Phil Costello sat behind the wheel of his pickup truck, eyes peeled for people in need of medical help.
As his truck pulled down a road in New Haven, Connecticut, about a mile west of Yale University, he outlined his plan. “We're going to look for some patients that work panhandling on the street,” he said.
Costello, a former automobile engineer, said he found his calling 12 years ago when he became an advanced practice registered nurse.
Since then, he’s treated thousands of unhoused people at Cornell Scott-Hill Health Center, a community health clinic, where he is the clinical director of homeless care.
Ten years ago, he launched the organization’s street medicine unit, which takes health care to people living on the streets. Each week, Costello and his team visit people in tarps set up beyond embankments or climb past poison ivy and sidewalk overgrowths to diagnose and treat unhoused people and prescribe them medication.
For Costello, the pickup has emerged as a kind of mobile office.
“Let's say somebody was struggling and they didn't have any sanitary napkins, or we needed to give them a surgical scrub to wash off potential MRSA [Methicillin-resistant Staphylococcus aureus] on their skin,” he said.
Normally, these are out of reach for unhoused patients.
“But with our program, the pharmacist will charge an account for us that we have," he said. "Then, we can then go and put that on our homeless account that's part of our funds over at Cornell.”
A bridge to care
Each week, Costello’s program serves around 125 people. The numbers are growing, driven by the rising cost of housing in New Haven and the ongoing opioid epidemic, Costello said.
He pulled the truck over to the side of the road and a short walk brought him to William Vicenzi, who was panhandling at a busy intersection.
Vicenzi came to this spot after attending rehab for substance use disorder, where he was given medication-assisted treatment, he said.
And now, he hoped that Costello would help him with psychiatric medication. Vicenzi said his doctor closed his clinic in New Haven and moved to Milford.
“I don't know Milford well like that, to get to his place on the bus,” he said. “I got a couple weeks before I see a new psych doctor. So I just need – they call [it] bridge medication to get you by until the next visit.”
It was Costello who set up Vicenzi with the new psychiatrist. Now, he went over Vicenzi’s symptoms and offered to write a prescription for the bridge medication.
Vicenzi said he’d pick it up immediately at a nearby Walgreens.
“He already ordered ‘em,” Vicenzi said. “He’s good. He’s the best.”
Costello said this quick and no fuss process was critical to Vicenzi’s well-being.
“A lot of the psych meds are not, it's not good to stop them suddenly,” Costello said. “The mental health would perhaps get worse. They can have pretty detrimental side effects and some of them can even be life threatening.”
Empathy without judgment
Turning back toward the truck, a young unhoused man approached Costello. There was an unhoused woman in need of medical help a few streets away, he said.
Walking back, Costello exclaimed with delight how well he believed the young man was doing. “About six months ago, he inherited a dog from one of the other homeless individuals, and you can tell how much he loves that dog and how it’s really helped his well-being,” he said.
Empathy without judgment and compassion for those struggling with substance use disorder are key to Costello’s work.
It’s an approach to care he said he learned while working with Dr. Jim O’Connell, who treats unhoused people in Boston. O’Connell’s Boston Health Care for the Homeless Program is a national model for how health care is provided to unhoused people.
“I trained under him,” Costello said. “He took me under his wing.”
‘We don’t want it to go back to her heart’
A short drive later, Costello arrived at the street where the woman with wounds was thought to be living. He learned from a group of unhoused people that she was on the back porch of a good samaritan.
The woman walked out to the sidewalk.
She had vivid, red wounds everywhere – face, arms, legs.
Costello opened his backpack, filled with swabs and tools to treat wounds.
“An EpiPen, a glucagon pen, some antibiotics I can inject, some toradol for pain, that I can inject,” he said, looking through the bag.
The woman, who said she did not want to be identified because she was in hiding, said she had been treated for endocarditis, an inflammation of the heart. She sat with Costello on the sidewalk and the two talked.
Later, Costello said that heart inflammation with chronic, draining, wounds is a bad combination — an infection was still in the woman’s body, he said.
“We’re making sure that she’s got the antibiotics she needs,” he said. “We don't want it to go back to her heart.”
In addition to the antibiotics, he quickly gave the woman several days worth of clean dressings and wound disinfectants.
While infections are a common medical problem among the unhoused, so is a poor diet.
Later that day, Costello happened upon another woman who called herself “Veronica” and declined to give her last name. She showed Costello rashes on her body, saying they were itchy and spreading.
Costello examined the rashes and put in an order in his phone for lab tests at no cost. He said rashes are a common condition among people who are unhoused.
“They're not eating appropriately, they're not getting the right nutrition,” Costello said. “One of the main things that suffer in your body when you don't have good nutrition is your skin. It drops your defenses [and people] get funguses, bacterias, eczemas.”
Colstello told the woman and her partner where to go for the blood test and advised them to arrive earlier in the morning, when the wait was shorter.
“Thank you Dr. Phil,” she said, with a grateful smile.
Costello said his patients knew he was not a doctor, but it’s what they call him with affection – after the TV show. He offered the woman a reassuring word, then got back to his truck.
Off to the next stop, where his patients were.
