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8 Sheep’s Clothing Lessons Learned from TB in the Field In October 2002, I visited New York City. Exactly one decade had passed since my TB training first began. Clearly, much had changed since then. But the autumn sky was blue and clear, and the city felt the same as I remembered it from ten years before, in spite of the gaping hole in the downtown skyline. The streets were full of life, and people of every possible derivation and affiliation mingled there, en route to offices, restaurants, hotels, boutiques, factory floors, flower shops, sweatshops, liquor stores, hospitals, and prisons. On the corners across from where the World Trade Center once stood, vendors hawked memorabilia of a national tragedy. Like a seasoned fighter, New York kept on punching even with two big teeth knocked out. The September 11 morgue was directly adjacent to the city shelter where Carmela’s office was now located. She was my field supervisor at the city TB clinic in 1993 and she looked much the same as she did then, a large, commanding woman with a loud, easy laugh, dreadlocks extending halfway to her shoulders. She said when the planes hit the towers, the whole city went quiet; out on the street, you could hear the whispers: “Oh my God, Holy Shit.” Through her office window, she says, she watched the bodies and body parts carried in from Ground Zero. We sat by that window and talked about the old days and what had changed. I said, “I still feel totally at home walking the streets of the city,” and she responded “That’s because you are.” She introduced me to a couple of the “fellas” at the shelter. One had been exposed to TB in prison. One had been homeless, living in a squat in Harlem for about ten years. One had gotten kicked out of an old folks’ project in the Bronx because of drinking and carrying on, and ended up in the shelter system. All of them were black men, all over forty. All had familiar stories of downward mobility, intersecting the vector of infectious disease, usually with the added help of an addiction. Gus, another of my former supervisors who still worked for the health department, walked in the room while I was talking to Carmela. He didn ’t recognize me at first, but then his eyes lit up. “Paul! How are you doing, man? What are you doing here?” He looked thin and healthy, 233 sporting a neat goatee but with the same intelligent glint and raised eyebrow that I remembered. His voice, with its musical Greek inflection, sounded familiar, as though I had just heard it yesterday. He told me to come over to his office for some strong coffee, and asked what the theoretical argument of my dissertation was. It was strange to have to defend my dissertation again on the 4th fourth of the shelter, but I did my best, talking about the social determinants of health, trying to sum up my argument without descending into academic babble. After I finished visiting with Carmela, Gus and I walked over to a noodle joint a couple blocks away. He was impressed by the things that I remembered, like the contact investigations we conducted at a Caribbean bar on the Lower East Side and a weird little gift boutique run by a Japanese couple. “Were you taking notes, man?” he asked, laughing. “Actually, I was,” I said. Over lunch we talked a lot about the social factors underlying TB and the social construction of medical facts, and the way the homeless are viewed as flawed individuals in need of correction rather than human beings living within difficult circumstances. He said they have meetings at the shelter where homeless people are gathered into groups and taught how to be “functional.” Gus said, “They are functional , they are just regular people.” After lunch with Gus I headed downtown to see Arturo, at the Department of Regulatory Affairs, where I had worked during the last few months of my tenure with the New York City Health Department. I rode the elevator to the 22nd floor of the Broadway offices, and waited for Arturo to come out, wondering what he would look like nearly ten years later. As it turned out, he looked almost exactly the same, and as he walked up he said to me, “You haven’t changed one bit.” My conversation...

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