It’s a late October afternoon, the sun plunging towards twilight. Earl’s tucked up under an overpass on Interstate 10. I’m his doctor doing a first “home” visit. He’s wrapped from the autumn chill by an old overcoat and a tattered blanket. A small barbeque grill glows with warmth. A plastic bottle, a cardboard box, and a roll of toilet paper sit next to a twin mattress.

I struggle up the angled concrete. “How do you get up here? It’s a hard climb.” He snorts a bent grin. “You get used to it, but there are days I’m on all fours.” He motions for me to sit next to him. I plop down on the cold slab. He has a salty, sweaty smell, flavored with smoke. He pushes the mattress to the back and moves the plastic bottle. “That’s my nighttime pee bottle.” I scrunch my brow. “I should get me one of those. At my age, I’m up and down the whole night.” My words seem hollow, like lip service meant to distract his discomfort. It’s not my intention. I apologize. He laughs a husky, cigarette-ripened laugh, tells me not to worry, then points to the cardboard box. It’s filled with gravel. “I try to poop at Hardees or McDonalds before they close, but if I have to poop during the night, I use the box and empty it in the morning.” It’s a human litter box. My shoulders slump.

I ask if the police allow him to live under the overpass. “Doctor, not only do they let me live here, they keep a watch on me. They know I’m no danger to anyone; I’m too old and sick.” He reaches in his coat pocket and pulls out a bottle of morphine pills. “They also don’t want anyone taking these from me.”

I warm my hands over the grill’s smoldering coals. I ask how he ended up without a home; his milk-flecked pupils roam the distant streets. “I’m poor, been that way my whole life. But when I was young, I didn’t know we were poor, to me it was just the way things were. Old clothes, old shoes—sometimes no shoes—and a little bit of food. But I got tired of being hungry. I dropped out of school in tenth grade, left home, and been drifting ever since, working odd jobs and begging on the streets.” He puckers his face and leans forward. “Don’t get me wrong, I’m thankful for what little I have, because it’s my own doing, but at sixty-seven years, I’ve never felt settled, never had roots.” I pat him on the shoulder. “I admire you, Earl.” And I do, for he has an inner strength and humble dignity that accepts each day with no assurances other than the demanding grind of sickness and survival.

We sit in a wordless silence broken by the muted rumble of cars and trucks. Finally, Earl stands, rubs his iron-filing stubble, and shuffles to the ground, arms outstretched for balance. Motes of dust ruffle from his coat and shimmer in the sunlight. He pulls a plastic bag from his pocket. He needs to go to the bakery before they close; they give him their throwaways. “You want to come?” he asks.

“No, you go, I’ll check on you again in two weeks.”

As I watch Earl hobble down the road, a breeze blows that cuts like scissors. He pulls his coat close, then turns and waves for me to follow. I relent and run to his side, gravel crunching underfoot. We walk quietly for a block. He stops and points to a man slumped on the sidewalk with a cardboard sign: “Homeless. Sick. Please help.”

“That’s my friend Joe, he’s dying of lung cancer too.” He pauses. “People see us, but they don’t see us, you know what I’m saying? It’s like we’re not even here. What’s worse, they don’t even care how or where we die.” I nod, sadly. “What makes one life more important than another?” he asks. “Every story counts.” He ambles over and gives the man a hug. When he returns, I notice tears leaking from his eyes. “Not having a home is hard, but not having a home and dying is harder.” I shudder; Earl’s words are painful and discomfiting.

As we continue to walk, I become angered and unsettled. Society maligns the homeless as irresponsible and lazy, and presumes their lives are a cluttered mess of mental illness, addiction, and criminal behavior. However, this prejudiced portrayal, while in part true, demeans all homeless, including the many who live on the lip of indigence where the difference between housed and homeless may be the loss of a job or an escape from domestic violence. But perhaps more important than cause is the lack of societal concern, the homeless left to grapple at the margins of a caste-like social order, seen but unseen, absent in the eyes of the privileged. It’s even worse for the dying, many of whom spend their final breaths in squalor and isolation, their legacies nothing more than scribbled footnotes in the back pages of a police blotter. As Earl said, “Not having a home is hard, but not having a home and dying is harder.” I can only imagine.

Paul Rousseau is a semiretired physician and writer, with articles published or forthcoming in The Healing Muse, Blood and Thunder, Intima: A Journal of Narrative Medicine, Months to Years, Cleaning Up Glitter, Burningword Literary Journal, Prometheus Dreaming, Hospital Drive, JAMA, Annals of Internal Medicine, Canadian Medical Association Journal, Tendon, and others. He is currently working on a collection of essays. Rousseau lives in Charleston, SC, and longs to return to the West. Lover of dogs.