“Sweet Feet” by Amy Shea
BLAST, TMR’s online-only prose anthology, features prose too vibrant to be confined between the covers of a print journal. In “Sweet Feet,” essayist Amy Shea reflects on her discoveries during a summer spent volunteering as a foot-care assistant for Boston’s homeless population. The essay was a finalist in our 2022 Perkoff Prize contest for writing about health and medicine.
by Amy Shea
When I first met Rebecca, I was taken aback by her stature; she was thin, so thin, likely weighing no more than a hundred pounds. She was missing some teeth, and she kept her hair short, complaining of sometimes intense head pain. Her skin clung to her bones, and she walked with a cane. She was less than ten years older than I: in her late forties. Some days, she would come in spirited and energized, one time regaling us with a story of doing free sessions of goat yoga that had been offered near South Station. Other days, she’d come in more subdued and would sit quietly, not making eye contact.
It was 2018, and for the summer I was volunteering as a foot care assistant at a day shelter for homeless persons. Walking is a primary mode of transport for many homeless; therefore, foot health needs to be addressed with those experiencing homelessness. Problems can include athlete’s foot, foot pain, improperly fitting shoes, immersion foot, calluses, corns, blisters, and loss of toes due to untreated infection or frostbite. The most common ailments we saw in the clinic were blisters from ill-fitting shoes, as well as athlete’s foot and immersion foot from wet and dirty socks and from using shared showers in the shelters.
Dr. Jim O’Connell is the founder and president of Boston Health Care for the Homeless Program (BHCHP), which opened in 1985. In its thirty-plus years, it has grown into a behemoth of safe spaces for those in need, its jewel being the Barbara McInnis House, the 104-bed medical respite unit on the main campus, plus additional sites around Greater Boston, including the foot care clinic inside St. Francis House, where I volunteered. The main campus, situated in downtown Boston across the street from Boston Medical Center, offers a plethora of services, including a dental clinic, a pharmacy, an eye clinic, an outpatient clinic for regular doctor visits for both adults and families, specialty care for those living with HIV, support for transgender people, a behavioral health unit, a substance use disorder unit, as well as a street team that meets a subgroup of homeless people (those sleeping the roughest of the rough) who can’t or won’t enter a shelter.
Dr. O’Connell wrote about his experience as a street doctor in the book Stories from the Shadows: Reflections of a Street Doctor. The first chapter, “The Footsoak,” leads the reader through O’Connell’s entry into street medicine, where he first began tending to the feet (and other ailments) of homeless people in Boston’s oldest and largest shelter, Pine Street Inn. O’Connell writes:
In keeping with the obvious biblical allusion, the footsoak inverts the usual power structure and places the caregiver at the feet of each patient and far from the head…After wandering the city for hours, suffering exposure to the extremes of weather, and then standing in a series of queues awaiting entrance to the shelter, a bed ticket, and the evening meal, homeless persons relished the chance to sit and rest while someone cleansed and soothed their feet. (16)
Having read about Dr. O’Connell’s experience, I was compelled to apply as a foot-care assistant. Although I’d never been homeless, as a hiker and someone who didn’t own a car and therefore walked nearly everywhere, I understood the role that feet play in our health. Without healthy feet, so much of our autonomy can quickly be lost.
Leading up to my first day, I was given the foot-care assistant duties and responsibilities sheet that outlined the basics of what I’d be doing: setting up basins for foot soaks and working with nurses to assess the condition of patients’ feet, distributing socks and towels to patients, assisting patients with the application of creams and powder for the feet, engaging patients in conversation (to establish rapport, which can result in the identification of further medical issues), disinfecting and washing basins, and assisting with restocking medical supplies and other administrative tasks. Yet I was still unsure what it would actually be like. I was nervous about the unknown: what the place would look, feel, sound, and smell like. I was concerned about whether I’d do a good job and be able to follow procedures and processes. I worried about trying to remember when you needed gloves on versus when you needed to take them off. What if I was bad at handling someone’s feet? Or didn’t know how to talk to the patients? Or got in the way of the medical staff?
Ultimately, I understood that I couldn’t know it all and that my fears wouldn’t be assuaged until I got there and began putting my training into practice. But I hadn’t expected to be schooled on the importance of something as seemingly small as the sock and its power to heal, to comfort, to offer a small moment of feeling human—of feeling normal.
How often do you think about socks? Socks get dirty and wet. Of course, I knew that. But that knowledge was now placed in a new context. I had never thought about what might happen if you couldn’t clean or easily replace your socks, and it hadn’t occurred to me just how quickly they became unwearable.
Before volunteering in the clinic, my sock buying had always happened passively. I’d be in Target and know that my husband had more holey socks than not, so I’d throw a pack into the cart for him and then wind my way through to the women’s department, where I’d see some ankle socks and think, Yeah, I could use some new ones too. Those packs of socks would then get absorbed into the cost of all the other Target purchases. But when I started going to the store explicitly to buy socks for the shelter, I was taken aback. I’d think, What do you mean it’s fourteen dollars for a six-pack of men’s crew socks? ‘Expect More. Pay Less’ my ass.
Here’s the thing: not all socks are created equal. I could have bought cheaper socks, but they wouldn’t have had the same padding, softness, or weight to them. A better-quality sock will go further in keeping blisters at bay, something that all too often plagues those who are homeless, because if you can’t afford a home or food, you also probably can’t afford a taxi or an Uber. Even a bus ride is likely out of your means, which leaves you walking miles upon miles to pick up your Social Security check, meet your social workers, get to the doctor, go to the foot clinic, and then, finally, head to the shelter for the night, where you’ll leave your socks on after that long day of walking and sleep with your shoes under your head. But as they say, Boston is a walkable city—thank God for small favors.
Most of the socks in the clinic came from donations. Some socks were individual one-off donations. Sometimes people would coordinate sock drives among their friends and family and bring in a larger haul. The biggest donations the clinic received came from the annually coordinated effort between BHCHP and the Red Sox baseball team: Sox for Socks. In 2017, more than four thousand socks were collected.
Of course, I should have expected to have more than just my ignorance of socks eliminated. One day when I came in for my volunteer shift, I wore a T-shirt from the local REI store that had an image of evergreen trees and “Take It Outside” written beneath. It was the first time I’d worn a shirt with writing on it into the clinic. I generally figured it was better to avoid this so as not to offend someone: no sports teams or sayings that could be otherwise contentious. But going outside, being out of doors, what was offensive about that? But what happens when you take something and place it in a new context? What might be considered virtuous or admirable can become mocking and distancing. One man pointed at my shirt as he was bending down to scrub his feet with a small piece of pumice and said, “I’m outside all the time.”
Rebecca wasn’t the only patient who would stand out and hold a space in my memory. On my first day at the clinic, I found myself tickling the feet of a grown man. He plopped down in the chair and boisterously answered the requisite questions on the intake form: name, date of birth, did he have diabetes or any known allergies, had he received a flu shot, did he smoke (we always specified that we meant cigarettes), where his primary care physician was located (at this shelter or somewhere else), and where he spent most nights. He was jovial, and as I examined his feet, he confirmed that he was in fact quite high. Due to his size, he was unable to bend over to take his shoes and socks off and would need help with the process. I crouched down and untied his shoes, placing them to one side, and took each sock off. Then we filled two buckets, one for each foot, as he couldn’t place both in just one bucket. It was hard to miss the large ankle monitor adorning his left leg. He, like so many others, seemed to be in a perpetual state of liminality. While his feet soaked in the warm, soapy water, he regaled the room full of volunteers and other patients with soapbox banter about how certain local universities were known for their love of weed. After ten minutes or so, I took his feet out of the water, toweled them off, and began massaging cream into them. As I massaged, I heard giggling. I looked up at him, and he said, “Girl, that tickles!”
Then there was Mark, a man around my age, who came into the clinic regularly. He was fit and muscular. He looked like a bodybuilder and was someone I would refer to as the invisible homeless. If you saw this man walking down the street, you’d never know that he stayed in a shelter. He was clean-shaven and had no other visual indicators that he might be experiencing homelessness. As Nick Flynn writes in his memoir, Another Bullshit Night in Suck City, “Sometimes I point out that eighty percent of the homeless are invisible, like the proverbial iceberg, that when I walk through the city now every other person I see is someone I know from the shelter, but if you didn’t know you’d think they were on their lunch break, enjoying a little sun” (184).
One morning Mark came in deflated and tired and told us about his previous day, which had begun with him needing to do laundry. He’d thought he had money on his card, but when he got to the laundromat, he realized the card was empty, so he retraced the two miles he’d just walked with a forty-pound bag of laundry in tow to get money from someone he knew so that he could go back to the laundromat. First errand over; on to the next. He waited for the bus to take him to the Department of Transitional Assistance—the local social security offices—to pick up his check, but the bus never came. So, he walked there as well. A late-summer afternoon spent walking from errands to chores and back. It was a day to treat himself: McDonald’s. He’d saved enough money for a double cheeseburger—just enough for the burger. But thirst was getting the better of him on this hot and humid New England day. He asked for a free glass of ice water. The woman behind the counter looked at him like he was crazy and hesitated and mulled over his request. He asked again, unable to understand why his question was such a difficult one to answer. Finally, after him asking multiple times, she gave him the water but no ice.
Daniel came in regularly, yet he still struggled to maintain good foot health. Some days he was cheerfully belligerent, and other days he was borderline abusive, depending on how drunk or how sober he was. Whenever he was asked about allergies, his standard reply was, “Is alcohol an allergy?” This was accompanied by a toothless grin, which was not uncommon with homeless alcoholics. His immersion foot was so bad that the entire bottoms of his feet were covered in wet, ghostly white, pockmarked skin. Their condition was always too bad to let him soak, so we just had him apply a lot of powder to his skin and socks. We also gave him two pairs (against the one-sock policy, as stocks always ran low) that he could layer up in a feeble effort to stave off the damp. The first time I took care of his feet, they looked particularly bad, and when I told him, he shrugged. He’d spent the previous rainy night sleeping under a bridge and was soaked through by morning. What was to be expected? All the socks and foot powder in the world were no match for the streets.
Walter, a veteran who lived upstairs, came in one day with an injury to two of his toes. After one look, one of the nurses insisted that he go to the ER. Two of his toes were such a dark purple they were nearly black, and the concern was that he had an infection that could lead to him losing the toes or, worse, the whole foot. He used a cane but could barely walk a block to the pharmacy. The nurse reassured him that she’d put him in a taxi to make sure he got to the hospital. In another instance, I saw the results of infections neglected or hypothermia in the form of lost toes. When I asked one man, who was missing four toes, one of our routine questions about where he spent most nights, he replied, “Streets, sometimes the back of an abandoned car.”
As the end of my time as a volunteer drew new, I encountered a particularly striking patient. He had waited for so long to get into the clinic that day, and although we were technically past closing time, it wasn’t hard to understand why they’d let him in: he was in a bad way. He walked into the room, slowly and deliberately pushing a walker in front of him, which required all his effort and concentration to do so. Thin and frail, he grimaced as he lowered himself into the plastic chair. He winced as we helped him get his feet into the tubs, as they were in severe pain to the gentlest touch.
After soaking, he needed help applying lotion and getting his fresh pair of socks on. I pulled over the leg support stand to rest his foot on, to minimize his pain. I’d touched a lot of feet over my short time there, but as I rubbed the lotion into his legs, I felt scaly, gritty skin through my gloves, as though it would peel off just with my touch. I’d never felt anything like it before, and I had to swallow my shock, as I didn’t want him to see it on my face. To put his socks on, I rolled them down to the toe and maneuvered over his toes (where his pain was the worst), with as little contact as possible. This was so difficult that he had to brace himself to bear the pain.
One of the staff nurses explained that he likely had peripheral neuropathy—diabetic nerve damage leading to pain, numbness, and weakness, usually in the hands and feet. It’s an all-too-common occurrence among homeless people and was something we often saw at the clinic. Without regular access to healthy foods, diabetes rates are high, and for those who are homeless, this can lead to severe complications that might otherwise be avoided through proper management. When you don’t have a safe place to store your medications, your belongings are stolen all the time, you can’t afford to get to the doctor because the bus ride alone is too expensive, or you’re in too poor health to walk the miles you need to, it’s not surprising that something which would be manageable for the housed becomes.
Pain lived in the foot clinic. It came in all forms and intensities, and I dare think that if someone had had the nerve to show the happy-to-sad-face pain scale to some in there, they would have shoved it right up the person’s backside to illustrate what kind of pain they were in. For some, that pain was so limiting that they couldn’t do basic things on their own, such as removing their shoes and socks, placing their feet in a bucket of water, drying them off, then putting everything back on. I often wondered what they did when they weren’t in the clinic and needed to take their shoes or clothes off, use the restroom, or take a shower. Did they have friends who helped, or did they simply not remove their clothing or take showers?
Community is so important, especially in a setting such as the clinic. Staff and volunteers began each morning before opening the clinic with a team meeting, led by Cecilia, the director of nursing. We’d end our meeting by standing in a circle, each of us with a fist extended into the center. We’d pump our arms and chant, “One, two three: SWEET FEET! WOO, WOO, WOO, WOO!”
Our patients were no different. As with any group of people sharing a common experience, they created tight communities that looked out for one another. They shared food; they shared clothing; they shared worries about their friend who heard voices; they shared jokes. We humans need each other.
On my final day at the clinic, I saw Rebecca once more, and she seemed worse than normal. She sat angled on the chair, in evident pain. Every muscle in her face tensed as she winced. She had an abscess on her bottom. Sometimes it’s hard to understand the kind of physical pain someone is experiencing. But I could feel her pain, if only a little. Years earlier I’d had a year-long battle with Methicillin-resistant Staphylococcus aureus (MRSA)—the scary staph that no one wants—from a tattoo that had become infected. Boils would pop up randomly on my body, the worst being a large one on my lower back, right beneath the waistline of my pants. Even wearing soft yoga pants, I remember hunching over and crying in pain the ten steps from the couch to the kitchen sink. But there’s where any similarity ended. I had a kitchen sink and a couch. I had a place to shelter in. I had doctors throwing every antibiotic at me they could. I was able to keep my wounds clean so that they healed with no subsequent issues.
I took extra care with her that day, cupping her calf—so small it barely filled my palm—in one hand and her heel in the other to lower each foot softly into the warm water and did the same to take them out. I wrapped the towel around her legs like a baby coming out of a bath, massaged the cream into her skin, moving my thumbs in soft circles. It’s such a small thing, but this contact creates a feeling of intimacy—to treat the body in a hands-on way creates a shared humanity between bodies.
Once her socks and shoes were back on, we helped her up, and the director of nursing took her into a room to look at the abscess. I wanted to give Rebecca a big bear hug to show I cared, but I was afraid I would break her. I settled for tucking her feet into a warm pair of socks, tying her shoes, and helping her to stand. Sometimes we need to feel useful, to help, as much as, or more than, we need help. In the beginning of Stories from the Shadows, Dr. O’Connell writes:
Remember that people have lived through hell and listen carefully to their stories…Each guest was invited into the clinic and addressed by name. Most homeless persons wander our urban landscapes for days without ever hearing someone call them by name, and the response was exuberant. Eyes opened, heads lifted, scowls became smiles. (15)
The motto of St. Francis shelter is Homelessness is an experience, not an identity. The clinic embodied this in practice. I’ve never been homeless. I can’t know what it’s like, but in the foot clinic, the physical and mental effects of not having a home are loud and visible. Foot care may not be the ultimate solution, but it does what it’s intended to do well by offering a brief sanctuary from that frenetic space, a sense of renewal and improving health. Dirty and wet socks came in, pained faces and broken bodies came in. A bucket of warm water and soap would be offered up, along with a choice of sock: gold-tipped, thick, thin, high, short, specialty diabetic socks. People soaked their feet, sat quietly, conversed with others, or even dozed off, leaving with clean feet and the comfort of a new pair of socks.
Amy Shea is an essayist with a PhD and MFA in creative writing from the University of Glasgow, where she wrote her doctoral dissertation, a creative nonfiction work titled Not All Deaths Are Created Equal. Her writing has appeared in Pangyrus, Portland Review, The Massachusetts Review, Spry Literary Journal, Fat City Review, From Glasgow to Saturn, End of Life Studies Group Blog, and the Journal of Sociology of Health & Illness. She works as the writing program coordinator for Mount Tamalpais College, a free community college for the incarcerated people of San Quentin.