Dr. Carlbom is the Medical Director, Harborview Respiratory Care Department, and Associate Professor, Division of Pulmonary, Critical Care and Sleep Medicine. One of his mentors was the late Dr. Michael Copass at the Emergency Department, Harborview Medical Center. Dr. Carlbom spoke with me about his medical work. I was struck by the depth of his compassion and insight into not only emergency/intensive care for patients from all walks of life, but also teaching medical residents and paramedics. Please listen to his powerful stories.

Lois Thetford began her work on health inequities, anti-poverty, and health care for the homeless work in Seattle in 1970. I talked with her about her life and work in Seattle and learned a lot from our conversation, especially about safety net health care in our city and county. I had the privilege of working with her at what then was the 45th Street Clinic's Homeless Youth Clinic (now part of the larger Neighborcare Health) two evenings a week. Lois and I both experienced how the clinic became, as she said, "much more of a corporate structure. It's not as people-oriented; it's much more numbers oriented." That is a change that has happened across the country with community health centers (CHCs), so it is not unique to Seattle. I worked at several other Seattle-area CHCs during this time (late 1990s into the early 2000s), and they all underwent similar changes. Lois points out that it is important to not stay in a place that no longer supports the quality of patient care that aligns with what you believe in. I often say to go where you are wanted, needed, and supported. A hard lesson to learn (and relearn) over a long career in health care.

Lois highlighted the important role of Harborview Medical Center in our region's healthcare safety net and how through federal research funding (now hobbled and stopped by President Trump/his administration) people at Harborview, the University of Washington, and Public Health--Seattle & King County developed world-class innovations in trauma-informed care, behavioral health treatment, motivational interviewing, and infectious disease treatment and control.

Of her decades of work providing quality health care to people, including youth and families, experiencing homelessness, Lois had this to say: "the thing that I love about patient care, and that I especially love about homeless care, is that you can make such a difference. You meet people when they are in a very bad place in their lives, and by treating them--what I think of as appropriately--which is respectfully, and hearing them out, letting them tell you who they are and what their needs are, you get to participate. You become a witness to their life journey, and that is an honor."

Please listen to Lois's stories and absorb and apply her wisdom.

Happy end of National Nurses Week with this year's theme of "The Power of Nurses." Last year, I highlighted some of the nurses I have interviewed for my Skid Road project. Today, I highlight an interview with a stalwart nurse, Mary Pilgrim, who ran Harborview Medical Center's nurse clinic at the main homeless shelter at the Downtown Emergency Service Center in Pioneer Square, Seattle. When I interviewed her a the Jack Straw Cultural Center on July 22, 2015, Mary had been a nurse for 42 years and was nearing retirement. Listen to what she had to say about her work and perspective on homelessness in our city and country.

"Where's the greatest need?" Frank Chopp said he constantly asked himself during his lifetime as a health, housing, and social care advocate, first in direct services in Seattle and then as our longest-term Speaker of the House in Olympia. From starting some of Seattle's earliest social housing programs, advocating for Apple Health for Kids, the Apple Health and Homes Initiative, behavioral health initiatives, Home and Hope, the Doorway Project, to new projects he was working on up until his death yesterday, Frank Chopp was a force of good in this world. As Frank said to me in my interview with him in 2022, "It's the right thing to do." I was fortunate to have worked with him on the Doorway Project and the Apple Health and Homes Project. I saw firsthand just how masterful Frank was at working across differences to help make policies and programs that "help the unfortunate," that help build healthy, thriving communities for us all. We need more people, more politicians, more true public servants like him. Frank, you are sorely missed.

"What is going on in our society, and what ways can we change what's happening?" Lois Thetford asked this in 1970 when she moved to Seattle and worked on grassroots community organizing--something she continues to do in her 80s. Questions that are as pertinent and urgent today as they were then.

I've had the pleasure of working with Lois since 1995 when I met her when I began working at what was then the independent 45th Street Clinic in Seattle. She is a mentor and an inspiration. We can all use positive change agents in our lives and in our communities. Listen to her story and her perspectives and be thankful there are people like her in our country.

Back to basics. Back to what we know works. That is my main takeaway from my interview with social worker Charlotte Tucker Sanders. I've had the privilege to work with her, first at Neighborcare's 45th Street Homeless Youth Clinic and then when I led the UW's Doorway Project. She said, "I feel like if we were to really think about this world which seems to be driven by money, and the costs and benefits. And if we were to really look at our system and not have it based on that (...) That if we keep people healthy, in the long run, we wouldn't be spending so much money on other issues related to unhealthy people. If we were to feed people, if we were to give people their basic needs, if we made sure that everyone had enough to live on, we probably wouldn't be so consumed with issues of violence, issues of homelessness (...) So I guess that would be my dream, that we would eventually recognize that meeting basic human needs, basic needs, would be good for everyone."

" 'The last thing you own when you're losing everything you own is probably your vehicle, so that becomes your home.' Jenn Adams knows this from six years living in her Seattle van starting in 2007. 'I've lived in three different vans and a doorway,' she said in a recent interview I had with her. She talked about her experience and current work as an advocate and peer outreach worker to vehicle residents in Seattle.

I had my own experience resorting to living in my car and in an abandoned shed for six months in my hometown of Richmond, Virginia, when I was a young adult. The topic of vehicle residency as a unique form of homelessness has long been of interest to me. I wanted to explore more of the nuances of vehicle residency from the perspective of a woman with a much longer experience than me and one based here in Seattle."

The above passages are from my new book, Way Home: Journeys Through Homelessness, in a chapter titled "Roll On." This chapter draws from my interview with Jenn Adams. Make sure to listen until the end for her powerful words, which literally left me speechless.

Anitra Freeman is a force of nature with an infectious laugh and a sense of humor. Freeman is a wise elder, a Raging Granny, a founding member of the Women in Black in Seattle, a housing/homelessness activist, a wife, and a computer wiz. Freeman also lives with a form of bipolar disorder and experienced homelessness in Seattle. She is now stably housed and continuously giving back to our community and working to make our city a safer, healthier place for everyone, including people without homes.

Her story is an inspiration. I have included my oral history interview here. I wrote a chapter of my Way Home book on Anitra Freeman. Freeman says, "I have often said that people have personal problems, of course, but personal problems don't cause homelessness. Personal problems don't dig the hole in the sidewalk; they just influence who is going to fall into it. It's systemic factors that create the hole."

Although only 1% of Seattle's population identifies as Indigenous, "hundreds of years of colonization, systemic racism, broken treaties, forced reservations, and more have resulted in native peoples making up a startling 15% of Seattle's homeless population," as well as 32% of people experiencing chronic homelessness (quote from the Chief Seattle website). Yet we have important Native-led organizations like the Chief Seattle Club coming up with innovative, culturally relevant health, housing, and social programs to reduce homelessness for our Indigenous community members.

Derrick Belgarde, who is Siletz and Chippewa-Cree, is the executive director of the Chief Seattle Club. He has lived experience of homelessness on the streets of Seattle. Leading the Chief Seattle Club through the COVID-19 pandemic and into its current expansion of services, including permanent supportive housing, Belgarde shared his insights and experiences with me. There's so much good stuff within this interview that I hope you listen to it in its entirety.

Focusing on the story of the police killing of the Indigenous woodcarver living in homelessness and in permanent supportive housing, John T. Williams, I wrote a chapter, "Displaced," in my forthcoming book Way Home: Journeys Through Homelessness. It was one of the more emotionally challenging chapters to write. In the chapter, I include content from my oral history interview with Derrick Belgarde. In addition, Belgarde graciously agreed to read, comment on, and suggest changes to the chapter. As a non-Native person, I wanted to honor the stories of people like Williams and Belgarde.

Dr. Simha Reddy is director of the Puget Sound VA Homeless Patient Aligned Care Team, where, for over the past ten years, he has done healthcare outreach and primary care with veterans experiencing or having experienced the trauma of homelessness in the Seattle area. In addition, he serves on the Implementation Board of King County's Regional Homelessness Authority and has served on the governing board of the long-running advocacy group, the Seattle/King County Coalition on Homelessness.

In early 2017, I had the pleasure of talking with Dr. Reddy about his work. At that time, he had been working on homeless veteran health care for five years. He said, "When I took my job, actually, that was the first time I learned of the VA's commitment to end homelessness. And I laughed because I thought it was ridiculous. After having seen what the VA has done, I think it is possible."

A significant reduction in veteran homelessness is one of the little-known (among the general public) successes in the US response to homelessness. Beginning in 2008, the Department of Veterans Affairs and the Department of Housing and Urban Development, with bipartisan support and funding from Congress, have reduced veteran homelessness by half while overall homelessness has risen. There was a recent slight increase in veteran homelessness caused by rising rents, especially in cities like Los Angeles. But even this increase was much smaller than for other groups of people experiencing homelessness. A recent New York Times article, "Decline in Veterans' Homelessness Spurs Hopes of a Broader Solution," by Jason DeParle (August 6, 2024), explains all of this well. What DeParle doesn't cover well in this article is the role of VA health care, especially community-based programs like that run by Dr. Reddy.

Housing without access to good trauma-informed primary care, including behavioral health care, will never work to reduce homelessness. VA Health provides access to comprehensive health care through its more than 13,000 hospitals and clinics nationwide. It is always imperfect, as with any healthcare system, but it is much better than the still fragmented, chaotic, and expensive US healthcare system for non-veterans. Housing First is the model of intervention used by the federal approach to reduce veteran homelessness. Housing First only works well if housing is combined with ongoing medical and social support services.

Towards the end of my conversation with Dr. Reddy he had this to say, "People sometimes have preconceptions of what a homeless person looks like, what a homeless veteran looks like. That's it's a drug-addicted, mentally ill, Vietnam-era veteran standing on a street corner with a sign. Maybe. But that person can get their life back together. I've seen that.

"But the other thing that has been remarkable to me is how close to the edge we all are. That the people I've cared for, all of them certainly, have been soldiers, sailors, veterans of all kinds, and have served their country, and have fallen on hard times at some point in their life by the time that I've seen them. But they have all been real estate agents, small business owners, cooks, priests, actually nurses, social workers.

"And what leads to homelessness is typically a crisis of some kind, and none of us are immune to a crisis. The loss of a family member. The loss of family through divorce, or something like that. A health issue. And those are the things I wish people could see; that we are so much closer to the edge than we think. But that if we live in a society where, if somebody falls over, there's somebody willing to help them stand back up, we are going to live in a better place. That is an investment in our people. And that's important."