The Things They Left Behind

More March 2016 coverThe Things They Left Behind

“WOW,” I would hear from people who hadn’t been to my house in a while, “the place looks… different.” “Of course,” I’d answer. “That’s because we’re now the museum of dead people.”

The line was a cheap shocker, sure, but also the truth. Every room in the house my husband and I had owned for more than a decade contained dozens of items that were ours only because their owners had died. My bitter undertone was honest, too. I wanted what I inherited, and I felt lucky to get it, but sometimes it felt less that I owned these things than that I bore them, like a weight.

From 2006 to 2011, one by one, everyone went: my husband’s mother, then his father, then my aunt and my mother. (My father had died years before.) The last years of their lives were an extended, painful decline—cancer, lung disease, dementia, loneliness, fear. We (mostly me) served as long-distance caregivers, and the experience left a bleak, grinding sadness; I learned about the reality of aging in a way I wish I hadn’t. The deaths, more tangibly, brought a lot of stuff. All our relatives had lived in well-furnished homes, and except when it came to my mother, we were the sole heirs. We sold the houses—in Fort Worth, San Diego County, upstate New York—and sold, gave away or threw out a lot. But much of what I saw filled me with longing. I stood in the dismantled rooms, pointing: I want that. That, that, that.

Across the miles, loaded trucks rumbled to our Los Angeles house, bringing from my Aunt Clarice a collection of 1960s abstract art, old cookbooks and knives, heavy saute pans, Waterford hurricane lamps, vintage wool blankets and a 1960s KitchenAid stand mixer, as heavy and solidly built as an old Buick. From my in-laws, Jo and Bill, we got dining room and bedroom sets, antique mirrors and a staggering extravagance of old sterling, china, crystal and cut glass. From my mother, Gloria, I took a couch, a wall storage unit, the 1950s Swedish blonde wood hutch, a table and a bedroom set that I’d loathed through childhood for its spare lines but now saw as Mad Men cool. Plus dozens of 1940s books with teeny-tiny print, a set of avocado-green Pyrex casseroles, boxes and boxes of crumbling photo albums and ancient diplomas and birth certificates.

Behind my greed was a logic. Clarice’s paintings filled many of our previously empty walls; my in-laws’ immaculate furniture replaced our embarrassing secondhand funk. We actually needed Gloria’s Mad Men bedroom set for the guest room, where there had never been a place for guests to put their clothes. All the kitchen items were serviceable, so why waste them? The photos and documents were family history. You don’t just toss such things in a Dumpster. And yet: I hadn’t foreseen the heaviness of it all. I’m not talking about literally feeling buried, though sometimes I did in my small home office, jammed to bursting with my old desk and file cabinets augmented by my mother’s Swedish hutch and end table, a chair from her den, my father’s 1935 handball trophies and a huge chinoiserie lamp. (Of course, nothing matched.)

What haunted me were the shadows. I’d spent so many hours in my relatives’ homes over the years, visiting when I was young, caregiving later on, when the knowledge that time was running out gave a luminous density to all that was said and done. Things from those places carried the memory of where they used to be, ghost images that rose unpredictably to throw me out of time. I’d open a drawer for one of Jo’s forks and suddenly see them in her yellow-and-white kitchen; I’d look at Clarice’s mixer and see it on her counter. I’d reach into one of my parents’ night-stands and catch a smell I recalled from childhood, and for a second felt I could look down to see my father’s carefully folded undershirts.

The old places, evoked, made the people rise so vividly, it was as if they were in the next room. The realization that they weren’t, and wouldn’t ever be, would hit like a slugto the gut, as if I’d only just heard the news. Living among other people’s things means you never stop thinking about them.

Ah. What I didn’t get when I booked those moving vans was that holding on had always been the real point. The unexpected blessing of caring for the old is how deeply you come to know them. The endless hours you spend listening to their stories creates an intimacy very much like that of early romantic love. You lean forward, begging, More, please. Who were you before I met you? Tell me what you know and have seen, who you are. In that intimacy, my relatives were transformed for me, their inner selves risingfrom their failing bodies, revealed in all their singular power.

Until you lose someone that close to you, you don’t understand the meaning of gone, and until you empty their cupboards and drawers, you don’t grasp how easily every physical trace of a life can be erased. When I grabbed what remained, I was seeking talismans, magic objects to stave off the disappearance. The battered dictionary my mother got as a gift in 1937, just before she became the first in her family to go to college, contained her, poor and ambitious and 17. A collection of figurines from Mexico, Europe and Africa held Clarice, traveling far and alone in the 1950s, when women just didn’t do such things. All that I kept, the diplomas, the photos, the perfume bottles, an ormolu jewelry box and the battered strainer my mother used to serve peas, carried a force field of human desire, decades of struggle and triumph, children born, journeys made, moments that I couldn’t bear—that I wouldn’t allow—to vanish on the wind.

Four years since the last death, I’ve learned that with their exile from life’s flow and change, the dead recede, whether you want them to or not. To live in the present, you have to turn away. I now keep Clarice’s mixer out of sight in a cabinet, have had Jo’s dining chairs reuphol-stered, have stashed boxes of paper in the attic. I let the dogs sleep on my mother’s couch—she’d die if she weren’t already dead.

Loosening my grip isn’t the same as letting go. I’ve given nothing away. At Christmas, I summon Jo’s thin, blue-veined hand to hover over the cut-glass bowl of cranberry sauce, listen for the whisper of Clarice’s cigarette-hoarse voice when I use her chefs knife. My parents’ nightstand drawers still have that distinctive scent, and sometimes I lean down to smell it—for the painful comfort of feeling them near.

The dead always cast shadows; the challenge of midlife, when their numbers accumulate, is to see them and yet face forward, so they fall behind. The act is its own kind of faithfulness: to what and who was, and to whatever comes next.

The Veterinarian Brings His Healing Presence to Pets of the Unhoused

 

 

The man standing outside the tent on Skid Row in downtown Los Angeles clearly doesn’t live in the neighborhood. Tall and fit, he’s dressed in jeans and a doctor’s blue scrub shirt and carries a medical bag. The tent, one of many rough structures on the stained sidewalk, sits amid heaped wooden pallets, old furniture and trash. But the man’s eyes are fixed on the dog lounging nearby.

“Hi, how are you?” he says when the tent flap opens. “I’m a veterinarian, Dr. Kwane Stewart, and I offer free pet care to people experiencing homelessness.” He gestures at the dog. “Can I examine your pet?” 

First comes confused silence—you’re who?—then suspicion: Is this animal control, here to take my dog? Finally, a slow nod. Stewart, who calls himself the Street Vet, kneels, pulls out his stethoscope and goes to work.

These Skid Row streets hold the nation’s largest concentration of homeless people who are not staying in a shelter, and at first glance it’s an unrelieved landscape of despair: mental illness, poverty, addiction. But love exists, too, including the love of pets. Across the nation, 10 to 25 percent of the people who are homeless keep pets, and there’s no reason to think the number is lower in sunny Los Angeles. Cats sit on sleeping bags, pit bulls, scruffy terriers and mutts trot alongside filled shopping carts, and chihuahuas ride in bicycle baskets and the laps of people who themselves are in wheelchairs. Various local groups and volunteers help the owners of these animals care for them, with weekly and monthly clinics, mobile spay and neuter vans, handouts of flea meds and food. 

Stewart, 50, has usually worked solo, walking the streets and looking for animals and people in need. “Maybe it’s because when I began this work, it wasn’t uncommon to find a pet that had never received care,” he says. “Everyone I met looked at me as if I’d just dropped out of the sky.”

Stewart grew up with dogs, loved them and science, and by the time he was 10 knew he would become a veterinarian. It was an unusual ambition for a Black track star in Albuquerque. Once, a coach asked about his future plans and laughed with disbelief when Kwane told him. “I’ve never met a Black vet,” the coach said. Stewart goes on, “At the time I didn’t think much about it. But here’s the thing: He was Black himself.” Decades later the number of African American veterinarians is still so small the Bureau of Labor Statistics has reported that it might as well be zero. 

Stewart graduated from the University of New Mexico, got his DVM degree from Colorado State University College of Veterinary Medicine and Biomedical Sciences, and headed to San Diego. He spent a decade there treating a suburban clientele with “bottomless bank accounts.” Then, in 2008, he relocated to Modesto, in California’s Central Valley, for a job as the veterinarian for Stanislaus County. And everything changed. 

The Great Recession flattened Modesto, a city of around 200,000, with plummeting home prices and 17 percent unemployment. And when humans go broke, animals often pay the price. Pet surrenders surged until the area’s aging shelter, built for 200 animals, held twice as many, and its euthanasia rate became one of the nation’s highest.

“I was destroying 30 to 50 animals every morning,” Stewart says softly. “Healthy dogs and cats. It was killing my soul. I felt like God was keeping score and I was losing. I didn’t go to school all those years to destroy animals. I wanted to help and save them.”

At first that meant he helped a homeless man he encountered almost daily by treating the man’s dog, which suffered from a bad flea bite allergy. Then he held a free clinic at a local soup kitchen. And then, on his own time, he began to walk around Modesto and some Bay Area sites looking for pets to help. He moved to Los Angeles to serve as chief veterinary officer for the American Humane Association, which makes sure animals are treated well on film sets, and his ramblings shifted to San Diego and Los Angeles. He wore scrubs to identify himself, carried a bag filled with meds, vaccines and syringes, nail trimmers, and he did what he could, free of charge. 

He was stunned by what he found. Like many people, he questioned why homeless people had animals to begin with—if humans couldn’t take care of themselves, how could they be responsible for pets? And yet they were. In fact, numerous academic studies over the years have revealed the vital role pets play in the lives of unhoused men and women—providing structure, purpose, meaning and love. “Researchers have consistently found very high levels of attachments to pets among the homeless,” Leslie Irvine, a sociologist, writes in her 2012 book about the phenomenon, My Dog Always Eats First.

Stewart agrees. “Pets were a lifeline to the people I met,” he says. “Most of them were great pet owners. They did remarkably well with the resources they had, and made sacrifices for them well beyond what you or I would. The bond between them was on a completely different level. They needed each other.”

 

For five years, his efforts were a kind of secret hobby that he says even his family—he has three children—didn’t know about. Then, in 2017, he and his brother, Ian, produced “The Street Vet” as a reality TV series­—it has aired on broadcast TV in Scandinavia and Eastern Europe and in the States on a Utah cable channel­—and Stewart acknowledges he’s now a “media personality.” These days he’s founding a new veterinary practice in San Diego and writing a book about his experiences on the street.

Last September he started a nonprofit, Project StreetVet, raising money on GoFundMe to cover the cost of treating pet medical problems beyond the scope of a sidewalk exam. He has occasionally volunteered with larger organizations assisting people who are homeless. Though he says “there are probably more efficient ways I could spend my time,” he likes doing it his way. 

“The wound is healing well,” he reassures a man named Ben, whose pet rat had been attacked by a cat. (“I’ve seen birds and snakes, but this was my first rat.”)

“The puppies look great,” he tells Julian, a tattooed man who has lived on the same stretch of pavement for two years and whose dog recently gave birth. (He also vaccinates the pups.) 

Stewart marvels at the generosity of a young man named Reggie, who lives in a school bus and uses his own cash to make lemonade that he gives away to his neighbors. Stewart vaccinates the man’s dog, Daisy. “You’re doing a good job,” Stewart says.

“Oh, this is such a blessing,” the young man replies. 

Most Americans Have Pets. Almost One Third Can’t Afford Their Vet Care

Since mid-2020, more than a thousand low-income families have brought their sick and suffering pets to the nonprofit Pet Support Space, housed in a tiny Los Angeles storefront. One 14-year-old dog had a tumor that a veterinarian had quoted $5,000 to remove. A four-year-old pit bull had been vomiting for days, a cat’s painful bladder stones required surgery, a pug limped from the foxtail embedded in its paw. Skin and ear infections abounded. Neither the animals’ problems nor their owners’ inability to afford help for them was a surprise.

recent nationwide study found almost 28 percent of households with pets experienced barriers to veterinary care, with finances being the most common reason. In low-income households, the researchers found, financial and housing insecurity can increase the risks that animals will not receive the care they need. Sociologist Arnold Arluke, author of Underdogs: Pets, People and Poverty estimates that 66 percent of pets in poverty have never seen a vet at all.

The “why” behind those numbers is complex. Of course, money is the primary problem. Veterinary care is expensive. A majority of practitioners work in for-profit clinics, consolidation in the industry has increased emphasis on profit margins, and vet prices have risen faster than the overall rate of inflation. That has checkups starting at $50, dental cleaning going for $70-$400, and blood work and x-rays at $80-$250. If a dog breaks a leg or eats a sock, surgery costs begin at four figures.

High prices aren’t necessarily about greed. Michael Blackwell, a former Deputy Director of the Center for Veterinary Medicine at the FDA, is the chair of the Access to Veterinary Care Coalition (AVCC) that was formed in 2016 to study this very problem. Veterinary training, he said, teaches vets to practice a “gold standard” of care, which means running every possible diagnostic test and pursuing every treatment option, even when a client’s budget is limited. (Many pet owners don’t know they can decline a recommended procedure, such as blood work, and even fewer are willing to decline care for fear of looking heartless.)

Some private vets offer struggling clients discounts, added Jeremy Prupas, DVM, Chief Veterinarian for the City of Los Angeles, but they themselves carry an average of $150,000 in student loan debt, so they simply “can’t carry the immense existing need on their own.” Telling clients you can’t help them because they have no money is one of the leading causes of burnout in the veterinary profession, according to Prupas. Pet insurance might help defray costs but requires monthly premiums and comes with such a complicated array of deductibles, co-pays, caps, and exclusions that one how-to guide recommends hiring an attorney to review the policy. Credit cards designed for medical care financing, if one can qualify, can carry punishing interest rates as high as 26.99 percent.

Equally critical is a long-term failure on the part of the animal welfare movement to consider, much less prioritize, the needs of low-income pet owners. Since the 1990s, the rescue/humane world has poured vast amounts of funding and energy into cutting shelter euthanasia through adoption, but far less into helping those without money take care of the pets they have. “If you can’t afford an animal,” the thinking went, “then you shouldn’t have one.”

“Until recently, we focused on shelter-centric challenges,” acknowledged Amanda Arrington, senior director of the Humane Society of the United States’s Pets for Life Program, which assists low-income pet owners. “There was a lot of judgment and making determinations on who was or wasn’t deserving of support and resources that was influenced by what I think a lot of society is influenced by, which is classism and racism. We conflated a lack of financial means and access with how much someone loves their pet or desires to care for it.”

In fact, owners can be punished because they can’t afford veterinary care — “most humane neglect cases stem from an inability to get care for a pet,” said Prupas. In Michigan, for example, failing to provide an animal with adequate care, including medical attention, is a misdemeanor that can carry 93 days in jail and/or a fine of up to $1,000. With a second violation, it becomes a felony.

The distorted belief that ‘those people’ don’t care about their pets has never been true.

What exists for pet owners in poverty is a patchwork of low-cost care options, ranging from local efforts — such as Emancipet in Texas and the Philadelphia Animal Welfare Society — to well-funded national enterprises such as Pets for Life, which operates in several dozen cities. The great majority, however, offer only basic services like sterilization, vaccination, and flea treatments. “We are not a full-service veterinary clinic and do not treat sick or injured pets,” warns one low-cost option on its website. Another suggests that needy people travel, since “vets in smaller towns may charge lower fees,” or start a GoFundMe. As a result, many types of care are largely unavailable: emergency care (by some estimates one in three pets will have an emergency need each year), management of chronic conditions such as diabetes or kidney disease, medication, dental care (dental disease affects perhaps 80 percent of older dogs), and the mercy of humane euthanasia (which can run $50-$300).

The final piece of the care gap is a practical and cultural disconnect. Because many economically challenged neighborhoods are “vet deserts,” with few if any practitioners, it’s not easy to find care, and reaching it can require wrangling an unhappy animal over distance and/or arranging private transportation. Keeping an appointment at an office with weekday-only business hours or a once a month clinic can mean losing a day’s pay. Paperwork raises the fear of immigration status inquiries. The veterinary profession also remains one of the country’s whitest: Just as people who feel alienated or unwelcome don’t utilize human health care options, pointed out Arluke, they don’t utilize care for their pets.

The result has been suffering: most directly for animals that remain untreated, die from what vets call “economic euthanasia” (putting an animal down because treatment costs too much), or end up in shelters. Fear of a looming vet bill, and the mistaken belief that all shelter animals receive medical care, is a prime cause of owner surrender.

But people pay, too.

Some sick animals can infect their humans. Roundworms, for example, can pass through contact with pet feces and cause lung, heart, and eye problems. Blackwell reports meeting an optometrist who practices in a low-income Florida community who has seen increasing numbers of children with roundworm larvae in their eyes.

The psychic toll is just as real. Families in poverty who love their pets and for whom “they offer an emotional core and possibly one of the only sources of joy” face “mental and emotional” devastation from the unimaginable choice of weighing that love against potential financial ruin, said Blackwell. Professor Katja M. Guenther, author of The Lives and Deaths of Shelter Animals, called the rupture of an animal-human bond “a kind of community violence” in a 2021 webinar.

Change seems increasingly possible. Covid-19 and the country’s recent racial and economic reckoning has prompted humane organizations to examine their assumptions and biases about who has the “right” to a pet’s love, and, said Arrington, there’s increasing recognition that “racial and economic injustice really impacts animal welfare.” Meanwhile, AlignCare, a new program out of Michael Blackwell’s Program for Pet Health Equity, is trying to create a national model of something like Medicaid for domestic animals. Under the program, families already found to be struggling (because they participate in SNAP or a similar program) and who ask for help at a shelter or veterinary clinic will be signed up and paired with a veterinary social worker or support coordinator. They’ll then be directed to a veterinarian who has agreed to offer preventative, dental, and even critical care, for a reduced fee; AlignCare will pay 80 percent of the cost. After three years of pilot programs in 10 disparate communities, it’s taking on its biggest challenge yet, Los Angeles, where one in five people live in poverty.

AlignCare won’t offer “gold standard” care, instead emphasizing preventative, incremental, and cost-saving measures (such as offering telehealth appointments and limiting diagnostics that won’t change treatment options) when possible. But it will expand the human safety net to include the animals most of us now consider part of our families. And while the effort is currently funded by grants from Maddie’s Fund, the Duffield Foundation, and Petsmart Charities, Blackwell’s goal is “community ownership:” The combined involvement of local vets, city animal services departments, social service agencies, rescue and community organizations, pet food and product manufacturers, and affluent pet owner-donors can make the model self-sustaining.

There is no perfect solution for low-income pet owners who need help accessing veterinary care. But growing awareness of the problem is a big step forward. “What we call ‘animal welfare’ is changing,” said Lori Weise, whose nonprofit, Downtown Dog Rescue, runs the Pet Support Space. “The distorted belief that ‘those people’ don’t care about their pets has never been true. People can’t afford care. Sometimes they don’t even know what’s out there; they themselves have never been in a hospital. As more people are brought into the system, we’ll see the first generation to get proper veterinary care.”

 

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