Hektoen International

A Journal of Medical Humanities


Gaetan Sgro
Pittsburgh, Pennsylvania, United States


Photography by Andrew R. Whalley

It is a mild Saturday morning in the fall. A breeze is blowing leaves and garbage past the entrance to My Brother’s House, a shelter on South 15th Street, and the sun is shining brightly off the inside of the open door. The door’s black paint is scratched through in places, and the naked streaks of silver underneath look like claw marks. Charlie stands in the doorway wearing a faded yellow sweater over a plaid collared shirt. The fuzz on the sweater, which is beginning to disintegrate, is standing up like the whiskers of a cat, and Charlie’s face is somewhat obscured behind a thick, white beard and round glasses. In the bright sun it seemed, even then, he was fading. He smiles at us from the doorway, extends his hand, and invites us in.

The roots of homelessness in Philadelphia were decades deep by then. By the early eighties, most of the state mental hospitals had been closed, and hundreds of men and women suffering from mental illness had been cast out into a world unprepared to receive them. Cities across the country were reeling in the wake of “white flight,” plagued by blight, and consumed by self-loathing. City Hall responded by razing abandoned buildings, outlawing dollar hotel rooms, and policing former “no man’s lands” such as highway underpasses. There was nowhere for the homeless to hide.

In this context, a friend of our family, a priest, was moved one night by a powerful vision. In the dream, his elderly mother was suffering, calling out to him in Italian, “Aiutami! Aiutami!” “Help me.” Soon after, he and members of his prayer group from the affluent Main Line began renting an apartment at 12th and Sansom Streets to provide shelter to a group of homeless women known as the “bag ladies.” They called their organization “Bethesda,” Hebrew for “house of loving kindness.” Their mission was to be family to those who had none.

Growing up in the woods of Chester County, we kept a list of easy casserole recipes at the ready. Every so often, we shuttled the frozen trays from the parish freezer to the city. We served turkey and hot gravy to the men on Thanksgiving. They sat on folding chairs around wobbly tables in a church basement, their knit caps tipped back on their heads. I liked being around the men; I felt like I was doing good just by showing up, but I didn’t get too close to them. As they ate, I stood aside, chatting with the kitchen staff and the other volunteers.

When I first meet Charlie, I mistake him for one of us. He looks like an old professor, a ringer for one of the area elites, middle-aged men who drive beat up Saabs and wear their loafers ragged so as to distinguish themselves from the “nouveau-riche.” Charlie has exactly the right sweater and shirt combination, only his clothes are dirty. Not stained, but really dirty. His glasses frames are bent. His teeth are bad. Yet, something about him is inviting. He is younger than my dad, but he has the mild manner of a grandfather. Over the next few years, Charlie becomes my pal. We complain to each other about the Eagles. He trounces me in checkers. He marches me around the room, introducing me to his friends. Together, we pass out Christmas presents, gifts of socks and underwear, for the other guys.

Eventually, Charlie moves off the streets and into a subsidized apartment above Bethesda’s main office. My dad is now the director, and Charlie answers the phone for him. This way, even after I go away to college, we stay in touch. Charlie follows the ups and downs of my swimming career, and I usually stop by the office to catch up when I’m home on breaks. Through the glass storefront I see him waiting patiently at his empty desk, smiling and rising to his feet to greet me at the door.

In the fall of my senior year, I get sick, and have to end the semester early. This time, when I stop by the office, Charlie looks stricken, as if something I said scared him.

I don’t know much about his past because he doesn’t want me to. At some point, Charlie had a family, but my dad says his children no longer speak to him. Unlike a lot of the men, I don’t think Charlie is a veteran; he wouldn’t have passed the physical. As if life’s usual afflictions weren’t enough, Charlie is an orphan who has lived most of his life with Crohn’s disease. Imagine living on the streets with an ileostomy. There are predators among the homeless, antisocial personalities who bully their weaker, older counterparts. They steal what few valuables they own, exploit any weaknesses they can find. It wouldn’t have been hard to find Charlie’s weakness, that crinkly, plastic bulge tucked into his waistband. For him, that illness was a death sentence. And yet I never hear Charlie complain. He treats everyone he meets with respect, and positively reveres the staff at Bethesda. He calls them his family. He says that family saved his life.

A few years after college, my brother and I share an apartment in the city, and both of us remain connected to the homeless community. He works as an intensive case manager, and I’m a medical student. Every December, when the weather turns and the cold winds start to whip among the tall buildings, poking icy fingers through splintered doorways, down subway staircases, invading hiding places, people gather to listen to the names of the men and women who died on the street in the past year. It’s like the annual tribute at the Oscars, only without the silver screen. Just candles in the cold, and a social worker reading names.

Charlie didn’t die on the street. My dad found him one Monday morning collapsed on the floor of his tiny apartment. A few hours later, he broke the news in an email:

Dear Family,

Charlie died last weekend, though I’m not sure which day exactly. He left a message on my voicemail—“Angelo, I fell, please send someone”—but that was Saturday, I was away.

This morning, I got the message and rushed upstairs to his apartment, knowing he was gone. I was so anxious I broke the key in the lock and had to get another one. I saw his bare feet as I cracked the door.

I probably should have taken his pulse, but I couldn’t get near him. You should have seen all the meds in his room.

I always knew that Charlie was going to die prematurely, just as he knew it. Just as you knew it. Like I said, he was fading from the day I met him. In many ways, it’s a marvel that he lived as long as he did—into his fifties with a lifelong affliction for which only limited therapy exists.

Charlie was so moved by the news of my illness because we shared the same diagnosis, though our experiences of that disease have been wildly different. I remember telling Charlie about this miracle drug, Infliximab, and him looking at me as if I were describing the lunar landing. I used to think that illness was the great equalizer because it doesn’t care who you are or what you own. Of course, that last part is true, but I have been disappointed, in my experience with our healthcare system, to find that the playing field is far from level. We need to do more to address this inequity. If we really want to heal, we need to focus less narrowly on disease and more broadly on the social context in which it occurs.

I like remembering Charlie. I like to think of his thin, fragile frame, wearing his second-hand clothes without shame. I still marvel at his gentle manner, still admire his courage. Charlie received a lot of recognition for his service in his final years at Bethesda, but he had a hard time accepting it. If he were still here, I imagine he’d blush, wave his hand in a dismissive gesture and mumble that he doesn’t deserve this all of this attention. I just want you to know, Charlie, that you do deserve this. You are missed.



GAETAN SGRO, MD, is an internal medicine resident at the University of Pittsburg. He attended the College of William and Mary for his undergraduate studies and attended medical school at Jefferson Medical College. Following his residency, he hopes to continue a career as a clinician educator with a particular interest in the humanities.


Highlighted in Frontispiece Fall 2013 – Volume 5, Issue 4

Fall 2013  |  Sections  |  End of Life

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