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Homeless, Shoeless, Even Nameless

When the police brought Jane to 3East, the soles of her feet were blistered.


Young and pretty beneath a layer of urban grime, she had been picked up for wandering barefoot around Portland, Ore., on a 90-degree August afternoon. She wouldn’t give her name and carried no identification, but went willingly with the young officer. By the time she came upstairs from the emergency room, she had acquired a pair of blue paper slippers, an involuntary psychiatric commitment (she was deemed a danger to herself) and a name: Jane Doe.

I greeted her at the locked doors that secured 3East. The chain of custody had passed from a thoughtful cop to a psychiatric nurse.

Everyone has a story, but my patients’ histories are often obscured by hallucinations and delusions. In time we can translate their encrypted chatter and make sense of their stories. Jane was my first Ms. Doe. Her story, like her name, was still a mystery.

I escorted her to the interview room and brought her a basin of warm water medicated with Epsom salts. She settled her feet in up to her ankles. I introduced myself and asked her name.

“Jane,” she said.

“Is that your real name?

“Yes, they gave it to me downstairs.”

I sat quietly while she smiled, nodded her head and moved her lips, apparently responding to internal voices. She didn’t seem distressed. I was accustomed to patients terrorized by the unpredictable commands and vicious criticism of auditory hallucinations. Jane reminded me of a child chatting with an imaginary playmate.

“Do you know where you are?” I interrupted.

“A psychiatric ward.”

“Do you have family? Someone who might be worried about you?

“No.”

“Has anyone hurt you?

She smiled. “No.”

I knew I had hit a wall. I took what medical history I could. She was healthy, sturdy even.

“I would like to go to my room now.”

She moved lightly on her damaged feet, like a sleepwalker gliding along the shabby hospital carpet. From our closet of donated clothes, she picked out a pair of pink chenille slippers. I worked two back-to-back 16-hour shifts each week. When I returned to the hospital five days after admitting Jane, she was striding purposefully down the long hallway to the community room, hub of the ward’s activities: group sessions, meals, visits, Ping-Pong and, occasionally, violent assaults.

Our job was to stabilize patients in the acute phase of their mental illness. Jane’s psychiatrist had settled on a diagnosis of schizoaffective disorder, a combined mood and thought disturbance. He started her on low doses of a mood stabilizer and an antipsychotic drug to quiet the internal voices.

When I reintroduced myself, she remembered me. Her hair was clean and neat, her shabby clothes replaced by donated jeans and a T-shirt. I asked about her week.

It had been a bad one, she said. “They’re leaving. My friends are leaving.”

She did not mean her friends on the ward. She meant the ones in her head.

“Jane, you have a chance at something new,” I said. I hoped it was the truth.

“Is it O.K. if I don’t like it?

“It’s O.K. You can try it for a while, before you decide.”

I had been complicit in taking something from her — her voices — and at this stage in her recovery I had little to offer in return. Jane was between two worlds. Without medication and an identity, she would soon slide back to homeless waif.

How we help the most vulnerable among us involves serendipity and the limited tools in our toolbox: conversation and medication, as much art as science. There are few, if any, “ta-da!” moments in psychiatry. Diagnoses are murky. The brain can be steadfast in guarding the secrets of its illnesses.

Timing is serendipity. Our intervention came early in Jane’s illness. She responded well to treatment; she was also nearing discharge with no place to go. She needed to be looked after, but no one had phoned to inquire about her. As so often happens, I didn’t have time to reach out to her once she had left 3East, but I thought about her often — a young woman so uncomfortable in her skin that she denied her name, a young woman running out of time.

The next time I saw her, she had a name and a family — a grandmother with whom she lived in eastern Oregon, who had prematurely grieved her granddaughter’s death until a neighbor knocked on her door holding an advertisement from the newspaper. She had a history. She had been an honors student in high school, then community college. She had plans. Then the voices began.

She quit school, was let go from a series of low-wage jobs because she talked to herself and made customers nervous. Friends fell away. She made it to Portland but left her name behind.

The door to 3East is a revolving one. Relapse is part of the struggle of mental illness. We see most of our patients more than once. Not Jane. She didn’t call or turn up in our emergency room. We hope for the best and brace ourselves for the worst.

Months later, her grandmother left a message that Jane was doing well and was back in school. Her story had some welcome new paragraphs now, if not yet a happy ending.

Evelyn Sharenov is a writer and psychiatric nurse in Portland, Ore.

Source: http://www.nytimes.com/2010/02/02/health/02case.html?ref=todayspaper

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