Remembering Joseph: The Catch 22s of a Life “in the System”

Joseph Digilio, with “Nadine”

By Gligor Tashkovich (United States)

For two and a half years now, I have been helping a homeless couple in New York City. In several blog posts here, their names were given as “Nadine” and “Jeffrey” to protect their privacy. But I would now like to record the man’s true name as Joseph A. Digilio. He died on March 11 at the age of 33 after suffering from liver failure, pneumonia, and acute respiratory distress syndrome. Joseph’s mother died of alcoholism at age 32. Almost since the first day I met him, Joseph has told me again and again that he did not want to live past his mother’s age. Joseph turned 33 on March 2, just nine days before his own death.

Late one night about a year ago, I spent 70 minutes on the phone with Joseph. He talked nearly nonstop about how the system was designed to milk people in poverty and never allow them to graduate to an independent life. I learned that he had been “in the system” for most of his life. He was so angry that I could barely get a word in edgewise. He and Nadine were rarely issued copies of important documents; appointment dates that were mailed to them were often sent to the wrong address and never forwarded.

At the time, the couple had finally been able to move into a temporary shelter after sleeping on the pavement for three years. Both Nadine and Joseph were struggling with methadone therapy for former drug addictions. His biggest objection that night was being told to participate in a behavioral therapy program (both group and individual) for one hour a day at East 161th Street — a little over a mile away from where they lived. Joseph said that when he was young, he used to take his father to that same program — and while Joseph waited across the street for his father to finish, he used to buy dope from the local dealer. Being ordered to go back to the same place raised bad memories as well as the temptation for him to continue buying drugs; and yet if he refused to go to counselling, their case would be thrown out of the system and their food stamps cut off again. He felt trapped in a “Catch-22” situation where he would lose out no matter what he chose to do.*

When I spoke with the current director of the program, she could not have been nicer or more understanding. She told me that she was pleased that she had eliminated drug dealing inside the building, which was not the case at other centers. But outside, the street remained a place where dealers knew they could exploit the addicts required to be there.

Joseph wanted to go into alcohol detox again, but he was very anxious, saying that during his past attempts, doctors wouldn’t give him enough of the medication (Librium or Ativan) used to reduce withdrawal tremors. Joseph also said that no matter what he told the doctors, they failed to understand, or even to acknowledge, that without the tools to deal with the feelings and sensations awakened by withdrawal, people are likely to relapse. But that was precisely the point Joseph was missing. His resistance to group therapy post-detox was depriving himself of those very tools. Joseph’s aversion to group therapy was the addiction “speaking” said the supervising social worker who was providing me with support and direction. That is to say, Joseph’s addiction was keeping him from making rational choices like attending daily group therapy sessions. Group therapy sessions have apparently been proven statistically useful; but Joseph said he felt depressed listening to other people complain about their problems.

A few weeks later, we found a third choice: five-day residential detox for both of them, in Queens rather than the Bronx. I arranged for a free car service to pick them both up. All alcohol detox places in New York City offer free car services to bring patients to their facility. Because of their co-dependency, Joseph and Nadine couldn’t stand the thought of being separated; but they had been through detox some ten times already and knew the drill. On a Wednesday, they were placed on adjacent floors; they knew that they would see each other five days later when they were released. However, when Joseph came down to the lobby that Monday morning, he ran into someone who identified herself as Nadine’s roommate. The roommate said that three days earlier, close to midnight, a spiteful nurse had been on duty. Despite knowing that Nadine’s peace of mind required knowing that Joseph was right upstairs, the nurse lied to her, asserting that Joseph had been transferred to another facility. Nadine became so distraught that the roommate thought an ambulance had taken her somewhere else. When I looked into it, I was told that Nadine had voluntarily signed herself out of the program “against medical advice,” leaving the facility between midnight and 1:00 am.

Even Nadine does not know exactly what happened that weekend. It was several days after leaving detox that she found herself in Queens Hospital Center with no recollection of how she got there — although she did remember receiving several injections in different parts of her body. She was released on Tuesday morning and found her way home. As near as I can tell, she was sedated for most of those missing days. Nadine signed an official Health Insurance Portability and Accountability Act document allowing me to request all her medical records, but Queens Hospital Center wanted over $250 to copy the records for me to look at; so that was a non-starter. What was publicly recorded did not make sense. Why would she have chosen to sign herself out of the detox facility in the middle of the night, only to walk into the hospital several blocks away? It makes more sense that an ambulance took her from one to the other, but we have seen no record of that.

Hoping to Be Role Models for Others

I needed to leave town on business for several weeks, so I invited my Facebook friends to send Joseph and Nadine postcards of encouragement. Many people responded, thrilling them with postcards from around the world. Joseph and Nadine said they couldn’t remember the last time they received anything by mail (other than official letters) for many, many years. On my return, they told me they had convinced each other to re-enter detox, this time in a different facility. The part that most impressed me was that they committed (completely at their own initiative) to transfer Nadine’s methadone treatment to a different facility in order to participate jointly in the group classes and individualized counselling that was recommended to them. They said that they wanted to make me proud, and I was!

That same week, I was able to show them printouts of the earlier blog posts written about them here. They both commented on how realistically these articles presented their situation. They were proud to have their story told and hoped that they might end up being role models for others fighting similar problems.

However, by August 2016 both of them had medical crises that landed them in a hospital emergency room. It took me a busy seven hours to advocate for them by filling out forms and having conversations with the hospital staff. That was on top of the time it took me to prepare three-page medical summaries (detailing all of their complications) for each of them to give their doctors and nurses. Both Joseph and Nadine had only an 8th grade education, were considered legally disabled, and suffered from short-term memory loss as well as difficulties in expressing themselves. It was impossible for either of them to even dream of doing this by themselves. Eventually, however, they were able to go from that hospital stay into a detox program that they felt positive about.

A Memorable Christmas Eve

On December 24, Nadine and Joseph called to tell me that they had found a Hilton hotel room key card envelope near a garbage can. It contained three credit cards and two driver’s licenses for a young Australian couple. They wanted to return these items to the owners — but this proved to be easier said than done. There are numerous Hilton-branded properties in Manhattan, but nothing connected the key card to a specific hotel. And in this age of heightened security, it boggles the mind that there is neither an email distribution list for all the general managers of Hilton-branded hotels in Manhattan nor for their security directors. I also called the Australian Consulate-General but was disappointed to learn that if a lost item didn’t specifically involve passports, they weren’t interested in helping. So, since Nadine and Joseph have limited free airtime minutes per month on their phone, I set about calling Hilton Hotel after Hilton Hotel in Manhattan, gingerly navigating around hotel privacy policies in an effort to track down the Australians. Finally during one call, a general manager passed the call to her security director, who promised to investigate and call me back. Predictably, he failed to do so. But something the hotel general manager had mentioned in passing led me to believe that I might have finally found the right hotel. So I walked to the DoubleTree Hotel at East 51st and Lexington and finally reunited the ID and credit cards with their rightful owners — tourists visiting New York for the holidays. They gratefully promised to call Nadine and Joseph to thank them for their honesty.

However, that day’s challenges were not yet surmounted. At the same time that Nadine handed me the items lost by the Australian tourists, she also gave me paperwork mailed to her by the NYC Human Resources Administration. Nadine and Joseph’s 8th grade education was too limited for them to read through and understand small font, single-spaced, multi-page bureaucratic forms with an ample number of words in bold and capitalized letters throughout. So I was the one who had to tell them that the wording was ominous: “This is to tell you that your public assistance will be DISCONTINUED.” The letter went on to falsely allege that a required recertification form had not been received by November 30. I personally completed the form for Nadine to sign, and I mailed it in mid-November, so I was annoyed that I needed to spend Christmas Eve completing it again in hopes of averting a cut-off of their aid. Not taking any chances, I also filed online for a fair hearing to ensure that their aid would not be interrupted by this bureaucratic obstacle. Despite the NYC HRA’s relatively poor customer service, the New York State Fair Hearing Department operates rapidly and efficiently.

Years of Being Stuck With No Good Choices

As I look back on Joseph’s life, I am frustrated by the Catch-22 nature of his existence.

• Joseph once had a steady job as a delivery man for Pizza Hut. But in 2012, Hurricane Sandy flooded the basement apartment where he and Nadine lived and which their landlord had been subletting to them illegally. This meant they had no paperwork to prove that they were homeless. Therefore, they did not meet the requirements for public shelter housing. That’s when they began sleeping on the sidewalk, where I met them around September 2014.
• In early 2015, when I planned to bring them to the Public Advocate’s Office to try get them housing, they knew they needed to be rested and look their best for the meeting. (The Public Advocate is the second highest elected public official after the City’s Mayor.) So they decided to spend the night in the subway, instead of on the sidewalk. However, a few weeks earlier, Nadine had been attacked while trying to sleep in the subway. So Joseph made a point of staying awake all night to protect her. He did succeed in helping her look her best — but he looked terrible that morning and had difficulty walking. Since they had no safe place to leave their belongings, they were carrying everything in heavy backpacks. And between the weight of the backpack and his sleepless night, Joseph lost his balance in the deep stairwell of the subway. His efforts to help Nadine prepare for the meeting ended up making Joseph himself unable to attend it.
• Joseph and Nadine had many problems with appointments for Medicaid’s verification eligibility process. They would attend one meeting, but then something would go wrong causing them to miss a follow-up meeting. For instance, when Joseph was hospitalized, despite showing written proof of his hospitalization, their Public Assistance case was cancelled, requiring them to wait 60 days before starting again.
• They had many experiences of being treated badly at official appointments. Again and again, as I wrote in November 2015, I was shocked by all the negative and unhelpful energy people who work in “the system” constantly directed at Joseph and Nadine. This ranged from disrespectful and hurtful attitudes to repeatedly making them wait until a city employee was done with personal things that should not be done during work. This is why, whenever possible, I accompanied them. My mere presence as an informal advocate often got them much quicker and more respectful treatment. Later, I was able to file Reasonable Accommodation Requests for them which gave them priority at City offices.
• In September 2015, just eleven days after they were finally able to get off the street for the first time in three years to sleep in a shelter, they received a ridiculous request: that both of them “provide proof of whereabouts” on specific random dates over the past two years. The city’s request added: “Proof of residency are mail, bills, letters, postmarked envelopes, etc. Proof of street homeless is where yu (sic) ate, washed, and slept.” This request was made after we had already sent the city a detailed support letter giving my confirmation as a neighbor who saw them on the street every day, as well as the name of a non-profit and the phone number of the case manager who could confirm it.
• Joseph did not have time to write the book he imagined, which would have been called Homelessness for Dummies. So perhaps these blog posts can stand in for some of what he had to teach other people about the challenges that can overwhelm any person living in the streets.

Rest In Peace, Joseph A. Digilio
(2 March 1984–11 March 2017)

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• The expression “Catch-22,” from Joseph Heller’s 1961 novel, means a dilemma or difficult circumstance from which there is no escape because of mutually conflicting conditions. In the novel, the term is used by a World War II army psychiatrist explaining why any pilot requesting mental evaluation for insanity — hoping to be found not sane enough to fly and thereby escape dangerous missions — demonstrates his own sanity in making the request and thus cannot be declared insane.