A public health emergency | Guest editorial

A homeless woman died in January in Kirkland, three months before the groundbreaking of the permanent women’s shelter.

By Cynthia Brown

Special to the Reporter

“I shall be loyal to my work and devoted towards the welfare of those committed to my care.”

That is the last line of the original Nightingale Pledge, created by a public health advocate in 1893 to both honor Florence Nightingale and serve as a statement of ethics and principles to guide the nursing profession. That principle guided my 20-year nursing career and my work now with those experiencing homelessness.

Six years ago, my younger sister had a ruptured cerebral aneurysm. She had no symptoms and no predisposing factors. There was no way to predict its occurrence and nothing we could have done to prevent it. We were powerless. Aid, however, was rendered with amazing speed. Colleagues, first responders and her medical team were “all in” and did everything within their power to care for her. There was tacit agreement amongst them that her survival was the priority. No one debated the cost or the “what next” if their initial interventions proved unsuccessful. No one cited past failures in stroke interventions as a means of deciding how much or what kind of aid to render. There was no meeting to discuss the complicated allocation of health care dollars and competing health care or funding priorities. My sister got the very best care with no caveats nor conditions. She was deemed worth saving. Eight out of 10 people who experience cerebral aneurysm die before they get to a hospital or while in surgery. Those are terrible odds. My sister survived.

I tell my sister’s story to highlight the success with which we can respond to emergencies when they are both viewed as and acted upon as a priority. In 2015, Seattle’s mayor and the King County executive declared homelessness a state of emergency. On Jan. 12, the body of a woman was found in Kirkland. Three years into our state of emergency, she died alone on the ground. She died because she was outside in almost freezing temperatures overnight. She died because she was homeless.

So many facets of this narrative are troubling. The woman was found wearing a hospital bracelet, which indicates that someone was aware that she had a need. Perhaps the reason she sought care was to be in a warm place for a few hours. Perhaps she left against medical advice or refused the care that was offered. Perhaps she was offered no care at all. The only thing that matters is that a woman froze to death, on a city street in a very affluent part of this county, three years after we agreed that this situation was no longer acceptable by declaring a state of emergency. It can take hours to die of hypothermia; it is not a pleasant transition from life to death. I am not ok with that. What makes her situation even more tragic is that no one knows her name. She may have family somewhere and they do not even know that she is dead. My grief for her is visceral.

Homelessness is a preventable public health emergency. The American Public Health Association’s website states, “those of us working in public health try to prevent people from getting sick or injured in the first place.” I dedicated the first 18 years of my career in King County to preventative health care. Dying of hypothermia is completely and irrefutably preventable. A woman’s medical emergency and subsequent fatality was completely preventable. This is what troubles me the most.

Her death should not be in vain. It should be a rallying cry for all of us committed to this work. The public health response to her senseless and preventable death should be as robust as our response to the latest measles outbreak. This woman’s public health emergency started the moment she lost her home and ended the day she froze to death on a city street. Unlike my sister, this woman’s intervention was not nearly as complicated as the multiple brain surgeries that she endured. This woman simply needed to be inside. There have not been effective and efficient responses to prevent this type of tragedy. There was no “all-in” response to render her aid. Her needs were not prioritized and she did not get our very best care. Not acting effectively in a prevention effort makes us complicit, not powerless. We, by no means, are powerless. We are hesitant. We put up barriers. We protect our own interests.

As I look around our emergency shelter — a place with 24/7 need and far less than 24/7 public funding — I wonder, who will die, alone and unwanted, next. Will it be the woman whose mental health issues are so severe that the voices will prevent her from seeking shelter or being able to remain in shelter? Will it be the woman who is wheelchair dependent and has asked my team to be her end-of-life surrogate decision-maker in the event of an emergency? How about the young mom who desperately wants her children back but is caught in the cycle of addiction, inpatient detox, no recovery beds and discharge to the street, only to start that cycle all over again? Could it be the 82-year-old woman who has now fallen twice in seven days while attempting to get up from her sleeping mat on the floor?

Without full public financial and systems support, and the professional clinically trained staff that is required given the escalating needs of the women we serve, my team is unable to have housing and goal-driven conversations. We spend our days caring for the ill and disabled, monitoring dope sickness, deescalating psychosis, and preparing to cope with the grief of another loss.

There is currently a five-hour gap in the service that we are financially unable to provide. We also close our emergency shelter for several months of the year because 12-month funding is not our reality. We who provide shelter are charged with providing this life-saving service — with limitations. The irony is sobering. We have the unpleasant job of deciding which months of the year or hours of the day are acceptable for a woman to be unsheltered. That gap could mean life or death for someone.

It already has in January on a street in Kirkland where I now stand memorializing the place where a woman died. Until homelessness is given the same priority and the “all-in” response as with any other public health crisis or state of emergency, we, providing this fragmented service, will be left to identify the bodies.

Cynthia Brown is the director of emergency services at The Sophia Way, a Bellevue-based nonprofit that works with homeless women, providing them with shelter, social services and permanent housing support. The Sophia Way will be one of the occupants of the upcoming permanent women’s shelter in Kirkland, which broke ground on April 10.