Still, lawmakers and citizens who recoil from the expense of ending modern homelessness would do well to ponder the cost of maintaining it: eight and a half billion dollars a year on emergency shelter alone, according to Culhane’s research (based on 2015 data), or about twenty-seven thousand dollars per bed per year—eleven billion and thirty-six thousand in today’s dollars. That eleven-billion-dollar expense doesn’t include, as Culhane reminded me, “the excess use of health care, emergency rooms, E.M.T.s, longer hospitalizations. It’s not counting the impacts on parks, sanitation, police, libraries, education. . . . There is hardly a public-sector system out there that is not impacted by homelessness.” In a landmark study from 2002, Culhane calculated the cost of chronic street homelessness for a single mentally ill person to be forty thousand dollars a year—about seventy thousand dollars in today’s money. That’s a lot of money to spend on a horrific status quo.
“Nobody wants to be confronted with a spectacle of human suffering every time you walk out your door with your kids,” David Giffen, the executive director of New York’s Coalition for the Homeless, told me. “I hate to put it in terms of enlightened self-interest, but if you don’t want somebody sleeping in your subway then let’s put a system in place that provides four walls, a roof, and a bed for that person.” In a country with skyrocketing housing costs and insufficient mental-health care, virtually anyone could end up in that position of need. “It’s not a question of these people,” Giffen said. “These people are us.”
In late July, Iishea’s case manager e-mailed to say that there seemed to have been some activity on her E.B.T. card, or food-stamps account. I returned to West Harlem on a sweltering afternoon to look for Iishea again, and this time I managed to find a hair salon on West 116th Street that I thought might be the one where she’d been getting her hair done. Sure enough, a woman who was braiding a customer’s hair inside the salon knew whom I meant. “Ah, Iishea. Wheelchair,” she said in strongly accented English. Then she added, sadly, “She pass away. Long time ago. Overdose.” The news had come from Iishea’s boyfriend, she said, the one who had been paying for her appointments.
Still not satisfied, I proceeded to the buildings where I’d left letters for Iishea two months earlier. I rang all the ground-floor apartment buzzers and managed to find one tenant who identified himself as a former crack user and said that he knew of Iishea’s overdose death “through the grapevine.” He told me which apartment her boyfriend lived in, and I left a letter in Spanish asking him to call me, so that I could find out exactly what had happened. I never heard from him. The Kelly was finally able to confirm with the morgue that Iishea had died on April 6th, the day before our scheduled photo session.
In a broader sense, I know what happened to Iishea Stone: a luminous and extraordinary woman was failed repeatedly—by her family’s pathologies, by poverty, and by a social safety net that couldn’t seem to catch her. Had Iishea grown up with the advantages I had, she might have accomplished anything. Instead, she suffered acutely and slipped away so invisibly that, thus far, the Kelly does not know what was done with her body. How many Americans are we losing this way? How can we—the wealthiest nation in human history—tolerate those losses? The fact that we can, and do, despite knowing that it’s wrong, is what is meant by the moral cost of homelessness.
For Jessica, April brought the unthinkable: her aunt Mary, the woman she called her mother and listed as next of kin on her 90 Sands lease, died unexpectedly on the operating table during a lung biopsy. When I visited Jessica a couple of days later, she hadn’t stopped shaking. She had spoken to Mary the night before the biopsy, trying to calm her fears about the procedure. “I woke up at four o’clock, wide awake, and I had a horrible feeling,” she said. “I waited, because I knew she wouldn’t be up at four. I messaged her at seven-thirty, and I was, like, I love you so much. I knew she wasn’t coming home, I knew it.” She sobbed openly as she spoke.
Jessica’s aunt never knew that she had relapsed into heroin after going on methadone a few years ago. “She’s the only person I’ve ever lied to about it in my life,” Jessica told me. “I couldn’t break her heart like that.” But Mary had known about Jessica’s homelessness and was hugely relieved when she moved into 90 Sands. “My cousin said, ‘She told me she’s so proud of you.’ I was, like, I don’t know what for.”
Jessica’s cousin had advanced her money for a plane ticket to get to the funeral, which was the following afternoon. She planned to leave before dawn to take the subway to LaGuardia, but was grappling with a logistical problem: she didn’t want to carry heroin on the plane and needed some way to keep from going into withdrawal while she was away. The obvious answer was to carry a sealed dose of methadone, but Troy, her sometime friend at 90 Sands, was demanding sixty dollars for one of his take-home doses. “I’m, like, ‘Are you fucking for real right now? I’ve given you money all the fucking time, I’ve given you dope, I’ve given you cigarettes, and you’re trying to charge me for methadone. Really?’ When I get back here, shit’s gonna change,” she resolved. “I’m not talking to none of them no more. I’ll change my number if I have to.” She left without the methadone, and returned, dope-sick, within twenty-four hours.
Changing her life was not as immediate or neat as Jessica had promised herself it would be. After a fight with her dealer’s girlfriend escalated into a fight with the dealer himself, she stopped buying heroin. Her withdrawal was manageable at first; she had tapered down enough that the sickness was bearable. But then illness seized her again; she vomited for days, and developed areas of infection in her legs that opened up into deep wounds. When those began to heal, she was too exhausted to leave her apartment. In mid-June she stopped answering texts, which was so uncharacteristic of her that I grew alarmed and went to 90 Sands, where I asked security to call upstairs on the internal phone to her apartment. She was there; her cell-phone service had been turned off because she was too drained to panhandle and hadn’t paid the bill.
I found her lying on her bed beside the small set of plastic shelves, from which all the drug paraphernalia had been removed. She was noticeably thinner. I asked whether she thought her recovery from heroin would stick this time, when it hadn’t before. She reminded me that, when she’d left jail on methadone, she’d returned to New York with no place to go: “It was wintertime, I didn’t have blankets, I didn’t have anything.” Medley wasn’t her case manager yet, and no organization she contacted could find her a bed. Inevitably, she had rejoined the safety of the homeless drug users she knew and, after holding out briefly, returned to heroin. Now, in her own apartment, the situation was different: “I’m not around nobody.” She had talked to her dealer on the phone a couple of times. “He asked me, ‘You coming again, Jessica?’ ” She demurred, “Uh-uh, I’m sorry, I love you, but I can’t do it. Can’t be around that right now.”
Unfortunately, she was still around heroin, and the rash of solitary overdose deaths had encouraged communal use. By the time I saw Jessica two months later, in August, she was using again (albeit on a smaller scale) and had new wounds caused by xylazine-adulterated doses that she said she’d purchased from a dealer living in the building. Still, in the halting realm of opioid recovery a spell of sobriety is an accomplishment—even if, as she’d insisted back in June, it was due less to grit than to sheer exhaustion, even depression, in the wake of her loss. “I just did not have the will power to get out of bed and go outside to try and make money—that’s what it boils down to,” she said. It struck me that what Jessica was describing was grief. Here, inside her clean, quiet, aromatic apartment, she had the luxury of indulging it. “My cousins are, like, ‘You need to get up and go do something.’ No, I don’t. You don’t understand. I was homeless on the streets. They can’t grasp how hard it is. I was always outside. I walked ten miles a day, probably. Like, I don’t need to get up.”
Jessica is hoping to enroll in a culinary-arts program next semester, and is trying to get bone grafts so that her teeth can be replaced. She has started working with her 90 Sands case manager, and is receiving medical care for her wounds from the on-site doctor. She still intends to get off heroin.
“The wins can be really small at times,” Lipsky reminded me at our last meeting, when I expressed distress over Jessica’s perilous health, without naming her. “You meet people and you see where they are at that current stage, and where they could be. It does take time. And it takes investment, and it takes consistency. It takes trust and belief in that person to get to that point when five, ten years down the line you look back and think, Wow! Look where that person came from.” ♦