Homelessness Visible

IMG_4667Our latest point-in-time count of people experiencing “absolute” homelessness in King County tallied 12,112 homeless individuals on January 26th, 2018 (see the All Home King County‘s 2018 report “Count Us In”). By the term “absolute” I refer to the fact that they use the strict HUD definition of homelessness, which excludes the considerable number of people (especially teens and young adults) who are couch-surfing, doubled-up with friends or extended family members and who do not have a safe, stable, affordable place to live. In this respect the HUD definition differs from the official definition of homelessness for healthcare services funded through the U.S. Department of Health and Human Services (see the various definitions compared here by the National Health Care for the Homeless Council).

The 12,112 homeless individuals counted for 2018 represent a 4% increase over the 2017 homeless count (which represented a 19% increase from the 2016 count). Some politicians claim that the slowing percentage increase in people experiencing homelessness can be counted as progress—although as a reality check, the 4% increase in homelessness is much larger than the total population growth for King County. The most recent published statistics show a 2.3% population growth for King County for 2016-17 (source: Washington State Office of Financial Management). As another significant reality check, the homeless count survey methodology changed considerably for 2017 such that comparisons with 2016 numbers should not be made.

Significantly, the 2018 homeless count found that over half (52%) of homeless people were unsheltered the night of the count, with many people living outside in tents and in vehicles. Having participated in the survey this year, I can attest to the difficulty of finding and assessing whether or not parked vehicles are being lived in between the 2-5 a.m. timeframe the day of the count. It is much easier to count the number of people staying overnight at an emergency shelter. And homeless people living in tents tend to find thickly wooded areas in which to live—and not, as in the photograph above, more visibly along well-lit streets and bike paths. But for all of us who live, work, study, and play in Seattle and throughout the rest of King County, we didn’t need the official homeless count to tell us we have a growing problem. We have homelessness, abject poverty and despair, quite visible.

Note: In a series of subsequent posts I will address intriguing, intelligent, and excellent questions which I have received lately about our homelessness crisis. They were too numerous and complex to address in one post.

 

 

Prostitution: Exploitation, Not Work

IMG_2219A few weeks ago I participated in a powerful healthcare system training titled “Beyond Sex Trafficking: Responding to Commercial Sexual Exploitation and the Role of Healthcare Systems.” Commercial sexual exploitation is the exchange of sex acts for money, or for anything of monetary value, including basic needs such as food, clothing, or shelter. Therefore, it includes survival sex, pornography, escort services, exotic dancing, stripping, and street or hotel or house-based prostitution. Often referred to as “sex work,” this is a mighty misnomer, because it is not a form of work; it is exploitation and violence. And it is gender-based violence since most, but not all, of the victims are girls and women, and the overwhelming majority of buyers are men.

The evidence is clear: no matter what city or county or country (including countries where prostitution is “legalized” and regulated and sanitized), upwards of 90 percent of “sex workers” have histories of childhood sexual abuse, untreated post-traumatic stress disorder, and are disproportionately persons of color from lives of poverty, including homelessness. They often come from backgrounds of violence and exploitation, and once they are in the “life” of sex work, they are once again victims of violence and exploitation. And those male buyers of sex? They are disproportionately white and well-off financially. Many buyers are married and occupy high status positions in society, including doctors, lawyers, and politicians. Another interesting fact is that the majority of buyers of sex at some level feel remorse and would like to stop.

The conclusion is clear: There is no such thing as a happy, healthy hooker. Julia Roberts’ character of a prostitute in Pretty Woman is a sick, twisted version of the Cinderella fairytale—a romantic comedy that has nothing to do with true romance and that is decidedly not funny.

Healthcare providers, including nurses and physicians, are on the front-line of caring for victims of prostitution and all forms of sex trafficking and exploitation. We need to learn about these issues and do something about them. A terrific new online healthcare provider training module series on human trafficking (includes sex trafficking) using a public health approach is SOAR, which stands for Stop, Observe, Ask, Respond. Offered free-of-charge through the Department of Health and Human Services, Administration for Children and Families, Office on Trafficking in Persons, it includes three training modules (for CE/CME): 1) SOAR to Health and Wellness, 2) Trauma-Informed Care, and 3) Culturally and Linguistically Appropriate Services.

For any nurse, physician, social worker, teacher (and other professions specified by law) in Washington State, it’s important to note that mandatory reporting of known or suspected child abuse includes commercial sexual exploitation of children (CSEC) and teens under 18 (1-800-ENDHARM  https://www.dshs.wa.gov/report-abuse-and-neglect). In Seattle/King County, there is the CSEC Hotline: 855-400-CSEC with community advocates 24/7 for sexually exploited youth ages 12-24 in King County; and the Human Trafficking Hotline (24 hrs) at 888-373-7888. Also in King County we have the innovative and nationally-recognized resource, Stopping Sexual Exploitation: A Program for Men. 

Sources and Further Resources:

Ending Exploitation Collaborative/ References and The Harm of Sexual Exploitation 

Organization for Prostitution Survivors 

National Human Trafficking Hotline

Polaris Project

The Life Story, including the powerful video for healthcare providers Medical Emergency 

 

Summer Reading Challenge 2018

IMG_4854This is the third installment of my annual summer reading challenge with a social justice (and feminist) slant. These ten library books include ones related to my current research and writing project, Skid Road: The Intersection of Health and Homelessness, as well as works by women authors I am delighted to discover. Here they are in the order (bottom up) they appear in the photograph. Happy—and meaningful—summertime reading!

  1. Race and Medicine in Nineteenth and Early-Twentieth-Century America, by Todd L. Savitt (Kent, Ohio: The Kent University Press, 2007).
  2. Tuberculosis and the Politics of Exclusion: A History of Public Health and Migration to Los Angeles, by Emily K. Abel (New Brunswick, New Jersey: Rutgers University Press,
  3. Imperial Hygiene: A Critical History of Colonialism, Nationalism and Public Health, by Alison Bashford (New York: Palgrave Macmillan, 2004).
  4. Body and City: Histories of Urban Public Health, edited by Sally Sheard and Helen Power (Burlington, Vermont: Ashgate Publishing Company,  2000).
  5. Good Woman: Poems and a Memoir 1969-1980, by Lucille Clifton (Brockport, New York: BOA Editions, Ltd., 1987.
  6. Woman’s Place: A Guide to Seattle and King County History, by Mildred Tanner Andrews (Seattle: Gemil Press, 1994).
  7. Whose Names Are Unknown: A Novel, by Sanora Babb (Norman, University of Oklahoma Press, 2004).
  8. How to Suppress Women’s Writing, by Joanna Russ (Austin: University of Texas Press, 1983).
  9. Half a Yellow Sun by Chimamanda Ngozi Adichie (New York: Anchor Books, 2007).
  10. Purple Hibiscus, by Chimamanda Ngozi Adichie (New York: Anchor Books, 2003).

Navigating Towards Adulthood

IMG_3677.jpgWhat does it take to become an adult these days? What does it take for a young person experiencing homelessness to become an adult? And, is it true—as many adults now claim—that young people in general, housed and un-housed, are way too coddled and over-protected and kept in a nest of some sort (including an emergency shelter or transitional housing nest) for so long that they end up with arrested development?

I’ve been thinking about these and related questions. They matter to me in my roles as parent to one young adult and one adult (and newly married); as university professor working with hundreds of young adult students; and as a nurse practitioner and researcher working with teens and young adults experiencing homelessness.  Having personally survived a difficult adolescence and young adulthood (including a spiral into homelessness), I care deeply about doing what I can to help young people navigate this important and precarious time of life.

And the nest/arrested development comment above that includes emergency and transitional housing/shelter for teens and young adults? That comes from the fascinating assortment of reader comments to a recent Seattle Times article on the Doorway Project that I am working on. The article by Scott Greenstone, “A cafe where no one is homeless: one solution to youth on Seattle streets” (December 11, 2017), highlighted the story of Brad Ramey, a young adult age 25 years. A transplant from Alaska, Ramey stays at ROOTS Young Adult Shelter (for young people 18-25), takes classes at a community college, and during the day spends time in coffee shops and the public library to stay warm and dry. Many of the reader comments included some variation of “he is not a youth, he is an adult,” along with the tired tropes of “there are plenty of jobs to be had” and “more enabling services attract even more and ‘lazy’ homeless people.”

I find these comments helpful in that they voice biases, views, and misperceptions that are likely widespread. They may, in some cases, represent teachable moments, at least for people who are open to new information. For instance, it seems there is confusion as to the definition of “young adult.”  The World Health Organization uses the term “adolescents” to describe youth 10-19 years (or age of majority for a particular country), “young adult” for persons 20-24 years, and uses the inclusive term “young person” for individuals ages 10-24 years. There are no standard age definitions of “adolescent” or “young adult” in the US. However, the ACA provision for health care coverage of young adults on a parent’s health insurance policy is until age 26. I wonder how many of the negative reader commentators to the Seattle Times article were by comfortably employed and housed parents of young adults taking advantage of this ACA provision.

Our country’s social and class and race structures continue to exert large and inequitable effects on adolescent development and life trajectories for our young people. I recently read sociologist A.B. Hollingshead’s now classic book Elmtown’s Youth (New York: Wiley, 1949). about “certain significant relationships found to exist between the social behavior of adolescents and social stratification in a Middle Western community immediately before the effects of WWII were apparent locally.” (p. 3) I found this to be a fascinating book, especially in the vivid descriptions of social class (including inadequate housing and homelessness) and its effects on adolescent development, on what are now called adverse childhood experiences/traumas, and life trajectories—and in the fact that so much is the same if not worse 78 years after Hollingshead’s research. As he concludes in his book, “Those aspects of the culture which foster and perpetuate the class system over the against the ideals of official America, embodied in the Declaration of Independence and the Constitution, will have to be changed, if there has to be change, before Americans will face in practice the ideals they profess in theory.” (p. 453) Navigating towards adulthood is difficult under the best of circumstances. Navigating towards adulthood while experiencing homelessness and the traumas that often contributed to homelessness is exponentially more challenging. But not impossible.

Pets Rock

IMG_6141A week ago I lost my sweet corgi, Quinn. He was 14 years old and had been in my life (and heart) for over ten of those years. He came into our family as an early retirement (okay, failed) show dog from a Montana breeder since he had developed an auto-immune disorder. Quinn was my steady companion, my guardian (he had a ferocious ‘big dog’ bark to turn away any would-be home intruders—as long as they didn’t actually see him). He allowed me to sob into his fur after the death of both of my parents and the dissolution of my family of origin. He made sure I took regular breaks from my writing life in order to walk him and to meet the neighbors in the process. He helped define safety and love and the meaning of home.

I am reminded of the importance of pets to the mental health and well-being of people in general, but especially to those dealing with depression, loneliness, isolation, and homelessness. My patients tell me this all the time and a growing body of scientific literature supports these claims. Even the Centers for Disease Control (CDC) has a web page devoted to the health benefits of pets, although their links to additional information are broken. (Hopefully, “pets” has not become a banned word.)  Pet Partners, a pioneer in human-animal positive bonds and community-based pet therapy programs, has a list of health benefits of pets and animal therapy.  The National Institutes of Health (NIH) through MedlinePlus Health News has up-to-date results of research studies on the health benefits of pets, including the article “Hey, Single Folk: Adopting a Dog Could Lengthen Your Life” (November 17, 2017, by Robert Preidt).

Whenever I do The Meaning of Home values clarification exercise with groups of people—whether or not they have ever been or are currently home-less or un-housed—pets invariably rank up there with family members as the most important ingredients of home. Below, I include some of my favorite pet-related results of this exercise.

IMG_0682IMG_1320IMG_1891IMG_2286

 

Solastalgia: Homesickness and Climate Change

BC642845-1D42-466F-870C-CC1456A62A08Population health effects from climate change are established scientific facts. Like anti-vaxxers (anti-vaccinators), climate change deniers are not only wrong-headed, they are dangerous to everyone’s health (and to planetary health). Case in point: beware of the pets of anti-vaxxers since many seem to be refusing rabies vaccinations for their cats and dogs/ see “Anti-vaxxers now refuse to vaccinate pets” by Nick Thieme, Slate, August 3, 2017; at the same time, global warming is increasing the spread of rabies among animal hosts such as foxes in Alaska/ see “Ecological niche modeling of rabies in the changing Arctic of Alaska” by Huettman, Magnuson, and Hueffer, Acta Veterinaria Scandinavica, March 20, 2017. And as a reminder, rabies in humans is almost 100% fatal (source: CDC).

The Centers for Disease Control has developed an excellent graphic depiction of the impact of climate change on human health, shown here:

climate_change_health_impacts600w.jpg

Of special note in this graphic is the fact that mental health impacts are shown twice, associated with both severe weather and with environmental degradation.

A recent (November 25, 2017) NYT article illustrates the mental health effects from climate change for people who live in Rigolet, Labrador. As Livia Albeck-Ripka states in the article “Why Lost Ice Means Lost Hope for an Inuit Village” there are increases in depression, substance abuse, domestic violence, and suicide related to the disorienting environmental changes and increased isolation for villagers. “An unpredictable environment means disempowerment,” she writes and links this with the stirring up of the intergenerational trauma of colonization for indigenous people. But she also points out that mental health effects from climate change and environmental degradation affect us all. She quotes Australian philosopher Glenn Albrecht as stating, “We weren’t around when the asteroid wiped out dinosaurs, but now we have humans in the 21st century who are trying to deal with a change to the world which is unprecedented.” Albrecht coined the term Solastalgia: “a form of homesickness one experiences when one is still at home.”

But what can we individually and collectively do about climate change and about the health effects of climate change? Perhaps the most important action is to become better informed and more civically engaged in respect to these topics. The Lancet has a good website: Tracking the Connections Between Public Health and Climate Change which includes a synthesis of scientific evidence in The 2017 Report of The Lancet Countdown. In the US reliable sources of information include the CDC (resources linked above) and the American Public Health Association (APHA). The APHA graphic “How Climate Change Affects Your Health” (included below) is a bit overly-busy and heavy on the gloom and doom (and curiously does not include mental health), yet could spur helpful discussion in certain settings:

Climate_Change_Overview

Another great resource that is geared towards a young adult audience is the Seattle-based environmental news site Grist, with the vision of working for “a planet that doesn’t burn and a future that doesn’t suck.” Their funny and informative (a good combination) “Ask Umbra” eco-advice column is worth following. Take a look at Umbra’s “21-day Apathy Detox” for great ideas on brushing up on civic engagement related to environmental justice and climate change. My two favorites are “Day 5: Read More Than Dead White Men” and Day 20: Art Brings Life to Social Movements.” 

Get involved. Do what you can to beautify and “green” the places where you work, live, and play. Work upstream for social and environmental justice. Bloom where you are planted. Those are some of the thoughts I’ve had this fall as I’ve been involved with this year’s University of Washington Health Sciences Common Book Changing Climate, Changing Health: How the Climate Crisis Threatens Our Health and What We Can Do about It by Paul R. Epstein and Dan Ferber (University of California Press, 2011).

In order to emphasize the what we can do about it, I’ve been part of a team attempting to green the ugly weed-filled concrete planters in the main courtyard at the University of Washington Health Sciences—a courtyard with entrances to the Schools of Nursing, Medicine, Dentistry, the UW Health Sciences Library, as well as the UW Medical Center. The photos at the beginning of this post show the planters in their current (dismal, depressing) state, along with my tiny (art project!) protest sign next to a fake flower “blooming” in a pot. Our team wanted to plant spring bulbs and a healing garden full of water-wise herbs like rosemary and lavender, as well as indigenous healing herbs and native wildflowers. We have had a seemingly endless series of meetings with people from the medical center, the health sciences schools, the building and grounds folks, and the UW Sustainability group. Something that would appear to be easy to do is not. As I understand it, the (ugly concrete/example of Brutalist “raw concrete” architecture) Health Sciences building where this courtyard is located, is crumbling and leaking inside, including in the rare books collection of the library. We have been told that we can’t plant anything until the courtyard infrastructure and water membranes are replaced, which would cost millions of dollars ($7.5 million to quote one reliable estimate).

This is a somewhat trivial problem when compared with other environmental issues affecting our most vulnerable populations, but it is a daily reminder of the negative mental health effects of environmental degradation—including from poor choices for our built environment and health institutions.

The Hospital on Profanity Hill

Version 2When Harborview Hospital in Seattle opened its doors to patients in 1931, advertising posters portrayed the striking fifteen-story Art Deco building as a shining beacon of light, the great creme-colored hope on the hill overlooking the small, provincial town clinging to the shores of Puget Sound. “Above the brightness of the sun: Service” is what one poster proclaimed; in the bright halo behind the drawing of the hospital, were the smiling faces of a female nurse and her contented-looking (and either sleeping or comatose) male patient with a bandaged head.1

Harborview Hospital—King County’s main public charity care hospital—was built at the top of Profanity Hill, on the site of the former King County Courthouse and jail. Profanity Hill got its name from the steep set of over 100 slippery-when-wet wooden stairs connecting downtown Seattle to the Courthouse. One wonders if it also got its name from being at the top of the original Skid Road—now named Yelser Way—where in the early days of Seattle, freshly felled logs, mixed with a considerable number of public inebriates, skidded downhill together into the mudflats of Puget Sound.2 The term ‘skid road’ soon became synonymous with urban areas populated by homeless and marginalized people.

Counties are the oldest local government entity in the Pacific Northwest, and King County, which includes the City of Seattle, was formed by the Oregon Territorial legislature in 1852. From the beginning, the King County Commissioners were responsible for such things as constructing and maintaining public buildings, collecting taxes, and supporting indigents, paupers, ill, insane, and homeless people living in the county.3 Seattle, with its deep-water shoreline and rich natural resources, was built on the timber and shipping industries, which soon attracted thousands of mostly single and impoverished men to work as laborers. These industries, mixed with ready access to alcohol in the always ‘wet town,’ led to high rates of injuries. Serious burns came from the growing piles of sawdust alongside log or wood-framed houses heated by wood fire and coal. Then there were the numerous Wild West shootings and stabbings. As in the rest of the country at that time, wealthier families took care of ill or injured family members in their own homes, with physician home visits for difficult cases. The less fortunate relied on the charity of local physicians and whatever shelter they could arrange.

David Swinson ‘Doc’ Maynard, one of Seattle’s white pioneer settlers, was Seattle’s first physician and, in a sense, he opened King County’s first charity care hospital, an indirect precursor of Harborview Hospital. A colorful and compassionate man, Doc Maynard built and operated a 2-bed wood-framed hospital facility in what was then called the Maynardtown district—now called Pioneer Square—a Red Light district full of saloons and ‘bawdyhouses.’ Although she had no formal training, Maynard’s second wife, Catherine, served as the hospital’s nurse. Their hospital, which opened in 1857, closed several years later, reportedly because Doc Maynard insisted on serving both Indian and white settlers. Also contributing to the hospital’s demise was the fact that Maynard disliked turning away patients who could not pay for his services. Around this same time, Doc Maynard assumed care for King County’s first recorded public ward: Edward Moore, “a non-resident lunatic pauper and crippled man.”2 The unfortunate patient had to have his frostbitten toes amputated, and then once healed, was given an early version of ‘Greyhound Therapy’ and shipped back East.

But the true roots of Harborview Hospital began in 1877 in the marshlands along the banks of the Duwamish River on the southern edge of Seattle. There, on an 80-acre tract of fertile hops-growing land, the King County Commissioners built a two-story almshouse, called the King County Poor Farm. They built the Poor Farm in order to fulfill their legislative mandate. Not wanting to run the Poor Farm themselves, they posted a newspaper advertisement asking for someone to take over operation of the King County Workhouse and Poor Farm, “to board, nurse, and care for the county poor.”4 In response, three stern-looking French-Canadian Sisters of Providence nurses arrived in Seattle by paddleboat from Portland, Oregon. The Sisters began operation of the 6-bed King County Hospital facility in early May 1877.

In their leather-bound patient ledgers, the Sisters of Providence recorded that their first patient was a 43-year-old man, a Norwegian laborer, a Protestant, admitted on May 19th and died at the hospital six weeks later. The Sisters carefully noted whether or not their patients were Catholic, and in their Chronicles, they recorded details of baptisms and deathbed conversions to Catholicism of their patients. The hospital run by the Sisters of Providence had a high patient mortality rate, but the majority of patients came to them seriously injured or ill. Also, this was before implementation of modern nursing care: the Bellevue Training School for Nurses in New York City, North America’s first nursing school based on the principles of Florence Nightingale, opened in 1873.

In their first year of operation, the Sisters realized that the combination of being located several miles away from the downtown core of Seattle and the unsavory name ‘Poor Farm’ was severely constraining their success as a hospital. So in July 1878 they moved to a new location at the corner of 5th and Madison Streets in the central core of Seattle, and they renamed their 10-patient facility Providence Hospital. The Sisters designated a night nurse to serve as a visiting/home health nurse and they accepted private-pay patients along with the indigent patients, whose care was paid for by King County taxpayers. The Sisters of Providence agreed to provide patients with liquor and medicine, both mainly in the form of whisky, a fact that likely helped them attract more patients.2

The Sisters’ list of patients included mainly loggers, miners, and sailors in the first few years, later mixing with hotelkeepers, fishermen, bar tenders, police officers, carpenters, and servants as the town grew in size. Many of their early patients were from Norway, Sweden, and Ireland, echoing the waves of immigrants entering the United States. Diagnoses recorded for patients included numerous injuries and infectious diseases—including cholera, typhoid, and smallpox—along with ‘whisky’ as a diagnosis, which later changed to ‘alcoholism.’ Their patient numbers grew, from just thirty hospital patients their first year, to close to two hundred patients by their fifth year of operation. The Sisters expanded their hospital to meet the increasing patient population.

Growing religious friction between the Catholic Sisters of Providence and the county’s mainly Protestant power elite, contributed to the King County Commissioners assuming responsibility for re-opening and running the King County Hospital in 1887. The King County patients were transferred from Providence Hospital back to the old Georgetown Poor Farm facility. Then, in 1906, the King County Hospital was expanded to a 225-bed facility at the Poor Farm site. It remained there until 1931 when the new 400-bed Harborview Hospital on Profanity Hill was opened. The old Georgetown facility, renamed King County Hospital Unit 2, was used as a convalescent and tuberculosis center until it was closed and demolished in 1956.5 The area where the King County Poor Farm was located is now a small park surrounded by an Interstate, industrial areas, and Boeing Field.

Harborview Hospital, now named Harborview Medical Center, still stands at the top of Profanity Hill, although the area is now officially called First Hill and nicknamed Pill Hill for the large number of medical centers now competing for both real estate and health care market share. Harborview Medical Center is owned by King County, and since 1967, the University of Washington has been contracted to provide the management and operations. Harborview Hospital has served as the main site for the region’s medical and nursing education. Since 1931, it has been the main tertiary-care training facility for the University of Washington’s School of Nursing.

Harborview Medical Center continues to fulfill its mission of providing quality health care to indigent, homeless, mentally ill, incarcerated, and non-English-speaking populations within King County. It is the largest hospital provider of charity care in Washington State. In addition, it serves as the only Level 1 adult and pediatric trauma and burn center, not only for Washington State, but also for Alaska, Montana, and Idaho, a landmass close to 250,000 square kilometers with a total population of ten million people. Harborview Medical Center has nationally recognized programs, including the pioneering Medic One pre-hospital emergency response system, the Sexual Assault Center, and Burn Center. In addition, Harborview provides free, professional medical interpreter services in over 80 languages, and has the innovative Community House Calls Program, a nurse-run program providing cultural mediation and advocacy for the area’s growing refugee and immigrant populations.

Harborview remains a shining beacon on Profanity Hill, rising above the skyscrapers of downtown Seattle. At night, it is literally the shining beacon on the hill, with blinking red lights directing rescue helicopters to its emergency heliport, built on top of an underground parking garage on the edge of the hill. Sharing space with Harborview’s helipad is the narrow strip of green grass of Harbor View Park, with commanding views of Mount Rainier to the south, and of downtown Seattle and Puget Sound to the west. In the wooded area below Harbor View Park, extending down to Yesler Way, along the old Skid Road, are blue tarps and tents of the hundreds of homeless people living in the shadows of the hospital. Construction is underway to add a new public park, mixed-income public housing, and a new—and hopefully less slippery—pedestrian walkway connecting downtown Seattle to the Hospital on Profanity Hill.

Note: This was published in the “Famous Hospitals” section of Hektoen International: A Journal of Medical Humanities in Spring 2015. Since researching and writing this essay, I have continued research (including conducting oral histories) for my project “Skid Road: The Intersection of Health and Homelessness.”

References:

  1. Seattle’s First Hill: King County Courthouse and Harborview Hospital. http://www.historylink.org/index.cfm?DisplayPage=output.cfm&file_Id=7038. Priscilla Long, curator. Published March 22, 2001. Accessed November 5, 2013.
  2. Morgan M. Skid Road: An Informal Portrait of Seattle. New York, NY: Viking Press; 1951.
  3. Reinartz KF. History of King County Government 1853-2002. http:your.kingcounty.gov/kc150/service.htm. Published July 31, 2002. Accessed December 12, 2014.
  4. Lucia E. Seattle’s Sisters of Providence: The Story of Providence Medical Center—Seattle’s First Hospital. http://providencearchives.contentdm.oclc.org/cdm/ref/collection/p15352coll7/id/1651. Published 1978. Accessed October 1, 2013.
  5. Sheridan M. Seattle Landmark Nomination Application—Harborview Hospital, Center Wing. http://www.seattle.gov/neighborhoods/preservation/lpbcurrentnom_harborviewmedicalcenternomtext.pdf. Published May 4, 2009. Accessed November 21, 2014.