Wednesday, November 2, 2011

Communities need characters!

Neighborhoods and small towns all have their characters.  We often view them in a one dimensional way and assign our judgments to them.  In my neighborhood, growing up, it was “Moose”, a big guy in his mid-thirties with intellectual limitations, a Yankees cap and a beat up baseball glove. Our responsibility as a society is not only to ensure the safety of our characters, but to try to make them a part of our community. They are a part of, not apart from our world.

The Story

He came out of the post office with a handful of flyers, ads and junk mail. He’d probably been attractive as a young man but time, mental illness and psychiatric medications had taken a toll on him. He was at least forty, just under six feet tall and had long dirty blonde hair. He was clean shaven and you could tell his face wanted to be long and narrow, but ended up puffy and jowly from weight gain. He had on a Motley Crue t-shirt that barely covered his protruding belly. The spandex pants and lace up boots had never really been in style, and no one had worn anything like them for twenty years. I knew it would take him about ten minutes to walk home so I went to a convenience store for a cup of coffee and sat in my car listening to talk radio. The little town Jim lived in was a strange mix of run down Victorian homes, empty storefronts and a new “super” drugstore that sold everything.  This community had been Jim’s home his entire life and he’d become a local character. “The Rock Star” was what the locals called him.
I went to the door of his basement apartment and gave the secret knock:  Tap- tap,tap,tap, - tap,tap. I could hear him behind the door looking through the peephole. He cautiously opened it and I quickly entered. The smell of cigarettes was overpowering. The white walls and ceiling were a light tan from twelve years of exhaled nicotine. The long, narrow living room was built just below ground level with windows at shoulder height. When other residents of the building entered or left you could only see their legs and feet. However, most of the day, the curtains were drawn, as they were this day. The bare bulbs of the fixtures made it brighter than it was outdoors. The sparse furnishings consisted of two lounge chairs facing a small TV and a kitchen table. Dolly sat at the table, she wore a floral print dress that went just below her plastic knees. “It’s only Terry,” Jim said to her. Dolly’s surprised open mouth  expression never changed. Jim had purchased her at the dirty book store in Ithaca almost ten years earlier and she’d been his companion ever since. Jim softly smiled at her.
The radio was playing hits from the past. “Classic 99” the voice from the radio said and Jim echoed “Classic 99.” He sang along with his favorites as they came on.
“I saw you walking back from the post office. It’s great to see you getting out,” I said.
“I never get anything anymore, just junk mail. I keep writing and nobody sends me anything. I think the interweb makes it so people don’t write except with that e-mail stuff. The last thing I got was a picture of Bon Jovi and that was almost a year ago.”
He lit a cigarette and waved his arm towards a wall of photographs, each sent and signed by his favorites: Kiss, White Snake, Alice Cooper, Def Leppard and many more of the genre know as Glam or Hair Bands. “Classic 99,” the radio said “Classic 99,” Jim repeated, laughing.
“The zombies pooped on my front step again first thing this morning. I went up to the door and cursed them. It smelled real bad. But they cleaned it up by the time I went out. They’re going to get in trouble. They can’t do that can they, Terry?” He asked.
“I’m sorry your day started out so badly,” I said. “Maybe tomorrow will be better. Have you seen your folks?”
“My mom came over yesterday and brought me groceries. I got Fruit Loops. Me and Dolly love Fruit Loops. Mom took the garbage with her too. I told her about the zombies and also I’ve been having a problem with ghosts. They keep flying around when I’m watching TV. They don’t really bother me, but they get in the way of the TV and sometimes they get together and make this buzzing sound, like there’s bees in the room. If I yell they’ll usually stop.”
“That sounds terrible, but you usually can deal with bad stuff,” I said.
“Where’s your med box?” I asked. Jim went into the bedroom and came out with a plastic box that was divided into seven long slots for each day of the week and further divided into four for morning, mid-day, dinner and evening doses. A nurse came every Friday to fill his medication box and he also had a two day emergency supply in case of bad weather. “Things look good here,” I said, handing the box back. “Any problems with the medications?”
“Just a little dry mouth, nothing too bad,” he answered.
“Mr. Cooper upstairs keeps cursing me. Dolly heard it too. I’ve never done anything to him. I can hear him curse at me. But I haven’t been banging on the ceiling.”
I looked up, seeing the marks where Jim had banged the broom handle earlier in the month. Jim’s caseworker had spent time with both the neighbor and the landlord reassuring them that Jim was not a danger to them. “Remember what I said? If anyone is bothering you while you are in the apartment you can take another pill to make you relax. Make sure you let me or your mom know. And if anybody is bothering you in town remember what I told you?”
“Yep, I can go to my mom’s or I can go to the police station.” Jim had been bothered a number of times in the street by local teens. The police chief had gone to high school with Jim and felt very protective of his former football teammate. “Chief Billy always watches out for me.” “Classic 99”, the radio said. “Classic 99”, Jim repeated.
“When I was at the post office yesterday, I heard people say I had AIDS. The people in line and the people behind the counter all said I have AIDS. I don’t have AIDS, do I, Terry?”
“When you hear people stay stupid things what can you do, Jim?” I asked.
“Just ignore them. That’s the best way to do it, right Terry?”
“I’ve got to get going. It’s really good to see you, and Dolly too. Tell your mom hello when you see her.” I got up and Jim unlocked the door and I slipped out. Behind the door I could hear, “Classic 99”.

The Stories
The stories are my remembrances. Each of them is based on a true event in my work for Tompkins County Mental Health. I have changed the names and identifying information of every client, patient and co-worker except for Beau Saul, of the Ithaca Police Department, who I was fortunate enough to have as a partner. When confidentiality demanded it, I have changed details. The dialogue is my reconstruction of what was said at the time.   I have felt honored to be let into the lives of so many individuals over the years. Their stories are a gift I have been given.  Please enjoy them in the spirit with which they were written; to educate and inform.

Saturday, October 22, 2011

Difficult lives can create challenging problems.

There are some people who live such difficult lives it is hard for us to imagine.  Pain and suffering are joined with fear in ways that produce unusual patterns of behavior as a way of coping. We can pathologize those behaviors if we are willing to help. But we must be careful about judging them.

The Story

            Her face had been sliced and cut at least fifty times. She looked like she’d been in a horror movie. The razor blade was still in her hand. “Would you please put that down?” I asked. “What? What?” she whispered back at me. “The razor is in your hand. Could you please put it on the table behind you? Can I come in?” “Yeah, sure. Come in.” As she backed into the house, I picked up a book from the same table and placed it on top of the razor, hiding it. “What do you want?” she asked, irritated that I had entered her world. “I need to make a call, give me a minute.” I said as I dialed the house phone to central dispatch asking for an ambulance and a deputy. “Shit”, she said, “Not the cops, there’s really no need for the cops. I’m not going to do anything stupid.” I remembered some time earlier that year when she had threatened suicide and made the same promise. While she and I were walking to the car, she pulled a piece of broken glass from her pocket and slit her wrist. I wasn’t taking any chances this time.
            I went to the kitchen and got some paper towels. ”You’re bleeding!” Many of the cuts were superficial, but some looked deep. There was blood in her hair and down the front of her shirt, on her jeans and splattered throughout the house. Her hands looked like they were covered in rust. I doubted she had even looked at herself since she’d started cutting. When she cut, it was usually slow, a process that could take hours, something she could savor like a fine meal.
            “What are you doing here?” she asked. I replied, “Dave called me and told me that you’ve been having a rough time. When he left to go to work, you promised that you would answer the phone. But you didn’t. I see the answering machine has eight messages on it. Two are from me. I had to come out this way for a home visit and I thought I’d stop by.” “You have no right to be here,” she said. “When I knocked on the door, you opened it and invited me in,” I replied.
            She had bunched the paper towels into a ball. She sat and stared at them. “I need my glasses. They’re in the kitchen, can you get them?” I went to the kitchen and found the glasses on the table next to a box of Cheerios. The dishes were done, the counters were clean. I was sure that after Dave went to work she’d fed Maggie, then fixed her lunch and sent her off to school. I went back to the living room and gave LeeAnn her glasses. “What time is it?” she asked. “Almost two. What time does Maggie get home?” I asked. “The bus comes at two thirty.” she answered. “Is there anyone who can stay with her until Dave comes home?” I said. LeeAnn picked up the phone and called a neighbor who agreed to meet her daughter and have a play date with her own child until Dave got out of work. She then returned to her chair and the ball of paper towels returned to her hand.
            “Do we really have to do this? I’m okay, I really am?” she said, pleading with her eyes for me to just disappear. I was tempted to have her look in the mirror. But her appearance was so shocking, I was afraid of her emotional response. Her history of dissociation had begun in childhood with daily physical and sexual abuse. She’d described to me how horrible her life had been. I was aware of her extended family, with generations of sexual abusers and victims, men and women, taking on both roles. The families poverty had been spread out over two rural roads with broken down trailers and roughhewn cabins, most of which had no running water and were heated with wood or kerosene heaters. The children who lived there were dirty and strange, almost feral. They existed on canned goods from food pantries and school lunch programs. The adult men seemed always to be working on rusted out trucks in the yard, small groups of them under the hood or searching for tools. The women were inside watching talk shows on small old televisions.
            LeeAnn had escaped. She’d graduated from high school and worked at Cornell in food service. She’d gotten her rotten teeth fixed and been presentable enough to become a supervisor. She met Dave when he made a delivery of paper goods for the restaurant supply company he worked for. They only dated a short time before they were living together and got married after she became pregnant. Somehow she was able to keep her cutting a secret for most of their early years together. She explained her dissociation as being “spaced out”. As a young mother she was able to juggle job and home as well as anyone. When her younger sister died she went off the rails. Her sister had tried to follow in LeeAnn’s footsteps and might have succeeded if she hadn’t gotten involved with a man who was like all the men in her family. He threatened and bullied and abused. LeeAnn’s sister found the only way out; she took her life.
            The death brought back all the feelings of fear and helplessness and guilt. “I go away! I just go away.” was what LeeAnn had told me when I asked her about what she described as “missing time” each day. “You know when you’re driving on the interstate, and you realize you’ve passed three exits you didn’t notice. It’s like that.” LeeAnn’s therapist had been working hard, using a variety of therapeutic approaches to help LeeAnn. I supervised treatment and we agreed that LeeAnn needed to retain a high level of functioning to be able to stay in her marriage and raise her child. It was difficult to tell how successful we were.
            I could hear the diesel engine of the ambulance as it pulled in front of the house. I went to the door and opened it. “You don’t need the gurney. I’ll walk her out.” LeeAnn continued to stare at the balled up paper towels. “LeeAnn, they’re here. Will you walk out with me?” She stood up and stared at me and I followed her out the door.

The Stories
The stories are my remembrances. Each of them is based on a true event in my work for Tompkins County Mental Health. I have changed the names and identifying information of every client, patient and co-worker except for Beau Saul, of the Ithaca Police Department, who I was fortunate enough to have as a partner. When confidentiality demanded it, I have changed details. The dialogue is my reconstruction of what was said at the time.   I have felt honored to be let into the lives of so many individuals over the years. Their stories are a gift I have been given.  Please enjoy them in the spirit with which they were written; to educate and inform.

Sunday, October 16, 2011

When Truth Lies available as an eBook

When Truth Lies, the first real novel about schizophrenia, is available today as an ebook. Print copies will be available for purchase beginning October 24, 2011. To find out more, or read an excerpt, go to

Praise for When Truth Lies from Dr. E Fuller Torrey-
[Garahan] "writes clearly and well, and the subject is certainly appealing." -Dr. E Fuller Torrey, author of Surviving Schizophrenia and the Insanity Offense

Friday, October 14, 2011

Context can create understanding

            There are actions that people describe as “crazy” that really aren’t as crazy as they seem.  Rather than saying what someone is doing is crazy, I often start with, “I don’t understand what that person is doing or why they are doing it.”  The action, in and of itself, is most often neutral. When we call it crazy there is a judgment attached that may or may not be true.

The Story
The first calls started about eight thirty in the morning. The initial call was from a friend of a friend who was driving through a small town about seven miles from Ithaca. “There’s a guy walking down the road with a yak. He’s got it on a rope like a dog on a leash and he’s got a big dumb smile on his face. I thought you should know.” I often got calls like this; updates on unusual happenings where someone saw something and they just needed to call someone. The next call was from the lone officer on duty in the town. He was running radar on the edge of town when he noticed an unfamiliar sight in his rearview mirror. “This knucklehead is walking up behind me with the strangest animal I’ve ever seen. I got out of my car and waved him over to the sidewalk. It turns out that he was at the livestock auction at the other end of town and bought a cow or steer or something called a Scottish Highlander. Damn thing has horns that are about six feet wide, and hair like bigfoot. When I asked him what he was doing with it, he said he was going to go to Ithaca and set up a petting zoo. He didn’t have ID or anything except a receipt for the cow. I called the Sheriff’s department and they knew him. His name is Keith Taylor. He’s been picked up a few times, all petty stuff, mostly noise complaints, disturbing the peace and some weird motor vehicle charge. He seems pretty harmless. He was on his way out of town, so I told him to stay off the road and be careful. I was glad to see the back of him. Sheriff’s dispatch said that you had been called a couple of times on him. Good luck!”
A year earlier I’d been called to the Sheriff’s department to help them with a man they had in custody. He’d been pulled over for driving 45 miles an hour in a 20 mile an hour school zone. When the deputy approached his car, the man began with “Do you know who I am?” The deputy was expecting a tale of local fame or high level connections. Instead he got an incoherent monologue that he referred to as “arble-garble.” At the time there was a suspicion of substance abuse. The police report stated that, “Mr. Taylor declined to take a field sobriety test and became quite agitated. When I suggested that he come with me to the sheriff’s department, he began to kick my car and curse. I then took him into custody.”
The deputy was frustrated. He met me at the sheriff department’s front door saying, “The guy can’t calm down. Maybe you can do something. All he’s got is a traffic ticket. I could charge him with harassment, but that is a huge pain in the ass for me. See if you can calm him down and get him out of here. I go off shift in a while and I don’t want to leave him behind.”
Keith was being held in a small corner interview room with glass on two sides. There was a rectangular metal table attached to the floor with a pair of metal chairs facing each other on either side. Keith saw me coming and stood near the door. The deputy pointed at the chair, “Sit!” Keith sat. The deputy unlocked the door and let me in. “I’ll come get you when you’re done,” he said and left.
Keith was a tall, thin white man, with a narrow face and crooked teeth. Even though he was only in his mid-thirties, he had a haircut like a fifties rock and roller, swept back on the sides with a big curl on the top of his head that hung over his forehead almost to the bridge of his nose. He had on jeans and boots and a western shirt with decorated pockets. “I’m Terry Garahan from the county mental health department. The deputy said you were pretty upset and thought I might be able to help. What can I do for you?” Keith gripped the table top with both hands, gritting his teeth. “Now I’m crazy! I can see where this is going. I’m Keith Taylor. I’m the man who is going to decide whether you keep your job or you move on. Understand? I might not decide your fate, but your fate will be decided by me. There are things that I know and things that you know, but I don’t think we know the same things or things that are the same. Understand?” The monologue continued for about twenty minutes with my few interjections of: “That sounds pretty difficult” or “I’m sorry to hear that.” I occasionally nodded my head in response to, “Understand?” with recognition of the fact that in listening to him, there were many things I did understand. I tapped on the glass for the deputy, and said to Keith, “We need to figure a way to get you out of here.” “Good stuff!” he replied.
After an hour on the phone, I had a story and a resolution. Keith was a local guy who was born and raised on a nearby farm. He’d joined the army right out of high school and was given a medical discharge for bi-polar disorder during his first year of service. He’d stayed in Texas, where he’d been stationed, until recently when he decided to return home. His dad said the Veteran’s Administration had been slow to transfer his case and he’d stopped his medications. Within half an hour his dad showed up and the deputy was happy for Keith to leave with him.
During the following months I got several calls about Keith from his dad. He either refused to take his medication or he took it and spit it out or took it and threw it up. Keith’s mom and dad had a small dairy farm a few miles from town and had their hands full. Keith was their only son and while they wanted to help him, they hadn’t really spent much time with him as a mentally ill adult. He’d been in Texas for fourteen years.
One early spring morning I drove out to the farm after an exasperated call from Mr. Taylor. I found Keith in a shop under the hood of an old, beat up Porsche with Texas plates. There was the number 11 formed by two long strips of duct tape on each of the doors of the car. The car was as loud as a jet plane with him revving it by pulling on the throttle. He looked over his shoulder at me. “This car, after I finish, will be the fastest car in the world.” “Your dad is worried about you!” I shouted. He replied, “The 11 is for the number of letters in my name.” He reached in and turned off the ignition, then leaned against the car, looking at me, saying, “A lot of people don’t believe in numerology. But if you think about it, it really makes sense.” I asked him, “Your dad doesn’t think you’re taking your meds. Are you?” He replied, “There is a lot of misinformation going around. Excuse me.” With that he got in his car and drove away.
About midnight that night, I got a call from the state police. Keith Taylor had been arrested and taken to the county jail. A trooper had been having a coffee break in a diner just outside the city limits when he heard the sound of a very loud car. He turned on his stool in time to see a flash of metal go by at high speed. He raced to his car and got on the radio looking for other available troopers or deputies in the area. Another trooper pulled over “number 11” about ten miles away after clocking it at one hundred and three miles an hour. “What is your problem?” Keith had asked the trooper when he tossed his license and registration at his feet.  Unfortunately, the problem was Keith’s; losing his license, car and spending nearly a week in jail.
Now, months later, I was preparing to see what new plan Keith had concocted.  I stopped to see one of the psychiatrists I consulted with. “Petting zoo! Really! He wants to open a petting zoo? Danger to self or others might be able to be met with the cow,” he said, “but I doubt it. Maybe you could trade the cow for three magic beans.”
I saw Keith about five miles outside of town. He was sitting in the grass on the side of the road. The cow was tied to a mailbox, grazing on the thick grass surrounding the wooden post. It was a beautiful animal, a movie star of cows. I drove past and turned the car around in order to be on the same side of the street. “Keith, how are you doing? What’s going on?” I asked. Keith lay back on the grass and closed his eyes. “The world is in turmoil. All I want to do is bring a little joy into the world. I grew up with cows. Kids should be able to see cows. But I’m so tired.” I stood over him blocking the sun. “Keith, you don’t look well. You are really pale and you’re sweating. Are you faint?” “I don’t feel so good,” he responded. “I think you need a doctor to take a look at you. I’m going to call someone to come get you.” The ambulance and the deputy showed up together. The emergency medical technician, after looking at Keith, conducted a simple test, pulling on the skin on his wrist. “He’s really dehydrated. No wonder he feels so lousy.”
The Scottish Highlander was tied to the rear bumper of my car when the deputy pulled away. “I’m glad I’m not you,” he called out the window. It was almost six in the evening when the livestock truck came to get the cow. They came shortly after I received a call that Keith had voluntarily admitted himself to the mental health unit at the hospital.
The Stories
The stories are my remembrances. Each of them is based on a true event in my work for Tompkins County Mental Health. I have changed the names and identifying information of every client, patient and co-worker except for Beau Saul, of the Ithaca Police Department, who I was fortunate enough to have as a partner. When confidentiality demanded it, I have changed details. The dialogue is my reconstruction of what was said at the time. I have felt honored to be let into the lives of so many individuals over the years. Their stories are a gift I have been given.  Please enjoy them in the spirit with which they were written; to educate and inform.

Thursday, October 6, 2011

Dementia, when ignored, may have deadly consequences.

Mental illness and mental health are part of our overall health concerns throughout our lives.  As our society becomes more fragmented, we must remain aware of those who have few relatives or friends. It is estimated that in the United States there are over five million people with Alzheimer’s and many more who have other forms of dementia. How we help them says a lot about our society.

The Story
                Muriel Davis was 78 years old when her husband Ray died. They had been married 60 years. Ray had spent his entire work life at a company that made timing chains for car engines. His cancer had been a long drawn out affair that caused heartache and cost a good deal of their savings. Muriel acknowledged the pain of her husband’s death by being constantly reminded of their only son’s death in an automobile accident many years earlier. 
                Muriel didn’t experience loneliness in any specific way. She and Ray had lived a fairly quiet life.  She’d spent nearly twenty years serving food at the hospital cafeteria. Her work friends had never been to her home and when they gave her a retirement party at a local restaurant, it had been Ray’s first time meeting them. When Muriel and Ray were in their forties, after Ray Jr.’s death, they’d attended church and joined a bowling league. The demands of both proved too much. One winter they “forgot” to join the league and also avoided the phone calls of a pushy pastor. When retirement came at age 65 they focused on their home. Ray built a garage and made small repairs. Muriel worked in her garden and made preserves. Winter months were spent in front of the TV.
                The house was a small white farm house a few miles outside of the city of Ithaca. When it was built in the 1850’s, it sat in a grove of trees 100 feet from a dirt track where people walked, rode horses  or drove wagons, beginning their decent into the valley where Ithaca and Cayuga lake lay. When I first visited, it was seven years after Ray’s death. The house was thirty feet from a busy highway where cars and trucks roared by at sixty miles an hour. Sumac and other scrub trees hid most of the front of the house, while a partially dead maple tree threatened the detached garage. I climbed the uneven front steps to a six by eight foot enclosed porch. Battleship grey paint chipped and peeled under my feet. Ripped plastic, an earlier attempt at winterization, snapped in the fall breeze all around me.
                I rapped with my knuckles on the door. “Mrs. Davis, Mrs. Davis? It’s Terry Garahan. I’m from the county and I need to talk to you.”  My voice was raised to overcome the sound of traffic and what I assumed was a TV blaring in the living room. No response. “Mrs. Davis, Mrs. Davis. Can you come to the door please; I need to talk to you.” My voice was just short of a yell.  I could hear movement in the room behind the door. “I’m sleeping. What do you want?”  A scratchy older woman’s voice said.  “Mam, I need to speak to you, can you come to the door please?”  “Hold on, hold on, I’m going to be a minute. “ Moments later the door opened to reveal a short broad woman with thinning white hair. She had on a faded, flowered housedress, orthopedic stockings and bedroom slippers. I tried to peer around her, but her body blocked most of my view.
                “What do you want?” she said cautiously. “I’m from the county and I need to talk to you, do you mind if I come in, it’s awfully noisy out here,” I said referring to the trucks passing by. “I don’t know. This isn’t really a good time,” she replied. “It’s really important that I talk to you today,” I continued. “Oh all right,” she said, pulling the door open. “Come on in, but be careful, I haven’t had time to clean.” I held the door and watched her wade through knee-high trash to a fake leather recliner.  She turned and sat, pushing back hard to elevate her swollen legs. Oprah spoke loudly from the television three feet in front of her. The door slammed behind me and I found myself in a swamp of Styrofoam containers, paper cups, plastic lids, brown paper bags and bits of food.  I took a step and noticed movement along the floor under the mess. Things scurried for a moment and then stopped. I took another step and it happened again. “I suspect you’re here about the plumbing. I knew somebody would finally show up. The bathroom is there,” she said, pointing to a partially opened door where the tide of trash seemed to dissipate.  I steeled myself for my brief passage across the room. Ripples of movement preceded me as I carefully raised my feet above the rubbish seeking a safe place to step. As I got to the bathroom door I turned and took in the scene.
Standing on the edge of this sea of trash I was able to confirm the call I’d gotten earlier in the week. A young Hispanic man had called to tell me about an older woman he was worried about.  He was the delivery man for a pizza and sub shop downtown. He’d worked there for about a year and delivered to Mrs. Davis four or five times a week. She’d also made a separate arrangement for him to pick up wine for her at the liquor store once or twice a week. “I’m worried about her. She seems to be really losing it and her house looks like a horror movie.  I tried talking to social services and they told me to call you. They think she might be crazy.”
The assault on my senses reached a peak with the smell of the bathroom. Feces and urine filled the toilet to the brim. The seat was smudged and cracked. The sink was a brown stain of iron from the well water. The bathtub was filled with dirt and dust. I tried the sink faucet. Nothing came out. “Mrs. Davis, there’s no water in here.  Do you know why?” “The well pump broke a while ago. Aren’t you here to fix it?” she responded. “Do you mind if I look in the kitchen. I want to check the sink in there.  Is that all right,” I asked. “Sure, help yourself,” she replied.
The counters and sink in the kitchen were filled with dirty dishes, pots and pans.  Empty wine bottles littered the floor and pantry. Near the back door was a five gallon paint bucket with a toilet seat on top.  It was nearly full. I peeked out the back door and determined that Mrs. Davis had dumped many other bucketsful onto the back steps. 
I went back to the living room to see what else I could learn. I waded through the mess trying to ignore the critters under foot. “Could you turn off the TV for a minute? There seems to be a real problem with the plumbing,” I said.  “Ray’s going to fix it when he gets home.” Mrs. Davis answered, clicking off the TV with a remote. Up close, I noticed the sores on her legs and the immense swelling around the ankles.  There was also a rash on her arms and what looked like blisters on her chin that appeared to be filled with pus. “Mam, you have some sores there”, I said pointing at her arm.  “Do you have a doctor? Has anybody taken a look at those?” “I see Dr. Spanger. She’s always treated me real good.” She replied.  “Mrs. Davis, I know you live alone here, but does anyone come in to help?”  “Her watery blue eyes stared at me. “Why in god’s good name would I need help?  I’ve lived in this house almost seventy years and I think I’ve done all right by myself. I forget, why are you here?  The cable’s fixed, see?”  She clicked on the TV just in time to see Oprah giving things away. “Mrs. Davis, I’m going to leave now.  I’ll be back in a little while. Are you going to be OK?” “Could you get me some of that Lambrusco wine when you come back?” she asked.
I went back to my office and called Dr. Spanger.  She said her office had been trying to get Mrs. Davis in for at least six months. She’d even arranged transportation.  When the appointment time came Mrs. Davis hadn’t answered the door. When I explained things, the doctor let out a sigh. “I knew she was demented, but I hadn’t thought it was that bad.” I signed the paperwork and arranged for the Deputy Sheriff and ambulance to meet me at a gas station nearby and informed them of our goal.  “She’s a nice old lady, but spirited. The best thing we could do is walk her out. Believe me; you don’t want to drag your gurney through that mess.”
The EMT’s and the deputy waited on the lawn.  I went up on the porch by myself and banged on the door a couple of times. The TV was still blasting. “Mrs. Davis, it’s me, Terry Garahan. I was here a few hours ago.” I pushed open the door and started to enter.  Mrs. Davis was leaning back in her recliner. In her right hand was a pistol. “What do you want? Get the hell out of my house.  I don’t want to have to shoot you!”
I pulled my head back behind the door. “Mrs. Davis. I’m from the county. I was looking at the plumbing. Remember? Could you put the gun down please?"  Behind me, the Deputy unholstered his weapon. Mrs. Davis waved the gun around for a minute and then set it on a table next to her. “Judge Judy’s on.  I like her!” she said to the TV. Moments later the small room was filled with the Deputy and two Emergency Medical Technicians.
When I visited her at the nursing home the next week she sat on a soft sofa next to another old woman watching an episode of Judge Judy.
The Stories
The stories are my remembrances. Each of them is based on a true event in my work for Tompkins County Mental Health. I have changed the names and identifying information of every client, patient and co-worker except for Beau Saul, of the Ithaca Police Department, who I was fortunate enough to have as a partner. When confidentiality demanded it, I have changed details. The dialogue is my reconstruction of what was said at the time.   I have felt honored to be let into the lives of so many individuals over the years. Their stories are a gift I have been given.  Please enjoy them in the spirit with which they were written; to educate and inform.

Friday, September 30, 2011

Mental patients are more often prey then predator.

                The popular media version of the mental patient is the crazed killer who is a danger to the community. In my experience, it is more likely that people with serious psychiatric illness are preyed upon by bad people. Living in poverty in unsafe housing and marginal neighborhoods, the few belongings they have are always at risk. Many times, when people are hospitalized, their belongings are lost and stolen and when they are released they have to start from scratch. The risk of physical harm is also great. Those with psychiatric illness are not viewed as reliable reporters of crime. They can be victimized not only by the people who prey upon them, but by law enforcement and a criminal justice system that has difficulty understanding their needs.

The Story

Gil was the sort of guy that when you met him, you couldn’t help smiling. This happened as a reflection of his smile, almost a permanent fixture on his face. It was genuine and welcoming and slightly amused as if he had a private joke he was about to share with only you. The tobacco stains on his teeth and mustache didn’t deter you from smiling back. Nor did his torn jeans and flannel shirt. Part of the joy that Gil relished was his secret knowledge that he was of royal blood. This idea had come to him when he was a second year student at Cornell. Having spent a good part of the year as a history major studying European history, he’d realized that the reach of the Hapsburgs went far and wide. They had many offspring and branches that entered every royal house in Europe. During winter break, visiting his parents in Delaware, he’d quizzed them extensively on their lineage. His father’s father had come from Germany as a child in the late 1890’s. A family story was told about his great grandfather working in the Kaiser’s kitchen. In the following spring semester Gil proclaimed during a seminar that he was of royal blood, most likely a prince. The professor ignored him until he became very insistent and disruptive. Gil’s roommate could only ignore him until a chair on a platform, decorated in red velvet, appeared in room they shared. Gil sat upon it dressed in a gold bathrobe with a crown made from wire coat hangers. The other students on the floor were more frightened than amused and when campus security came, Gil meekly agreed to go to the hospital. Gil’s dad, who had an uncle and several cousins with schizophrenia, wasn’t surprised by the call, just saddened that his only son had joined what he’d viewed as a family curse.
At the time, in the middle 1970’s, claims of royal blood combined with upsetting behavior could land you in the state hospital. Gil was a model patient, cooperating with all treatments, helping other patients and participating in groups and vocational programs. Unfortunately, he never gained “insight” into his illness and it took him several years to understand that there are some things that you just need to keep to yourself.
When Gil got out of the hospital, he found living in Ithaca more pleasing than his parent’s home in rural Delaware and stayed on. During his decades here, he thought of himself as an “alternative” sort of guy and Ithaca suited him fine. Much of the time he spent here was on our downtown pedestrian mall or “commons” as we call it. Summer or winter, he’d hang out with friends, sometimes playing his guitar or joining in a chess match. His apartment was nearby and well maintained, primarily through his caseworker, Helen.
Helen was very upset when she came into my office on a Monday morning. She plopped down in a chair and said, “The McCabe brothers have moved in on Gil.” Unfortunately, I knew exactly what that meant. The McCabe brothers were a real problem. Their primary occupation was to prey on the elderly and the disabled. The local cops had trouble deciding who was a bigger troublemaker, Danny or Davey. Danny was an alcoholic and substance abuser who would drink, smoke, snort or shoot anything he could get his hands on. He was a liar and a thief and worst of all, he was a bully. He always found someone weak and frightened to threaten and intimidate. At age 42, he was a little less than six feet tall with thin blond hair, cracked, broken and missing teeth, and a pitted lined face. His arms and legs were filled with bad ink from jail. He had a mean streak that could lead him to hitting and hurting anyone who didn’t give him what he wanted.
Davey was a runt. At a little over five feet tall, he was prone to wearing cowboy boots with lifts in them, except when he was working and then he wore Converse All Star sneakers. His work was stealing, and he maintained a specialty. He stole women’s purses off the backs of chairs and floors in bars and restaurants. He was good at it. I once went into a college bar at about 11:00pm and at least a dozen women were lined up to give statements to the uniformed cop. The purses were discovered the next day floating in a creek two blocks away. Money, credit cards and all other valuables had been removed.
Bar owners and bouncers knew Davey and what he did. But he somehow managed to get past them and ply his craft. Occasionally, he was caught, but the charges never gave him more than a month in the county lockup.
When I got to the apartment, Gil answered the door. “It’s not a good time.” He half whispered. “I need to talk to you,” I replied as I entered the room. Davey was lying on the couch smoking a cigarette. Danny was asleep in Gil’s bed. A pillow and blanket were on the floor where Gil had spent the night. I banged on the bedroom door. “Danny! Danny! Hey! Rise and shine. I have to talk to you.“ I heard him curse under his breath as he pulled on his jeans and got out of bed. “What’s the problem?” “Look Danny, you know the deal. Gil has an agreement with us and the landlord that he won’t have overnight guests. If you guys crash here, he’s going to get evicted.” “He asked us to stay,” Davey said from behind me. “Yeah, I know. Gil is a really good guy. He’s always ready to help somebody out,” I said.
Fifteen minutes later the McCabe’s were gone. “Terry, I’m sorry that I got Helen so upset. I was out on the street last night and those guys didn’t have a place to stay and we got a twelve pack and I told them they could crash here.” He was smiling that winning smile. “You know those guys,” I said. “They act like your friends, but they just use people. Did you give them money?“ “Just twenty bucks. But Danny said it was a loan, he’d pay me back.” “How long have they really been here?” I asked. “About a week,” he replied.
I received a call from Helen just before the work day ended. Gil had shown up at her office in tears. He reported that a watch his grandfather had given him and a coin collection (that was hidden in his closet) were gone.
The next day I was joined by a police officer and we found the McCabes hanging out in front of the Department of Social Services. “Look guys, there’s some stuff missing from Gil’s apartment. We’re not saying you took it but you may know where it is. It might be best if it was returned,” I said. Davey replied, “Hey, there were a lot of people in and out of that place. Anybody could have taken that stuff.” “It would be really good if Gil got his grandfather’s watch back,” I strongly suggested.
The next day Helen called to tell me Gil had found his watch. “He said he misplaced it,” she said.
Over the next several months Helen called multiple times to tell me about the McCabes and Gil. She took over managing Gil’s finances and transferred the lease from his name to his elderly parents. She got their power of attorney, in an attempt to control the apartment. She and I tracked down the McCabes one Friday afternoon and Helen gave them a written notice stating that they were not allowed in Gil’s apartment under any circumstances. The next Monday Gil showed up at Helen’s office with stomach pains. When Helen pursued the cause of his distress he lifted his shirt to show multiple bruises all around his mid-section. She called me, and an officer and I met with Gil to get his story. The McCabes had shown up late Friday night and gave Gil a beating. They stayed at his apartment all week-end, having a party that got so big that the police had been called with a noise complaint.
Gil went to the police station and wrote out a statement to file charges against the McCabes. We met with an Assistant District Attorney and reviewed the charges. Trespassing was an easy one because of the documentation, including the police report from the noise complaint. Aggravated harassment was as high as they could be charged for the beating. “It’s a ‘his word against theirs’ kind of thing,” the ADA advised us. Beat cops brought the McCabes in later that day and they were both taken to the county jail, neither having bail money.
Helen called me to her office later that week. “Gil’s staying at the shelter in Rochester and they’re going to get him an apartment up there. He says that the McCabes will kill him when they get out.”
A year later, Danny’s body was found in an abandoned house.  He'd died of natural causes but nobody missed him for a week. Last month I saw Davey in a bar I frequent. When he saw me staring at him he made a quick exit. I never saw Gil again.
The Stories
The stories are my remembrances. Each of them is based on a true event in my work for Tompkins County Mental Health. I have changed the names and identifying information of every client, patient and co-worker except for Beau Saul, of the Ithaca Police Department, who I was fortunate enough to have as a partner. When confidentiality demanded it, I have changed details. The dialogue is my reconstruction of what was said at the time.   I have felt honored to be let into the lives of so many individuals over the years. Their stories are a gift I have been given.  Please enjoy them in the spirit with which they were written; to educate and inform.

Wednesday, September 21, 2011

We all seek community, some more successfully than others.

        Many people with serious psychiatric illness live in isolation.  Their behaviors can drive away family and friends. When they are symptomatic, many of their actions are misunderstood. Because of the perception of the mentally ill as dangerous, the way they conduct themselves may be viewed as threatening or menacing.  Landlords, neighbors and acquaintances fear that interactions may bring on negative consequences. When they are stable, the person with mental illness may have little understanding as to why they are shunned by those around them. In seeking companionship, they may compound the fear their behavior has created.  Most of us want to be part of a community, either the geographic community we reside in or the community of interest that makes our lives fuller. My experience suggests that even those with the most serious illness are well intentioned in their hope to make their lives better.

The Story

                     I stood behind a column, peeking around it at the café that occupied the public space between stores.  A short woman with dark hair in her late forties was moving from table to table, a coffee pot in her right hand and a large pad of paper in her left hand.  She reached over and around patrons, pouring coffee in cups, bowls and glasses.  Behind her an elderly woman began to rise from her chair, pushing herself away from her finished meal.  “Sit down! You sit down!” the younger woman screamed as she turned, facing the tables behind her.  “Don’t get up until I tell you to get up.  Do you understand me?”  The elderly woman regained her seat, clutching her purse in her lap. It was late morning.  The café’s twenty tables were only half full.  The rest were set for lunch. I could see two cooks and two waitresses crowded together in the small kitchen.  They had closed the kitchen door and were staring at me from behind the pass through, one cook clutching a large knife. 
Directly across from me and down the hallway, a police officer gave me a thumbs up.  I held my hand up motioning him to wait and walked slowly toward the woman with the coffee pot.  She put it down as I approached and turned to fully face me.  “Rosa,” I said. “What’s going on?”  “So they called you?  Why is it that every time I get things straight in my head, every time I get my life together you show up?”  She was an unattractive woman with a big nose, bulging eyes peering through large black framed glasses and hair that had not seen a comb in months. She had on a flowered knee length skirt with a dungaree shirt jammed into it. Over this she had a bright vest that someone had bought at a tourist shop in Central America.  A backpack rested on her back, a paisley bag on her left shoulder, a waist pack cinched around her stout middle.  A pair of torn black hightop sneakers without socks completed her outfit.  “Why don’t you go away?  Why don’t you just mind your own damn business and get the hell out of here?” she screamed.  “Somebody called me.  They were worried about you.  When they call I have to come, you know that.  Why don’t we go someplace else to talk?  Everybody doesn’t need to know your business.”  I could sense movement behind me as people began to leave their tables.  “I hope you’re happy?”  Rosa said as she leaned on the table closest to her, palms down, her notebook under her arm.
I looked over my shoulder to find the police officer escorting people down the hall.  When I turned back, a mass of cheese, avocado and sprouts on toast exploded in my face, the small fat hand rubbing it into my nose and eyes.  Moments later, Rosa was on the ground screaming at the cop wrestling her one cuffed hand behind her to join under the backpack with the other hand waving in front of his face.
I’d known Rosa for many years.  I’d first met her in the 1970’s, when I coordinated programs for mental health patients being discharged from Willard Psychiatric Center during the late stages of deinstitutionalization.  Rosa was a revolving door patient who would become briefly stable and discharged and never keep appointments or follow up with treatment.  As she got older, she cooperated with treatment more often, but still had periods of bothersome bi-polar symptoms.  Several months earlier Rosa had visited the psychiatrist in our office stating that she no longer needed medication.  ‘I’ve been doing some research”, she had told the doctor, “And I believe that I have aged out of my illness.”  She then presented copies of journal articles to support her proposition.  She had a master’s degree in city planning and was able to use her academic background to articulate her case.  What she presented was her decision.  It was not open to discussion.  When the doctor had me join them, she said, “He may be in charge here, but he is not the boss of me.”
The calls started to come in shortly thereafter: her grown daughter pleading “Isn’t there anything you can do?  Can I sign a paper?  Do we have to go through this all again?  We know what’s going to happen.  I’m the one who has to clean up her mess.”  Her ex-husband stating, “If she shows up again I’m going to press charges.  I don’t care how crazy she is, she can’t just show up at my house threatening my new wife.  If she goes to jail, so be it.”
Rosa owned a beautiful home in a neighborhood of small ranch houses on a hill overlooking the city.  I’d been there in the previous year to drop off a prescription that the doctor had forgotten to give her.  The small inheritance she’d used to buy the house had also been spent on some nice antiques that she had restored.  At the time she’d asked me in to take a tour and be dazzled by the views of Cornell and the valley below.  “What do you think?” she’d asked, smiling.  “I’m jealous,” I replied.  Having seen Rosa years earlier stripped to her bra and panties on a foam pad in the isolation room at Willard, screaming and banging on a concrete wall, I was pleased to see the life she made for herself.
I visited again, after the calls began.  When she opened the door, it appeared that a giant had picked up the house and shaken it like a snow globe.  The rug was bunched up, the furniture overturned.  Books pulled from bookcases, dishes dirty everywhere.  “It took me a while, but I found it.”  In her hand was a binder containing her master’s thesis.  “Look at this,” she said guiding me to the kitchen table where a large piece of poster paper was unrolled.  Books were piled on one corner; duct tape held the other three.  A slide rule, protractor and plastic ruler, educational instruments long abandoned by academics, were at the bottom of the drawing. Her work showed a crude illustration of the valley as seen from her window.  Near the top were wavy lines indicating the multiple rivers, streams and creeks flowing down the hills and into the lake.  Each of them was well marked.  At right angles to these lines were broad strokes made by magic markers that seemed to enter buildings erected on the top of the hill.  “Well!  What do you think?” she asked.  “I don’t know what I’m looking at,” I replied.  “Are you stupid?  It’s the valley.  See these?” she said indicating the wavy lines. “This is all water and water is power.  You move the water from the streams and rivers, through the pipes and into the generator buildings.  The wheels spin and the water falls downhill into the lake.  The people who first lived here understood that.  That is why they settled here.  For the last 100 years we’ve ignored it.  I’m the only one who understands it.”  She walked over to the picture window.  “Look at that!  Ithaca doesn’t need to have one once of electricity come from the outside.  I’ve solved it.  That smelly coal plant up the lake can be torn down.  It’s time for old to be new again.” She began to sing and dance. “It’s time for old to be new again; it’s time for old to be new again.”
“Rosa?  Rosa, I need to talk to you.  Your daughter called and…?”  “Get out!” she yelled, not touching me, but moving me toward the door. “That little bitch is an ingrate.  Her father raised her to hate me.  He has always been jealous of my success and he can’t wait to see me fail.  When people see what I’ve accomplished, what I’ve given back to this community, then he’ll have to apologize. Now get out and don’t come back and don’t tell anyone about my plan.  I want to have an unveiling at City Hall when it’s all complete.  If you tell anyone, anyone at all, I’ll sue you.  Don’t think I won’t.  The house shook when the door slammed.
Two days later I was at the city engineer’s office, a police officer at my side.  “I’m going, I’m going.” Rosa said, gathering her things. “But you haven’t heard the last of me.”  That afternoon, her ancient Volvo wagon was spotted parked sideways at the food co-op.  Later, when I’d responded to the convenience store at the edge of town, the woman behind the counter said, “I don’t know what her problem is, but she better not bring it in here again.”  Eventually I got a call from the woman who owned the café.  She’d called just before Rosa had taken over her restaurant. “I don’t want her to get in trouble,” she’d said.
I sat across from Rosa at her hospital discharge meeting nearly a month later. “Sorry”, she said. “I know you’re trying to help.  But sometimes you’re really a pain in the ass.”
The Stories
The stories are my remembrances. Each of them is based on a true event in my work for Tompkins County Mental Health. I have changed the names and identifying information of every client, patient and co-worker except for Beau Saul, of the Ithaca Police Department, who I was fortunate enough to have as a partner. When confidentiality demanded it, I have changed details. The dialogue is my reconstruction of what was said at the time.   I have felt honored to be let into the lives of so many individuals over the years. Their stories are a gift I have been given.  Please enjoy them in the spirit with which they were written; to educate and inform.

Wednesday, September 7, 2011

Fifty years from now, we will look back in shame! How could we let the mentally ill be treated like this?

                History will judge our actions harshly.  We closed the hospitals and placed the impossibly high burden of “danger to self or others” as our treatment criteria.  Meanwhile millions who are seriously ill either live on the streets or are incarcerated.  It is estimated that there are as many mentally ill in jails and prisons now as there were in hospitals at the beginning of deinstitutionalization; almost 500,000.  We have protected their rights:  the right to be ill without treatment, the right to live in poverty or in a cage.  We have returned to a time before the asylum movement where the serious mentally ill were left to fend for themselves until their behavior interfered with our lives.  Shame on us and the choices we have made.

The Story

                He was standing next to our billing administrator screaming, “My brame, my brame. Turn that off, it is hurting my brame.”  His left hand was banging on the computer screen on her desk; his right hand was pressed against his head above his ear.  “Stephan!” I called.  “Stephan, what’s the matter?”  He turned toward me, his narrow face contorted with pain, his eyes moist.  His eastern European accent was thick.  “The computer!  It is hurting my brame!  Ronald Reagan first put the radioactive isotopes in my skull and now he is trying to control me with this computer.”
                “Karen, could you shut the computer down and I’ll get Stephan downstairs?”  The frightened woman had already shut it off and was grabbing her purse from under her desk moving toward another office.  I led Stephan to the elevator and we went down a few floors to my office. Colleagues stationed themselves near my door as I directed the yelling man to a chair. A nurse mimed a call to the police as we passed her. I shook my head no, but left the door open.
                Stephan was the strongest person I’ve ever met. He wasn’t tall, less than six feet. But he was so broad he had to turn sideways to walk through most doors. When he’d emigrated from the Ukraine twenty years earlier he’d gotten a job on the loading dock at a local factory. When the fork lift broke, he loaded barrels by hand.  I once watched him pick up the back of a small American car.  He was psychotic most of the time. The only time I saw him stable was after an extended hospitalization. Even then, he was symptomatic but not agitated.  He drank and smoked pot and most likely used other substances.  He also screamed and yelled and frightened almost everyone he met, including me.  He’d recently grabbed his file from a nurse who was treating him and ran out the door into the street.  I’d needed the police to get the file back.
                However, there was a sweetness about him that would emerge when he realized how fearful he made people.  “Ok, ok! Don’t worry,” he said smiling. “Maybe the computer is only to get money for mental health.  That lady was a nice lady. She wouldn’t hurt me.  But Ronald Reagan did put isotopes in my brame!”   In the clinic, we held his prescription for an anti-psychotic medication that had a sedating effect. I offered it to him. He swallowed two and said, “I need some beer.”   Then he got up and left.
                Waiting for him in our reception area was Jane, his girlfriend.  She was a tall, thin woman with stringy black hair.  She’d met Stephan in the state hospital when they were there on a long term admission.  She’d found him exotic and interesting and had attached herself to him.  Ten years later she still followed him around, helping and supporting him and cleaning up his messes.  One of her main roles in the relationship was to find apartments.  Landlords would never rent to Stephan, but when Jane went to rent a place, she was neat, clean, pleasant and cooperative.  She’d never had a problem finding a place.
Jane’s first hospitalization was at age 17.  Voices told her that her father was evil so she’d attacked him.  She’d been taken directly to the state hospital where she spent several years.  As a consequence she’d taken medication most of her adult life. Every few years she would stop taking medication and become catatonic, entering a world that only she knew. Unfortunately, she would stop eating and taking care of herself and eventually agree that she needed to be hospitalized. Even when she was stable, she still was psychotic in a quiet, internal way that, for the most part, gave her pleasure. She called it “active dreaming”.  She created a world in her mind where many millions of people lived.  She controlled them consciously, but they lived in what she described as a “wide awake dream state.”
                Jane would work with her caseworker to secure an apartment, pretending that she would live there by herself.  The caseworker would join in the fiction, imploring Jane to keep Stephan out.  Jane would agree, but within hours of moving in, Stephan would be there.  He was a presence.  Even in his most stable moments he was three times louder than any other person.  He occupied space with constant movement, walking to and fro; arms flailing with a lit cigarette dropping ash.  Soon after moving in, the apartment was a mess, with empty beer cans and liquor bottles strewn about.  Fast food containers would fill the trash cans and burn marks would appear on the furniture and rugs.
                The first complaints would come from neighbors, those unfortunate enough to share walls, ceilings or floors with Jane and Stephan.  Often, the inexpensive housing was occupied by graduate students who would tap on the door requesting that Stephan please quiet down.  Drunk or sober Stephan would explain that he had been made into a nuclear weapon by Ronald Reagan. Once I was called by a student’s roommate and went to the apartment to find Stephan sitting on a coffee table yelling at his frightened neighbor trapped on the couch in front of him.  Stephan was wildly gesticulating, bits of ash and trails of smoke everywhere.  “Look in my eyes!” he yelled at the young man. “See the bits of gold?  They always use gold when they place the isotopes.”  The student nodded in agreement.  “Terry, my friend! Tell him this is true!  I’m not lying about this,” he said, turning towards me and standing up.  I replied, “Stephan, you’ve certainly had some very difficult and frightening things happen to you.  But I need to talk to you.  Is it okay if this guy leaves?”  The student was out the door before Stephan turned around.
                “This is a nice place,” I said looking around. “You and Jane can make this work for you if you settle down. “  Jane came out of the kitchen where she had been reading a book. “Don’t worry, we won’t screw it up.  Stephan promised to stay away when he gets drunk. That should help.”   “A few drinks is not drunk,” he said.  He then proceeded to touch his nose, stand on one foot and walk a straight line, replicating a police field sobriety test.
                Jane’s caseworker came to my office the next day.  “Other tenants are already threatening to leave if Stephan keeps coming around. Just thought I’d let you know.”   When I stopped at the police station later that morning I was presented with three separate complaints about noise from Jane’s apartment. One included a question about domestic violence with the officer concerned about Jane’s safety.  It was something I often wondered about, but the only time I had seen Stephan get physical with Jane was out on the street in front of the mental health building.  He had grabbed her head and put her ear next to his ear.  He’d been screaming, “Hear them, they are cursing me.  They are laughing at me. They are trying to kill me.”  When Jane agreed that she’d heard the voices, he let her go.
                The eviction notice came the next week.  The caseworker tried to get them someplace else, wanting to stay on good terms with the landlord.  Weeks and then months passed as the eviction proceeded, and no living alternative presented itself.  Stephan’s drinking got worse and he spent most days on the street downtown, yelling at passers by.  When the police told him to stop or move on, he quieted down and left. I had numerous conversations with the psychiatrists and nurses and social workers I worked with to try to figure out a way to resolve the situation. I met with the Commissioner of Mental Health and the head of the hospital psychiatric unit.  Although Stephan put himself at risk by yelling at people and menacing them, he did not meet the criteria for “danger to self or others”.  Finally, the day arrived when they had to leave.
                Jane came to my office with her few possessions in a garbage bag. “I stopped taking my meds three weeks ago.” she said. “I want to go in the hospital.  I’m having difficulty knowing what’s real and what’s not.”  With Jane in the hospital, Stephan became a bigger problem.  He began living outside, staying in the parks and gorges that are plentiful in Ithaca.  His caseworker prevailed upon a shelter in a nearby city to help.  Stephan only had the clothes on his back when he left.
                The Ithaca police department Deputy Chief called me at my office several months later.  “Stephan was shot and killed last night.  The duty officer in ____, found out he was originally from here and called me. They wanted information to justify the shooting. Apparently, he’d had a small fire in his apartment, probably from unsafe smoking.  When the fire department came, he wouldn’t let them in.  When officers arrived to assist, he jumped out of a window and ran down the street.  When they finally cornered him he had a kitchen knife.  He wouldn’t put it down so they pepper-sprayed him, and then shot him with a bean bag round.  You know Stephan, that would only piss him off.  In the end, he came at them with the knife and they put four rounds in him.  Sorry to be the bearer of bad news.”
                I go to the library every week.  Each time I visit, Jane is in a comfortable chair reading a book.
The Stories
The stories are my remembrances. Each of them is based on a true event in my work for Tompkins County Mental Health. I have changed the names and identifying information of every client, patient and co-worker except for Beau Saul, of the Ithaca Police Department, who I was fortunate enough to have as a partner. When confidentiality demanded it, I have changed details. The dialogue is my reconstruction of what was said at the time.   I have felt honored to be let into the lives of so many individuals over the years. Their stories are a gift I have been given.  Please enjoy them in the spirit with which they were written; to educate and inform.