There’s something killing the IV drug users in my city. And it’s not the drugs.
Horror
SLUM FEVER
Note: this story isn’t based on any specific person or place, but rather pastiches of real people and places
Warning: this story has dark themes and mentions of drug use
Serious drug users die young, right? A couple years on meth or heroin and society expects that person to be on their deathbed. Unless, of course, they do it in some “glamorous” way. “Controlled use” – which we all expect won’t stay that way.
Yet here’s what I’ve noticed: serious drug addicts often live a surprisingly long time, provided they don’t overdose. Surprising, because it’s not what any drug education program had you expecting.
That 30 year old guy, 12 years down of both regular meth and heroin use… Looks skinny and sick, diagnosed with chronic heart and lung conditions, who self-presents to hospital with cardiac-sounding chest pain. He lives. He discharges himself by the end of the day, only to re-present with the same symptoms for the next 10, 15, 30 years.
This is no endorsement for drug abuse. Unless luck picks you as its punching bag, your body can take a hell of a lot of abuse. But it’s no fun life. It’s a dirty mattress on the ground (if you’ve got one) and a great deal of misery. It’s pain and sickness of all varieties. And your 70s, if you get to them, are not going to be a picnic in retirement.
But that person who has every visible vein replaced by track marks? They will often live longer than you expect.
Which is why I’m writing this. Because something is killing the intravenous drug users in my city, and it’s not the drugs.
I’m a volunteer. I’ve got no power, but the community I volunteer in welcomes me as, at least, just another familiar face. And I come with information and assistance about housing, rehabilitation, Covid-19 vaccinations, methadone clinics, and safe injection sites. I come with anger for the lack of adequate housing, the showers that are only open in homeless shelters between 10 in the morning and 3 in the afternoon; the seemingly impossible uphill battle – the despair. Charity willing, I also come with food and monetary aid.
If you want to know what the part of town I volunteer in is like, listen to Godspeed You! Black Emperor’s East Hastings. You know, the song inspired by Vancouver’s Downtown Eastside used as the soundtrack to the apocalypse film 28 Days Later.
I use the Downtown Eastside as an example. I don’t work in Vancouver, and while I did before, I don’t live there now. But Vancouver’s Downtown Eastside is like the down and out part of my city. Like the down and out parts of every city, just with varying degrees of available assistance.
Where I work has never proved physically dangerous to me. It’s more dangerous to your mind. A thousand and more different stories of misery: that’s why people are here.
I first noticed there was something more here on a Tuesday two months ago.
Behind a row of nice houses not too far from city centre is a hidden single-storey and sprawling slum, fed by narrow paths of crumbling asphalt. Built somewhere around the 1930s or 40s, the place stretches in thin brick walls, holes below eves for the rats to get in; shared bathrooms path-side open to the air outside with nothing more than rotten wooden gates for privacy. And forgotten apartment after forgotten apartment, consisting of no more than a single room with what approached a kitchenette attached.
It’s been on the demolition list for years, but the people here won’t leave. It’s where, years to decades ago, they found a roof over their heads. They have no certainty they’ll have somewhere else to live if it’s demolished, and less certainty they’ll like any new place to live.
Mr Roberts lives here. In Number 43. Most, though not all, of the people in this sprawling slum have drug addiction problems. Mr Roberts does: a result of one of the many opioid crises this world has seen.
Like finding the gateway to another world, I slipped into the narrow passage between the fences of attractive old houses. It’s several ragged steps down to get onto rubble paths that lead you past door after door and broken drainpipe after broken drainpipe, greyish sludge in the concrete drains lining the path.
Mrs Clara was in her usual seat: just under the eaves beside her door, head hanging, greying hair dangling, half matted, around her head. She raised it as I approached and gave me a toothless grin.
‘Gemme ‘em sweeties, Miss Jane?’ she asked, her voice croaky and her eyelids drooped.
Mrs Clara is an immigrant. I don’t know her story. She won’t tell it. Among the empty and broken bottles by her plastic chair was a fresh one, half full. I don’t know what she does beyond alcohol, she doesn’t want any help from me but the toffees I bring her. I hoped she wasn’t diabetic. And if she was, it would be undiagnosed.
Smiling, I handed Mrs Clara a handful of toffees. Her grin grew wider and she stared up at me with watery dark eyes, her gnarled hand wrapping around mine in a friendly squeeze.
‘Bless you,’ she whispered, then, louder as I moved on, ‘Ah-ah… Careful Miss Jane.’
I barely had to question her with a look. Mrs Clara pointed to Number 28 with a shaking hand.
‘He got a man,’ Clara croaked at me. ‘It no good.’
I tuned in to the shouting and banging several doors down. It got louder as I got closer, the thin walls not hiding much. It wasn’t the first time Lorraine had had a problem customer, and she never appreciated it when someone called the cops. What she did to earn a living was illegal.
Drawing up to Lorraine’s place, I steeled myself and banged on the door of Number 28.
‘Stop it!’ I screeched through the door. ‘Stop it or I’m calling the cops!’
The shouting stopped abruptly.
‘I mean it!’ I yelled, edging out of the way of the door. ‘You better get out now!’
And then I dodged away, ducking into a toilet stall and pulling the creaky gate for cover. I peeked out through a gap between wooden planks, waiting.
It didn’t take long. I saw a man stumble out of Lorraine’s apartment. He looked around, doing up his belt, then slouched away, scooping his stringy hair back out of his face as though nothing had happened. Lorraine leaned up against the wall beside the bathroom gate.
‘Why do you try?’ she asked. ‘You know you ain’t getting anywhere here.’
I eased the bathroom gate open. It was grimy as hell in the bathroom, the porcelain toilet bowl cracked. I was glad to get out. I wasn’t glad to see the fresh shiner on Lorraine’s cheek.
But Lorraine didn’t want my help. She waved me on with a roll of her eyes.
‘Hey love!’ she called after me, ‘I can handle myself!’
I turned back to acknowledge it. Lorraine had lit a cigarette. She leant against the wall in her robe, smoking it. Past her, Mrs Clara had nodded off again, her head hanging where she sat.
‘Thought more about my offer of a lift yet?’ I asked Lorraine.
Once again Lorraine rolled her eyes. It had become something of a sad ongoing joke. I’d offer to take her to a safe injection site, she’d tell me to mind my own business. Only, this time, she didn’t.
‘I got my methadone, love,’ she told me, shooing me with a hand, fingernails perfectly painted in lavender. ‘I’m outta that game.’
I was glad to hear it, and when I said so, Lorraine told me to fuck off and slammed her door.
Mr Roberts, alone in this hidden slum, did take my help. In his 50s and sure it was too late to change, he at least let me drive him to the safe injection site most days a week. I got to his door, knocked and called out to him. He was slower than usual to open up, and when he did he looked terrible.
Mr Roberts is a spritely man, despite everything. His limbs may be held together by nothing more than skin and sinew, but they move with surprising energy. Usually.
‘Ah fuck it Jane,’ he muttered, yanking the blanket more tightly about his shoulders as he lowered himself, shaky, back into the sunken and stained armchair in the middle of the rubbish heap that was his room. ‘I’m not going today.’
I wasn’t too surprised by that. Mr Roberts doesn’t always want to go. He hadn’t wanted to go yesterday either, though he’d looked better then. It was the pallor of his face that had me worried.
‘You all right?’ I asked him, staying in the doorway. I’d have sat down somewhere if I could, but Mr Roberts’s room had only the armchair and the mattress on the floor to sit on, and I suspected he slept in his chair as the mattress was covered with garbage bags, bits of broken plywood, clothes, and tins of food.
‘You got the shot against this virus?’ Mr Roberts asked me.
I had, as had he. It was one of the things I could achieve for the people here: arranging a Covid-19 vaccination drive.
I watched as Mr Roberts coughed into his blanket. He had a chronic cough, been there ever since I’d first met him. It didn’t usually sound this congested, though.
‘Doesn’t sound much like Covid,’ I said. ‘You actually coughing stuff up?’
Mr Roberts rubbed sweat off his forehead.
‘Yeah,’ he said. ‘Pink shit.’
‘If you get on a mask,’ I said, ‘I can run you up to the hospital.’
Unsurprisingly, Mr Roberts didn’t take the offer. He wasn’t that bad, he said. Just a bug. He’d go to the hospital if he was having a heart attack, and that was it. The last time he’d been to hospital was when he’d found out he had HIV, in his late teens, and that was after he’d been beaten up by a couple cops in a raid on a gay bathhouse. I checked whether he was still taking his meds, he said yes. I asked if he wanted to go see his doctor, he said no.
Under the eyes of a staring neighbour, I closed Mr Roberts’s door, telling him I’d check in on him tomorrow. Mr Roberts’s neighbour, Ben, was high, but he didn’t want to talk to me that day. He just stared, his pupils huge, as I headed back up the path.
*
Mr Roberts was worse the next day, and even worse the day after that. He refused to go anywhere with me, but after a week I needed Ben to let me into his room.
Mr Roberts had fallen and was laying, unable to get up, in amidst the broken side table, laundry, and general detritus on his floor before his chair. He coughed weakly as I called the ambulance.
When the paramedics, dressed in their full PPE, pulled the blanket away to get him up off the floor, I saw Mr Roberts’s arms. Deep red patches, like broad blood blisters, had appeared all over them, adding an extra appearance of sick to his skinny arms and track marks.
‘HIV?’ the one ambulance officer repeated as Mr Roberts coughed into his lap. The officer leant down and spoke very loudly to Mr Roberts, ‘You been taking your medications? Checked your virus levels?’
They were thinking it was AIDS. Mr Roberts was coughing too hard to answer, so I did, telling the paramedics what Mr Roberts had told me, how diligent I knew him to be about his antiretroviral drugs, and that he had been vaccinated against Covid. I’m not entirely sure they believed me.
When Mr Roberts raised his head, his nose was bleeding. The skin under his eyes was speckled with broken blood vessels, them and his bloodshot eyes bright red against his pale face.
It took some persuading to get Mr Roberts to go to hospital. He couldn’t walk on his own, was barely strong enough to hold his head up on his neck. He got me to hang on to his keys for him, scared that if he left they’d bulldoze his apartment and he’d lose his home, and I gave the paramedics my phone number so the hospital could call me. Ben, Lorraine, and me watched as the ambulance officers pushed Mr Roberts away over crumbling asphalt, heaving the stretcher through potholes to the closest spot they’d managed to get their ambulance.
‘Hell of a disease, AIDS,’ said Lorraine. She gave me a sidelong look. ‘You want to be that saviour, love. But you can’t save the world.’
Lorraine hoiked up her skirts as she stepped over an uneven part of the path, headed back to her apartment. I stared after her. She was sporting a split lip. Yeah, I’d wanted to help. Funny thing, though, that I never really felt I did.
And I didn’t think Mr Roberts had AIDS. When I got the call from the hospital two days later, they confirmed that for me: Mr Roberts’s viral load was low. He’d been taking his meds. But he was still getting worse. As to why, the doctor on the phone pointed out Mr Roberts’s long history of smoking and drug use.
*
That was the first case I saw. Mr Roberts died a week later. I still have his keys.
The next was while I was bringing cooked meals and offers of assistance with social housing to those who lived below the underpass near a train station. There’s a man you’ll usually see sitting outside the station, a big old dog dutiful by his side. He wasn’t there today, and, now I remembered, I hadn’t seen him for a week. I remembered that when I heard the coughing emerging from what looked like a bundle of blankets beside the dog. Few shelters take dogs. That man had been on the streets with his dog, refusing any shelter, for years.
Leaving a fellow volunteer to hand out the food and pamphlets, I made my way over. The man was tucked right into a shadowed corner. Bringing food, I squeezed in. The dog didn’t growl or bark. Its eyes doleful, it just looked at me as I hunkered down.
‘Hey,’ I said quietly. I had full PPE on, and I was careful with it. I reached out when the man didn’t respond and touched where I thought his arm was. ‘I’ve got food. Chicken and veg… There’s more for your dog if you want.’
For a long moment, there was nothing. Fearing he was dead, I gave the man a bit of a shake, then, my worry ratcheting up, another.
A clawed hand flew out from the blankets. I fell back, yelping – the box of food skittering along the ground.
Now the dog was barking. I pushed myself up. It was just an arm, emerging from the blankets. Nothing more sinister than that. Only that arm was emaciated and covered, like Mr Roberts’s, in patches of big blood blisters. It shivered in the air.
‘Hey,’ I whispered, crawling back. ‘You’re sick. I can call someone, if you want.’
And then I saw it. The face. I’d seen Mr Roberts’s, but he wasn’t as bad as this man. This man’s eyes had gone completely red, like he’d bled into both his irises and the whites of his eyes. He was staring up at me with those red eyes, broken blood vessels all over his gaunt face, like a corpse that could bleed. I breathed small, scared breaths.
‘You’re sick,’ I whispered again. ‘I can look after your dog if you go to the hos–‘
I didn’t get the last word out. With a squeak I jumped back again as the man sat straight up. His nose started to bleed. He stared back at me, skin and bone and zombie-like with those terrifying red eyes. His lips were so thin – his face so skinny – it showed what was left of his teeth, bared at me. The dog had started barking again.
His mouth moved as though he was trying to make words, and he reached out for me with a clawed hand covered in those dark red patches. I scrambled away.
*
The ambulance took the man, like Mr Roberts, to the hospital. I left my number, once again, with the paramedics, and took his dog to the vet, then home. I didn’t get a call this time.
There was nothing in the papers. I looked, day after day, for some mention of whatever the hell was going on. But there was nothing. And there were becoming more of them. A woman in an alley with those same red patches on her arms, her eyes bloodshot; another around the back of the train station, just a heap of sleeping bag beside a shopping cart, who shot awake with red eyes when I tried to wake them.
I sent letters to our local government representative, the mayor, and our health minister, telling them of what I was seeing – telling them to check with the hospitals and giving them what names I had. I didn’t receive a response. I’ve emailed the papers that supply the area, giving them the story. Nothing.
‘It was AIDS,’ Lorraine said to me, leant against her doorframe smoking the next time I visited. ‘It causes a skin cancer. That’s all.’
I disagreed with her. Never mind squabbles over whether those red spots on the people’s arms were Kaposi’s sarcoma or not, AIDS didn’t make people’s eyes go red. Lorraine shrugged expansively, as though sure she was never going to change my mind and was done with trying.
‘You got a mask love?’ she asked. ‘I need one to get to the methadone clinic.’
I did. I kept a spare pack of them in my car.
‘I can drive you,’ I said.
For once, Lorraine took me up on it.
‘You know,’ she said as she settled herself in my passenger seat, ‘I don’t think Clara’s doing so well.’
*
I looked in on Mrs Clara the next day. She wasn’t in her usual seat out the front of her apartment. She had been the day before, though she hadn’t woken up as I approached. I knocked on her door. After a minute, I knocked again, hoping it was just a drunken torpor Clara was in.
There was the sound of shuffling from inside. I waited. Another couple minutes and I knocked again.
With barely the click of the lock as warning, the door suddenly swung wide. Staring back at me was Mrs Clara, though she didn’t look like Mrs Clara. Her eyes were bloodshot, her face more sunken than usual – and she didn’t smile at me. She bared her missing teeth and stumbled forwards, a hand grasping for me.
I jumped back, stunned.
‘Mrs Clara?’ I breathed.
And then Mrs Clara bent right over and vomited straight blood at my feet.
I went with in the ambulance this time, telling the paramedics all about the red spots, there on Mrs Clara’s arms, that I’d seen on several people now. They nodded, considering, but said nothing about it – too focused, I assumed, on making sure they had an IV drip. I told the triage nurse at the hospital as well. He didn’t seem so interested. “Oesophageal varices” was his concern, and he sent us straight to an intensive care bed. So I told the doctor.
She nodded, taking in all I said, then ushered me away from Clara and to a chair. The doctor came back to me about an hour later.
‘Sometimes people get big blood vessels in the tube that leads to your stomach,’ she said. ‘Particularly when they drink alcohol heavily for many years…’
On and on she explained, then explained what they were doing about it. I was glad to hear they were stopping the bleeding, but I still had questions.
‘Look,’ the doctor said, ‘we’re going to refer Clara on to some specialists. But it’s completely possible the small haemorrhages on her arms and face are the result of liver disease from excessive alcohol consumption.’
And the doc had no better explanation than that, nor any good answer why Mr Roberts, who hadn’t been a heavy drinker, had had the same marks on his arms. The doctor told me she wasn’t abreast of Mr Roberts’s condition, but that there were many conditions that could cause bleeding under the skin, and that if Mr Roberts had been an intravenous drug user, it could have just been sores from that, or AIDS. She had no response for why the owner of the dog I was looking after had ended up with red eyes. I think she assumed I was misunderstanding medicine.
And that, coupled with Mrs Clara dying three days later – despite them stopping her bleeding – made me angry. Angry, perhaps, because of my emotional connection with these people. Without that, I was probably just frustrated. And that got me looking things up.
*
Go back to the 70s and the sufferers of “Junkie Flu”. If they sought out healthcare, it was sporadic, they may not have stuck around for all the tests, and, back then, the common understanding is few people cared. Now we suspect those intravenous drug users were dying of AIDS, but doctors didn’t know that then. AIDS was only diagnosed in the 80s. People then put it down to drugs, if they thought of it much.
Today things have changed in some ways. That 30 year old meth and heroin user may well not stick around for a full battery of tests, but we like to think the medical world cares a bit more. Today, if the patient stays for them, HIV, along with anything else it could be, will be tested for.
But you can only test for things that are known.
That’s my concern. Mrs Clara may have had a condition explained by alcoholism. But what about the rest? Why were there people dying, with similar symptoms, when they weren’t all doing the same things? Mrs Clara didn’t have HIV. It did seem, though, that she’d used something intravenously, from the scars the nurses found on her body.
And why was no one looking into it? I’d told every doctor I saw. I sent more letters off to the press and members of the government. I got only one response, from my local federal representative:
“It’s lamentable that these people have passed away, and I’m sorry for your loss. I stand for increased prevention of drug and alcohol abuse. All evidence points to the benefits of early intervention in drug and alcohol abuse, and I am committed to…”
I haven’t bothered to type out the rest. Here is the summary: they tied it all to their platform, why I should vote for them, and the horrors of drug abuse and HIV.
Back in the 80s, there was a divide in reporting between the “innocents” that got HIV, and those who the media thought deserved it. Drug users, homosexual people, sex workers – people didn’t look into those cases. It’s a sick reality, but I do think it will take someone who doesn’t fit into those categories – an “innocent”, by the press – to get sick before anyone bothers to pay attention.
*
I developed a cough two days after Mrs Clara died. But for going out to get a Covid test, I stayed home, doting on the homeless man’s old dog. Though I hadn’t heard anything, I assumed that man had, like Mr Roberts and Mrs Clara, died.
I got my negative, and used it to pay a visit to Lorraine for the first time in over a week. Ben was out front, waiting street-side for someone to pick him up. He was high again, and wanted to tell me about his issues with the people who owned the slum. He had no idea, though, what was going to happen to Mr Roberts’s and Mrs Clara’s apartments.
Not Lorraine, but a person I assumed was a friend of Lorraine’s opened the door. they gazed blankly at me as I explained my relationship with Lorraine, then just turned and walked back into the apartment, leaving the door open.
Wary, I followed them in. The light was dim in Lorraine’s apartment, her single window heavily draped with ornate curtains. Unlike Mr Roberts, her room was cluttered but tidy. Lorraine’s friend took the sofa. I carried on to the bed where Lorraine lay bundled up in blankets, her face tight in lines of sick misery.
‘Hi love,’ she said without opening her eyes. Her voice was weak and there were the marks of broken blood vessels all over her face, old makeup, half rubbed off, not managing to conceal them.
They tell you not to get too invested when you volunteer with stuff like this. I’d like to know how in the world I was supposed to not. It may not be a textbook friendship, but I liked Lorraine. My heart had fallen to the pit of my stomach and I wasn’t sure my voice would sound steady. I pressed my lips together to combat a sad tremble, and breathed slowly through my nose.
‘How long you been sick?’ I asked quietly.
Lorraine opened her mouth to respond, but didn’t get to it. She’d started coughing, rolling away from me and grabbing for a towel on her bedside table. When she finally stopped, she wiped pinkish gunk off her lips. Like mucous stained with blood.
‘Longer than old Roberts was,’ Lorraine answered, her voice croaky. ‘Couple weeks.’
She struggled to roll over onto her back and opened her eyes. I sucked in a gasp. Though Lorraine didn’t seem as sick as the man under the overpass, her eyes, too, had gone completely red but for the pupils.
‘Can’t hide these with makeup,’ Lorraine said. She pulled a small rueful smile. ‘You were right, love. I ain’t got HIV. And I’m shittin’ blood.’
She also had the red patches on her arms. And it looked like she’d lost a lot of weight in a short space of time.
Lorraine wasn’t having an ambulance, but with only a bit of pushing, she agreed to go to the hospital. I helped her up the path to my car, her arm over my shoulders and leaning heavily on me.
‘You know…’ she said, winded, once she was in my passenger seat. She took a breath and turned bright red eyes on me. ‘You might be a saviour-type, Jane, but you’re one who doesn’t look down on us too much. I like that about you.’
I wasn’t too sure what to say to that. I didn’t think I looked down on Lorraine at all. But I pulled a small smile and just said, ‘I like you too Lorraine.’
*
Lorraine lasted longer than Mrs Clara and Mr Roberts. I visited her when I could. She didn’t have HIV. She didn’t have Covid. And the last time she’d shot up had been a few weeks before she was admitted to hospital. No one had answers for us about what was going on with her, except to tell us her blood clotting factors were depleted – for no reason they could find.
Lorraine died three days ago. She refused to do it in hospital, so took herself home where I sat beside her and called the ambulance once she’d passed.
And now I’m coughing up what looks like a mix of blood and mucous. There are little red dots on my face below my eyes, like broken blood vessels. I’m not a drug user. I’ve got no medical history. I don’t even smoke. But I’ll admit, however this disease gets into you, I could have been more careful with PPE.
I thought I’d write this before I take myself to the hospital. In case I don’t come out. So people can hear this. So people know, and hopefully can do more about it than I’ve been able to.
Looking in international news online today, I see that dysentery is circulating in Vancouver’s Downtown Eastside. Fucking dysentery, that historic disease we thought we’d largely gotten rid of in places with decent sanitation.
If it is dysentery… Blood in the stool is a symptom of dysentery. The rest of what I’m seeing in my city isn’t.
My online searching is not comprehensive. Have a look at your own city. See if any of this is there yet. Maybe your papers and politicians will listen more than mine.
Person after person after person, many intravenous drug users, from third world countries, or sex workers, died of AIDS in the two decades at least before the AIDS crisis hit the papers in the 80s. The disease was in the Western world and spreading long before anyone noticed it.
We’ve had new disease after new disease. Epidemics and pandemics of them. The mysterious encephalitis lethargica, Spanish flu, AIDS, Ebola, SARS, MERS, and now Covid-19. That’s just in the past century. There is nothing far-fetched about a new disease emerging among intravenous drug users. Like the renewed rise of fascism, it’s just the past century repeating itself.
I’m not going to tell you where my city is. Because my city could be any city.
We’ve been living in a fragile safety, where we like to think every disease is identified already, with some, if not perfect, treatments available. If there’s something new that is yet to be treatable, we like to shrug it off as being isolated to a marginalised group: “it’s only experienced among gay people” or “it’s just people from so-and-so location” or “it only affects intravenous drug users”. But that just shows our hand in fear and hate, and disease is an equal-opportunity offender, even if you’re not seeing it yet.
Because, despite the current pandemic, we don’t want that fragile safety fractured. I get it. I don’t want that safety fractured either. Because, of anything that can happen, this is the scariest.
The Lantern Library 