Christmas Eve 2002
Assertive community treatment was an all consuming program.
When one participant stabilized and gained independence, another participant immediately rose up to fill the crisis void.
Janice stabilized and other participants demanded more time. It was good news. This was exactly how it was supposed to work.
We rarely had a crisis call on Janice.
She maintained her outpatient appointments. She followed her medication protocols. She was in recovery.
Life was better. Not great. But much better.
This made the call on Christmas Eve 2002 all the more surprising.
Hit By A Bus???
We had an incoming call on the crisis line from Janice’s “uncle” (neighbor) who reported she was at the apartment “bleeding everywhere”.
He said she had been “hit by a bus” and was refusing to go to the hospital. She would not let him call an ambulance.
He did not know what to do.
The city was a busy place. A pedestrian getting tagged by a bus was not common. However, it was also not unheard of.
We told the uncle we would be right over.
When we arrived, it was clear that Janice had indeed been hit by a bus.
The bus had clipped her as she crossed the street. She was bleeding quite a bit from a cut on her scalp.
She had some other obvious injuries. It was not a life-threatening situation but she clearly needed to go to the hospital.
Go To The Hospital
Why won’t you just go to the hospital? Very quickly, the discussion got heated.
As we encouraged Janice to go to the hospital for care she became more and more angry.
I hadn’t seen Janice act like this in quite some time.
She was aggressively defending her right to refuse help. She was especially upset when we suggested getting an ambulance on scene.
We could not let this go on for long. She needed to get medical treatment. Therefore, we called the ambulance despite her protests (which had become louder and more demonstrative).
The police and ambulance arrived.
Fortunately, this crew handled Janice with great care. Sometimes the police are all business and have little time for these type of “mental health games”.
In this case, they were very compassionate.
Been Down This Road Before
Janice, was able to quickly get her self under control when the police officer and ambulance crew entered the apartment.
The officer approached her and talked quietly about what had happened with the bus. The paramedics began to dress the wound on her scalp. The situation was brought under control.
I took a breath and thought “Thank God”.
But she still needed transport to the hospital.
Janice knew she would be taken by the police if she continued to refuse to go via ambulance. She had been down this road before.
Janice began to weep uncontrollably. She was begging to not be taken to the hospital. We were all taken aback.
We tried to comfort her. The officer was especially kind.
He asked her; “I don’t get it… Why won’t you just go to the hospital and get this taken care of?”
Everyone Has An “Origin Story”…
Janice then told us all the real reason she was against a trip to the hospital.
I had assumed it was the normal hospital aversion that so many of our participants had.
Most of the time a trip to the hospital equaled involuntary commitment.
Most of the time a trip to the hospital came at the end of a very nasty relapse.
Most of the time a trip to the hospital was perceived as some type of failure.
All of these were legitimate reasons, in my mind, to avoid the ambulance ride. However, they did not even approach Janice’s motivation for resisting the hospital.
It turns out that Janice hadn’t always been homeless. She hadn’t always been addicted to crack cocaine. It turns out that her schizophrenia diagnosis was late onset.
More To The Story
She began to tell us about her now grown daughter.
Janice had, in fact, been a good mom. Somewhere in the distant past she had cared for her children. A son and a daughter.
We all knew she had kids. It was mentioned in her records.
The kids had been taken away and become part of the child welfare system. There was little mention other than that.
But apparently, there was more to the story.
Before the wheels completely came off, Janice had struggled and fought for reunification.
There were periods of recovery. During these periods she would occasionally get time with her kids.
But then, when her daughter was around the age of 13, everything feel apart.
Gone Radio Silent
Janice de-compensated. She went on an extended tour of psychiatric hospitals, jails, rehabs and even the state hospital system.
Her kids grew up in the foster system. According to Janice, her daughter landed in a “good place” and did well. Her son, apparently, not so much.
Janice was unstable for the majority of the time as her kids grew up. However, she did try to connect during the brief periods of calm in the storm.
There was sporadic contact. Nothing sustained and then eventually it was radio silence. No contact.
Amazing! Truly Amazing!
However, during the past 2 years of stability Janice had reached out to her now grown daughter. Her daughter was living in another state but they were able to connect.
Although reluctant at first, Janice’s daughter became more and more open to contact. They talked on the phone semi-regularly.
Janice shared: “My daughter became a doctor! My daughter is smart and successful”!
Janice was the proudest person on the face of the earth.
She then gave us the bottom line.
Her daughter had agreed to come visit her for Christmas. She was supposed to arrive later that evening. If Janice was in the hospital when her daughter arrived she would miss her visit.
Worse yet, her daughter would think “here we go again”.
Wow… I think about this 17 years later and I am stunned by the story.
It All Worked Out
Of course, we were able to contact the daughter that day. We were able to make arrangements for her to visit Janice in the hospital.
We verified that Janice had not relapsed and we advocated for Janice and her daughter’s reunion.
In the end everything worked out…Had we known that Janice had this back story we would have taken care of things right up front…
Society’s Narrative
That is what is most troubling. Why did we assume that there was no family connection?
Why didn’t I probe deeper for information on her family?
I made a judgement without all the facts. I allowed myself to feed into the narrative. Society’s narrative.
Think about it. We do it everyday.
This is What We Do!
We tell ourselves stories about people even though we know nothing about them. We tell ourselves stories that fit into stereotypes.
Then we make up our mind about co-workers, people we see in the street, people we see on television without any background information.
We allow society to tell us who is good and who is bad. Who is worthy and who is worthless.
Homeless people have families that love them.
People who are “hopelessly” addicted and mentally ill have families and kids they love.
They were children once. They were parents once.
