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729: Making the Cut

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Prologue: Prologue

Ira Glass

Government in this country, you may have heard, is not running so smoothly these days. That was true in the United States Capitol this week if you were a senator wanting to do the official count of electoral college votes, having your work delayed by an angry mob. That was true if you were a dentist in New York City, hoping to get a COVID vaccine from your state government.

Dentists are supposed to be in group 1A, according to the Centers for Disease Control guidelines. They were supposed to be in the very first group to get the vaccine, because peering closely into people's open mouths all day puts them in danger of a virus that is carried by droplets on people's breath. But when they started rolling out the vaccine in December in New York, not only did dentists not get vaccinated--

Alisa Neymark

We were just kept in the dark.

Ira Glass

Alisa Neymark's a New York dentist. She says she and other dentists did get emails from their state dental association.

Alisa Neymark

I can send you some of the emails that they've sent to me. And they're just very confusing.

Ira Glass

Confusing like how?

Alisa Neymark

Like they're confused. They say, we know that dentists are in group 1A. We don't yet know when or how you'll be able to make an appointment.

Ira Glass

For Dr. Neymark, at one level-- and I don't want to overstate this. She seems like a careful, measured kind of person, who does not get up on a soapbox. At one level, to her, it is not surprising that dentists would get this kind of treatment. Dentists, she says, they don't get respect.

Alisa Neymark

There is a bias against dentists. There is definitely-- there's a cultural kind of fear. I'm just thinking about that-- what's the movie--

Ira Glass

I thought she was going to say Marathon Man, but no.

Alisa Neymark

--where they go to Las Vegas?

Ira Glass

The Hangover. She meant The Hangover, where Ed Helms plays a dentist.

Alisa Neymark

And he's a dentist. And he gets made fun of for being a dentist, right? It's like this big joke that we have. Oh, you're not a doctor. You're a dentist.

Ira Glass

So not even being told when they'd get the vaccine, even though they're 1A, she said par for the course. She and other New York dentists did get an official email on New Year's Eve, an email that had been sent out at the very businesslike time of 5:07 PM, New Year's Eve, that did have a promising link to vaccination locations. But when Dr. Neymark clicked on that link with her information, she found there's nothing for dentists in New York City.

It isn't just that they seem to be at the back of the line. It's the lack of information. That's what gets to Dr. Neymark. She finally did learn when the state would be vaccinating dentists, but it wasn't from any official source. Somebody she knew just texted her. The vaccinations were supposedly going to start this week, the week that began Monday, January 4th, the fourth week of the vaccine rollout. But when she tried to actually schedule an appointment for a shot on the official website, there seemed to be no available appointments for dentists.

Alisa Neymark

But people have been checking, and so, we've been emailing each other. So it's kind of this underground network, people who are kind of looking out for each other. Oh, I know that you haven't been vaccinated yet. I just got an appointment. Let me text you.

Ira Glass

So, basically, it's this underground thing, like it's a Russia under Stalin or something. And you guys are passing each other little pieces of paper, saying, here's where you go for your shot.

Alisa Neymark

Exactly, it's like, the bread line is over there.

Ira Glass

Mm-hmm.

Alisa Neymark

Go ahead and sign up. I was actually born in the Soviet Union, so. [LAUGHS]

Ira Glass

Oh, you were?

Alisa Neymark

I was, yeah.

Ira Glass

So you have training. You're ready.

Alisa Neymark

Yeah, I'm ready.

Ira Glass

I talked to somebody on the New York State Vaccine Distribution Task Force, which is supposed to be advising the state on how to do all this. Her name's Rose Duhan. She also runs the Community Healthcare Association of New York State, where she says she is spending all day, every day, trying to distribute vaccine. I have to say, she made a pretty convincing case for why dentists are not being vaccinated till week four, even though they're designated 1A.

Rose Duhan

In New York state, the state estimated that there are two million healthcare workers, two million people who fall into that 1A priority. So that's a lot of people. And it's just not feasible to vaccinate everybody the first day.

Ira Glass

So the state decided the first dibs should go to people who are in more immediate danger, like medical personnel who care directly for COVID patients and nursing home staffs and residents. When I ran that by Dr. Neymark, she agreed it seemed sensible. But nobody had told this to her.

Nobody is pretending vaccine distribution is going well in New York right now. The state has only managed to administer about 40% of the vaccine that it's been given, which is actually better than the country as a whole, which has used about a fourth of the vaccine that's out there. But still, the phrase that Rose Duhan used to describe her own feeling about how it's going was this.

Rose Duhan

Somewhat panicked. [LAUGHS]

Ira Glass

She ticked off some of the many, many logistical challenges they faced-- figuring out which facilities could deliver the most shots and how to staff and schedule and track hundreds of thousands of people getting vaccine.

They had to create scheduling software to figure out what to do in smaller health centers if people don't show up for appointments, which is an issue because once you have opened up a vial of the vaccine, you have to use all the 10 doses inside of it in a few hours, or they go bad. There are health centers who have been told to vaccinate people from other kinds of facilities, like mental health providers.

Rose Duhan

And the health centers are trying to figure out, OK, how much allocation do they have, how much of the other provider's staff can they accommodate, how can they get those people either to come to the health center, or is there a way to get some of the vaccine to those residential settings.

Ira Glass

Oy. It's so-- I don't know. The details are so kind of mind numbing when you describe it.

Rose Duhan

Yes.

[LAUGHTER]

Yes.

Ira Glass

I love that this process begins on the front end with these super geniuses using this incredibly advanced science to invent the thing. That was the hard part. And then, just literally, like, how do we schedule people from this facility into a time when we can get enough of them to use all the dose in the vial? That's where we're getting stuck.

Rose Duhan

Yes, and I think that's really where the people who do that kind of thing don't get enough credit. Exactly.

Ira Glass

There's no Nobel Prize for that.

Rose Duhan

Right.

Ira Glass

There's no Nobel Prize for scheduling people.

One person who finally did get scheduled-- Dr. Neymark. Though the only appointment that a dentist like her could get was 40 miles away. The situation we're in now is that the CDC made a carefully thought out plan for who should get immunized first and second and third. And then, that plan collided with reality. And when and where we'll all get our vaccine is going to depend on these logistical details and how well they are managed.

Today on our program, we see just how common this is. We have other stories of this happening-- scarce resources that need to go to somebody and how they end up getting allocated, whether those resources are a place to stay for the night, or love and companionship being redistributed in all kinds of new ways since the pandemic. From WBEZ Chicago, it's This American Life. I'm Ira Glass. Stay with us.

Act One: God Committee

Ira Glass

Act One, God Committee. So we start with this example of a very pure situation of people who have been given the difficult task of trying to figure out how to distribute something important-- in fact, in this case, life-saving medicine. They're deciding basically who will live or die, and the very idealistic solution they came up with. Lilly Sullivan tells the story, which starts, as you might expect, with a medical breakthrough.

Lilly Sullivan

Back in 1960, a doctor named Belding Scribner had a patient-- a young man with kidney problems. It was something Dr. Scribner had no way to treat, so he had to send the guy home to his family to die. The case haunted Dr. Scribner.

One night, he woke up at 4:00 AM with an idea, a way he could have saved that man-- a Teflon tube that could be stitched into the blood vessels of the arm and stay implanted there. It made long-term dialysis possible for the first time. They'd pull the blood out of someone's body, clean it the way a kidney does, and put it back in. People called it a medical miracle, an artificial organ that could cheat death.

There was a problem, though. The machine they came up with was big and complicated. They built it from a Sears Roebuck freezer that they'd modified with a bunch of other parts. Nurses called the machine "the monster" because it was so big and unwieldy. And every patient needed to spend dozens of hours each week connected to it. And only five of these machines existed. This was still in the experimental stages, so they could only take care of a few people. And there were thousands of people dying from kidney failure every year in the country.

So, on one hand, a miracle. On the other, Dr. Scribner had traded one harrowing problem, a medical one, for an equally harrowing ethical problem. How do you choose which few to save and which thousands would die? Dr. Scribner started getting flooded with requests from people desperate to be put on the machine. The pressure was crushing him. Saying no was ensuring a person's death. He went to the administrators who were helping to oversee this whole project and asked for help. The administrators took it from there.

The first thing the administrators decided is, you know what? This isn't a medical decision at all. This is a societal decision. So they decided to assemble a group of people. They chose these people not because these people had any medical knowledge-- or, really, any relevant experience at all. These were ordinary people, hand-picked to represent a cross-section of moral American society.

Man 1

I am a banker.

Man 2

I am a surgeon.

Man 3

I am a lawyer.

Lilly Sullivan

This is from a documentary from 1965.

Man 4

I am a labor leader.

Woman

I'm a housewife.

Man 5

I am a clergyman.

Man 6

The names, the faces of those who serve on this committee are never made known to those who apply for the places on the kidney machine.

Lilly Sullivan

The committee was strict about anonymity. In the documentary, their heads are darkened so you can't see their faces. These people had just been going about their lives when the dialysis center's administrators asked them to come in. One of the people in the group, a young minister, told them it wasn't for him to choose who would live and die.

The doctor said, "We are not asking you to decide who will die. This is already determined. We are asking you to help decide who will be given the opportunity of extended life." The minister agreed to do it. They all did. A few of them said it would be too cruel to force this responsibility onto someone else. Officially, they were called the Admissions and Policies Committee of the Seattle Artificial Kidney Center at Swedish Hospital. But a lot of people called them the God Committee.

At the time-- again, this is in 1960-- there was no blueprint for this. The doctors gave them no guidelines. The committee considered first come, first served, or drawing straws. But they'd been told to use their consciences. So they came up with a set of principles and rules.

The first rules were clear-cut. The treatment was in Seattle, so they'd only look at applicants who lived in Washington state. Washington taxpayers were funding the research. They also decided no one over 45. There could be medical complications. And those people had at least had a shot at life. And no one under 18. The treatment was physically and emotionally demanding. No one knew how it might affect kids.

But those rules only got them so far. They decided they'd base their final selection on something else-- social worth. They'd try to save the person whose death would most hurt society. They made a list of the factors they'd weigh-- marital status, number of dependents, income, net worth-- to pay for the treatment-- sex, education, occupation, emotional stability, past performance, future potential, and personal references.

They made a policy of never meeting any of the candidates in person or even knowing their names because denying a person you'd met face-to-face seemed too hard. They once let a journalist come see how they made one of these decisions. They just had a meeting where the doctors had presented them with five applications, and the committee could only pick two. They walked the journalists through how they made that choice, tried to recreate for her the conversation they'd just had. Here's a transcript of their discussion.

Banker-- "Just to get the ball rolling, why don't we start with number one-- the housewife from Walla Walla?" Surgeon-- "This patient could not commute for the treatment from Walla Walla, so she would have to find a way to move her family to Seattle." Banker-- "Exactly my point. It says here that her husband has no funds to make such a move."

Lawyer-- "Then are you proposing we eliminate this candidate on the grounds that she could not possibly accept treatment if it were offered?" Minister-- "How can we compare a family situation of two children, such as this woman in Walla Walla, with a family of six children, such as patient number four, the aircraft worker?"

This is something they talk about a lot. If one candidate has one kid and the other has two, should you pick the candidate with two kids? They go round and round, trying to answer a question that has no answer.

Labor leader-- "For the children's sake, we've got to reckon with the surviving parent's opportunity to remarry. And a woman with three children has a better chance to find a new husband than a very young widow with six children." Surgeon-- "How can we possibly be sure of that? How do the rest of you feel about number three, the small businessman with three children? I'm impressed that his doctor took special pains to mention that this man is active in church work. This is an indication to me of character and moral strength."

Housewife-- "Which would certainly help him conform to the demands of the treatment." Lawyer-- "It would also help him to endure a lingering death." Housewife-- "If we're still looking for the men with the highest potential of service to society, I think we must consider that the chemists and the accountant have the finest educational backgrounds of all five candidates."

In the end, the people they chose were mostly men, white, and well-off-- people like them. Which seems inevitable, given the criteria they'd come up with to select for what they called social worth-- education, future potential, income. The treatment cost about $15,000 a year, what would be about $130,000 today, and it often wasn't covered by insurance. They'd written all these rules to try to be fair, but they'd created an outcome that was anything but. Sometimes, when you try to guess your own biases, you come up with a very incomplete list.

In a letter the minister wrote a few years later, he talked about how he'd been extra careful to guard against his own biases and not favor people who were good church members. But later on, he worried that he might have gone too far, been unfairly hard on religious people. The final votes were always made by consensus. They said that gave them some comfort.

Man 1

--some differences. I think that we are all of the same opinion at the present time. Does everyone agree?

Man 2

Agree.

Man 1

Well, I think having arrived at that point, that we are then ready to cast a vote in our poll. All in favor of accepting Mr. D, say aye.

Man 3

Aye.

Man 4

Aye.

Man 5

Aye.

Man 1

And opposed? Mr. D is accepted as the next candidate for our kidney center.

Lilly Sullivan

It's hard to find many recordings of Dr. Scribner. But I found an oral history recorded decades after all this happened, where he talked about the God Committee.

Belding Scribner

This was widely criticized afterward.

Man

The problem, just in a word, was you were faced with more people.

Belding Scribner

Impossible choices. All right. Of course it wasn't fair at all, but it was the best we could do, and--

Lilly Sullivan

Dr. Scribner, he talked to these patients constantly. He couldn't have the distance that the God Committee had. I've talked to a few of his patients. They all said he was a really caring doctor. And there was one patient he particularly liked, a patient whose experience ended up changing everything for dialysis and for the God Committee. She was a teenage girl named Caroline. I talked to her mom, Susan.

Susan Vukich

She had a sunny personality. She was a very happy, happy, happy girl, a very likable one. Well-rounded, I would like to say.

Lilly Sullivan

How did you know that Dr. Scribner liked Caroline so much?

Susan Vukich

It's sort of instinctive. As a mother, you get the feeling for if somebody likes your kid or not.

Lilly Sullivan

Caroline was 15, a good student, scout leader, taught piano. When she was sick, the athletes would carry her up and down the stairs at school. Kids from her youth group at church would donate blood. When Caroline's kidneys started to fail, Dr. Scribner submitted her case to the committee, even though he knew the rule-- no one under 18.

Lilly Sullivan

Did he tell you when he put Caroline in front of the committee? Did you know that it was going on?

Susan Vukich

Did I know what was going on? No. No, I didn't know until after the fact that that's what he had done.

Lilly Sullivan

Oh.

Susan Vukich

Mm-mm. I didn't know there was a committee to choose who lives and dies. And she was turned down.

Lilly Sullivan

What was that like for you?

Susan Vukich

I can remember the conversation. I just know I was totally silent-- trying, I guess, to absorb what was being said. I don't know how you would put into words the feeling you have when you're delivered a death sentence like that. A part of you dies. Everything stops. And it still does when I think about it, as a matter of fact.

Lilly Sullivan

Were you ever angry that the committee didn't just--

Susan Vukich

No.

Lilly Sullivan

Or that she didn't just--

Susan Vukich

No, not at all.

Lilly Sullivan

No?

Susan Vukich

Not at all.

Lilly Sullivan

Really?

Susan Vukich

I mean, they have their rules and regulations. And where you may have 100 people and can only take two, you pretty much have to stick by the rules.

Lilly Sullivan

Dr. Scribner didn't see it that way.

Susan Vukich

Dr. Scribner was not content with that decision. He thought he had a good case and had pleaded it well. And I really thought he felt that his cohorts would go along with him. He was a highly respected man. And I don't think he was used to having anybody say no to him.

Lilly Sullivan

Dr. Scribner tried to find a way. He told the committee, "I'll treat her on my own time, nights and weekends. Just let me use the machines." They said no. He couldn't accept it. He had another idea, something he'd been thinking about for a while-- a smaller machine, one that someone could take into their house and run themselves without any medical staff.

Susan Vukich

It was nowhere near ready to be tested. And that's where we lucked out. And he was going to do whatever it took to keep her around until that machine was ready.

Lilly Sullivan

He called the guy who had helped him build the dialysis machine, an engineer named Albert Babb. He told him about Caroline and said, "Do you think we could make this? She only has four months." Albert asked Dr. Scribner, "Won't the committee get mad that you're going around them?" Dr. Scribner said, "No, this has nothing to do with them. I'll get other funding."

The engineer wanted to help. His whole team did. They weren't technically supposed to. They were at the university, and they were supposed to be working on something else. But they worked nonstop to do it. They decided not to tell the university, concerned that the dean would shut it down. Someone on their team would actually do "dean watch," as they called it, keeping an eye out for the dean and warning their team over the intercom if they saw him.

In their lab, they put their designs and sketches on sliding panels. When the dean entered the building, they'd quickly switch the panels around to hide their work on the machine. To get around the God Committee, Dr. Scribner set it up independently as a research project. Caroline would use the dialysis machine at home. Susan would run the whole thing.

Susan Vukich

It was presented to us as being a strictly family matter.

Lilly Sullivan

To see if a family could run it.

Susan Vukich

Correct. I believe it was phrased something like, can layman non-professional people assume the role of engineer and nurse? So, can lay people be trained?

Lilly Sullivan

The engineers finished the new machine in four months and rushed it to Caroline's house in August of 1964. Susan learned how to do what before had only been done in a hospital-- run the machine that would remove her daughter's blood from her body, wash it, and feed it back in through her arm, except it was happening in the basement of her house in a special room they'd set up for Caroline.

Susan Vukich

I would put her on the machine usually between 6 and 7 o'clock at night. And that would mean taking her off after nine or 10 hours. So it was early, early morning, and then she would just stay in bed maybe for an hour and then eat breakfast before she went back to school.

Lilly Sullivan

And you'd take her off around 3:00 or 4:00 AM. So you'd wake up in the middle of the night and--

Susan Vukich

Oh, I was awake all night for sure.

Lilly Sullivan

Oh, you would stay awake all night.

Susan Vukich

Our machines were so experimental, Lilly. Alarms were going off all the time, and then we'd have to figure out what was wrong with it.

Lilly Sullivan

A constant problem was that her blood would clot and clog the little tube, the little shunt that Dr. Scribner had invented, in Caroline's arm.

Susan Vukich

I would have to get out heparin and saline in a syringe and unblock the clot. If it was unclottable, that was very painful for her. And it hurt me to pain her that way. But I mean, you had to get the blood flowing again, and I had no alternative but to do that. That was probably our biggest hurdle, was just keeping her blood moving.

Lilly Sullivan

Were you ever worried that you would get something wrong?

Susan Vukich

Oh, sure. Sure. Oh, sure. Sure. I mean, when somebody's life is in your hands-- I mean, at least when I felt her life was in my hands, I was always aware that something could go wrong. But I better not let it happen. You have to concentrate. Do everything just right.

Lilly Sullivan

Hm.

Susan Vukich

Because she was sick. And I think my feeling was, oh, I hope she feels better after this, because she was sick.

Lilly Sullivan

And in just a few weeks, Caroline felt better.

Susan Vukich

Oh, yeah, she did. Her eyes sparkled, and she was talkative. And I felt like this was the beginning of a new chapter in our life.

Lilly Sullivan

Yeah. How did Dr. Scribner-- do you know how did he feel when he saw that it was working?

Susan Vukich

Oh, of course, he was just jubilant. Oh, he was just grinning from ear to ear.

Lilly Sullivan

This research project was supposed to take three years to show whether or not home dialysis could be a viable treatment. But within one year, doctors agreed-- this would work. This is what they would do. Susan kept dialyzing Caroline, and Caroline kept getting better. She graduated high school, started college.

But dialysis is a treatment, not a cure. And it was still experimental. A person's veins and arteries would often scar over and stop accepting the treatment. As the doctors had said, it was a chance at extended life. In Caroline's case, that meant four more years.

Susan Vukich

She used up all of her usable veins and arteries. And they were having a very difficult time putting her on dialysis, so that during the time she was in the hospital-- it was two or three weeks, I think. I would dialyze her there as best I could for maybe as little as an hour before the blood quit flowing.

Lilly Sullivan

Oh.

Susan Vukich

And then, she just deteriorated, Lilly.

Lilly Sullivan

Oh, I'm so sorry.

Susan Vukich

She was in intensive care in the hospital. And she died at night when I had gone home. We knew that she wasn't going to come out of it. But so, I guess I was as prepared as anybody could be, knowing that we had done everything we could and that the bottom line is, we'd left a legacy for all the rest of these people-- not only our country, but in the world-- that can live because of what we pioneered.

Lilly Sullivan

After Susan and Caroline showed that home dialysis could work, Dr. Scribner immediately put dozens of patients on home dialysis. People around the world started building these machines. It got cheaper. And with way more access to dialysis, they no longer needed a committee to play God.

The God Committee story now, it's seen as a dark moment in medical history. People actually point to it as the birth of bioethics. We had to invent an entire field to deal with these questions. And we've agreed that having people vote on who makes the cut to live or to die was a bad idea.

Although, the truth is, we vote on life and death decisions all the time, just from a greater distance, deciding things like who gets health insurance or where the best hospitals go-- which, in a pandemic, can make all the difference. We decide these things a lot. We just don't use the words "God Committee." It's easier that way.

Ira Glass

Lilly Sullivan, she's one of the producers of our show. Susan Vukich, the mom in that story, died a few years back. She was 91. After her daughter Caroline died, she spent the rest of her life teaching people how to dialyze their family members at home.

Act Two: Winter’s Bone

Ira Glass

Act Two, Winter's Bone. So when it comes to who will love, that, of course, is not decided by a panel of experts somewhere. We each decide for ourselves who we want to be with. And one of our producers, Elna Baker, has noticed the way people are deciding on that, deciding on who makes the cut, who gets first date or becomes part of their life in a much bigger way. In New York City, where she lives, she says all that's changed lately.

Elna Baker

Have you heard about finding your winter? I hadn't either. Apparently, it's a thing single people in New York have been doing since COVID. Basically, over the summer and fall, people started scrambling to find someone, anyone, before winter in a second lockdown.

Back in August, completely oblivious to this phenomenon, I went on a date with a guy. We met on Hinge, the dating app. Our first date, we'd spent six feet apart in a park. For our second date, we met at an outdoor restaurant.

It was going well. We just put in our order when he said, "What do we do about Hinge?" "What do you mean?" "I mean, do I delete my profile?" "Why would you delete your profile?" "Because I met this really great girl, and I'm totally into her."

I paused. "Is it-- me?" "Yes, of course." I was so confused. I'd had to pull up Hinge right before the date to remind me of his name. And he was ready to be exclusive.

I am not new to dating. This doesn't happen. Straight men in New York City rarely want relationships. The whole game is to stay single. At best, you get invited into their harem-- one of three or four people they're sleeping with. No one ever wants to eliminate the possibility of other options so quickly. But then, this kept happening. I'd go on dates, and everyone wanted to have road trip style marathon bonding sessions that lasted hours longer than usual. They wanted to see me again. They sent me flowers. They even held hands.

This was my first time back in the game for a while. I'd taken a break from dating for nearly a year. I'd gone through a bad breakup. I left town for a while, did some therapy, meditated. And now, back on the scene, I felt like Rip Van Winkle, waking up to a world where men suddenly wanted commitment. I went on 10 dates. Of them, nine wanted to keep seeing me.

By comparison, three years ago, when I was last single, I went on 35 dates. Of them, two wanted to keep seeing me. I thought, did I get hot? All those months of work on myself had really paid off. I told this all to my friend Hamza. "Did I get hot?" "Did you get hot?" He could not stop laughing. "You idiot, it's COVID."

That's when Hamza explained about people trying to find their winter. A friend of a friend named Christine, a single woman in her 50s, told me, in her experience, it's not subtle.

Christine

One or two men has said to me, winter's coming, and I'm really hoping to meet someone to spend the winter with. They've said that.

Elna Baker

Another person I talked to, Kelsey, 22, said she recognized what was happening early because she used to see it in Chicago every winter. Before temperatures dropped to below 0 and going outside was a non-starter, people would rush to couple up. She said everyone called it cuffing season, as in handcuffs.

Kelsey

I was out. I was kind of seeing this guy casually, and we were out one night. And we were sitting down at the bar, kind of talking. And he was like, "Oh, by the way, we're together, right?" And I was like, "Oh my God, you don't know me. Like, no. I don't want to be exclusive with you." And by the end of the night, he had gone home with someone else.

So basically, it was like-- it was musical chairs. He was trying to sit down in my chair, and I said no. And he found another open chair, and he was done. And he had a great cuffing season, and I'm sure that relationship ended by the time people were going out again.

Elna Baker

Kelsey says now it's COVID cuffing season, like we're living in a forever winter. We're supposed to stay in. Dating multiple people is reckless. So people are settling. She told me one roommate of hers ended up with a girl he wouldn't normally be into around Thanksgiving.

Kelsey

And then, another one left and is now living in a van in Colorado with an ex-boyfriend. But she doesn't want to date, but I think she just didn't want to be anywhere near New York. That's like an extreme cuff, destination cuff.

Elna Baker

I guess you'd think it'd be nice. After all these years of rejection, guys being into me right off the bat or being texted, "I miss you," hours after meeting. But here's the problem with what they're doing. Projecting, building up an entire fantasy based on barely knowing someone-- that's my thing. You can't take my thing.

One time, I liked a guy so much after meeting him once that I spent a week imagining all the dates we'd go on together, including one where we got stoned and bought crayons spontaneously and colored in coloring books. By the time we went out again, I'd been on so many imaginary dates with him, my brain genuinely didn't know the difference between real life and what I'd pretended we'd done.

But only one person can do that at a time. Otherwise, you're both too into it way too soon. And that's bringing delusion to delusion, and it cancels the whole thing out. Now, I feel like I'm on the other side of the equation. And watching people try to find their winter, I am watching what I used to do and how disturbing it must have been. I get why 33 out of 35 men passed on me. It's offputting. I told Kelsey, I don't like this new world of musical chairs we're living in.

Kelsey

But the real question is, do you need a chair? I've just really-- I'd so much rather just be dancing around and not have a chair.

Elna Baker

It's nice to sit on a chair sometimes. Sometimes, you got to sit on a chair.

Kelsey

Sometimes you've got to sit on a chair. But if it's an uncomfortable chair, you're going to be more miserable in the chair than not in a chair. Oh, gosh, I don't know.

Elna Baker

I had this-- oh my God, I was getting out of the subway. I was getting out of the subway. And this guy approached me, and he had a mask on. And he was like, "Excuse me. Can I ask you a question?" And I thought for sure he was going to ask directions. So I said, "Yeah."

And he was like, "I just bought a farm upstate, and I'm growing my own locally sourced produce. And I'm looking for a girl to get in a relationship that I can bring upstate with me. Is this something you would be interested in?"

Kelsey

Oh my gosh.

Elna Baker

And I--

Kelsey

That's good.

Elna Baker

--was like--

Kelsey

You should have given him my number. I'm interested.

[LAUGHTER]

Elna Baker

I was like, what is happening to the world? Is this truly the end of days? Also because I'm used to guys using, like, "I work in finance," or, "I have financial stability." Like, using things to reel me in, but never crops. No one has ever said, "I have--"

Kelsey

No.

Elna Baker

"I got some crops."

Kelsey

Crops, but it's totally-- he's using his space. He's like, "I have fresh air and land." That's capital right now.

Elna Baker

That is total-- it's total capital right now.

I get that it's hard to be alone. But this level of desperation is a bit much. He was a step away from saying, "I have a van, two shotguns, and a can of gas. Get in. We can make it at least two weeks before the zombies catch up to us." When, really, all we're in danger of is watching Netflix alone.

I thought I could never be this way. But as I talked to people, I admired the single-minded practicality of some of these New Yorkers. My friend Mica is a psychologist. She says people suffer when they're isolated. People need to be touched. She went looking for a winter to preserve her mental well-being. She's not deceiving anyone. She's clear about what she's looking for-- a warm body.

Mica

Which doesn't sound very romantic, but I feel like that's kind of where we're at-- where I'm at-- in this moment.

Elna Baker

So you just want somebody for how long?

Mica

Until I get my vaccine.

Elna Baker

And you're totally fine with it being someone that you wouldn't normally be attracted to or want to spend time with?

Mica

Well, I'm having to come into that. I'm having to lower my standards.

Elna Baker

Would you say that you're picky?

Mica

So I guess I used to be picky. I guess I had my list that had to be checked off, like money in the bank, good credit. Also a gentleman. Has the same vision as me, right? We're aligned, and we both want to build and community and close the racial wealth gap. You know, whatever. Be a Black power couple. I used to have on my dating profiles, I would just say, "looking for the Barack to my Michelle." That's all I would put. Someone that I--

Elna Baker

Your standard was Barack Obama.

Mica

Yeah, but Barack with Michelle because Michelle's smarter than him, better than him, and he values that. And yet, she pushes him to greatness. And now, well, if you can hold a conversation, you're not overtly an asshole, and you're smart enough, yeah.

Elna Baker

Even these new lower standards were not low enough. Like, she matched with a guy who had kids, which is usually a deal breaker for her and was a, quote, "filmmaker," which is another deal breaker because she feels like filmmaker is a job everyone in New York claims. But she agreed to a first date. He told her he'd bake a pie. She was expecting an entire pie. He just brought a piece. He'd eaten the rest. But she was willing to overlook it.

Mica

I was like, you could even tell me about your "film," quote unquote. I'll listen to that. Whatever. I'll listen to your stories about-- I don't know-- parenting during remote learning, whatever. I'm so willing.

Elna Baker

But for their second date, he insisted on coming over. She kept pushing for an outdoor restaurant. When he said no, she countered with, how about coffee? Finally, he confessed he'd spent all his money on Thanksgiving dinner, and he couldn't afford it. She is still seeking a winter.

Most people I talked to weren't as pragmatic as Mica. If anything, it's been kind of stunning, seeing people who were players before COVID suddenly questioning their life choices and wanting families, or at least, real love. Like my friend Ian, who used to be more of a Mica.

Of all the people I saw searching for a winter, I was most surprised by him. When Ian is single, which he usually is, he's prolific. He would, as he put it, order men on apps to come to his apartment like you order food on Seamless. He also dates women. But the pandemic broke him-- something about being alone all those months during the first lockdown.

Ian

You can't help but feel like, are we at the end of Fight Club with the world falling down around us, and you better grab onto someone's hand, or else you're going to go through it alone?

Elna Baker

Ian would bike through the abandoned city. It was so empty, he laid in the middle of Fifth Avenue one afternoon. It felt apocalyptic. Being alone, it changed him. When he was dating before, there were always unlimited options, always someone better.

Ian

When you stop seeing everyone as an option, you can't help but start seeing people as The One, for better or worse.

Elna Baker

It's so dramatic, the shift.

Ian

Totally. We're living in a very dramatic time, you know? When it starts to get dark at 2:00 PM, you have no choice to be like, alone? No! You know? Alone in the darkness? No, I'd rather have someone next to me, and we'll figure it out later.

Elna Baker

Being alone also changed Christine. She's used to being super busy. She's a successful theater person. She has two kids. Her ex and her would trade off week to week, and she'd go from having a full house to being completely alone. She lives facing the highway. And for the first time ever, there was no traffic sound.

Christine

And I can remember just waking up in the morning or falling asleep at night and just being in my bed and so wishing that there was somebody with me that I could hold and that I could just hug and be with in that silence. And I eventually bought myself a stuffed animal. [LAUGHS] So.

Elna Baker

I did, too.

Christine

Did you?

[LAUGHTER]

Elna Baker

I bought a teddy bear. She got a unicorn and wrapped it in a baby blanket. Christine and Ian, they're not looking for someone to winter with till they get their vaccine. They want to find their person. They want love.

I think the guys I've been dating during COVID are looking for that, too. I think they genuinely believe they've found it in me. Our minds can play tricks on us when we need a break from reality, like the guy who told me he'd had a vision of the woman who he wanted to be with a month before meeting me and that when I walked up to him in the park for the first time, he recognized me because I was literally the woman of his dreams. Or the guy I dated for a week who told me I was the one and that he'd never felt a connection this powerful. These are lovely men, every one of them-- I think. I don't actually know them.

Ira Glass

Elna Baker is one of the producers of our program. Coming up, working a hotline where you help people who are in desperate need and realizing during one of the calls that you recognize the voice of one of the callers. That's in a minute from Chicago Public Radio, when our program continues.

Act Three: Reluctant Bureaucrats

Ira Glass

It's This American Life. I'm Ira Glass. Today's program, Making the Cut. In this difficult moment that we are all living through, with a pandemic and the economy the way it is, we have stories of people who need stuff and how it's decided who's going to get the stuff they need. We have arrived at act three of our program. Act Three, Reluctant Bureaucrats.

So when producer Katie Mingle started to put together a series on homelessness for the podcast 99% Invisible, she learned that if you're homeless in the Bay Area, the first thing that everyone tells you is to call this hotline, 211. That's how you get access to shelter or housing. She says you would hear about this hotline all the time from people who were experiencing homelessness. But usually, when people mentioned it, they were frustrated. They would say, "I called the number. It didn't help. I didn't get anything." And she wondered what is going on here.

So, over the past few months, Katie spent some time with the 211 operators as they took calls. And it turns out, whether you get access to certain kinds of help depends on exactly how homeless you're considered to be. Not everybody makes the cut. Here's Katie.

Katie Mingle

Rashana Robinson used to answer 211 calls from a small office about halfway between Oakland and San Jose. Now, because of COVID, she takes the calls from her dining room table. If there's time between calls, she moves around the house like a hummingbird, prepping food for dinner or proofreading her daughter's homework, doing sit-ups.

211 is a crisis hotline for people in need. Since COVID, they've been getting more calls than usual from people who are hungry or need help paying bills or rent. The operators can refer them to programs that might be able to offer assistance.

Rashana Robinson

I talked to a homeowner the other day for almost an hour, losing her home. Talked to someone else that owns a daycare, losing it. May lose her house. Said she's losing her mind. It's devastating. It's devastating calls now. It's a lot more work.

[PHONE RINGING]

It's nonstop. Alameda County 211, how can I help you?

Katie Mingle

The most common reason people call, both before and after the pandemic, is homelessness. 211 can find callers a shelter bed for the night if there are beds available. Often, there's not. On a good day, they may have four or five to offer. This in a county where there are at least 8,000 people homeless on any given night. Callers seeking something more permanent, like longer term housing, there's not much of that either. But 211 can help get callers on a list. Maybe. It all depends on how they answer one question.

Rashana Robinson

And where did you sleep or stay last night?

Katie Mingle

Here, Rashana is screening a caller to see if she qualifies as literally homeless. You're literally homeless according to the county guidelines if last night, you slept in a shelter or in some place not meant for human habitation, like a tent or a car. But the caller, she's been couch surfing for the past few weeks. And last night, she tells Rashana, she slept in a motel.

Rashana Robinson

Paid for by yourself or?

Katie Mingle

Yes, the caller says, paid for by herself. But that's not the answer Rashana needs, so she can't forward her on to the next step to get longer term housing.

Rashana Robinson

You're welcome. Bye bye.

Katie Mingle

This technicality, what does and doesn't qualify someone for housing, it's upsetting to the callers. It's upsetting to Rashana, too. She thinks about it even when she's not at work.

Rashana Robinson

When we're at McDonalds, me and my sister in Union City, that Motel 6, it's always all type of action over there. I see this family going in there. And I see them packing all these bags. Three or four kids, right?

And it's like, oh, they are homeless, but they can't get help. That's fucked up. And these are the kind of people that will call me, and I say, can't help you because you stayed in a room last night. It's sad, and that's why I tell people, no, I hear you. I feel you. I know you're homeless. I'm not saying you're not. But Alameda County guidelines, these are the stipulations.

Katie Mingle

If callers meet the definition of literal homelessness, they can go into the system and be put on the list. There, they get ranked by how needy they are. The people considered most in need might get housing in two or three months. But a lot of people just languish at the bottom of the list and never get anything and end up calling 211 again. It can be a maddening cycle.

And sometimes, people get so exasperated that they yell at Rashana. She tries to listen, not take it personally, and move on to the next caller, not get too attached. But every once in a while, a caller will stick with Rashana long after she hangs up. I've heard her recall names of folks she talked to months ago. And in January of last year, she had a call she still thinks about.

Rashana Robinson

Good morning. Thank you for calling Alameda County 211. How can I help you?

Caller

I'm homeless at Alameda County with a two-year-old son, and--

Katie Mingle

The caller sounded familiar to Rashana. She said she and her son were homeless and looking for help.

Caller

You know, like, a shelter that provides some type of housing after work, something like that, just resources. So I'm willing to move anywhere that I can get help.

Katie Mingle

Rashana starts asking her usual questions. Have you called 211 before? What's your phone number? What's your name?

Caller

So my first name is spelled [BLEEP], and my last name is [BLEEP].

Rashana Robinson

Now Rashana knows why the voice sounds familiar, and you can hear her take it in. The person she was talking to was her cousin. The two hadn't seen each other in a long time. And her cousin didn't seem to realize she was talking to Rashana.

Rashana Robinson

OK. One moment.

Katie Mingle

She puts her cousin on hold and turns to her co-workers. "Fuck, this is my cousin," she tells them. When she gets back on the call, she seems not to know what to say at all, like she's lost the script completely.

Rashana Robinson

OK, um--

Katie Mingle

Finally, she recovers a bit, makes her way through the screening questions.

Rashana Robinson

And do you have any friends or family you could stay with?

Caller

No.

Katie Mingle

Rashana wants to tell her cousin it's her. But they're deep in the call, and she doesn't know how to say it, so she sticks to the script. It's now nine minutes into the call, and she's finished with the screening interview.

Rashana Robinson

OK, so you have been determined to be literally homeless. By Alameda County guidelines, you have been determined to be literally homeless.

Katie Mingle

Rashana tells her cousin that since she's literally homeless, she can pass her through to the next step. She might eventually get some help. And in the meantime, there's one space available in a shelter in Oakland that she could go to right away.

Caller

OK, so does this shelter-- how long can I stay in the shelter for?

Rashana Robinson

It just depends. It just depends. You could either, um--

Katie Mingle

Finally, Rashana finds the words.

Rashana Robinson

This is Tiny.

Katie Mingle

Tiny is Rashana's nickname.

Rashana Robinson

This is why I sound so--

Caller

Are you serious?

Rashana Robinson

--discombobulated right now. You're messing me up right now. Oh. Yeah, I'm dead serious.

Caller

That's crazy.

Rashana Robinson

I feel so bad. This is not supposed to happen to you all. [SOBS] But, um--

Caller

So I guess I'll take the number to the one in Oakland, and then--

Rashana Robinson

All right.

Caller

Well, hi, Tiny. [LAUGHS]

Rashana Robinson

I know.

Katie Mingle

For the next few minutes, the two cousins catch up a little, both alluding in vague ways to difficult and complicated family history.

Caller

Yes, it's been hard.

Rashana Robinson

Yeah. Man, I know. I know. I was just talking about you guys the other day. It'll get better for you. It definitely-- you're seeming still to be a go-getter, and this is the way to do it. I mean, if you got to stay through some shelters and things like that--

Katie Mingle

Rashana's not the only 211 operator to know someone who became homeless. Nearly all the operators who work for Alameda County 211 are women of color. And homelessness is disproportionately affecting Black and Brown people in the Bay Area. One operator named Gwen told me she'd been homeless herself for about five years, not that long ago. At the end of the call, Rashana transfers her cousin to the place where she can get on the list for help with housing.

Rashana Robinson

I'm going to connect you. I got you connected, OK?

Caller

OK. Did you take my number down?

Rashana Robinson

Yeah, I got your number down. I'm going to text you mine, OK?

Caller

OK.

Rashana Robinson

OK, I love you.

Caller

I love you, too.

Rashana Robinson

All right.

Katie Mingle

Looking back on that call, Rashana recognizes that some of her hesitancy around telling her cousin it was her had to do with her own doubts around what she was ready to offer.

Rashana Robinson

And I didn't really want to fully, at that point, extend my hand as in a place to stay because I didn't feel like I was in the position to do that. I just didn't want to be faced with that because, in my heart, I wouldn't have had the heart to be like, no, you can't come here.

Katie Mingle

Rashana had been in this situation before-- not with this cousin, but with another family member. And she knew once you invite someone in, you have to be willing to let them stay until they find another situation. After that 211 call with Rashana, it ended up being about six months before her cousin was able to get herself back into her own place.

When these operators actually do have something tangible to offer their callers, they jump at the chance. At the end of one of her workdays, Rashana answers the phone for a caller who needs a shelter bed tonight. Luckily, she's just gotten word that five beds have opened up in a shelter in Oakland. So she has something to offer. Only, there's a problem. The client is across town at a kidney dialysis center, and he needs to be at the shelter by 6:00 PM. It's currently around 10 minutes after 5:00.

Rashana Robinson

So you need to get over to EOCP by 6:00 PM. Is there anyone there? No, calm down. Calm down. It's OK. Is there anyone there that would be willing to give you a ride? No, no, no, 6:00. Yeah, 6:00 tonight.

Katie Mingle

This caller-- his name is James Reese-- was panicking. If he couldn't get into the shelter, he imagined he'd have to sleep outside that night.

James Reese

No one here. There's no one here to help me.

Rashana Robinson

Um, let me place you on a quick hold to see what I can do about transportation. OK? Let me place--

Katie Mingle

The 211 operators don't really have a budget to help callers with transportation. But there is this very small fund, Rashana tells me, for Lyft rides, although she doesn't think this situation meets the criteria to use the funding.

Rashana Robinson

You don't have a way to even take the bus home, Mr. Reese?

James Reese

No. I really-- you guys are trying to help me, and I appreciate you so much.

Katie Mingle

Rashana puts Mr. Reese back on hold and opens the app for Lyft on her computer. Her brow is furrowed. Her cursor is hovering over the Request Ride button. She says to me, this is where the humanity comes into it. Most of the day, it's do you fit the criteria or not. Call the number, read the script, go through the protocols. But now, she's going to make her own decision.

Rashana Robinson

(WHISPERING) I'm going to do it. OK, um, Mr. Reese, I'm going to get you a Lyft ride.

Katie Mingle

It's rare having a problem she can solve, even if it means bending the rules a bit. Mr. Reese has 40 minutes to get to the shelter, but it's a 30 minute ride with traffic.

Rashana Robinson

Oh, you'll be getting picked up in 3 minutes by a Ricardo. He's driving a white Honda Accord.

James Reese

OK.

Rashana Robinson

OK?

James Reese

I'm going to get-- I'll be sitting in the lobby. Thank you.

Rashana Robinson

Have a good night.

James Reese

Bye bye.

Katie Mingle

Rashana hangs up the phone, but on her computer screen, we can see that Ricardo the driver has pulled up to the address Mr. Reese gave. He's just sitting there. Why is Ricardo just sitting there if Mr. Reese is in his car?

Rashana Robinson

He's waiting. He's going to leave.

James Reese

Hello?

Rashana Robinson

Hi, Mr. Reese. He's there.

James Reese

OK. Hey, I'm coming out. I'm coming out right here.

Rashana Robinson

OK, you may want to hurry.

James Reese

OK, OK. Here I go. Thank you.

Rashana Robinson

Mr. Reese, he's now left, and the ride was canceled.

James Reese

Huh? No, no, I'm right here!

Rashana Robinson

Hold on one second, Mr. Reese.

Katie Mingle

She puts him back on hold. I'm not sure if she's going to get him another Lyft or if that was his one chance. It's 5:30. He'd already be late, but maybe not too late. Rashana tries again.

Rashana Robinson

Robel in a green Toyota Prius will be picking you up in six minutes.

James Reese

Pardon me? Oh, gosh. Hello?

Rashana Robinson

I'm still here, Mr. Reese.

James Reese

Oh, OK.

Rashana Robinson

I have to stay on with you until you get in that car.

James Reese

Mm-hmm.

Rashana Robinson

Five more minutes. He's not going to make it. He'll still be late.

James Reese

Oh, come on, car.

Rashana Robinson

Oh, he's there. He's waiting for you. Green Toyota Prius.

James Reese

Oh, man. I am standing right here--

Rashana Robinson

OK, Mr. Reese, you may have to walk around and look for a green Toyota Prius. Come on, let's look for the vehicle.

James Reese

OK.

Rashana Robinson

Yes, so you can get in there.

Katie Mingle

We can see the driver's blue hovering on the screen, circling the block. But they don't seem to be finding each other.

Rashana Robinson

OK, let me try to call the driver. Hold on one second. There are four more agonizing minutes of back and forth on a conference call between Rashana, Mr. Reese, and Robel, the Lyft driver. Mr. Reese is describing landmarks, describing himself. Finally, they find each other.

James Reese

I'm getting in the car.

Rashana Robinson

You're in the car?

James Reese

Thank you. I'm in the car.

Rashana Robinson

Perfect. You're going to be a few minutes late, but just calmly explain that you were told to come.

Katie Mingle

He thanks her. She hangs up.

Rashana Robinson

Good. He's on his way.

Katie Mingle

Whoa.

Rashana Robinson

Yeah. Good, that's a good thing. I guess that's what keeps you going, even if it's one person that gets a place inside tonight. It's like-- [SNIFFS].

Katie Mingle

Getting Mr. Reese to that shelter was one real thing before the day's end, one person who Rashana knew for sure wouldn't sleep outside that night. It doesn't always go like that.

I hadn't thought about it that much before this, but bureaucracies aren't just frustrating for the people trying to navigate them. They're frustrating for the people working inside of them, too. No one really has any agency, no power to make a decision that could really help someone. All the operators told me the best calls are like this one, when they feel like they actually have something to offer. But calls like this are rare. Mostly, Rashana has to be the voice telling people they're not going to get what they need-- not right away and maybe not ever.

Ira Glass

Katie Mingle, she's normally a producer for the 99% Invisible podcast, though she just released an entire series on homelessness in the Bay Area. It's called According to Need. It has big fans on our staff. You can check it out on the 99% Invisible podcast feed wherever you get your podcasts.

[MUSIC - "I HOPE I GET IT" BY A CHORUS LINE ENSEMBLE]

Credits

Ira Glass

Well, our program was produced today by Lina Misitzis. The people who put together today's show include Bim Adewunmi, Elna Baker, Susan Burton, Ben Calhoun, Dana Chivvis, Sean Cole, Aviva De Kornfeld, Hillary Elkins, Noor Gill, Damian Grave, Chana Joffe-Walt, Stowe Nelson, Katherine Rae Mondo, Nadia Reiman, Ari Saperstein, Lilly Sullivan, Christopher Swetala, Matt Tierney, and Diane Wu.

Our managing editor is Sarah Abdurrahman. Our senior editor is David Kestenbaum. Our executive editor is Emmanuele Berry. Special thanks today to Lisa Pollak, Whitney Henry-Lester, Abby Madan, Alison DeJung, Ian Fidance, Andrew Collins, Kelsey Padgett, and Simon Adler and Molly Webster at Radiolab.

Our website, thisamericanlife.org, where you can stream our archive of over 700 episodes for absolutely free. This American Life is delivered to public radio stations by PRX, the Public Radio Exchange. Thanks, as always, to our program's co-founder, Mr. Torey Malatia. He always notices the little things. He started rolling the bottom of my pants in a new way. He is not into it.

Kelsey

That's like an extreme cuff.

Ira Glass

I'm Ira Glass. Back next week with more stories of This American Life.

[MUSIC - "I HOPE I GET IT" BY A CHORUS LINE ENSEMBLE]