The smell of rotting flesh fills the Toronto shelter room where Pat Gallagher lives at the north end of town.
He loosens the bandages covering his left foot. His toes looked like lumps of black coal. Diagnosis: severe frostbite.
“I pretend it doesn’t bother me,” he says, “but when you look at your foot and realize, ‘I saw that at the Royal Ontario Museum, it was on a dead mummy.'”
“It starts to crawl into your stomach and you get a little panicked and feel a little sick.”
Gallagher was ready to amputate his toes and part of his foot this week. The surgery was to be preceded by consultations with nurses, doctors and psychologists, followed by a lengthy rehabilitation to learn to walk again.
Healthcare practitioners say this is the second difficult winter in a row for those living abroad. Epidemiological stresses on an already stretched shelter system, as well as restrictions banning eating — and heating — at fast food restaurants have left many with nowhere to go on cold nights.
Elizabeth Harrison, a nurse at Inner City Health Associates who treats the homeless, says Gallagher’s case is not unique.
I’ve seen quite a few cases of severe frostbite this year and the past. Many lost fingers and toes.
“These injuries are life changing,” she says.
Warmth is one treatment.
“The most important thing about frostbite is that she never gets frostbite again,” she says. “It’s an amazing difference that makes if someone is able to get into one of these lodging hotels, or anywhere that’s warm, compared to getting back on the streets after getting frostbite.”
No lodging beds available
The Toronto shelter system has been full or close to capacity for years. This winter, Harrison and others say they often called the city’s central reception to be told there were no beds available.
Emergency departments are becoming designated centers for warming, says Dr. Stephen Hwang, MD, a physician and researcher at the MAP Center for Urban Health Solutions at Unity Health Toronto’s network of hospitals.
He says the network has an outreach worker who advocates eating out on cold nights in an effort to find places inside the shelters.
“There wasn’t enough space for people,” he says.
The city says it has added 400 new shelters and 165 heating center locations this winter. It has also kept heating centers open since January 7, rather than only cold weather alerts.
Advocates say this is not enough.
At least two homeless people died as a direct result of the cold, although data on this is difficult to obtain.
Huang says Bernard Kelly, a 74-year-old man with cognitive impairment and multiple physical health problems, froze to death at a bus shelter in late January.
“I knew him, he was a good man, but he was so weak and it’s tragic to see people like this freeze to death,” Huang says.
The danger also continues on cool, temperate nights
A spokeswoman said there were fewer than five homeless deaths at St Michael’s Hospital from hypothermia between November 1 and January 31, citing patient privacy as a reason not to give an exact figure.
Toronto Public Health says three homeless people died of hypothermia between 2017 and the first half of 2021, although it notes there has been no systematic collection of data from police, hospitals or paramedics.
Hwang’s research — published in 2019 in the International Journal of Environmental Research and Public Health — indicates that while frostbite and hypothermia are at their peak on frigid nights, the dangers are also present on moderately cold nights.
His team found that 72 percent of deaths or hypothermia occurred when minimum daily temperatures were warmer than -15°C.
“People may not realize that there is still a risk of death or injury on those nights,” he says.
“I’m starting to realize I’m in serious trouble.”
It wasn’t cold the night Gallagher’s feet froze.
Snow fell quickly on January 17 when a snowstorm hit southern Ontario, but temperatures were between -2°C and -3°C.
He was out shoveling a local grocer who was paying him on food cards. He says it was warm and wrapped properly. But he was sweating.
“I should have known better,” he says.
Gallagher has spent the past twenty years on and off the streets. He says that a bad car accident and a fall from a roof – he was a roofer – made him take opioids, which quickly became an addiction.
He has become adept at staying warm and dry. Holds plenty of dry socks and extra gloves. He wears layers under snow pants and a heavy coat.
“But with COVID, everything was closed and I couldn’t actually go to Tim Hortons or another place to use the restroom,” Gallagher says.
“This prevents any opportunity to change socks, change shoes, and dry things with a hand dryer.”
That night he didn’t want to go home – a chest in the woods at the western end of town. It will be very cool.
So he went to the laundromat all night to warm up.
“When I took off my shoes, they found what looked like my feet, except that there was a glass surface on them,” he says. “And it was like looking at a misty glass tube. It was weird. And I started to realize I had a big problem here.”
Call 911 and wait for the ambulance.
Weeks later, while he waited for surgery on his left foot, he hoped that his right foot — which was still swollen, but healthy pink — would heal.
“It might seem like losing toes isn’t a thing, but it’s hard to walk on just a small stump,” he says.