarette. (The staff later explains it a little differently.)
"Can you help me?" Whitaker asks. "I got nowhere to stay."
I send him across the street to the Midnight Mission.
Bleakley, meanwhile, is whittling down the waiting room crowd.
It may be that 85% are doomed, he says, but if you can save 15%, what's wrong with that?
"If you can save even one," he says.
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