TALK TO ME:
Street Outreach Among the Homeless
Mentally Ill on Los Angeles's Skid Row
by Emmett McGuire
Chapter One: Roger Doe
We got the tip by phone late Tuesday evening, so I couldn't get down to the identified location on Hope Street until the following day. The message slip I was handed said simply: "Female, age indeterminate. Poorly groomed and dressed. Possibly Hispanic. Apparently living in makeshift shanty. Seemed to the caller kind of weird, out of it." Not much of a description so I hoped at least the location - Hope and Eighth - was accurate.
It seemed to be. When I parked the Outreach Car across from the medical center on Wednesday, I could see what looked like a typical homeless dwelling down the block. It was composed mostly of paper and plastic bags overflowing with nondescript contents, stacks of newspapers, and a few odd pieces of wood and broken wallboard. The whole structure was covered by a long piece of clear, although dirty, plastic sheeting. In homeless camps around Skid Row, I had seen dozens of similar shelters over the previous year. Homeless people build their houses, like their lives, from whatever's available. Plastic sheets are particularly valued, when they can be found, as they help keep out rain or, more frequent in Southern California, morning dew. Any ground moisture can become treacherous on a cold morning, even deadly, dropping body temperatures and leading to hypothermia.
It was chilly and windy for March. Getting out of the car, I zipped my thermal vest up to my neck, but let my hands hang free, open and unthreatening, as I approached the site.
Nothing could be seen very clearly through the filthy plastic as I walked up, although I
thought for a moment something might have stirred briefly within the rubble.
Well, here we go. Again. From the top.
I addressed what appeared to be the front of the shanty and introduced myself.
"Hi - in there - my name's Emmett; I'm an Outreach Worker. I came by to say hello, see how you're doing or if I can help you with anything."
Nothing. A few passersby on the sidewalk looked at me oddly, hunkered down in the street against the cold, talking into an apparent void. Down the block I could dimly see a large grey truck approaching, and men milling around it. I pressed on.
"I've got some food out here if you're hungry, nothing special, just some granola bars and fruit juice, but it's pretty good." I always carried some kind of snack along with me, as a gesture of good will more than anything else. Certainly, there was no way I could possibly provide a decent meal out of the backpack I was using, but the gesture alone was often appreciated, and accepted. Sometimes, it even served to open up a conversation with a paranoid (or simply frightened) street person. Not today.
"Well, I'll leave it out here - in case you might like it a little later...."
This wasn't uncommon. Often it would take months of careful, respectful encounters before a hesitant man or woman would actually accept something - anything: food, clothing, a blanket - from one of our outstretched hands. And it was becoming obvious that this morning wasn't going to be very easy for me. A few people had even stopped nearby and were watching, smiling. I nodded pleasantly in their direction, then ignored them. I knew the kind of perseverance that was demanded by the work we did and I was willing to appear foolish at times if that was necessary.
"Just so you know, I work with the County of L.A., and one of the things I could help you with is getting off the street...if that's what you want to do..." Was that something stirring in there amidst the piles of scrap? Or just the wind?
"Pretty tough on days like this; pretty cold..."
The onlookers were snickering amongst themselves now, and I noticed the grey truck down the block lumbering closer to us, but I turned my gaze away from the men moving around it in the street, and concentrated on my goal.
"I could get you an emergency bed for tonight while we work on a better crib - maybe some Welfare money so you could do what you like." It was noisier now and I had to speak louder as the truck loomed closer, men slipping around it slowly, rhythmically, just at the edges of my sight. "Or we could go someplace nearby for some coffee or a hot meal..." But it was not to be.
I looked over sharply as the first man from the truck hit the far end of the "shanty". With a practiced hand, he flipped the plastic sheeting smoothly into a ball and then into the maw gaping open behind him; working his way towards me, flinging the bags to his partner, he followed with the newspapers, the broken boards, the (I could see them now) cans...of trash...
I had spent my morning chatting with California Medical Center's weekly garbage pickup.
It was a great job...
I used to think it was the best job in the world, doing street outreach to the mentally ill people who were homeless on L.A.'s Skid Row, working to link them up with emergency services. Even on a bad day - see "Prelude" - I felt privileged to be there. And that was in spite of the joke I made that my work gave me complete job security - "No one else wants it!"
For over three years I walked and worked those meanest of streets - alone at first, later with a series of partners and, finally, the Outreach Team we created - mostly loving every inch of it. Until the day eventually arrived, as I had been warned that it would, when I looked inside myself and discovered that I was spent, played out, just couldn't do it any more; my own time on Skid Row was over.
This is a story about those streets, that time.
Mostly the story is about a very special group of people - the chronically, severely mentally ill men and women who let me share their lives for a while in the streets of Skid Row: Sad Susie, Mary of the Veil, Roger DOE, "Darlin' Rosie," and Oscar the Boomerang and all the many others. Along the way, the story also tells of those who worked side by side with me: Lani and Robert, Jack, Art, Beverly and Robbin and Lew...And, in all the many ways that my life changed just from being there, it's also about me.
Hi, my name's Emmett.
I started thinking about all this again because they're tearing down St. Vibiana's now, or trying to. The Roman Catholic cathedral sat on Main street for years, hard by the old Union Rescue Mission where I had spent so many hours, long ago...
I went back there the other day, my first time in years; I don't know why exactly, maybe just to say a tentative goodbye to the old girl. After all, she sits near the center of an area that has a lot of memories for me.
I walked around the streets for a while just getting their feel again, and it was an odd experience. Much has changed since I left in 1989, but I guess some things never do: in three blocks, I saw two homeless people I had known, and worked with, back then. Seeing them started me thinking about my time on skid row and the people I had known there...
Early in 1986, I had been hired by the Los Angeles branch of the Travelers Aid Society, under contract from the L.A. County Department of Mental Health, to do street outreach in the skid row area of downtown. My job was to move among the homeless people there and look particularly for those who were chronically and severely mentally ill, primarily those with untreated schizophrenia. Once found, my goal was to link these "identified clients" with the emergency services that were available to them: food supplies, shelter, counseling and medical attention.
Sounds simple, doesn't it?
I realized pretty quickly that success at my job would require teamwork, a joint effort among many of the social service groups working on the Row. In the course of the next few years, a number of different alliances evolved including workers from the Department of Mental Health, Travelers Aid, Homeless Health Care, drug and alcohol rehab groups and many others. Teams composed of different individuals took to the street on a daily basis working together to build trust with the scores of frightened, sometimes hostile psychotics and schizophrenics living there until we could bring them off the streets and into decent, safe surroundings.
The work was always slow and incremental, although in varying ways. Some clients would immediately flee from the mere sight of our outreach car turning into their block, until eventually they got used to seeing us around and, finally, allowed us to approach them. Others seemed comfortable enough with our presence from the start, but refused to accept food from our hands for weeks; we would have to leave it near them, at first, and walk away. Only later would more direct contact be permitted. Still others would allow both our presence and our contact but would remain internally aloof, refusing shelter or meetings with medical personnel until we had proven our good will over the course of many months.
In truth, we often failed in our efforts, sometimes failed completely, unable to overcome years of habituation to street life, accommodation to delusions and hallucinations, and the familiarity of daily ritual, even when that ritual was pointless or self-destructive. I like to think that I am honest enough with myself that I insist on remembering all my clients, those I could help and those I could not. But some of them, quite a few actually, hold a special place in my mind and heart.
"Roger" was one of them, and one of our success stories, I guess, the kind that would keep us going through all the many failures - of nerve, or wits, or resources, so let me tell you about him: "Roger Doe", of course.
Skid Row is full of people who have misplaced or abandoned so much out of their lives, it shouldn't be surprising that even names are on the list of the lost. Our team had long-since stopped using "John Doe/Jane Doe" as a way of referring to clients before we ever met Roger: the sheer numbers of nameless homeless that we encountered undid that plan. (At one early point, we had five "John Does" as open cases and team meetings were becoming utter chaos: "What do you mean, 'he was limping'...he hasn't got any legs!"
"The old black guy standing on the corner at Fifth and Main doesn't have any...? "
"Black guy! What black guy? John's the white kid in the wheelchair at the Midnight...isn't he ...?")
So, to keep track of those clients who wouldn't or couldn't identify themselves, we would find some personal marker to distinguish them and add "Doe" to that. I had already worked with "Redline Doe" (because of a knife scar along her jaw), "Man Mountain Doe", a huge, hulking character, etc.
But in Roger's case, "Doe" seemed an unusually apt designation for this gentle, fawn-like man. Slight of build and slow of speech and movement, he seemed almost like one of those wild, fragile creatures that sometimes wander into our cities, accidentally, and need help finding their way out. Some of them even make it.
"People call me Roger," he had told us, the first day we met, "but I don't think it's my name..."
The first tip we got about him came from a nurse whose son worked for a roofing company. The young man had been doing a hot-tar job on a commercial building just east of Ragtown (our name for the downtown garment center of L.A.). While on break one day, he had glanced down from the roof into the service alley alongside his building and was taken aback to see a strange, scraggly form emerge from under the cover of a dumpster:
A Caucasian in his mid-to-late forties, long brown hair and beard, Roger was starting his morning "rounds"; back and forth up the alley he glided in a graceful, though seemingly purposeless routine of gestures and pauses - Turn. Wait. Wait. Step and TURN.now... - all while the young roofer stared, entranced. He had never seen anything like this.
Later that day, inquiring among the local businessmen, the boy was told that Roger had been sleeping in that dumpster for quite a while, never venturing very far beyond the maze of alleyways that all converged around there. His shyness was local legend, a painfully indrawn manner that showed itself whenever anyone approached.
And the nurse's son did try to approach him, as had others in the area, captured by this strange vision of Otherness living in their garbage. But without much response; just a long searing look from his intensely blue eyes, and a little smile as he backed away; silently, away. The son told his mother about the stranger and the nurse got on the telephone, calling local agencies for help; eventually someone told her about us. We thanked her and said we would go look for him.
As it turned out, we didn't have far to look. Unlike many homeless people who become constant wanderers, sometimes over hundreds or even thousands of miles, Roger never strayed far from the alley he had adopted and consecrated to suit his particular needs.
He was sitting quietly along a fence when we arrived, murmuring softly to himself as he gently stroked a small object on the ground next to him. It was a toy car made of plastic, yellow, the wheels broken off, obviously retrieved from the trash. He didn't seem to be playing with it, not exactly, not as you might see a child doing, just sliding his hand across it again and again, almost reverentially or as if to invoke some spirit from within to grant his wishes.
In a rare accident of scheduling, a luxury, three of us were working together that day we first met Roger - Lani, Robert and me. Lani was an RN with the Skid Row Mental Health Center and in many ways, the soul of our team. Japanese\Hawaiian by birth, Lani was tiny in stature, a fact we kidded her about constantly. She took it all good-naturedly, even sweetly, her Christian faith combining with an easy-going disposition to make her a natural charmer, and a born pro at outreach. At the same time, everyone who knew her even briefly could see the enormity of the compassion and commitment that she brought to her work.
Robert, an Outreach Worker with the Department of Mental Health, was the team's "gentle giant": huge and endlessly affable, Robert's largeness of heart could be counted on repeatedly to ease our way into - and out of - any number of tense situations we met on the street. He had grown up nearby and knew the area and its people thoroughly, reading situations intuitively, defusing problems with an easy grace and charm. What was not so obvious about Robert, what was hidden deep beneath the self-consciously clumsy "latin lothario" act that he loved to perform, was an acutely intense political awareness. Over time I discovered that it was not just his heart that had led him to his work on Skid Row, but also his analysis of the societal forces that created and maintained poverty and homelessness in our country.
Then there was me: shorter than Robert, older than Lani... We all knew and liked each other enough to have developed, over time, an easy way of working together. Now, we quickly divided duties amongst ourselves as we got out of the car.
"Who's lead-off?", Robert asked, unfolding his cramped frame from the front seat. "I want to be lead-off."
"Let the dwarf do it, man," I suggested, nodding at Lani, "You'll scare the shit out of this guy like you always do...take back-up."
"Why Emmett you hurt me, man," Robert smiled, "You know I'm just as gentle as a puppy at heart..."
"The Hound of the Baskervilles thinks he's a puppy..."
"And you know he is," Lani shook her head; "You two should both be sent to sit in the corner till you behave. But since I can't do that,...I think that 'dwarf' comment earned you the perimeter, Emmett."
Perimeter watch meant that I was free to examine the physical environment around us for clues about our new clients' state of mind, as long as I kept an eye peeled for passersby who might intrude upon the scene, intentionally or not. I accepted my punishment/assignment and started to look around. Lani and Robert strolled over to Roger.
Unlike a lot of Skid Row alleys that were choked with crack and heroin and the people who used them, making them almost impassable and certainly unusable for commerce (their original purpose), this one seemed to be deserted. Broad and cobbled, a chain-link fence ran down its center, with two smaller alleys branching off it in opposite directions at its top and bottom.
As I walked along the fence my eyes were immediately drawn to the many brightly colored bits of cloth, string and ribbon that were tied into its links, apparently in a random manner. Interspersed with them I found an odd assortment of pictures that had been torn by hand from the pages of magazines and newspapers and then wedged into the spaces of the links. One picture simply showed an old man holding a hat in his hands as he gazed off into space. Another was of a "beauty queen" in a gown and tiara. Others seemed only to be illustrations from ads - a sweater, a dishwasher, etc. If there was a theme uniting these disparate elements, I certainly couldn't see it.
Crossing over to the wall of a building that bounded that part of the alley, I came upon mounds of...what can I call them? Artifacts? Technological Icons? Detritus? Whatever they were, all seemed, like the yellow car, to have been retrieved from the garbage for some private reason. Most were broken and unusable (a toaster without a cord, etc.); some, merely damaged in such a way as to make them unappealing (a dented lampshade), bent at odd angles (forks, spoons), twisted, smudged. Their arrangement in relation to each other, however, was utterly precise, geometrical; obviously, these piles were laid out according to some inner plan. One after another, down the alley.
I left them undisturbed. The area seemed secure so I returned to my partners and our new client.
Walking up, the first thing that impressed me about Roger was his aura of quiet composure, a sense of peaceful self-possession. It had often struck me in the past that my clients on Skid Row managed to maintain a degree of dignity and grace that I knew would have been impossible for me, in their circumstances. Now, here was a man sitting utterly at ease in this strange byway, nothing but rags to cover him - his pants might have been Levis once, and only the remnants of socks on his feet. Still, he was gracious, calmly answering our questions as best he could: no, he wasn't hungry just now, thank you, so he didn't wish to come with us for a meal, or a room, and no, he didn't really know where he was from, but he was doing all right where he was, thank you...all delivered in a soft voice difficult to hear even a few steps away, and without any inflection or facial expression.
Except in his eyes; they were the second thing that caught my attention, and caught it fully. Blue and clear - "as blue as snow" - they seemed almost to search you as he spoke, piercing, scanning, stinging, entering your mind, leaving, finally, but leaving you somehow...changed, different. I can't really describe them very well even now; I guess in a way they were just too much for me. Some things are like that.
Lani and Robert had been speaking with Roger for about ten minutes and indicated to me that they were done. We had learned not to push too hard at a first contact; the odds of pushing away a sensitive person were too great to risk, so we broke off and headed back to the car, promising to return soon.
Driving back to our office in the Weingart Center on San Pedro Street, we exchanged ideas about our new client and tried to work up a rough assessment of his mental condition.
"Jeez, what a tough time this guy musta had," Robert began. "He can hardly talk, he's so down in it. And those clothes! Wow. Must've been in them for months. I think something came down he couldn't handle."
"Reactive Psychosis?," Lani mused, turning the car onto Temple Street. "I don't know; he looks so,... so sickly...I wonder if there could be an underlying physical cause."
"Like a brain tumor, you mean? I don't know that we have to reach that far for an explanation." I described the bizarre decor of the alley fence, and the layout of the mounds I had discovered. "I think it's schizophrenia; the place looked like a romper room on a psych ward..."
We argued the case easily amongst ourselves driving back, although each of us knew it was an academic exercise; we would proceed in much the same way regardless of formal diagnosis. We were doing street outreach not psycho-analysis. As long as a person was clearly mentally ill in some way, as Roger clearly was, he or she fell within our guidelines and would be approached with much the same strategies: We would visit as often as possible but no less than once per week, bringing along items we thought would be appreciated (shoes, most immediately, in Roger's case), and food. Working slowly or quickly depending on their response, we built trust with our clients by being honest and gentle, and true to our word. Don't lie. Promise nothing you can't deliver. And glean as much information as possible about the background and resources of the client.
In Roger's case, the work was painfully slow. Often, he would forget us - or, pretend to - between visits, even if only a few days had elapsed, and this after weeks of contact. Always shy and reticent with any personal information, he seemed guarded in a way that was very deep, almost muffled. "I don't know," he would reply, after long silent reflection over the simplest query, while his eyes chased us down with their own questions: "Is it safe? Can I trust you? Can you see me?"
Some progress occurred. He was very grateful for the shoes we brought him, and within a few weeks he was accepting food directly from our hands. As to his past life, however, he remained vague or mute.
On one of our visits, I took some time after checking in with Roger to interview a few of the businessmen who owned or worked in the warehouses bordering his alley. They were glad to learn that someone was taking an interest in him and were able to fill us in with some of his more recent history. Roger had been living there for at least two years before we met him, one said. Two years in a dumpster. Several had tried to offer money or food but had been met with...not indifference exactly, but rather an enormous, engulfing passivity. He accepted everything, responded to nothing, just gazed at them with those enormous crystal eyes. They were quickly disoriented by this, put off, and soon ceased trying.
Only slightly more successful than they, we could certainly understand their response. It seemed to us that we had been able to establish only the most basic kind of contact with this fragile and oddly tenuous soul. Perhaps that was all he would ever be able to accept.
We were stuck on a low plateau with Roger and it showed no sign of leading any further.
When the team assembled for our weekly strategy meeting at the Center, we agonized over what to do next. After months of concerted efforts, many of our ploys had failed. Roger continued to deny any interest in getting off the streets, repeatedly refusing to accompany us to check out any of the shelters or hotels where we could have arranged housing for him. He even refused - gently, as ever - to come for a hot meal, and any talk about his mental condition was lost in his vagueness and his silences. Nevertheless, it had become increasingly obvious to us over time that he was both severely depressed and physically quite weak.
"I'm worried about him," Lani had summed up for all of us. "I don't know how much longer he can survive in that alley of his."
Art nodded gravely and Robert shot a glance at me. We had good reason to be concerned.
Without belaboring the point, people like Roger were prime victims, constantly used as prey by the more vicious scum that treated the downtown area of Los Angeles like their private hunting grounds, gangs that roamed at night - sometimes, even by day - looking for violent sport. He was incredibly lucky to have escaped their notice as long as he had. On a sunny afternoon only a few weeks before, while cruising across Sixth Street in the Outreach Car, Lani and I had watched in horror as a half-dozen thugs surged suddenly from the mouth of an alley to grab and beat an unsuspecting man innocently walking past. In broad daylight and while passers-by on the street hurried away from the scene, they dragged him back into the alley, squirming and cringing at their blows, all while they tore at his pockets.
That day, unthinking, Lani had yelled the equivalent of "CHARGE!!" and I had gunned the car into the alley after them, honking the horn and screaming. Somehow we managed to drive them off. But similar things had been seen by each of us on the team on other days and we all knew how very differently it might have turned out.
In addition, that winter we had another predator to worry about: the Skid Row Slasher. Over the course of several months, a number of "transients" had been found either stabbed to death or with their throats cut, their bodies dumped usually in a downtown alley. The police had few leads, just a general idea that the killer might be himself - or, herself - a transient. You can imagine how that made us feel, we who were working on the street every day.
I knew from my own contacts in the police that at any given time there were surely some very, very bad people, wanted people, walking alongside us, using the anonymity of Skid Row for their own purposes. That was a given and we could all deal with it; in truth, it caused us few problems.
Another kind of given was that most homeless people carried a weapon of some sort for self-protection, even if only a knife or shard of glass hidden in a pocket. (Walking sticks were not uncommon among certain long-distance travelers down there; you might think little about them unless, glancing at the ground, you happened to notice that a nail or razor blade had been carefully implanted near the tip. Just in case.) Actually, you would be very foolish indeed not to be prepared in some way like this for the kinds of assaults that were a daily occurrence in the area.
The presence of the Slasher, however, in this already turbulent mix added something new. These deliberately vicious executions showed a cold-bloodedness that bespoke a savagely sick mind, or soul. During the period when they occurred, everyone walking on the Row walked a little tighter...
We had been going around and around with all of this for over an hour and the room finally fell silent, exhausted. Lani lit another cigarette and put her feet up on the desk, her eyes hooded. I had seen her do this before in meetings, sit back, gathering herself into herself in an almost trance-like state. I had come to think it was her way of indicating that she felt there was nothing more to discuss, and she would merely wait quietly now for others to realize that. Robert stood up and stretched like a huge cat, almost touching the ceiling. Art Stella, a grad student in Social Psychology and new team member, bummed a light from Lani. I rubbed my eyes, tired from all the smoke and the talk.
"You know, " Art finally began, slowly, "we can't just ignore the very real danger Roger is in..."
"Hell no; him more than most," Robert said. His eyes were alert, watching us all.
"Of course we can't protect everyone", Art continued, musing almost to himself, playing devil to his own advocate.
That was another kind of given.
"But we're not talking about everyone," I said. "We're not even talking about just anyone. This is Roger."
After a long moment, "You know where this is going, don't you? Where it has to go?," Art had asked the room. I shifted uneasily in my chair. Robert glanced out the window, thoughtful; Lani nodded. We knew.
Another minute passed like this, in silence, before Lani nodded again and said "I'll start the paperwork."
We had made the team decision to hospitalize Roger Doe against his will.
In California, involuntary psychiatric hospitalization is called a "5150" after the number of the statute that regulates it and certain requirements must be met in order to qualify. You have to prove, in essence, that the person you are describing in your filing papers is either a "danger to self or others" or "gravely disabled" due to psychological factors. In the first situation, you would have people who are overtly suicidal, or those who are psychotic in a manner that is violent, assaultive. Few of our clients fell into either of these categories.
As to the definition of "gravely disabled", our team members argued for years both with others and amongst ourselves as to what the term should and actually did mean. To this day, I take the most radical position on its interpretation: anyone homeless in a psychotic state. Period. Philosophically, it seems simple to me. Not so in practice.
Depending on which intern was on duty at the psych emergency room when we brought the person to County/USC Medical Center, they either were admitted or walked away. Actually, the relevant factor of greatest significance usually had nothing to do with the clients' mental state; it was simply whether or not a bed was available. We learned to stay in close touch with the staff at the hospital in the days preceding a 5150 to be sure we weren't just spinning our wheels. When necessary, we would put a client into a "holding pattern" until a bed opened up, calling the hospital hourly while we tried to keep track of the person roaming the streets.
Even if we could secure an admission, however, our problems didn't end there. Often enough, the patient would simply be given a shot of thorazine, stabilized for a few days and released without any effective follow-up planned. In all fairness to the hospital staff, the sheer volume of homeless, combined with lack of funding, frequently made it impossible for them to do any more. The result, however, was that patients would be released "to the streets," the medication would wear off, and in a few days they would be back in the condition that led to their being hospitalized in the first place: the "revolving door syndrome" in all its glory. We didn't want to contribute to that syndrome so, first of all we tended to be very conservative in using the 5150, and secondly, we worked hard to link up with sympathetic ward clerks and discharge planners. They, in turn, would contact us when one of our clients was due to be released so we could be waiting with shelter, clinic and medical appointments, etc. already scheduled. This was what we wanted for Roger.
At our team meeting that week, we had begun the paperwork necessary to substantiate our claim that Roger was in need of hospital care. First, we all pooled our observations of him over the previous months, the depressed mood, bizarre behaviors, flatness of speech and affect, inability to nourish himself, etc. When we thought we had developed a sufficiently compelling clinical profile, Lani wrote it all up in the technical language required and presented it to one of the staff psychiatrists for review and approval. Once he had signed off on our work, it only remained for us to decide who amongst ourselves would accompany the ambulance staff to Roger's alley for the actual commitment. It wasn't a part of the job that anyone relished.
Practically speaking, there were dozens of things that could go wrong on the street once you made it clear to a person what was about to happen, horrible scenarios of 5150s with hysterical clients fleeing into traffic, fighting savagely against team members while passersby, misunderstanding, attempted to intercede, etc. We had each made our share of mistakes in these situations and wanted desperately not to repeat any of them.
But beyond these concerns were philosophical issues, human issues: we were all acutely aware that we were, in effect, stepping into the center of another person's life, assuming control and depriving them of their freedom of movement, an action with enormous implications. Each of us took this responsibility very, very seriously. We accepted the fact that our job required this at times to safeguard vulnerable people like Roger from the most severe ravages of their illness, but we didn't have to like it, and none of us did. Still, we each took our turn when the time came according to the decision of the team. In Roger's case, Beverly and I were picked.
We were a good choice to work together on this. Beverly O'Rourke had been my first partner in street outreach years before when I was just beginning. Quiet, intense, yet often with an ironic little smile curling around the edges of her lips, Beverly was a good-looking black woman around my own age. I liked the fact that she was smart as well as street-smart; it meant we could talk, analyze situations as we moved into and through them, even dissect them later if necessary for our understanding of how we were doing. Over time we had learned each others ways and we trusted them.
Also, while she had had almost no contact with Roger, I had been working with him weekly from the start. This was an advantage, a good balanced pairing. The act of hospitalizing someone against their will frequently disrupted any rapport between the team and the client. It helped to have some relatively new face along to "take the heat", deflect any anger away from the known, familiar team member - in this case, me - who was there to provide continuity for the client.
We started out that day by checking with County/USC to be sure there was an available bed; once that was confirmed, we let them know what we were doing and they prepared to receive our client. Next, we called the ambulance company, gave them Roger's location and description, and arranged a time to meet them.
Arriving early, we parked around the corner out of sight and walked slowly into Roger's alley. He was in his usual spot along the fence, sitting quietly, drawn into himself in a state often labeled "vegetative" because there is so little movement or apparent awareness, so few signs of emotion or thought.
Beverly and I waited for the ambulance to arrive before approaching him; once begun, this was best done quickly, and Roger seemed oblivious to our presence. Even when the attendants navigated up the alley to within a few feet of him, he continued to stare fixedly into his hands as if trying to discern there a meaning or pattern...of some kind...
We briefed the ambulance driver and his assistant quickly, assured them that Roger was not violent and that, in any case, we would take the lead in the process. Then, while Beverly was getting the soft restraints that had to be placed on his wrists, I walked over to talk to him.
I crouched down beside him on my heels, looking for some sign of recognition. Slowly, he raised his head, and eventually, his eyes, those amazing eyes, to mine. After what seemed like an hour, he nodded.
"Roger," I began, "we need to get you out of this alley and into a place that's safe. Some people are going to take you now to a hospital where you can get care..."
"Uh, wh...what...?" He squinted at me, incomprehension drawn like a veil across his face. I repeated what I had said several times in slightly different ways, but it was clear that I wasn't getting through to him. He sat staring at me.
By this time Beverly had walked up holding the leather padded restraints and was waiting next to me for my signal.
"You can't stay here any more, Roger. You're sick. You need food, shelter, medicine..."
He gazed at me for a long moment. Then said, "Wh...why?"
I gaped at him as his question exploded inside my mind.
The word rocked me, stunned me, caught me completely off guard, coming as it did from such a pathetic figure in such dire circumstances. Why do you need food? Why do you need shelter?
Why is there anything at all? Instead of nothing? Why? WHY?
And how do you answer a question so fundamental, asked so simply by a person without the ability to grasp any answer you might make. Gently.
I put my hand on the fence to steady myself while my mind raced through possible responses.
Because you're sick.
And hungry, whether you can even detect that any more or not; maybe starving.
Because you're a human being. In need. And no human being should have to live in a garbage can in an alley in rags and filth...and because...because...
But I was reeling and I couldn't make my mouth say any of that. I was out of my depth, over my head. In the end, all I could get out was, "...because."
I stood back. Beverly stepped forward and smoothly slipped the first restraint around Roger's left wrist, all the time talking to him calmly, telling him what she was doing as she did it, and what would happen next, then doing that. She eased the other restraint around his right hand, still talking softly, tightened them both with a light tug, working swiftly, watching him closely for signs of a struggle, but there were none. Roger merely watched us, silently, as his hands were bound and we helped him to his feet.
I waved down the alley and the driver brought the ambulance abreast with us. His assistant jumped out to open the side door, sliding it back and stepping aside. Together, Beverly and I helped Roger, unresisting, step up into the vehicle and seat himself. At that point, the driver leaned into the back compartment to secure both of the wrist restraints to a bar so they couldn't get loose during the short ride to the hospital.
"Uh,...what about...my stuff...?", Roger finally asked, but Beverly was already walking the length of the alley with a large plastic bag we had brought along for the purpose. Quickly but carefully she gathered together from his mounds the icons or ritual objects he had amassed there.
I took a deep breath and tried to pull together a fragment of my self-possession, decided to once more try to reach him, reassure him.
"You're going to be all right Roger", I said, touching his arm lightly. "I know you're afraid now but we're going to take you somewhere that will help you. You're going to get what you need."
He stared at me as before, slowly nodded, appeared to accept what was happening to him. Sitting back in his seat he seemed to settle down into himself, showing the same equanimity that he regularly displayed to us, and I supposed, to the rest of the world. It was as if he were still sitting by his fence, in his alley, in his sad world, and none of this had ever really happened.
Beverly returned with the bag containing his few possessions and handed them over to the driver. We also gave him the 5150 papers ordering Roger Doe's "72 hour hold for observation". After checking them, he shook our hands, put the car in gear and drove away.
Walking back down the alley to the outreach car, Beverly glanced over at me and offered, hopefully, "Well, that went pretty well."
"Yeah, I guess it did. For us," I grudgingly admitted. "I don't know about Roger..."
She was right; we had each served 5150's on clients who had reacted wildly, savagely, biting, clawing, charging at us or off into traffic, so we knew how awful these events could be and were grateful when they didn't go that way. Still, enormous unanswered questions haunted us at times like this: How will he take it? Have we done more harm than good?
You could never really resolve that one, not at the time. You could only search around inside yourself to see if you had honestly made the best decision of which you were capable for the welfare of your client. You then had to act on that, and live with the consequences. Later on, if you were lucky, you might be able to determine if you had been wrong. Or right.
ON THE WARD
Calling the hospital the next day, we learned that our "hold" had held: Roger had been admitted as an involuntary patient onto a locked ward and was receiving a number of medications, including lithium, for what was diagnosed as psychotic depression.
This was hopeful news. Lithium is a powerful medicine in the treatment of depression, but it is also potentially very dangerous. Blood levels must be carefully monitored with tests daily to insure that an overdose is not occurring. Obviously this can't be done on the streets with a non-compliant patient. Having Roger there on the ward, the staff would keep a close watch on his reaction to the dosage, thus giving him his best possible chance to benefit from the treatment. At the same time, we knew that he would be placed on an enriched dietary regime to counteract his years of scavenging for scraps. Things were looking...if not good, at least better.
Winter was always a busy time for us, so it took almost a week before we could actually swing by the hospital to visit and follow-up. This time, Robert and I went. Beverly would not be involved again because of her critical role in the 5150 and I was only there tentatively, to see if Roger would accept me. If not, I would simply fade into the background and leave it to Robert, and later Lani, to work to re-build rapport with Roger.
To my considerable surprise, it turned out that nothing like that was necessary. Roger greeted both of us with as much warmth as I had ever seen from him. Although still shy and hesitant, he admitted that he remembered us from the alley and appeared to enjoy having visitors!
Physically, the change in him was significant. He had always been thin, gaunt, but now he had begun to put on weight in such a way that filled out parts of him I had not even realized were empty. His face in particular was ruddy and glowing and full with a life force I had never seen in it before.
I had seen repeatedly over the years how large a change can sometimes be worked with just a hot bath and clean clothes, not merely in a person's appearance but in demeanor, attitude. Combining this with a healthy diet and effective medical care had produced, in Roger, the clear beginnings of one of the most pronounced transformations I had ever witnessed.
He even carried himself differently now. His manner seemed relaxed in a way that surprised us at this first in-patient visit. Certainly, we would never have described him as tense before, but now he possessed a kind of poise that made his interactions easier. His words came more fluidly. He was, I thought, even inhabiting his body more fully, like a long-absent landlord come to reclaim property due him.
In conversation he remained somewhat vague still, but told us that he had been remembering more things from his past, snippets of memories of places and people. And for the very first time, I saw his smile. It appeared as he talked about the "holes in his head" - as if his memory lapses were some kind of joke being played on him, by himself. When we were getting ready to leave, he reached out - to us - and took our hands to shake, gazing into our eyes.
Over the next few weeks we continued to visit Roger at the hospital as often as our other duties allowed, and continued to be awed by his development. It was like watching a man slowly digging himself out from under the rubble...of his own life. Or, a long-absent landlord returned to inhabit property that was rightfully his; though in this case, the "property" was a human soul. Every time we saw him, there was more of him to see. The therapist working with him on the ward confirmed our observations and gave us updates on his progress by phone.
She told us that as his depression continued to lift, more and more of Roger's memories seemed to return. He even began to speak, tentatively, obliquely, of his life in a small town in Oregon, but it was hard to determine how long ago that had been, or the precise name of the town (was it Johnson? Johnstown? Jonsonville?...) Finally, one day in group therapy, he rocked the entire group by correcting another patient when she referred to him.
"No," he said, "Not Roger...call me...Walter...my name is Walter...D........t."
The news that our client had finally produced a name for himself electrified our team, representing as it did a major step forward in the attempt to trace back and re-tie the broken thread of this man's life. At the same time, it was hard to really evaluate the meaning of this development. Had "Walter's" memory only now improved to the point where his name was accessible to his conscious mind? Or, as some of us suspected, was it not just his memory but his trust that had grown stronger, trust in his therapist and the therapy group? Was it this that enabled him to speak out, reveal what he had hidden all along, too shaky in his relations with the world to admit? Reveal himself.
As with many other aspects of him, and all of my clients, it was something I would never really know. But if outreach work teaches you anything, it teaches you tolerance for ambiguity, for uncertainty. You search for answers, for information, knowing you'll never get most of what you want and hoping you get enough of what you need to do your job. The rest you just have to let go. I still find myself wondering about the meanings, the personal significance that he placed on those strange ritual objects he had retrieved for himself from the trash. No one ever managed to get a very clear explanation of them from him; he actually seemed embarrassed whenever the subject came up. Oh well, let it go.
Work to do. Move on.
In "Walter's" case, we now finally had enough of what was needed, although it took an outside "assist" - a major one - for us to see it.
Remember the nurse who had first contacted us about "Roger" months before? She had taken an active interest in him from the start, calling us for updates and offering any help she could. All of us working with him felt that her involvement rated some special recognition, so we had bent confidentiality guidelines enough to keep her apprised of his general progress. Now, upon somehow learning his real name, she was jubilant. In a phone conversation with Lani, she offered the opinion that "D.........t" was a surname uncommon enough to be, perhaps, traceable? In Oregon? Lani didn't disagree, but said she didn't have the time on that particular day to...
"No problem," was the reply, "I'll see what I can do this weekend."
True to her word, the nurse spent the following Saturday morning calling Directory Assistance in Oregon. She worked her way through several possible spellings of the town's name, finally finding one where there were indeed several listings. The first number she dialed didn't answer. The second number was answered by Roger Doe's - Walter D.........t's - cousin, who told her that after seven years Walter's wife was, reluctantly, in the final stages of having him declared legally dead so that she, and his children, could get on with their lives.
What happened next happened quickly, and I only heard about it second hand, so I have to rely on others' accounts. Apparently, a flurry of phone calls flew back and forth between Roger - sorry - Walter and his family and the hospital. Within 48 hours, his mother, wife and eldest son were on a plane to LAX for a tearful reunion at the hospital, followed by a quick release into their custody, and a return flight home.
Before they left, the family told hospital staff that Walter had been a prominent man in their community up until the time that business reversals had led to the loss of the print shop that he had owned and operated for years. Following that, a steadily increasing gloom had seemed to invade his life, and he had begun rambling aimlessly throughout the area, sometimes being gone for days. Finally, one day, he had apparently just kept going. Thousands of precious dollars spent searching for him over the years had yielded no really useful leads; his family had had to endure the uncertainty that such tormented and unresolved situations create. Until now.
Walter's mother was kind enough to slip in a quick visit to our office to thank the team for its efforts, but it happened at a time when I was in the field; I have to rely on Robert and Lani's description of her.
A small, fragile lady with blue-white hair, she reminded them both of "Roger", except, of course, that she was so openly emotional, crying constantly as she held their hands...
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