PHILADELPHIA (KYW Newsradio) — After years of being homeless and addicted to opiates, there is little that Samantha R. can’t handle but she looks genuinely worried as she rolls up her sleeve to reveal a red, swollen, oozing wound on her right arm.
“This one is most concerning, this is the latest one and the worst one. They seem to be getting worse and worse every time I get another one,” she tells nurse practitioner Mary Marquis.
Samantha, pale with wavy red hair and blue eyes, is sitting on an examining table in the back of a plain white van, parked beneath the Market Frankford El tracks near the Somerset station, that’s been equipped for medical use by Kensington Hospital. The mobile wound care van is a partnership between the hospital and the city's Department of Behavioral Health and Intellectual and Disability Services to address a disturbing side effect of the latest drug to permeate Philadelphia’s street drugs, a horse tranquilizer called xylazine.
In 2021, the hospital started seeing increasing numbers of patients coming in with sepsis from wounds in different parts of their bodies. Some were so severe, amputation was required.
That’s how city health officials became aware that xylazine, known as “tranq,” was replacing fentanyl as the most common drug on the street, cut into fentanyl and other drugs because it’s cheaper and easier to get. Medical researchers believe xylazine constricts veins, reducing the skin’s ability to heal and leading to grisly infections that get continuously worse if not treated.
The city asked the hospital to help take treatment to the street, to head off the worst cases, first in a tent, then a small van. Last May, the hospital deployed the larger van, stocked with bandages, antibiotic ointment, medi-honey (a concentrated honey that draws pus from wounds) and other supplies, as well as snacks and spare clothes. In the worst cases, Marquis has had to cut patients out of their jeans because the pants were sticking to massive, oozing wounds that had eaten away the skin on both legs.
“This is really reality, when you come out here and see and hear their stories, what they’ve been through and you think, ‘There but for the grace of God go I,’” Marquis said of her work on the van. “Just to help them a little bit, give them clothes, even just cleaning their wounds, you feel like, ‘Okay, at least I cleaned it up and wrapped them with an ace wrap and put medication on it’ and they’re saying, ‘Oh it feels so much better.’ You really feel like you’re making a difference.”
Marquis looks younger than her 57 years, with shoulder-length brown hair and a welcoming smile. She’s one of a rotating group of nurse practitioners that tend the wounds. Zach Taub, 22, drives the van and signs in patients.
“We really see people at their lows, which is sad,” Taub said, “but it’s a great thing to get them something they need, fix a wound, send them to detox or rehab.”
One of the side benefits of the van is that it gives Taub and the nurse practitioners the opportunity to talk to patients about getting addiction treatment. Taub said they’ve referred dozens of patients since May.
“We are doing little things that help in the present. But we also want to help for the future,” he said.
That urge to help, to make a positive difference, stands in sharp contrast to the drug trade going on around the van, an island of mercy in a sea of despair. For some patients, Marquis takes a chance and goes a step further. She reaches beyond medicine to try to heal more than broken skin.
***
Samantha and her boyfriend Zach were among half a dozen patients who entered the van for help on a recent Tuesday.
“I guess it’s the tranq that’s doing it?” Samantha asks as Marquis prepares an ointment for the wound on Samantha’s arm.
“Yes,” Marquis says, “it’s in the fentanyl. It doesn’t matter where you inject, it causes all these wounds to come out. You been out here a while?”
“A year and a half,” Samantha answers.
“When did you start using?”
“I started three years ago, the fentanyl.”
“What made you start?“
“So…”
“You don’t have to answer.”
“No, no, it’s fine,” Samantha says. “I did regular brown dope [heroin] when I was younger, 18, 19, then I went to rehab, spent ten years off of it, but I was in a car accident and I was prescribed pain medicine. And then once that supply was cut off, I was addicted to them and the fentanyl was easier and cheaper.”
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It’s a familiar story.
Jimmy, another patient, also traces his use to being prescribed Percocet after shoulder surgery.
“It started out as a sports injury, then a work injury, then, ‘Oh, s---, I have a habit,” he says. “I was blown away by how it took hold of me. I mean, I’ve been a party animal in my time, but no drug’s ever really taken hold of me like the opioids have.”
“And the fentanyl’s so much stronger,” Marquis notes as she examines a wound on his leg.
“I don’t even think we’re really doing fentanyl anymore,” Jimmy says. “It’s just all tranq.”
He knows the wounds are a consequence. This is a return trip to the van.
“I almost lost my hand and I relied on this van,” he says, “but it was the smaller van. This one’s nice. You can stretch out in here.”
Marquis touches the wound area lightly.
“Do you inject there?” she asks.
“No, not now. But people do,” he says with a touch of astonishment. “I mean I’m not better than the next person but at the same time, I see people injecting in what looks like hamburger meat and I’m like, ‘You don’t need to be sticking a needle there. It’s not a vein, dude.’”
Jimmy is there for more than his wounds. He is in excruciating pain every time he takes a step because, he believes, he has a stress fracture in his right hip. He thinks it’s from favoring his left leg to avoid exacerbating the wound.
“I was limping hard, using this leg,” he says. “I literally woke up one morning and I couldn’t walk the same.”
The wound care van is not equipped for fractures, but Taub emphasizes that there’s no need to let a wound reach a point where it affects his bones.
“We’re out here five days a week,” Taub says.
“I was trying to, it’s not so much take care of it myself, but not deal with it,” Jimmy says frankly.
Taub urges him to come back for follow up treatment, which he did a week later, the wound healing but his hip still painful.
***
The van is a last resort for Dave, who prefers to deal with his wounds on his own.
“I had four of them on my upper left arm in less than six months. I remember the first one. I never knew what they were. I heard of them but I had no idea how disgusting they are,” he says. “Usually I try to massage (the swelling) out and put my thumb right directly in it and try to spread it out.”
At 56, Dave estimates he’s been on the streets in Kensington for more than 20 years. The wounds are a relatively new phenomenon for him. He has theories about what causes them.
“My veins are weird because I can have them protruding out, with a brand new needle, micro-centered like a bulls eye and still not get it all the way. I don’t like these new needles. I think they’re just cheaper in quality. It’s like garbage bags and diapers, you never go cheap on certain things,” he laughs.
And he has his own way of dealing with the infection.
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“I’ll get a brand new syringe and I’ll assist it to drain. I’ll do it once or twice and it will just go…. Psssshhh,” he says, popping open his fist to show how puss shoots out of the wound.
He recognizes this new wound on his hand, though, as something dangerous.
“I slept outside without a pillow so I was using my arm as a pillow. I think that’s what does it because you’re cutting off your blood supply,” he tells Marquis. “When I move a certain way, it feels like I’m pulling a vein, like it’s ripped in half. It shoots straight to my fingertips. This is the cheap needles they give us, just to save a few bucks.”
“Plus it’s the xylazine,” Marquis says.
“Oh, yeah,” he agrees.
Marquis gives him a prescription for the antibiotic doxycycline, a new pair of pants, some snacks and urges him to come back the next day for a follow-up. He does not return.
***
A career as a nurse practitioner has taught Marquis how to put patients at ease, even during serious conversations. She asks every patient if they’ve thought about quitting. All of them have.
Samantha and Zach are sure they will do it. She has two daughters. He has a son. They want to live together as a family. Samantha talks about taking them on camping trips together. As soon as they get clean, which she thinks is only a matter of time.
“But we’re hearing, with the xylazine, what they’re giving, suboxone, it doesn’t really work for the withdrawal,” Samantha tells Marquis.
“Maybe we could help you,” Marquis says. “Kensington hospital has a methadone clinic.”
Then Marquis takes the conversation in a surprising direction. She does not do this with every patient but with Samantha she senses a receptive audience and takes a chance.
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“Do you pray?” she asks.
“Yes,” Samantha replies. “I was raised Catholic but I strayed away but, I’ll tell you, since being here, I’ve found religion again and I’m convinced there’s not only a good presence but also evil. You definitely feel that here. We try to be as good as we can out here but, definitely, the negative spirits can take over. Sometimes we feel like we’re being pushed or pulled down the street, toward something or away from something. But when we get away from this area, it’s like we can breathe better. I do think just this area, because of all the despair and the negative things that happen here, if there’s evil in the world, this would be a hot bed.”
“I have this rosary bracelet. You know the rosary from being Catholic. Do you want that?” Marquis asks, slipping a ring of blue crystal beads off her wrist.
“Yes, I mean, it’s beautiful. Thank you,” Samantha says, her face flushing.
Marquis tells Samantha the rosary can be a weapon against the evil she senses on the street. Then she writes her a prescription for antibiotics.
Samantha and Zach head back to the street, the rosary bracelet dangling from Samantha’s wrist.
“A lot of times, we don’t want to talk about it, but a lot of times it’s going to be prayer or faith or something good,” Marquis says after they’re gone. “Really, it’s like they need a miracle or something. They need something to hold on to, something stronger than what we can do.”