On the long and diverse list of calls that make it to my “worst” list, one that vividly comes to mind involves the eviction of an elderly couple in Manhattan in the early 1990s. It still causes me immense sadness to remember this older couple haphazardly rummaging around their large two-bedroom apartment in midtown. This was probably the first time I had been called for someone who was being thrown out of their home, but definitely not the last. In the late 80’s and early ’90s, there were several eviction-related jobs I ended up responding to. A city marshal was involved and they often brought along a representative from social services, either Adult Protective Services or another agency. It was this representative who would call EMS.

When we arrived at this home, the door was wide open and we walked in. No one said anything to us except the building super and honestly, it was always the building super on the scene at any of these things, that had any humanity. He was a short, bald man with a Spanish accent who shook his head sadly and directed us to the couple. When we introduced ourselves to the woman she stopped what she was doing and looked up at us in a confused manner. She slowly looked towards the marshal who was busy marking off things on a clipboard. He never looked up but pointed to another man in the apartment. That man wore a lanyard with some sort of official ID and he had a clipboard of his own.

“Oh yeah,” he said when he saw us, as if calling for us had been a quickly forgotten detail. “You’re here for the gentleman. Ah, he has high blood pressure.” In his mind, that was sufficient explanation and he resumed whatever he was doing with his clipboard and walked away. We had been dismissed.

The woman had short brown hair and sad-looking eyes that predated the events of that day, as noted in several of the photos she took off of end tables and dressers to toss into bags they had quickly grabbed and started filling. The man was slim, balding, and wore thick-framed glasses. He seemed a little absent-minded, distracted, and more than a little embarrassed. Neither of them said much to each other as they moved around their apartment for the last time, trying to figure out what, out of 30+ years worth of living in that place, warranted immediate removal.

The couple seemed busy although they moved very slowly. It must have been difficult to prioritize all of their possessions. This had been their apartment since they had gotten married. They raised a daughter here, participated in activities, interacted with neighbors, and held family celebrations in these rooms. Everything they owned was inextricably tied to a lifetime of memories. They had a souvenir from the 1964 Worlds Fair that made it into the suitcase, along with several religious articles of their Jewish faith. A few changes of clothes went in as well.

The man was going through some papers in his desk, trying to figure out which were important and which were receipts he probably could have gotten rid of years before. “Sir,” I asked tentatively. “Are you not feeling well?”

He looked at me like I was out of my mind and I deserved it. Of course he wasn’t feeling well. He didn’t say anything to me for a long time, just continued shuffling through his papers. “Can I take your blood pressure?” I asked. He looked at me with the face of someone who was placating a child but he held out his arm.

His blood pressure was only slightly elevated, nothing unusual, and nothing that required an ER. I asked him if he had any medical problems. He told me only the hypertension. Then he remembered his prescription bottle and went to the kitchen to put it in one of the bags.

The couple continued doing their unorganized pack as if we weren’t there. A fat tabby cat was coerced into a carrier where she howled, fearfully looking at the strangers who had taken over her territory through the mesh of her small container. The woman carried the cat around with her as she looked for things to pack, holding up random items as she considered their importance.

Every once in a while a question was asked by either the husband or the wife and directed toward the marshal. The answer was always some version of ‘no’, with increasing levels of impatience. A defeated look would come over them and they would continue. The marshal seemed very annoyed, almost angry, with the couple. He rarely looked up from whatever important notes he was writing on his clipboard. It appeared that he had a long list of other families to throw out into the street that day and this couple was delaying his schedule.

I do not know the circumstances of that brought about that sad day. Probably, I assume, it was not one big thing but more likely hundreds of little disasters that lined up like inconvenient dominoes leading to that unwelcome knock on their door.

I’m sure the couple had received notices and warnings. Perhaps they were in denial or perhaps they thought they had more time to either fight the eviction or make other plans. Either way, when the marshal had shown up they were unprepared. I understand that evictions happen, that responsibilities need to be met, and that there are consequences for failing to meet them. But to be oblivious to the obvious distress this couple was experiencing was so callous. And the man sent there specifically to assist them couldn’t be bothered to do anything but call 911.

Both the marshal and the social services representative spent the time appearing busy, shuffling papers, and talking on the phone. I have no idea what services were available to the couple or what had been done prior to the eviction. But if there was nothing the social service man had to offer why was he there? I got the impression that he was not working for the couple but for the marshal, to make things easier for the eviction to proceed. The two men seemed to know each other although they did not interact with each other all that much. But when the marshal made a demand of the couple, either to hurry up or deny a request, the social service representative would reiterate what he said in some way, which came off as a supportive measure as if they were united and sometimes it appeared as if they were ganging up on the unfortunate pair, and us when we offered any assistance to the couple that didn’t involve rushing them out the door to our ambulance.

At first, my partner and I just stood around wondering what to do. The last thing we wanted was to interfere with the couple on one of the worst days of their lives. It was obvious the man wanted nothing to do with going to the hospital. We were standing near the man from social services when we started discussing how we were going to RMA [Refuse Medical Assistance]. It was enough to get him off the family’s phone he was using and stop writing on his clipboard.

“He needs to go. They both do. Take them to the hospital.” He tried to dismiss us again, expecting us to just follow his directions. It killed me to do his bidding but at the time we had an age discriminatory rule that he seemed to be exploiting.

Unfortunately, the man was 65, which in those days required us to call our telemetry doctor if he wanted to refuse. It was a terrible, ageist protocol that has thankfully gone the way of leeches and skull boreholes. But at the time we were bound to this archaic rule and the whole service revolved around it. We had been through this routine before with other patients who had reached an arbitrary milestone that rendered them incapable of making decisions that didn’t need to be second-guessed by a doctor. When we called telemetry, we would be asked why the man didn’t want to go. We could say that he didn’t need to, that he never called, that he was just being directed to go to the ER so that they could get him out of the apartment. And the doctor would tell us that it wasn’t our decision to make. When the man presumably got on the phone to speak to the telemetry doctor they would try and convince him to go, because everyone over 65 should have to go. There was a liability issue. The man could argue and they might let him refuse but before that happened there was a likely possibility he could be threatened with a visit from social services if he did so. The same social services agency that was assisting the marshal in kicking him out.

The man from social services started to rush the couple, lest we found the loophole we wanted that would have allowed them to skip the trip to the ER. “Come on, we need to get you to the hospital.” The couple looked at him with bewilderment.

The super stepped in and took the cat carrier from the wife. “I’ll look after Ophelia,” he told her. “And don’t worry, when you’re done at the hospital I’ll let you get the rest of your things.”

The marshal interjected, “Your things will be packed and put into storage. Have your lawyer give us a call and we’ll let you know where you can pick them up.”

The super then offered to put their items in the basement. The marshal told him he was not allowed to do that. The super offered to take some things into his apartment. The marshal now became impatient with the super as well. He spoke slowly, as if trying to reprimand a belligerent child, “You can only take what they give you right now.”

The man from social services stepped in and told the super that wasn’t going to happen because the couple had to go to the hospital right away.

“We can wait,” I yelled out, glad to throw another delay in the way of these two unfeeling individuals. My partner and I offered to help and immediately started putting random items into boxes. We found a crate and filled it with kitchen items. The super put them all in the hallway and called up his wife to take the cat.

Then, after a very short interval, the alarm clock on the marshal’s internal timetable went off and he put a stop to any more last minute packing. “This should have been done weeks ago. Time’s up. Just go to the hospital.”

The couple gave the super some of the bags and a box they had quickly packed. The woman looked around and started to cry.

The husband tried to comfort the wife. All the previous emotions in his face of determination, embarrassment, and confusion gave way to adoration towards this woman. He put his arm around her and looked at the two men who both looked away.

The couple moved slowly to the door, looking around the whole way. It was the last time they would see the home where they had spent their adult life. All the memories they made there would be tainted with this attached experience of being forced out.

The social service man suddenly became very friendly. He handed them his business card and told them to call with any questions or assistance they might need. It was incredibly disingenuous. During the entire time we had been there he had not offered any kind of assistance or made any arrangements on behalf of the couple, except to call EMS to rush them out of their apartment. They were only going to the hospital because he had no other place to offer them. He told the couple to contact the social worker at the hospital who, he assured them, would provide them with a place to stay. He had just passed this couple off for someone else to deal with. His presence on the scene had been as useless as ours was.

I attempted some small talk on the way to the ER but the couple remained silent. I’ll never forget how they just sat together without saying a word to each other.

At the hospital my partner and I asked the registration people about the social workers. They put us in touch with the one on duty and we talked to her about the situation. She became angry, complaining to us that all she could do was refer the couple back to the very same department the man on scene was from. “They pull this crap all the time!” she told us.

I gave her the phone number that I had written down from the business card. She called it up immediately and had a heated discussion with someone from his agency. Then she called the man’s supervisor. In the end she just shook her head and told us the couple was screwed. There was not much she could do for them except refer them to a shelter.

We went with her when she talked to the couple who had been sent to the waiting room. She asked if they had anyone they could call to stay with, she suggested their daughter. The wife started to cry and the husband told the social worker that their daughter had died almost a year earlier.

I have no idea what happened to them after that and I wonder all the time about them. How does someone pick themselves up from that situation? Where do you go from the lowest depths of tragedy to move forward? You would hope that there would be a safety net out there to help people that this happened to.

On many of our calls, we have patients or families in need of far more than we can provide them with, people living in squalor, people in need of counseling, people in need of basic necessities, and it’s often a catchall response for us that they just ‘speak to someone in social services. It’s what we were taught to do as a way to convince someone who doesn’t want to go, to take the ride to the ER (it’s all about getting them to go, I concluded) But now I knew that the advice and recommendation I had been giving had been far more limited than I would have ever thought.