Unexpected privilege

How quickly a day can change, how quickly a life can change.

I was heading to work yesterday, Saturday, preparing myself to begin an overwhelming six months of work, internship, and a law class. I had just gotten a wicked speeding ticket from an extremely nice state patrolman, and the morning wind was bitter.

As I got out of the car on the side of the agency, a man in a dark blue jacket and the blue pajamas of a doctor met me on the sidewalk. His phone was open and I could hear the on-hold music through the receiver.

"Excuse me, do you work here?" he asked and I nodded. "Please help me; I... I don't... I'm a doctor at Barnes Hospital and I was working last night. I got off at 4 am and was driving home, and I found a woman in the middle of 64 (the local highway). I've been trying to get in touch with someone who can help," he pointed helplessly at his unanswered phone, "and somebody told me to come here - that you're a homeless shelter?" My agency isn't a really a shelter, but that wasn't the point. Again I nodded, noting his uncertainty and following his lead. He said, "Come and see; she's still in my car."

By this point, we began walking around the building to his car. The wind was whipping around us furiously, and bitingly cold. He continued, "I'm not a social worker, and I don't know what to do. I picked her up and just drove around; she couldn't talk. I didn't know what to do, so I just drove. I went to Hardee's and spent a few hours drinking coffee while she slept." he said. "I'm going on no sleep, and I didn't know what else to do."

He was clearly anxious and it seemed like he had about reached his stress limit, so I tried to calm him. "We're not really a shelter, just have a few cots for women, but it was the right thing to bring her here. We can help." He pointed again to his phone. "I heard that she can't get into anywhere without a referral, I'm just..." he began, and I again reassured him, hoping to settle his nervousness.

We reached his car, and I looked fruitlessly through the window for another person. He opened his driver's side door, and I saw see a bundle of coats slumped against the passenger door. We both stood by his open door, and he leaned in to wake her. "Maria? Maria?" After several moments, she was roused, and he circled around to the passenger door to help her get out and told her that he had found a place where she could receive help. Very groggy, she got out of the car and stumbled while trying to pull her too-big jeans up. I asked her a few questions, but she had trouble answering them. I told her my name, and told her where she was. "Can we go somewhere out of the cold?" she asked, one of the first coherent things I'd heard her say. As I led them both into the building, I asked her some basic questions, trying to learn about her and also trying to ascertain if she was under the influence or ill. The doctor was following behind us, juggling a sandwich and coffee he had bought for her with his phone.

We entered the building and I took them upstairs to the day center. I showed Maria where she could sit, pointed out the coffee pot, and told her we would be serving breakfast soon. I went back into my office where the doctor was waiting on his phone, and when I entered he asked me, "Do I still need to be on here?" I told him she could call herself from my building, that she would be warm and safe all during the day. He hung up slowly; tears were brimming in his eyes. "Let's exchange contact information in case you need to get a hold of me," he said, "and let me have your card; maybe my wife can call you when she asks where I've been all night," he finished jokingly, yet mirthlessly. I took his name and number and gave him my card.

He turned away, and then quickly turned back to me. "Do you guys take donations?" he asked, catching me off guard. After I told him we did, he quickly pulled out his wallet and selected several bills and gave them to me. I didn't really know what to say to this, after all he had just done for a stranger. I just thanked him, knowing that was inadequate.

He didn't say anything, but just stood staring blankly for a few seconds before quickly leaving my office. He might have been having trouble leaving Maria, especially after having cared for her all night. I caught up with him at the security lock and buzzed him through. I led him down to the hall to the stairway, and when we reached the top of the stairs, he slowed to a stop and turned to me, staring over my shoulder. Tears were again forming in his eyes, and he opened his mouth as though to speak. After a few minutes of not finding the words, he gave up and began to go downstairs. After a few steps, he again stopped turned to me, and again, stared over my shoulder. "I don't do this kind of thing," he said softly, shaking his head. "I diagnose brain tumors in children, but I don't..." he trailed off. He went down a few more steps, and again stopped and turned to me. We stood silently for another minute, after which he quickly went the rest of the way downstairs and fled the building without another word.

After saying a few words of prayer of thanks for being able to witness such humble and selfless care of another human being, a stranger, I went back upstairs to check on Maria and help her get settled. She ate breakfast and slept until lunch when she awoke and was able to speak more clearly. I finally got a better idea about what she might need help with. She told me she didn't think she could eat for fear of vomiting, and she was feeling more and more agitated, a token of the DTs of alcohol withdrawal. She said she'd never been in treatment before, and she said no. "I've tried to quit," she said, "but by the time I get to this point, I get another drink." She quietly stared in the distance. "I don't know," she said, "maybe this is God's way of telling me I should quit now."

As the day went on, Maria became more and more lucid and sober, though her legs began to jerk uncontrollably, another symptom of DTs. We took her to the agency clothing room to get her a change of clothes, and also some toiletries and a shower, after which we talked more about what was going on with her. "I don't even know how that man found me," she said, having completely blacked out. I said, "Maria, it was 4 am, and you were walking in the middle of the highway." Her expression became one of frozen disbelief, and I continued. "He stayed up with you for the rest of the night until he found us and could get you help."

*****

This is the kind of event that has the potential to change a person's life. I don't yet know what change this will have on Maria's life, though I suspect that it will, at the very least, stay with her, as it will certainly stay with the doctor, and me as well. What an unexpected privilege to have witnessed it and been a part of it.

Mental Health Hero nomination

A department within this state (I forget which one) runs a little contest each year for the Mental Health Champion in which the case worker writes about a client with a mental illness, their recovery, and the ways in which they inspire other people. There is a recognition ceremony
in the capital for them, and a little prize as well. Most importantly, they get recognized for how special they are to have not given up, to have continued working. There is a woman I've written about before on this blog, Shalle, who I nominated this year. I haven't yet heard if she's won, but I wanted to share what the nomination essay.

Shalle is a mental health champion for both the recovery in her own life and the effect her spirit has on others. Even without bipolar disorder, the forces that threatened Shalle’s successful life chances were great. Raised by a single addicted mother, she began abusing crack herself when she was 13, and for almost 20 years, perpetuated the family pattern of drug abuse and prostitution. In 2008, this combination left her pregnant with her second daughter. She felt compelled, for the first time, to seek a new way of life, foreign to her, in which her coming child would be spared the drama and trauma of her own childhood. She had no example to follow, but began to take tentative first steps towards adulthood.

She again quit using drugs, for the final time, the most important time, and moved into a homeless shelter. She began to access and utilize services available to a pregnant woman and prepare for her coming daughter. She tenaciously adhered to the medication requirements through the uncomfortable give and take of different combinations, and she faithfully attended 12-step meetings. Most importantly, in the face of loneliness and rejection, she began to seek out a different social support system, one that did not glorify the street life.

Upon her daughter’s birth, some well-meaning family members, unaware of Shalle’s budding transformation, involved child protective services for fear of possible mistreatment. There was little chance of this, however, as her motivation to succeed was renewed every time she saw her baby. With the help of local agencies, she secured an apartment, took parenting classes and maintained the many DFS requirements necessary to keep her child. She did such a good job that, at the end of September, DFS decided that she no longer needed their supervision.

During this time, she began to work small jobs, particularly around the mental health center she attends daily. They gave her a small job of doing other clients’ laundry in exchange for a small stipend, a position reserved for someone mature and trustworthy. During this time, she has grown in self-confidence and self-respect, and she treats every person she helps with dignity and care. She continues to fearlessly face her own emotions, insecurities, fears, and ghosts of the past that continually threaten her sobriety. Finally, she is also reaching out to her elder daughter, who followed in her own footsteps of life on the street.

She faithfully and bravely works to reach her goals of sanity and self-discovery. Even in the face of disappointments, she perseveres. She is a model for others of a successful transition from a drug abusing mentally ill woman wrapped up in prostitution, to an independent sober parent. The changes that Shalle is continuing to make in her life and the way she bravely shares them with others makes her the local mental health champion. People look up to her as proof that the sober life can be achieved. She has done it with perseverance, humility, dignity and class.

I knew I wrote him!

Kent is a man who has been around my center for many many years. His attempts for sobriety have been sporadic, and even now, is not total, however, he has stopped smoking crack and, though still drinking, doing it less. A simple man, its sometimes difficult to talk to him, and I have frequently mistaken this as a reticence to talk to me, but over time, I think I understand him a little better, and our relationship has solidified into one of humor. He's quiet and self-conscious about his missing teeth, which prevents him from smiling broadly, so it usually takes him a little while before he feels comfortable saying something.
My agency organizes Christmas giveaway for our clients who usually fill out an anonymous form with shoe and clothing sizes for themselves and their children, as well as special toy requests. For our department's guys, since they don't have any place to store gifts, we ask for gift cards, and each counselor gives them to their clients. We also ask them to write a thank you note for the donor. I caught Kent on his way through my office to give him his. I said, "Santa came and left a gift for you." He said, "Did he? I knew I wrote him!"
This was such a quick response and one so witty that it still calls up a chuckle and was a good beginning to the holiday weekend.

Meeting Maurice

Maurice has come into our agency for several months, if not years. Homeless for many years and extremely delusional, he can be loud and frightening. As part of his protective street persona, he rarely smiles, is loud, and often talks to the voices he hears so it frequently doesn't make sense.

For a long time, we've just been working with him so that he'll become used to a routine, coming into our program every day, remaining calm, remaining around people all day, the fundamental kinds of social intercouse that can be extremely difficult for one so delusional and accustomed to censure. He became willing to complete an intake with us - something that had before now been too threatening. I was assigned as his direct worker - someone he would connect with on a regular basis, someone with whom he would, eventually, utilize a treatment plan.

The first morning he had his route sheet - the slip of paper someone needs to enter the program every morning - he was taken aback when we asked for it. He did not react abraisively, as I was afraid he would, but I could tell that he was starting to feel overwhelmed, which can easily elicit an expected response. Having a hunch that he perhaps didn't fully understand, I approached him later in the morning and asked if he had a minute to talk. "No," he said, his face expressionless. After a moment, the mask cracked as I saw the corners of his mouth turn up. "I've got years." he finished, streching out the vowel sound. It took m a second to piece together his joke, but he was smiling wider than I'd ever seen before. We sat down together, my mind racing with what I would say and also marveling at how proud he seemed of himself, what this might mean for him.

I took out a route sheet and explained it to him: the purpose of it and our expectations surrounding it. This hadn't before been explained to him, and I could tell he didn't understand at first, but he paid close attention to the things I was saying and eventually got it. On these sheets are spaces left for people to attend certain programs we offer, but I wasn't going to ask that of Maurice just yet. He pointed to the spaces anyway and asked if he needed to attent them. I told him that, eventually, I would ask it of him. For several minutes, he stared off straight ahead of him, he face arranged in a scowl I so often see on him. Suddenly he said, "Different music." At first, I was unsure whether he was talking to me or to something else only he heard. Then I realized that he was referring to the classical or ambient CDs that people play sometimes. By that point, he was smiling, and I realized that, while he was serious, he was also playing with me. I asked him what music he would pick, and again, he started in the distance. "Soul," he finally answered with a large smile. I laughed with him for a little bit, and then we went on with our mornings.

Insignificant, this interaction could be, perhaps for someone historically more functioning. For Maurice, however, this is evidence of playfulness and good humor that I've never seen before, that he may have never been able to reveal before. This interaction also revealed to me how little I know him, how little I know of him, but that's the fun part.

Beautiful hope

Last Thursday was a day that I was glad I keep this blog to remember happy and good things about the job. Because that evening, I was not feeling a bit of it, neither happy nor good. I had just returned from a trip to the police station with a client, Maria, who was raped several weeks ago. A report was filed that night, and a week later, as the rapist was lurking around her, she called them again, added to the report and a warrant was issued for his arrest. As it happens, this rapist was my client about a year ago, so I knew his name and information, but was kept by HIPPA laws from providing it to the authorities. Instead, I merely stood by her and prompted her to provide useful details she omitted.

Over the weekend, the guy was found and brought into the police station. When they tried to find Maria, however, they were unsuccessful, because she's homeless and wanders. Since they couldn't find her, they let him go. Last week, she and I went to the police station to learn what her options were, but we didn't hear any possibilities. In fact, it sounded like it was just dropped. Just closed. Like it was nothing, nothing at all.

I found myself doing what social workers shouldn't do - take something like this personally. I kept thinking, "This could be me. But for the grace of God, this could be me." It got to the point that I couldn't think about any way to help my client, because any time I thought about it, I felt helpless and weak, and I was so frustrated. I felt further disempowered because I couldn't help her in her case, even though I knew the information she needed.

The turning point came when I read responses to my frustrated post on Facebook. As a social worker, I have a number of social worker friends, and they are connected with resources that I can't think of in the moment. Furthermore, they could offer support, even over a digital medium, and their words were encouraging. The following morning, armed with resource names and contact information, I began making calls to sexual assault and legal advocates, and was immediately lifted up. They were extremely helpful and uber informative, and I was quickly armed with several options for empowering and assisting Maria.

But it didn't end there. Later that morning, I met with another woman I've been working with for about a year. She'd recently left a long-term relationship she was no longer happy with, but this day, she disclosed how controlling and abusive he's been to her, something she'd not before let on to me, I think out of embarassment. He's slapped her several times, and he threw a brick into her father's window, almost hitting her. As she was sharing this with me, I could see the shame that had been wrapping around her for so long, finally being a little bit released because she could share it with someone. Because of the the research I had done for Maria, I immediately provide her with phone numbers, talk to her about different options and -most importantly - reassure her that she was not to blame.

I almost have chills when I think about how all of this came together. As dreadful as these circumstance are, I can't help but, when I think about them, marvel how the seemingly unrelated events harmonized. Through the discouraging day of bottomless frustration, an evening of tears, then loving support and suggestions, a morning of furious searching and information-gathering, and then - right when it was needed - hope. Beautiful hope.

Peace be with you, S.

While I try, in this blog, to focus on the positive things that I see in my clients, I feel moved to share a somewhat negative thing that happened last week. One of our clients, S, killed himself. This was his third attempt. I don't know how; one of my co-workers found him when she went to take his medication to him.

While this, in itself, is tragic and devastating (there were many tears flowing around the office that day), out of respect for S, I would like to talk a little bit about him, remembering him.

S first came into my day program after months of outreach from the mobile team establishing a rapport with him on the street. He came to us extremely delusional with symptoms untreated before he came into my center. For the first several weeks, he wouldn't communicate with any people but the mobile outreach team. He actively conversed, however, with the voices in his head, in all volumes. He frightened a number of the clients, and even offended one or two of them when he imagine himself to be God, as he did pretty regularly. Most of the clients, however, could see that he was not well, and they treated him gently. It was really sweet to see them, as tough as they tried to pretend they were, treat someone who was hurting with a kind of quiet care and respect.

When S became extremely loud, one of the workers would go to him, point out his volume, and ask him to lower his voice. When I first began doing this, as soon as I approached him, he would avert his eyes. He would lower his voice, but only for a minute. The longer I knew him, however, the more comfortable he became, and he began to look me in the eye and smile. After a little longer, he began to hold small conversations with me.

He became of client of our Assertive Community Treatment team, which houses chronically homeless and severaly ill clients and then follows them every day or so, making sure they take their meds and go to the doctor. S had only been with them a few months, and then this happened. My agency has a number of burial plots for clients who do not have family so they can be buried with dignity, and S will receive one of those.

When I think about his passing, I'm a little sad, of course, because his was such a simple and sweet spirit. But it was also tortured, and I like to think of him now completely and finally at peace.

Reverend Bobo and Bubblegum

Today I saw one of the more colorful characters I’ve known from my day program. He’s working with our intensive community treatment team, which is the only way the wonder of his current stability is possible – he’s been housed through my agency for over a year. He takes medication regularly, he bathes regularly, and when one asks him a question, he answers in a way that makes sense. This is a far cry from the years he spent on the "hobo trail." He was rarely clean and a hopeless hoarder, saving papers and food, empty cups and trinkets in an old backpack. The only clothes he owned were those on his back - and he had several outfits on his back.

His very name is truly unique. I won't give the actual name here to protect his identity (in the small chance that you'd know him) but it's akin to Empee. As a testament to his then untreated mental illness, however, some days he wanted to be called Earl, and sometimes he wanted to be called Reverend Bobo. Unfortunately, one couldn't tell who he was on which day, and he got very angry when we called him incorrectly.

Not only did he adjust his own name, but also other people's names. He frequently called people Bubblegum, particularly when he was frustrated. "I put that there for a reason, bubblegum.." He had trouble with my name for awhile, and so he just called me Gracie. I don’t know how he got Gracie or why, but I was sad when he stopped. Whether this was due to his personality or mental illness, I don't know.

One thing that I do believe is a testament to his mental illness is that when one asked him a question about how he was or the status of his meetings, he would answer a different question. Very frequently, the answer was to remind us that Darth Vader was his father. Sometimes, though, the answer was an angry outburst, and no amount of soothing voices or corrected names could fix it - he was excused for the day.

The first time that he revealed to me how sweet and gentle person he is was when one of our staff members was leaving. This made him very nervous and anxious, but he really didn't have the words to communicate how he was feeling. Instead, like a frightened child staying near their parents, he hung close to different staff members throughout the day. My turn was during lunch. He hovered around me, almost wringing his hands, and frequently reminded me that she was leaving. Though he was sad, his reaction was touching. He was handling it the best way he knew how.

I remember the day that President Obama was inaugurated – my center has a big screen TV and we let people stay after lunch to watch it. The whole center was darkened, and all of the clients were arranged in a half circle around the TV to watch. Despite the unusually large number of people in the room, they were hushed to hear the television commentator announce the different parts of the ceremony. When they announced a performance by Yoyo Ma, Empee’s voice piped up from the quiet darkness to announce, “Yoyo Ma’s my cousin!”

While I miss Reverend Bobo and Bubblegum, it was nice to be able to hug him hello today and to really be with Empee.

Epilogue: When I was working on a project in my practicum, I was working with prominent members of the faith community, and did, in fact, meet a Reverend Bobo. I spoke with other people about Empee, and they suggested that he knew Reverend Bobo, who is extremely involved in his community. And all this time, I thought it was a delusion...