On World AIDS Day 2017, WNCAP held a complimentary Community Breakfast Celebration to honor WNCAP staff, community partners, and longtime allies. Several speakers delivered remarks, including WNCAP Medical Case Manager James Plunkett. Below is the full text of his speech, which left many in the audience in tears:
When Katherine asked me if I could speak at this event I was daunted, to say the least. I’ve only worked at WNCAP for a relatively short time and am just coming to terms with what it means to be a medical case manager. When I started this position it became clear right away that I was stepping into an immense historical narrative, of which I knew very little. As we all know, this is a story of death, of hope, of love and liberation, of oppression and an indomitable spirit that has disallowed the struggle to go unheard.
I have the privilege to work with true advocates at WNCAP; people with boundless compassion and an audacious commitment to reduce the suffering of others. Mark Collins, the President of our Board, perhaps said it best at one of my first staff meetings, telling us that at its origins WNCAP was founded to ease the process of death for our clients and now, in 2017, we have the perhaps even more ponderous task of helping them learn how to live.
More than anything, I see this job as an act of solidarity. We have the gift to stand with our clients: to hold their hands while they cry, to learn their grandkids’ names, and rejoice with them in the many tiny victories. It is, in its very essence, an act of resistance. We all know that our clients are waking up every day to a system that is not only broken but often rigged against them. Their lives are symptomatic of the forces of structural violence that they experience and that make accessing medical care so absurdly difficult. We are holding their hands in solidarity to jointly defy this heinous status quo. A norm of racism, homophobia, classism, ableism, and economic oppression has infinitely increased the difficulty of accessing one of the most basic things on this planet: health care. And yet, those we serve get up every morning and say, “Not today. Not me”. And we have the most distinct of gifts to bow our heads in understanding and simply say, “Ok, let’s do it”.
Working within such a fractured system demands innovation. When a client that was experiencing homelessness could not use the more busy showers of our community partners because of his extreme social anxiety one of our team used their personal YMCA membership guest pass so that he could feel safe. When a client, untreated since his diagnosis in the late ‘90s, is living somewhere illegally but desperately needs to get to the doctor to get on medication we arrange to meet in secret locations day after day to get him to his physician safely. And after being hospitalized three times in three months for pneumonia we, along with the finesse of our community partners, got his viral load to “undetectable” in three weeks. It is making up reasons for a client to walk you out to your car after having just spent an hour with her and her partner/abuser talking about how “great” everything is just to ask, “How are things really?” and when she tells you how bad it is you know exactly who to call because this community is full of genuine advocates with compassion that I can only describe as intrepid.
Being a medical case manager is far from glamorous. In many ways it’s akin to going to a museum and, instead of admiring a finished painting, having to watch the artist go through her entire tedious process replete with neuroses as you stand back and simply wonder, “What the hell is she painting?” The incredible scientific developments that have allowed for stronger, streamlined anti-retroviral regimens, while obviously fantastic, are too often conflated with ease of access and adherence. A doctor said to me once that a patient taking their pill is the easy the part. Yes, it is incredible and honestly unbelievable that someone can take one pill instead of thirty, but we should never assume it is easy. As soon as a patient walks out of the doctor’s office and is told they need to be back in six months, easy as that, I can promise you that there is a vast wilderness of forces between them and that appointment. They will lose love, miss the bus line, get their check late, waste their money on dope, get a job, lose their car keys and miss their first day at work, try to get their kid into daycare, do load after load of laundry, stay up for five days, feel like sleeping for their rest of their life, and, yes, if the stars align and we cross our fingers and smile real big maybe they will take “just” that one pill a day.
Amidst all this, there is a depth of joy and ridiculousness in this position that is difficult to describe. I had a client call me Eddie for six months. I once drove four hours to get a client to an appointment only to find out that he had been told the wrong time and would have to come back another day. Shaking his head and grinning wryly at me he merely asked, “Well, wanna go to Taco Bell?” I had a client text me quite angrily in all caps only to explain at the end that, “I AM NOT TYPING IN ALL CAPS BECAUSE I’M MAD, IT’S BECAUSE IT’S EASIER FOR ME TO SEE.”
These are the moments I really love; when the walls come down and we can have human moments together. Sitting on a client’s porch after an impromptu couple’s therapy session, looking at the mountains silently. Having someone arrive an hour late for an appointment with two Cookout Milkshakes in hand, sheepishly offering, “I got one for you.” This is the point, I think, of the work: to make people feel human again. Despite systems and experiences that have led them to the conclusion that they are somehow lesser, it is our job to defy this inane edict of the political, social, and economic structures that govern our client’s lives. We are merely humans suffering together. My clients have been dealt a much, much harder hand of suffering than I have and I see it as my responsibility to provide some modicum of solace.
I’ll end with one last story. I had a long time client come in this week to bring some of her friends to get tested. She came into my office just to talk, to catch up. She’s using but she wants to stop. Her cousin’s stealing from her grandma, her boyfriend’s in jail, and we’ve got to find someone to watch her dogs and keep her wood fire burning so her pipes won’t freeze while she’s in rehab. She told me that she was feeling scared and anxious this morning but that she came to WNCAP just to sit in her car in the parking lot, “I feel safe here”, she said. It was then I realized that it didn’t matter if it was me or her previous two case managers or the one after me sitting across from her hearing about her life. What matters is that there is a place to go, a place for people to sit and feel human again; to feel that their health care is not something they have to struggle to obtain but deserve as a basic human right.
What a fantastic privilege it is to fight alongside them.
James Plunkett is a Medical Case Manager at WNCAP. He delivered these remarks at the World AIDS Day Community Breakfast Celebration on December 1st, 2017.