Being able to fall apart is a luxury many people don’t have. They carry their burdens until it breaks them. 

Miss Jamie was one of the most aesthetically pleasing  women I had ever seen in my life. She simply glowed. When she entered a room, everyone had to stop to pay attention. She took that space over. Her smile was radiant. Her energy was infectious. She was a fireball of a human. Her petite frame was always draped with carefully selected skirts, dresses, and form fitting sweaters. She paired this with her signature plum lipstick and acrylics.  She always came late in the day, usually when I had the lowest energy. Yet, I never refused her entrance. I was happy to see her. Happy to listen to her while she held court in my desk area. 

    On this day, Jamie was wheeled into the clinic by a person I had never seen before. Instead of scrubs, he looked as if he had woken up on the streets. He looked left like a caretaker, more like a person in need of our services. Our patients in poor health were frequently at the mercy of unscrupulous people who wanted to get close to them to use them for what little they had. The “friend” would try to tap into whatever limited resources. Try to move in their subsidized housing, eat the delivered meals, frequently steal their checks. It was a scenario that played out each and every month. In this case, this person sought to exploit a system set up to help those who needed extra in home healthcare support (IHHS). IHHS is a program that pays for caregivers, usually LVNs or care aides, who will come into the patient’s home to help with basic needs such as cooking, cleaning, laundry, help in and out of bed, etc. Most patients chose to interview caregivers picked from a pool of qualified applicants. Other times, the patient could opt for a caregiver of their choosing. In theory, this was wonderful. A partner might be able to earn extra income they already do. A trusted friend might take the place of a stranger. A family member that lives outside the home could pick up a few dollars for helping perform tasks that the patient might be too embarrassed to have done such as bathing. 

Unfortunately, our clients frequently got sweet talked by an associate in search of a quick check,not a vocation. They would sign up, get screened, do a few things, then disappear. Embarrassed that they had been hustled, our clients took months to request a new aide. This man pushed the wheelchair with the speed and delicacy of a bull in  a china shop. Before Miss Jamie could even speak I  overheard “How long are you going to be?” That told me everything I needed to know. I found out later this was Jamie’s neighbor. They had a symbiotic relationship with Jamie being the kind host and the neighbor fulfilling their role as the parasite. Jamie was always looking out for other people. 

“Tracey….” she called me over. “Have you met Chet?”

I wave hello, force a smile. Chet clearly has places to be. 

“Tracey, can you push me honey. Chet will be back later. Isn’t that right Chet?” 

By now, Chet is sweating like a motherfucker. The dosing window is on the third floor where the heat rises by the mid afternoon. Pushing the wheelchair up the ramp from the bus stop must have sucked out Chet’s last little bit of energy. He was wiry and could not have weighed more than 120 pounds soaking wet. He had on a shirt that was about two inches too short showing off his midriff flashdance style. 

“I am going out to smoke,” he told Jamie. 

Chet never came back. Not that day or any other day. At 2:00pm when the clinic closed, the staff had to get a paratransit voucher from the social worker. We had to make sure Jamie got home safely. 

Chet was the least of Jamie’s problems. 

“Girl, I can’t take any more of this radiation. I don’t have any more hair to lose!” In  the time I had known her, Jamie had gone through a variety of hair styles. There was the blonde bob, the Whitney Houston “I want to dance with somebody”, the Sunday Church wig, and today’s snap on ponytail. There were bruises all over her neck and arms as if a person had shook her violently. “They can’t find a vein in me. They said I used them all up. Those damn phlebotomists don’t know what the hell they are doing. I said Let me have the needle. They told me Miss Jamie you are an expert of putting things in. Today we need to blood out. I hate them Tracey.” 

Jamie loved to call me by my name. She really is the only one. In my mid thirties, I am a decade younger than most of the patients here. Many had been put on methadone because it was a safer alternative to shooting heroin while HIV positive. We had many holdovers from the days when HIV was considered a death sentence. Getting a spot here was considered the junkie equivalent of winning the lottery. One of the other local clinics was well known for involuntarily detoxing clients if their payment was one day late. There is a scene in Black Tar Heroin where I am shooting heroin with a woman who isn’t identified. She had been on the clinic for over 18 years. When there was an issue with her benefits, she was immediately “fee detoxed” turning her back to the needle to stave off sickness. As for the term “Junkie”, that is slowly going extinct.  As a former junkie myself, I say this with love. There are a bunch of clinical terms for what we have “opioid use disorder” “substance use disorder” or “opioid dependency” to name a few. But to many in this older crowd, they want me as a counselor because they want another human that understands the struggle of being “hooked on that shit”. 

Self disclosure is a funny thing. I call it the salt in the stew. When you tell clients too many things about yourself, the conversation becomes about ME and not about THEM. There is a time and a place for self disclosure. It can’t be the only tool in the toolbox. With new clients, I don’t tell them my history. I don’t find it to be particularly useful. Then the conversations become about how much dope did I do, did I know such and such person, and critiques of my transformation. But to many of the older clients, they recognize me. They saw me in those streets. Now they see me behind the desk. We don’t always rehash the past but theirs is a silent understanding that we all just know. 

Miss Jamie and I did not know each other from my previous life but I came with letters of recommendation. Miss Jamie wasn’t even my client but she liked to hold court in my space. She has heard about me from a large network of Black Trans women in the city. There were some I had used drugs with and others that had been my mentees over the years. I would never claim to be an expert on these women, just their ally. In my early twenties, I listened while they told their stories. I helped them prepare for what they called “the illusion”. Things got plucked, tucked, and manicured until the butterfly emerged from her cocoon to flit from place to place in Tenderloin. Truthfully, I was in awe of these women. I had spent my time on the spectrum of gender non conformity but I always returned to the same familiar roles. I have no idea what kind of courage it takes to fight every fucking day just to get the right to be yourself. So I listen. 

“I started my transition in prison,” Miss Jamie reached into her bag to get an iced tea and a bag of candy. Other times there were ribs, pork rinds, chips, or soda. She knew and I knew she wasn’t supposed to be eating that shit. There was no point trying to argue. “I’m sixty two years old. Do you know the average Black Trans Woman is lucky if she makes it to 40? Just let me live.” It wasn’t long ago that Jamie brought me a paper bag that was overflowing with all of her pill bottles. “Can you tell me what all these medications are for?” I had asked if we could arrange for one of the nurses to help her with this “I don’t trust these people, Tracey.” Why trust me then. This was completely out of my “scope of practice…” She stopped me “Don’t give me any of those five dollar words. You think you are fancy now Miss Tracey? Just look them up for me.” How could I refuse? 

       One of those bottles was for diabetes, there were HIV meds, one for high blood pressure, antibiotics and one was for “That’s my pain medicine. I don’t take those.” she told me. 

“You don’t take them?” I was confused. 

She showed me a different bottle of pain meds. “Those are too strong. I take these. And the methadone helps.”

The other bottle was clearly empty so I had questions.

“I am old and I am dying Tracey. They give me anything I want.”

I try to reassure her. “You aren’t dying Miss Jamie. You will outlive all of us.”

She looks me in the face. “Cancer is not about fighting. AIDS is not about fighting. I know people who clung on to life. You can fight and lose. No one is brave here. We are doing our best. I’ve seen young people get hit by a car and the worst of people live to be an old age. If only the good die young, I am living forever. ”

I handed her back the bottle. She continues “I sell those to the police anyway. That lady sheriff pays me $500 for the bottle. She calls me FIRST thing on my refill day. You would think I wouldn’t want anything to do with the police with my history but I like their money. I took one of them things morning so they will be in the piss I give the dr.”

I am still fixated on how she has all these pills with not much information on why she is taking them. I hand back the paper bag with all the bottles. 

“That’s why Chet is here. He’s hoping to get his bit when I go to the pharmacy. He is not.”

I didn’t ask about her life. I didn’t have to. She wanted to tell me. An oral history of the Tenderloin. Of the john who had tried to murder her when he found out she had parts he did not like. Of the prison riots. Of the perils of dating men from the Church. I felt as if I was witnessing something important week after week. Maybe I provided a comfortable place to sit for an hour or so or maybe I was a friendly face. Either way, I looked forward to these visits. 

      “Well, I killed him- the neighbor. My girlfriend had asked me to watch her baby when she went to work. I guess it wasn’t really a baby baby but I said I would. We lived in these tiny apartments where everyone would leave their front doors open so the kids could play out in the hallways. There’s no places to play around there. You know the type of place I’m talking about. Well one day the baby went out and didn’t come back right away. She had got into a neighbor's place. When I pushed open the door, I knew.”

    “I grabbed that baby and stepped out. You can’t have no black man coming into a white man’s place. Right? . I got so angry, thinking about what he did. I went upstairs, gave the baby to a neighbor lady. She watched the little boy all the time. I knew he was okay.  I got my gun and shot him. That dirty old motherfucker was touching little kids because he knew he could. Like they’d touched me. And I could never say a thing. Well they wanted to give me the death penalty. Said he was an upstanding member of society. Who was I? Nobody. A gang member. Said I took his money. Living there, he didn’t have any.” 

   She gave me a look to see if I was placing judgement. I was not. Nor could I fully comprehend what she was saying. Did it shock me, no. I had a friend from high school that killed his abuser- shot him in the back. He was 14 at the time. I saw it on the news. The big difference was he was white and he got acquitted. Even he was surprised by the outcome.  “Please don’t ask me why I didn’t call the police. Do you think the police care about black kids? Maybe I’m asking the wrong person” she told a labored drink of her ice tea “they would’ve beat me and put that child in foster care. So the state tried to kill me. Wanted to give me the death penalty!” 

“You want one of these?” She pulled out a bag full of candy. My teeth hurt just looking at it. Plus, we aren’t supposed to accept anything from clients. This was especially relevant since a client recently gave brownies to the dosing nurse that turned out to be “medicated” with cannabis. He said he didn’t eat it but then I have questions about how he found it out. “No, I’m not big on sweets. Thank you.”

“So I don’t know if I found myself in prison or if I was allowed to be myself. It wasn’t an easy thing but it was natural. Hard to explain to my kids though. They were young.”

“I didn’t realize you had kids Miss Jamie.”

She smiled “Girl-I got three of them. Kids and grandkids. They don’t all call me grandma. They call me Jamie. Kids and animals. They will always clock your tea. You can think you look as fishy as possible and they point to a whisker you didn’t know you had. Luckily I didn’t have to change my name.”

I didn’t get to say goodbye to Jamie before she died. The cancer didn’t kill her. She died of old age nearly a decade later. She moved, I moved, I switched jobs, she got a new boyfriend. She’s come to see me every Friday until one day, she didn’t. In those years, I never did get a word in edgewise and she never stopped offering me candy.


  1. I could hang onto every word you write, simply amazing

    1. Thank you so much. Slowly getting back into writing

  2. Well done Mrs. Helton-Mitchell!
    Greetings from an old couple of methadone patients from over the pond.

    1. I’m glad you enjoyed this story!! 🤩

  3. I have always hated the word junkie. Almost caught a fade in rehab after I warned a dude multiple times the I didn't like it. He was an alcoholic so he thought he was better than us and I couldn't stand that.

  4. Thanks for this wonderful story, I was totally imagining Jamie and your conversations, I think I would enjoy those conversations too.

    It is nice both you and Jamie had kids, it seems time has ran out for me, it is beautiful to have young ones accompany you now and having good time with them. For me, if wife and I don't succeed (every day chances are slimmer), it will be a cold second part of my life.

    I just hope the depression won't get me and God forbid give me ideas to go back to the old ways, which don't lead anywhere in fact.

    1. I had my last one when I was 40. You never know- Tracey


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