Nurse Learns How To Make A Difference After Experiencing Homelessness

TW: A warning: This story contains material that may not be suitable for young ears. We mention suicide and sexual assault. If you or someone you know is struggling, call the national suicide hotline 1 800 273 TALK.

A few years ago Josephine Ensign was working on a homeless project with city and county health officials in Seattle. They were going to get a tour of the women’s shelter to learn about their medical respite program, essentially how to provide a safe place for young people who need health care but not a hospital.

Josephine took the bus and arrived a few minutes early and waited in the lobby for the rest of her group to arrive. She purposefully dressed down in jeans and a sweater. 

JOSEPHINE: It's kind of like kind of ground zero for a lot of drug activity, prostitution, all sorts of things, um, in Seattle. And so, you know, I was buzzed into the building kind of in the waiting room … and a woman, um, came up to me, you know, a resident who said, oh, um, did you stay here last night instead of Aurora Avenue? 

She had mistaken Josephine for someone staying at the shelter.

JOSEPHINE: Right at that moment, when she, when she said, ‘oh, did you stay here instead of Aurora?’ My teammates came in the door and they overheard it. So then after we did the tour, we're back out on the sidewalk …one of the women from the health department who knew me really well said, ‘oh, that was really strange. You know, the woman thinking that you fit in so much that you live there.’ And I laughed about it cuz you know, and she was like, go figure here you are, you know, university professor, there's no way you could be homeless. 

Josephine says homelessness is a type of deep illness that leaves you feeling dislocated and casts a shadow over your entire life. She would know… for a dark period in her 20s Josephine experienced homelessness.  

JOSEPHINE: And I just, I realized thinking about that whole episode afterwards of how, um, how bad that made me feel, you know, because I was, um, not being honest with other people with myself.  I was judging myself judging homelessness and kind of by extension judging, like the woman who asked me.

It was in that moment that Josephine knew it was time to come clean with her own story of homelessness. 

JOSEPHINE: And I was not out with my story, um, really with anybody, um, at that point and you know, was still like working on tenure, you know, belonging at the university being let in to that exclusive club. And, and I really felt, um, strongly and I think it definitely is still true that, um, you know, being out about my own history of homelessness as a, as a young adult, um, would that people would judge me negatively, you know, there's that stigma. And I felt that stigma myself. 

It was only after becoming homeless herself that she learned how to effectively help others like her. This is a story about how Josephine came to experience homelessness and the lessons it taught her.

This is 2 Lives. I’m Laurel Morales.

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Josephine grew up outside of Richmond, Virginia, on a 600 acre Christian camp that her father ran … the Civil War still embedded in the land and its people. She frequently found evidence of it on her long walks in the woods with her mother.

JOSEPHINE: She taught me to look for arrowheads as well as, Civil War bullets and, and different kinds of artifacts from the Civil War… It had been the land of the Powhatan tribe, and then was also the site of some of the bloodiest Civil War battles.

Josephine recalls seeing ghosts of some of the men who died there but she never told her parents. She kept other secrets to herself that she writes, “over time hardened into the skeleton of her identity.” 

Her dad was a presbyterian minister and ran the south’s first racially integrated summer camp in the 1960s and 70s. That meant he had regular run-ins with the KuKluxKlan. 

As a teen Josephine wanted nothing more than to get out of the racist, ghost filled woods of Virginia. She dreamed of becoming a great scientist or missionary doctor going off to exotic countries to cure the world of hunger and disease. 

JOSEPHINE: I remember wanting to develop a variety of rice that would like cure famine in the world. That would be high protein, where I got that who knows and also of wanting to be a writer … Then especially as I got into my teenage years, um, of feeling like, my life needed to be way beyond Virginia, I knew that very clearly.

So after high school Josephine went north to a small liberal arts school in Ohio. During her sophomore year she took a psychology course that had a profound impact on her. The professor paired each student with a child in the foster program. Josephine was matched with a 12 year old girl named Carrie. Little did Josephine know but Carrie would become the first of many Josephine felt compelled to understand and help.

JOSEPHINE: She had survived sexual abuse and was in a group home and, you know, struggling with foster care and running away.

Josephine would take Carrie for ice cream, go swimming or just hang out at a diner talking about clothes and boys. Sometimes Carrie would open up about how sad she was that she couldn’t live with her mother. 

JOSEPHINE: I still have a special kind of connection, I think, and heart for children and teen and young adults experiencing homelessness, because I know how vulnerable they are in terms of their development, um, and how important it is to, um, you know, draw on their strengths and help them to, to find the, the positive connections that they need to thrive.

During the summers Josephine would come home to her father’s camp and work washing dishes and scrubbing toilets. It was there that she met Charles, who was starting seminary in Richmond. 

JOSEPHINE: I had a lot of unaddressed, traumas …He was so sure of his faith Charles felt safe. …, you know, six foot, six, he was like a very much of a gentle giant.

After dating for over a year she and Charles got married. They went to bible study meetings. She dressed in frumpy clothes, sipped tea and listened without saying much. Josephine says she felt numb and detached. She knew she was playing the role of a pious, Southern, Christian wife.

JOSEPHINE: I remember even vividly like, uh, getting Laura Ashley fabric. I mean, that was like a thing back then, right? But, you know, we had like no money, but I remember getting some fabric, maybe my mother-in-law bought it for me and, you know, I sewed my own dress. We joined some church prayer groups. My husband was much more kind of Pentecostal charismatic Christian where they even like spoke in tongues, which was very, very different for me.

Josephine went to nursing school and in 1986 she graduated with her family nurse practitioner degree and got a job running a conservative Christian clinic for people experiencing homelessness in downtown Richmond. A year into her job they had a baby and named him Jonathan.

JOSEPHINE: What I remember enjoying the most was the bonding with him. I nursed him, I breastfed for as long as I could. When I returned to work, it got to be more difficult to keep all of that up and I lost too much weight. The physical, emotional closeness with him as, you know, a tiny, tiny little infant. And then, you know, as he started to develop his personality, you know, that whole amazing, you know, smiles and giggles.

She was a new mother, working full-time to support her family while Charles finished seminary. At the same time she was the only health care provider at the Crossover Clinic, which was seeing an increased number of patients with complex social and health needs. 

JOSEPHINE: Some of the leaders including the Reverend Buddy Childress tried to intervene and to tell me that I couldn't refer, like, do, do any kind of options, pregnancy options, counseling, or refer women girls and women to abortion services. And that, for me, was the first red flag, a pretty significant red flag.

The director wanted her to institute policies preventing people with HIV and pregnant women who wanted abortions from getting the care they needed. But Josephine had become attached to the people who came to the clinic. One man in particular Lee, an African American man who had contracted HIV, AIDS and tuberculosis, was one of the few people who could make Josephine laugh at a time when she took things too seriously. 

It was the late 80s before antiretroviral medications were available for Lee. Some of Lee’s conditions and medications made him incoherent. At one point he was speaking gibberish at a public park and police arrested him saying he was a threat to others and to himself.

JOSEPHINE: He called me to help get him out of a psych ward and then we followed up with him, we got him a place to stay. It was not a good place, but it's what he wanted was his own room. And it was in kind of the most abysmal. It was not fit for human habitation in, in the center of Richmond. 

For three years Josephine cared for Lee. The outreach van would bring him everyday to the crossover clinic for his medicine and a hot meal. The van driver told Josephine he’d throw pebbles at his second story window to let him know he was there. (The house had no doorbell.) For three days in a row Lee didn’t answer the driver’s pebbles so Josephine decided to check on him. His house reeked of feces because the toilets didn’t work. When she found Lee in his tiny room, his breathing was so shallow he could barely speak. So Josephine drove him to the hospital.

JOSEPHINE: As I was accompanying him I ended up being checked in as his next of kin, advocated for him as they couldn't contact his family at first. So I was also called in to the hospital ethics committee to weigh in on whether to take him off life support or not…

The medical team voted to stop his machines and Josephine went back to his room and said a silent good-bye. She told him she would make sure no one ever dies like this again.

But when she returned to the clinic her boss reminded her patients like Lee didn’t deserve her attention. 

JOSEPHINE: He told me that I needed to ask people like Lee how they got HIV aids so that they could repent of their sins before they died. 

Buddy also wanted Josephine to encourage unwed White mothers to give up their babies to Christian families.

JOSEPHINE: What I wrestled with was how out of sync, my own kind of social,belief, system within a Christian, you know, what I considered a Christian faith, um, differed from, you know, Reverend Buddy Childress. 

She felt she was literally and figuratively putting band-aids on the problem of homelessness. She felt restless and frustrated she couldn’t do more. The pressures from her boss, the intensity of the work, and Lee's death were causing Josephine to burn out. On top of all that she was suffering from severe postpartum depression. She says she was overwhelmed physically, emotionally, and spiritually. 

JOSEPHINE: I didn't recognize at the time I just kept going or kind of grrr a type A personality pushing through and praying about it… and just questioning my faith of okay, what does it mean to be for me at the time, a Christian, if this is how it's being acted out in the world by the people I was working for?

Josephine stopped going to church. After three and half years at the crossover clinic Buddy put her on mandatory leave saying essentially she wasn’t Christian enough. So Josephine quit.

Her depression worsened. She didn’t feel like she could share her crisis of faith with her husband, who had become a minister at that point. 

JOSEPHINE: I wanted a separation from my husband just to get a time out. You know, I was, I knew I was overwhelmed at that point … that's when I started kind of couch surfing, um, just to get away, I was feeling overwhelmed and suffocated, um, at home. 

But Virginia didn’t allow a couple with a child younger than three to divorce. So Josephine and Charles made their own agreement and decided that Jonathan should stay with Charles until Josephine was back on her feet. 

JOSEPHINE: ​ I could barely take care of myself and much less take care of a young, uh, very rambunctious, um, child. Charles was a really good father. He had Jonathan, we had childcare because he was at seminary. So made the decision. It was very difficult, especially with gender based kinds of roles. Um, that Jonathan stayed mostly with him… 39 I was going through a lot, he needed stability. My husband was in, um, was in seminary. He's, he's a Presbyterian minister now and there was a lot of support structures. It was like even seminary, housing, daycare, like stability. Um, so both of us were in agreement about that.  

Josephine slept on friends’ couches, in her car. Her father hired her to work at the camp scrubbing dishes and toilets as she had in her teens and twenties. She found a place to sleep in an unheated storage shed on a fold out army cot. She says it felt regressive and demeaning.

JOSEPHINE: I hid a lot of what was going on for me. Um, because it was embarrassing. I mean the whole stigma of being homeless so that I know it firsthand. I wasn't visibly homeless unless somebody was really looking hard. ... I have always been very athletic and I had a reduced fee membership at the downtown, why to the pool had access to showers. Um, and so I was able, you know, to keep up my hygiene, um, I was maintaining at least part-time jobs. I just didn't tell people, you know, where I was sleeping at night. PAUSE I was so depressed. I mean, I, I was suicidal. Um, I had a plan, I had a means. Um, it was, it was very close to that. 

Josephine knew it was time to ask for help and made an appointment to see a counselor. 

JOSEPHINE: I lived like in a shed in my car, um, for a while and I knew that, um, that wasn't helping my mental health. So I that's when I started getting therapy. Also, working on like getting a, kind of a, a low rent, but safer place to live, for one thing, to be able to have Jonathan, um, back in my life and to figure out what was next for me.

It was in therapy that Josephine started coming to terms with some of her own childhood trauma. She began to recall memories of when she was 14 her father came into her room when Josephine was sick in bed with the measles. 

JOSEPHINE: I mean, I had like 103, 104 temperature was insane and my parents took turns checking on me and giving me cold compresses. And I woke up with him, fondling my breasts and that, um, I began having panic attacks, I mean really serious panic attacks. And that's also when I started spiraling into an eating disorder, which again, in retrospect I realized was my, my way of trying to get some type of control, right. Um, over an outta control life. And my mother would not acknowledge it even when I confronted my father. 

Josephine asked her therapist for antidepressants but he refused. She asked him to admit her to a psych unit but he told her that her insurance wouldn’t cover it. Prayer – her old go to – wasn’t working, so she turned to books for answers including Graham Greene’s “A Burnt-Out Case.” 

She started to make small but significant changes. She stopped focusing on the numbers of people she’d seen die – the death list she called it – and began to work with groups of people where she saw a more positive impact – children, victims of domestic violence, and runaway teenagers. It was then that she started to get a clearer picture of her future.

JOSEPHINE: What is it that I want to do with my life? Um, I mean, I love this kind of direct service. I love working as a nurse practitioner with populations, with people experiencing traumas and homelessness but wanting to do more, um, in terms of policy change, um, kind of upstream kinds of measures. And, I also knew I wanted to be a writer.

Josephine realized her burnout stemmed from a gap between the ideal of what she wanted to do, and the reality of what was possible as a nurse practitioner. She was fed up with a dysfunctional health care system, the corrupting power of Christian zealots, and the old south mentality and made the decision to get out of Richmond. She applied to Johns Hopkins public health doctorate program and got accepted. 

She made frequent trips from Baltimore to Richmond to spend time with Jonathan, although the time apart did put a strain on their relationship…

JOSEPHINE: When I was with him and when I was in, you know, got myself back into a good place, especially like when I moved to Baltimore, um, he, and I would do like science things together and outdoors things together. 

While going to school, she worked full time as a nurse practitioner to pay for her apartment, some tuition, and therapy.

JOSEPHINE: It was really in Baltimore where I knew I needed a female and a competent therapist and so I was at Johns Hopkins and that's where I was able to start establishing actually good, what I call female-centric, competent therapy.

It was with the help of a good therapist that she came to understand how she could work with people experiencing homelessness AND make a difference.  

But it wasn’t until years later that she confronted her own period of homelessness. 

JOSEPHINE: I definitely did not consider myself homeless even at the time and that is not at all uncommon. There's stigmatizing, internal stigmatizing kinds of things … I've always had a high level of empathy, so I've always identified even with some aspect of myself, right. With even the most distasteful or, you know, difficult, I hate that term, but we use that unfortunately in healthcare, difficult patients. So it really wasn't until I came out to Seattle, I got my son back full time and had really excellent therapy … and began writing about it. I was like, ‘oh, holy crap. I was, I was not just having a difficult time. I was, you know, literally homeless.’ 

She had moved to Seattle where they have one of the highest rates of homelessness in the country. She took a job teaching nursing at the University of Washington. Jonathan, now nine, came to live with her full time (as Charles and his second wife were going through a difficult period.) 

Josephine saw two therapists – one was a psychiatric nurse practitioner the other was a career counselor with a social work background. They both supported her practice of journaling. As she wrote about her own experience of homelessness she realized how many people without a home are coping with unaddressed childhood trauma. And she saw a tremendous need for resources to overcome that trauma. 

JOSEPHINE: I really like the term resistance. Um, and just thinking of that within ‘2 Lives’ that yes, you know, these things happen to me. Um, they're part of who I am, what I wish that I didn't had not had to have dealt with them. Yes. But, um, I also see, um, kind of the resistance that I've been able to have and that those scars will be with me forever, but they, they don't define me. There's truth in that cliche. I mean, I really, I, I remember specifically when it was just kind of like, oh, that's what they mean by that, by that phrase. For me just like, not wallowing in, you know, like trying to reopen those wounds all the time, um, that they're there and acknowledging them, not trying to forget it. Um, uh, but that, I'm just like my life and, and me as a person, um, just so much more than that. 

In her journals she reflected on how her work changed her and her work itself changed as a result of experiencing homelessness. Her writing eventually turned into a book called “Catching Homelessness.” 

JOSEPHINE: Catching Homelessness we talk about the health and social care safety net, um, which, you know, we're trying to catch people before they fall through the holes. …But then also part of what happened to me was significant when I worked at crossover… was significant professional burnout… I'm not saying that I caught homelessness by working with people who were homeless. Um, uh, but the, the, um, profound, um, burnout was again, part of the multifactors that went into my spiral and depression into depression and homelessness.

Initially Josephine was reluctant to publish it and out herself in the world of academia. 

JOSEPHINE: There is a lot of pressure within academia and within society at large, but I think extra layers within academia and especially as a junior faculty to not divulge too much because there unfortunately is still a whole lot of unaddressed unacknowledged bias, um, within the powers that be, um, and, you know, my job literally was in their hands. Um, you know, my stability to be able to have my son back to be able to have health insurance, good health insurance, to have good, ongoing therapy, to even be able to think about buying a house and, you know, even back then, it was a crazy housing market, um, dependent on them. So I kept silent about it for a long time.

So Josephine waited until her son was an adult and she had tenure and more job security.

JOSEPHINE: I felt like, okay, they can only fire me for moral turpitude I love that word, moral turpitude, which I, you know, didn't think that I was in danger of doing. I was just more confident with myself of, okay, this is who I am… I definitely have experienced, uh, people then judging me just like, I've learned to deal with that, but that's there that's, that's their trip.

LAUREL: And coming from probably their own fears.

JOSEPHINE: Exactly. Um, yes, but then having people who, you know, who I already kind of felt a connection to, or, or you know that then yeah, that, that did get it, um, in a, in a more supportive and understanding way.

Today Josephine has a different partner of 26 years. Her son Jonathan has a wife and two daughters and Josephine takes great pleasure in being their grandmother. 

In addition to her teaching at UW, she works toward better policies surrounding homelessness. She’s heard from former patients and they give her hope and a reason to keep working toward better solutions.

JOSEPHINE: A lot of them not only survived, but have gone on to thrive to, you know, have families, careers, … and are just doing amazing work in the world and are really more than okay. … that my presence and my work within, especially like this team of caring, compassionate people, in the community that, that helped them turn it around. So that's, you know, just realizing the interconnectedness of, of, um, people within hopefully a compassionate, um, caring community. That's what gives me a glimmer of hope.

She says it’s about meeting people where they are, recognizing their strengths and how they’ve been able to survive homelessness.

Josephine’s written three books about homelessness and she’s frequently asked to give talks about her experience and the lessons learned. 

VIDEO OF ONE OF HER TALKS

JOSEPHINE: I just feel like it's, I'm at this point in my life where all of those kind of different threads are our coming together, um, in, uh, in a satisfying way.

She says unaddressed trauma can lead to homelessness but there are larger forces at play. 

JOSEPHINE: The physical, emotional, psychological state of being homeless … looking back at it, there's just no way that being within that completely unsafe, um, you know, chaotic, um, unstable situation, there's no way that you can attend to your own health, um, physical or mental. It's just, it's not possible … good, safe, stable, affordable housing is healthcare. Um, I, I know that, um, viscerally.

This is 2 Lives. I’m Laurel Morales.