Dan Gorenstein: A quick note: This episode includes strong language. 

Antonio Matthews: I could beat being homeless, I could beat drugs, but this one I can’t win.

DG: Antonio Matthews was staring at a few choices, none of them good.

He could stay home and skip his doctor’s appointment.

He could go to the doctor’s and risk getting the coronavirus.

There was a third option, but he was doing his best to not even think about that one.

From the the Annenberg Studio at the University of Pennsylvania, I’m Dan Gorensetin, and this is Tradeoffs.

Every month, Antonio takes the bus to a clinic in Camden, New Jersey, to get a shot of buprenorphine, a drug that blocks his craving for heroin. He’s been taking that ride since last summer. And then, one Friday in the middle of March, the 53-year old got a phone call from the clinic reminding him he needed to be in on Tuesday.

Antonio Matthews (R) and Brian Thompson (L) (Photo courtesy of Brian Thompson)

AM: I was like “Oh, my god, I gotta get this shot.” And I was like, “I gotta get on the bus!”

DG: The 400 bus: a packed, shoulder-to-shoulder 7-mile ride from his place to downtown Camden.

His mind jumped to a recent news story about a Detroit bus driver.  

Reporter: The family of Detroit bus driver Jason Hargrove is grieving tonight and pleading with the public. 

Desha Johnson-Hargrove: This is not a game out here. This is not a joke out here.

AM: The bus driver said somebody had coughed on him, and he died. 

DG: By then, Antonio was already pretty scared.

He has kidney failure, and earlier in the month the doctor where he goes to get dialysis put the risks for people with kidney failure in stark terms.

AM: He says, “Listen, I want to explain it to you like this. You got to be careful.” He said, “You have to stay very neat and clean.” He says, “I’m not trying to scare you, but if you catch this virus, you are going to die.” And that was enough for me.   

DG: People with multiple chronic conditions — Antonio has kidney failure and high blood pressure — are more susceptible to getting COVID-19. And people with kidney disease are at higher risk of becoming seriously ill if they get it. Early data show that 70% of people with kidney disease who got COVID had to be hospitalized.  

AM: I thought that if I went out this house and got on that bus, I would die.

DG: Until the summer of 2019, Antonio had spent 30 years in and out of jail and living on the streets.

But now, he’s got his own one-bedroom apartment. He’s also nearly nine months sober, his longest stretch since he started using heroin in 1988.

Antonio makes all of his dialysis appointments these days. Lately, he’s been picked up by a dialysis center van and gets treated in a private room.

Taking the bus to a monthly doctor’s appointment meant putting all of that at risk. 

One of the most striking things about living through a pandemic is this: The most basic parts of our daily routines suddenly become terrifying choices with huge consequences. 

AM: I was like, “Why me?” You know, so much bad shit has happened in my life, and I always feel like I’ll be the one to catch it. 

DG: Catching the bus was inviting danger in, and Antonio did not want that. The prospect of getting on the bus was so terrifying that he thought of what he always thought of when he got scared.

AM: I know that when I do dope, everything’s all right. I don’t care about nothing after I do dope. So that was my solution to the problem was to do some dope. I’d just do dope and OD and say fuck it and that would be the end of it anyway.

DG: In his mind he had two choices.

Option 1: Take the bus to the clinic. 

Option 2: Kill himself by overdosing on heroin.

Antonio was as sober and stable as he had been in decades. But the fear of getting the coronavirus had him thinking of turning back to his old comfort: heroin.

It was an ugly choice, and it didn’t sit right. Friday night the pacing started. Antonio turning over his choices, his anxiety ratcheting up.

AM: It got worse and worse and worse. The anxiety got really, really bad. I couldn’t sit down for five seconds without my body just reacting, and I would just walk around the apartment back and forth and talking to myself. And then after a while, it got so bad that the anxiety started making me throw up. I was in bad shape.

DG: He got so twisted in his thoughts and fears Antonio barely slept. By Sunday he needed some help. 

AM: At first I was embarrassed and felt like I was weak, but after about two days I started reaching out to people because I was like, I got to tell somebody what I’m going through. 

DG: Antonio called friends from his support group, a group that for the past month has been forced to hold weekly conference calls instead of in-person meetings.

And, of course, he called Brian. 

AM: When shit goes to shit, he’s usually the one I call. If it’s not something major, I’ll figure it out. But when it’s out of hand and I know I don’t know what the hell would do, I’ll call him.

DG: Brian Thompson works for the Camden Coalition of Healthcare Providers. 

He helps lead the support group and runs the Coalition’s housing program that Antonio is in. 

Before Antonio started his more stable life, Brian would show up in the hospital after Antonio had overdosed on heroin or passed out after skipping dialysis.

That call with Brian helped Antonio see something about his heroin plan that he couldn’t see on his own. 

AM: I know a lot of people that OD’d, and I didn’t want people’s last thoughts of me to be like, “He just couldn’t beat his addiction.” I didn’t want people to be like, “He was a real good guy. He made it, and he got his own apartment. He was doing good, but he just couldn’t beat the drugs.” I don’t want people’s last thought to to be like, “He OD’d.” And that’s what changed my mind around. 

DG: Brian told Antonio, “Look, just do what you’ve been doing: Be smart, be safe.”

Antonio decided he was going to get on the bus, so he called the dialysis center to find out the best way to gear up for his ride.

Antonio Matthews took a picture of himself in the protective outfit — featuring multiple masks and gloves, as well as long sleeves and pants — he put on before he got on the bus to get his buprenorphine shot.

AM: When I get on the bus, I wear a long sleeve shirt. I put duct tape around the edges of the shirt where nothing can get up through there. I wear sweatpants and put the sweatpants in my socks to cover my legs up. I put my gloves on. I got like a little cap that I wear that I pull down over my head. And then I put my mask on and, I got a facial mask too that I wear when I go out. Like it practically covers the whole face. So that way if someone does cough, it won’t hit my face. Kinda like a spaceman. 

DG: Even all suited up, Antonio paced back and forth in his apartment, pepping himself up: “It’s gonna be alright. I’ll be OK.”

And then, Antonio got on the bus.

Antonio: I sat by the door and when people would come on the bus, I would just move out of the way. Give me six feet and see which way they went, and then I would just go back and stand by the door where there was nobody at. And I got my shot and came home.

DG: Antonio held his breath that day. Staring down his fears. Staring down his addiction. It hit him when he got home. 

AM: I walked back through the door and I said, “Son of a bitch, it didn’t get me!” I fucking made it. I fucking did it. I kissed the floor in my apartment. And I said, “I made it. It’s gonna be all right. I know I can do this now.” I was like, “I didn’t use. I friggin’ made it, man. I friggin made it.“

DG: Being courageous in the face of real danger feels good. But Antonio says one reason coming out on the other side is special is because it gives him the chance to live the life he’s been mapping out.  

AM: Nobody deserves to be on dope. That’s a horrible life to live. I want to help somebody to get off of drugs and off the streets. I want people’s last thought to be, “He made it and he gave back to people and he tried to help people after he made it.” I want people to know that I did something with my life. 

DG: Antonio is scheduled to get his next buprenorphine shot next week. He says he plans to take the bus to get it.

I’m Dan Gorenstein, and this is Tradeoffs.