Street Mission Endures, 1 Foot At A Time

As Phil Costello swept through the city this week helping homeless people weather a pandemic, he couldn’t perform surgery, prescribe expensive medicine, or offer a home.

He did shave down a painful callous, recommend antifungal cream, hand out new socks, and lend a trusted ear.

Sometimes, taking the edge off the pain in someone’s feet is the most important first step.

They call Costello ​“Dr. Phil.” But he’s not a doctor. (And he’s no fan of the celebrity of the same nickname.) He’s the clinical director of the Healthcare for the Homeless program at Cornell Scott Hill Health — a well-known and well-loved street outreach worker assigned to maintain relationships with some of the hardest-to-help people in town.

That mission has become more important than ever — and his relationships more valuable — as Covid-19 spreads its deadly toll. (Click here for a story about the role he played during a previous crisis, when a bad batch of K‑2 wreaked havoc on people on the Green.)

The city has upped its efforts to help the homeless during this crisis. Costello, meanwhile, is on the same rounds as always. The pandemic has made him and his crew think more about social distancing. They’re wearing masks.

“Well, it scared the hell out of us, number one,” he said of how the pandemic affects his work. He said that when he first heard about the pandemic, he recommended to his stronger clients that they go stay outside in camps, away from crowded shelters.

Otherwise, the mission remains the same, the work flowing from trust and wisdom developed week in and week out.

Like the importance of feet.

On Wednesday, Costello sat cross-legged with his back to the brick wall on the southern edge of the St. Thomas More courtyard on Park Street. Roy Law sat in a metal folding chair in front of him in a jacket printed with red, yellow, and pink dragons, a gray knit hat, and an American flag bandana tied around his neck. His blue surgical mask rested below his mouth, on his beard.

Law had come to get a meal at the soup kitchen offered every Wednesday at Yale’s Catholic center. Costello, knowing that many members of New Haven’s homeless population would be there, came to treat whoever needed medical attention. Law was a new client. Costello, a nurse practitioner, is clinical director of the Healthcare for the Homeless program at Cornell Scott Hill Health Corporation.

Costello held Law’s foot in his gloved hands, resting it on his knee.

Law said he had been in a bus accident in February. He went to the hospital and was then released back onto the street. He had spent the last few nights outside, the previous night at a bus station.

“I’m too old. I’m 64 years old. It’s taking a toll,” he said of his days and nights in the street. ​“I just need a place to stay for the next few days. I can’t keep walking around. This is driving me crazy, man.” He had walked up to the black folding tables Costello and his team had set up and explained his situation to them.

Law said he has been on the wait list to get a hotel room. He doesn’t have health insurance. He needs help getting set up with food stamps.

Costello couldn’t help with most of those challenges directly. He asked Law if he had a case manager, who could help get him set up with health insurance, food stamps, and housing. Law gave his case manager’s name.

Then Law told Costello about the bus accident and about his feet. Costello could address that problem right there. That how Law’s leather, lace-less right shoe ended up resting on the cold stone of the courtyard while his foot sat between Costello’s gloved hands.

Nurse Jessica Arroyo took down Law’s information and started trying to contact his case manager. Medical Technician Chloe Andree sat next to Costello ready to hand him supplies.

“I could trim this down for you right now,” said Costello. ​“Take this callous off for you and make you feel a little better.”

Andree handed Costello a small packet. He opened it and pulled out a stick with a gob of viscous maroon goo that he wiped on the bunion on Law’s foot. Next, Costello took a small blade and carefully scraped away the dead skin. White flecks began to dot his black pants.

He trimmed Law’s toenails, which had become infected. Snip. ​“I’m trying to give you a little relief in there,” he said. Snip. Snip.

“The pain is killing me. I’m walking all night long,” said Law. ​“The pain is killing me.”

“Show me your shoe,” said Costello. He turned it about in his hands, and flexed the base. ​“This is a good stiff shoe, but I bet it’s too small for you,” he said.

Costello trimmed down a callous on Law’s other foot, as well as the nails. He wrapped the first foot up in a bandage and placed padding over the toes, before putting a new pair of socks on Law’s feet and putting his shoes back on.

Arroyo reached Law’s case manager. She was at a new drop-in triage center for the homeless at Blake Field, where Costello had been the day before.

Andree, meanwhile, was on the phone with a friend of Law’s from church, who said he wanted to come see Law. They agreed that the friend would meet Law at Blake Field, where Law would go to see his case manager.

Costello handed Law two pieces of paper. One of them would get him an anti-fungal cream. Costello said he has relationships with a few pharmacies in the city. He can give his patients a ​“prescription” for an over-the-counter medicine or hygiene product that will allow the patient to pick up the item for free. The pharmacy then bills Cornell Scott Hill.

Costello told Law to put the cream on his feet three times a day to help with his infected toenails.

The other sheet of paper was a real prescription for a custom pair of shoes. Law will need health insurance to get those. To obtain insurance, he needed to go meet his case manager at Blake Field. Once he has health insurance, Costello said, Law will need to see a podiatrist, and get surgery. And for the next few nights, he would need to be off the streets.

Costello stood, bracing himself against the brick wall of the church. He brushed the white flecks of dead skin and nail from his pants.

Law stood, too. He took a step

“That’s a little better than it was,” he said. ​“It’s better than it was.”

For the first time throughout the entire encounter, a slight smile eased onto his face.

“Roy, if you’re back here next Wednesday, I want to know how you’re doing,” Costello said.

“I appreciate all you guys,” Law said, beginning to walk very slowly to the car that was waiting to take him to Blake Field to meet with his case manager. Joanna Vincent, a retired doctor who volunteers with Cornell Scott Hill’s medical corps, had offered to drive him over.

“Well, you know, you get better and help someone else,” said Costello.

“Yeah, I guess so,” replied Law. ​“Thank you. Thank you guys.”

When you do street medicine, you sometimes have to adapt to what people need right away, said Costello. If someone has trouble walking because of foot pain, you can’t fix the bunion in the street, but you can shave down a callous to ease the pain, and it shows the patient they can trust you. Once you get someone’s trust, you can help them seek out the more intense help they will need to get elsewhere, said Costello. But the first step is shaving off a few callouses.

At The Camps

Costello doesn’t treat homeless New Haveners just at food pantries and soup kitchens. He treks to where he knows some live, camped under bridges or hidden in the bushes.

He made the trek Tuesday afternoon. He parked his black pickup truck, which carries his medical supplies, at the East Rock Magnet School and stopped by the triage center at Blake Field on its first day in operation. Then he set out on foot, a stethoscope around his neck, a red backpack full of supplies on his back, and squirt bottle of hand sanitizer wrapped in black duct tape in one hand.

He passed a man eating a sandwich on a bench. He asked him how his arm was doing.

“It’s all right,” the man replied.

“Don’t sleep on it,” Costello reminded him.

As he neared the first campsite, he yelled out: ​“Anybody home? Phil Costello, Cornell Scott Hill.”

No one answered. He kept walking.

“Their campsite is like their home, so you want to ring the doorbell before you go in,” he said.

The next one was under a bridge. He stood at the base of the slope leading up to an enclosure of tarps. ​“Phil Costello here! Need anything?”

No one answered.

“He usually hollers down if he does,” he said.

Building trust with residents is essential, he said as he walked to the next encampment.

How do you build trust?

“It’s over time,” he replied. ​“It’s really showing a bit of your own humanity. Not making promises you can’t keep. And keeping promises you do make.”

No one was home at the next site, or the next. At the third, a young woman poked her head out. At first she said she didn’t need anything, and thanked Costello. Then she called him back and asked for ​“supplies.”

As he walked away, Costello said he would tell someone at Sex Workers and Allies Network (SWAN) to go back out to the campsite to deliver the clean syringes the woman had asked for. Costello can’t give them out. His colleagues at SWAN, with whom he often goes on his check-up walks, can.

“I find it really important to try to reframe from drug abuse to words that really do identify it as a disease,” he said. In order to treat the disease of addiction, you have to treat it as a disease. You have to help people with the symptoms if you’re going to address the root cause.

Costello started out for the final cluster of encampments, walking along a road and then cutting off into the bushes.

He spoke of how the American healthcare system helps the homeless better by treating the disease of addiction in emergent care. Ease the symptoms so patients are in a position where they can receive treatment for other problems.

“But mostly I think the healthcare system in general has become very dehumanizing and capitalist,” he said. When doctors must see 20 patients in a day for the health system to turn a profit, they don’t have time to hear someone’s story. When a doctor barely sits down in a room, said Costello, it doesn’t help people struggling with cognitive and other problems.

The healthcare system needs to allow care providers to spend more time with patients, he said. ​“It’s hard to trust somebody that spends five minutes in a room with you.”

No one was at the last campsite either.

“Just That Little Word”

After Law left Park Street on Wednesday, Costello, Andree, and Arroyo began packing up their supplies and carrying them to Costello’s truck. An older man with a cloth mask hanging loosely below his nose walked into the courtyard to get a meal. As he left with the plastic bag of food, he greeted Costello and handed him a crumpled-up newspaper clipping. It was an article that had made him think of a recent conversation the two had had.

They stood and chatted for about a minute. Then the man went on his way. Costello set the article on the table and continued assembling his supplies.

A few minutes later, Andree folded up the first table. The clipping sat on the second. She picked it up and turned to Costello.

“Do you want this?” she asked, holding it out to him.

“Yeah,” he replied. He took it and tucked it into his coat pocket.

Costello said he got into nursing because he wanted to work with people and help them. What he likes most about the job are his patients. ​“They’re my friends. They’re like my extended family.”

Costello has been a nurse for about a decade. He has been with Cornell Scott Hill since 2013. Before that, he was a mechanical engineer for 20 years.

From 2000 to 2008, he commuted to Michigan every week.

“I just started feeling a kind of emptiness with engineering and I wanted to do more,” he said. He had a lot of time in those years in hotel rooms in Michigan to study and get his nursing degrees.

“People were sick for different reasons in my life. I just thought it would be nice to have some more direct interaction and help people that way,” he said.

At that, Gregory West, who had been listening from a bench on the sidewalk where he was looking through the food in his plastic bag, cut in.

“There’s a lot of people out there, when they hear what you just said, it gives them strength,” he told Costello. ​“Just that little word you just said, that going to help somebody.”