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1969-70 FOL



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Talk to me! (Chapter 2-Sad Susie)
By Emmett McGuire
May 9, 2000, 3:37pm

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CHAPTER TWO: SAD SUSIE

"Candy??"
With the door flung wide, the speaker confronting us was startling: a woman, long, lean, gaunt, with powdery pale skin. A dirty, sleeveless, once-white shift hung limply around her stringy frame, draping down to the ground. The snow of her face was framed by a jet black halo of hair and pierced by two glowing, coal-black eyes, their expression one of abject panic.
"CANDY?" she croaked again.
Most disturbing to me at the moment, however, were the thick globs of a gelatin-like substance that covered parts of her neck, cheeks and huge "lantern" jaw. Thick and pebbly in places, they gave her face a sort of brindled appearance, like you might find on an animal, perhaps a cow; at the same time, their oiliness was vaguely reptilian.
Hovering, almost floating there in the shadows of the doorway, she somehow gave the unsettling impression of both moving out to us - Art and me, standing in the hall - while simultaneously receding back into the murky depths of the darkened room behind her.
We all stared at each other for what seemed like a very long minute; she found her voice again, repeating, "CANDY?"
In a sudden, disorienting shift of perspective, I found myself wondering if we looked as strange through her eyes as she did through ours...

Some background:
With our outreach work becoming better known throughout the downtown area, referral calls had started to flow in to us from a wide variety of sources: businesses, church groups, individuals, even occasionally from other service organizations that had come across someone with needs they were unable to fill.
"Hotel Alert" was such a group, providing food and a certain amount of personal contact for the people living on Skid Row. Their specific goal was to serve at least one hot meal daily, usually in the lobby of whatever hotels would allow them access, and always at reduced prices affordable for those on limited or fixed incomes (SSI or GR, most often.)
Meals became social occasions for the isolated, often elderly tenants of small single rooms. They were served graciously by H.A. staff members who also used the time with the diners to check on their mental and physical health, see if someone was in need of medication or, perhaps too frail to live alone any longer, etc. Such informal assessments would sometimes lead to a referral for an outreach worker to make a more thorough evaluation.
In Sue L...'s case, the staff member who called us had his interest attracted by her unusually vehement refusal of their meal service. At first, he had thought little of it - to each his or her own - but then rumors of her bizarre eating habits and behavior started trickling in from other tenants.
Her particular hotel was, we were told, quite tiny; since there existed no large public space there, an arrangement had been made in which the tenants were served in an adjacent hotel's lobby. Susie, however, would not walk the few feet next door, or even (it appeared) leave her room. Instead, she bribed or cajoled others to act as go-fers at all hours, sending out for an endless supply of junk food snacks and desserts. The Hotel Alert staff was concerned that she might be seriously malnourished. We, in addition, suspected that she might be agoraphobic, an unusual diagnosis for us to be dealing with, admittedly, but we thought we could at least take a look.
Our work up to this time had taken us into quite a few hotels on Skid Row, and it seemed to me then that they basically fell into two distinct types. By far the best were those owned and operated by the Single Room Occupancy Corporation. Publicly funded, SRO's mandate was to buy and renovate older hotels in the downtown area, bringing them up to a condition that was "decent, safe, and sanitary"; at the same time, their rents must remain accessible to those on tiny fixed incomes such as General Relief. Under their director, Andy R., however, SRO's results always far exceeded these minimum standards. A great, grizzled teddy-bear of a man, Andy was a fixture on the Row, and fiercely committed to his work. Without exception, the properties he re-opened were well-designed and maintained, attractive and comfortable. Individual rooms were small, of course, and far from luxurious, but still they stood head and shoulders over anything else available. Whenever possible I would try first to place one of my homeless clients in an SRO hotel before even considering any other options.
The other category of hotel with which I was familiar encompassed the privately-owned, and usually un-renovated buildings that were much more common. To me, these seemed generally shabbier in appearance than SRO's, with hall carpeting torn and stained, peeling plaster throughout public and private areas, and a certain general lack of cleanliness, the kind that can easily come to pervade a building. Often, though the rooms might actually be larger than an SRO room, they were far less comfortable due to older, decaying appointments and furniture. In addition, we often found that many of these hotels were less safe for their occupants due to laxness in security and rental policies. Still, I have to admit that most of them were at least adequate, providing basic shelter cheaply.
Entering Sue L...'s hotel for the first time, however, I realized that there was a third category of which I had previously been unaware.
We could tell from the address that her hotel was located in that section of Fifth Street nicknamed by locals - not affectionately - "the kitchen" (as in "if you can't stand the heat...") Cruising along in the outreach car we passed a few of the street's more squalid hole-in-the-wall stores and flops, until I called out to Art, who was driving, "Hold on, we must have passed it. Let's park and walk back."
Searching for numbers on the facades of the crumbling structures as we went, I soon realized how we had missed it. The entranceway was tiny, un-numbered and completely unmarked, and so choked by garbage piled in front as to be almost invisible. The "hotel" was upstairs, a second-floor walk-up over a dingy liquor store.
As we started up the wide staircase, I smiled, said "Excuse me, gentlemen" to the junkies quietly cooking their fixes on the steps. They glanced up at us disinterestedly and I patted them gently on the arm to move them aside. They gave way to us slowly, then continued their business as we stepped over and around them. Such encounters were common in "the kitchen." I didn't expect any trouble from them and we didn't get any.
At the top of the stairs, a wrecked gate half-hung across the entrance to a drab hallway, uncarpeted and piled with the same mounds of garbage that stood in front of the building.
"Maybe they're waiting for the boys on the steps to finish up, so they can just kick this junk downstairs," I suggested to Art.
He smiled, started down the hall searching for the room number we had been given. It was no easy task in the dirty gloom we were moving through, an almost greasy murkiness cut only briefly, every few yards, by a dim, bare bulb. The corridor we were in formed a square around a central core. Following it slowly, we barely managed to read the few room numbers that remained on the rough, unpainted doors.
In one place, not only the number but the door itself was missing; apparently, the owners had decided it was an unnecessary luxury - for the one communal toilet. Unoccupied, it still threw off a strong fecal reek as we passed and I could see, through rotting floorboards beneath a stained urinal, into a space far below. I wondered if it was the liquor store's stock room.
Occasionally, we could hear music seeping from behind a partly opened door. Once we encountered a small, naked baby boy sitting in the doorway of a crowded room; as Art stooped down to say hello, the child was whisked briskly back inside, the door hurriedly shut. Behind it, a murmur of voices in Spanish marked our passing.
Finally, rounding a corner, we interpolated between two marked doors and decided that a middle one had to be our destination. Art glanced over at me - Ready? - and knocked.
Immediately, a conversation that had been going on inside came to an abrupt halt. After a moment a throaty voice called out, "Who's there?"
We introduced ourselves as best we could through a closed door, said we were outreach workers looking for a Sue L... and asked if we were at the right room.
"Well yes, of course this is the right room, I mean, how could it not be the right room, everybody knows that, of course, it goes without saying it says without going, it's obvious, of course, but the issue remains, I mean...who did you say you were?"
We could hear fumbling noises from inside the room, as if someone were moving furniture around, slowly redecorating while we stood there talking to the air, ignored. I felt about as foolish as usual. Art tried again.
"The Hotel Alert people have asked us to come by, to see if your nutrition is adequate; we have some granola bars here and some..."
"CANDY BARS ?", the same thick voice called out, much more interested now. "Well, I really wasn't expecting guests, I mean," furniture noises picking up tempo now, casters sliding along wood, "but CANDY!...the place is such a shambles, you'll have to forgive..." her voice trailed off as she threw open the door.
And there we were.
"Well, uh, granola bars, actually, health food," I heard Art mumble, after a moment.
"They're like candy, I guess, but better...for you...", I said, trying to regain some of the composure I had lost with her sudden appearance. I offered her a few of the snacks from my bag; "Are you Ms. L...?"
"Ms. L...?", she echoed, tearing off a wrapper and chewing thoughtfully on the treat. "Well! Of course I'm Ms. L...; I'm actually Mrs. L..., that's Susan L... L..., or Susie for short or long, I'm really not Ms. L... as you can plainly see, I'm Mrs. L..., although I used to be a Ms. at one point in time, but that was quite a while ago, and actually I wasn't 'Ms. L...' as such but rather 'Ms. L...', before becoming 'Mrs. L..., so I guess I'm really all of those designations, that is, of course, if one could be said to be a designation, I mean..."
As she chattered along in her distinctive, rhythmic gush, she sat back onto her bed positioned next to the door and I noticed it slide a little from her weight. The sound made me realize that this was the furniture we had heard being moved as we first arrived, shifted away from its place barring the door.
While Art tried to navigate his way through this flood of words, I took a moment to glance around the room. A glance was about all I could take. In spite of its tininess, the place spoke loudly, a litany of squalor.
Peeling paint hung in sheets out from the ceiling and the walls, revealing layers of undercoats in different colors and textures. Slashed diagonally across the wall opposite me, a huge crack ran deep enough to see glimmers of daylight outside, though not deep enough to add any real illumination to the gloom within. This, in turn, was caused by the torn, quilted cloth that had been hung over the rooms' single, broken window, an attempt to keep out the winter cold, largely unsuccessful.
In a corner, I could see that the small, stained sink had an ongoing drip; one of its handles had been wrapped with a rag in an apparent effort to get more leverage to shut it off. This, too, had failed. Bare wooden floors were carpeted only with discarded clothes and wrappers from potato chips, cookies and crackers long-since consumed and forgotten. On an aged dresser, the only piece of furniture in the room besides the bed, sat an ancient hot plate and a large, inverted paper bag.
Suddenly, I realized that the room was empty except for the three of us; the "conversation" that our arrival had interrupted had been a solitary one.
"These are good, very tasty," Susie was saying, as she finished off the last of the granola bars and looked over at me. I took the hint.
"Perhaps you'd like to keep a few for later, " I suggested, handing over a box.
"Oh, well, I mean yes, of course, I'll just pop them in the refrigerator to keep fresh, thank you", she enthused, rising and heading toward the dresser.
I started to say something to the effect that the food was wrapped to preserve it already and didn't really need to be...when I stopped myself and thought, "Refrigerator?"
As I watched, Susie carefully lifted up the paper bag on the top of the bureau revealing an open carton of milk underneath. She placed the box I had given her next to the milk, and then slowly inverted the bag, again positioning it over the two objects.
"You call that a refrigerator?", I asked, looking over at Art who had remained expressionless through this.
"Oh, well, of course, I mean, it acts just like one, you know it keeps out the germs and the light and the bastards and therefore functions as such..."
Art and I glanced at each other, working hard to absorb the implications of this rather bizarre theory of food preservation. Then we started to talk with Susie about her diet and eating habits. As the Hotel Alert staff had suspected, she subsisted mostly on fast food take-out procured through various runners sent to local shops and markets. She told us she was receiving Social Security Disability benefits, so we figured she could probably afford to spend her money in this way as her rent must have been minimal. Still, her haggard and unhealthy appearance, as well as a general air of lassitude around her, convinced us that she was not getting the food she needed. This was to say nothing of her strange speech, loose associations, and odd behaviors.
As usual with us, we tried to avoid pressing too far on a first contact call, so when we alluded gently to the dark masses on her face and she froze up, then changed the subject immediately, we let it go. We both felt that we had established a basically positive connection with her; all that remained was to get her assent to have us visit again the following week.
"Oh yes, do stop by to chat; I love a good chat," she assured us as we left.
The stairway was empty now as we made our way back towards the outreach car comparing impressions of our new client.
"I don't know if she'd technically qualify as 'malnourished'," Art said, kicking away garbage and stepping out to the street. "But she's certainly close to it; and that...that place is clearly the most despicable, unsanitary hovel I've ever seen!"
One of the things I liked most about Art was his sense of moral outrage, his real anger at the appalling circumstances in which so many of our clients had to live, homeless or not. Younger by a few years than most of us, Art was the newest member of the team, and a real addition to it. His background in Community Psychology, combined with a voracious intellect gave him insights and perspectives on our clients that were new to most of us. And as Lani was fond of pointing out, usually at the most inopportune times, his "little beard is just seriously cute..."
Now, he was fuming. Slamming the car into gear, he headed us back to the office, ranting about slumlords, and avarice, etc. All of us on the team had often had occasion to discuss the political issues of poverty in Los Angeles, the forces that kept it in place and our role in dealing with those forces. Over time we had come to the reluctant, but realistic conclusion that it was not our place to become agitators of social reform, or watchdogs over the city's slums: others supposedly already had those jobs. Our time and energy, like our skills, were limited and specific. So, eventually we would always return to the immediate question of what we could actually do for the people we encountered every day, here, now.
In Sue L'...s case, we decided in the car to bring as much nourishing food along with us in future visits as we could carry; this was to encourage better eating choices as well as to build rapport. Only then did we think we could broach some of the mental health issues that we thought were important with her.
"She had some pretty strange ideas," I said, "like about the refrigerator."
"To say nothing of the radio," Art replied.
"Radio? What radio?" I hadn't seen or heard one.
"It was on the floor beside the bed, near the foot. I think it was turned off, but it may have just been turned down while we were there; at any rate, I couldn't hear it at all. But she could. She was definitely responding to something from it whether it was turned on or not."
"I didn't notice."
"It was pretty subtle. Every once in a while when I was talking to her, she would move her head slightly towards the radio and say 'yeah' or 'uh-huh' very quietly. It was almost as if she were agreeing with what I was saying. But then she would nod - toward the radio. She wasn't addressing me."
"...the conversation when we arrived, before she opened the door."
"Yeah."
Over the next few weeks we noticed several more instances of this kind of interaction between Susie and her transistorized "friend". At first she appeared almost embarassed when we asked about it, but soon came to admit quite frankly that she heard voices coming from the radio constantly and regardless of whether or not it was turned on. While generally neutral in content, they would at times veer suddenly into darker, crueler, more intimate tones, sneering at her, commanding that she do things, to herself...
We tried to give her reality feedback on these "voices", and to offer our support in dealing with "them", limiting their effect on her, but with only mixed results. Susie was unable to grasp - or use - the notion that they were originating within her own mind. The fact that we couldn't hear them she attributed to some shortcoming in us, rather than entertain the idea that they might represent disowned, alienated parts of her own interior self. As with any fixed idea in someone's mind, it was just not amenable to reason, certainly not to argument, so we concentrated our efforts on trying to improve her external conditions.
Here, too, we often hit a brick wall. While she gratefully accepted most of the food we brought, we couldn't manage to get her next door for the hot daily meals available there. Instead, she would complain loudly of being too weak to even leave her room. Our sense of the situation was that this was an exaggeration if not an outright manipulation of us and others. She refused, we noticed, to have her condition examined by either a nurse or a clinic doctor, both of whom had agreed to make an (unprecedented) on-site visit with us. With no verification of a physical cause to her supposed "weakness", it was hard for us not to be frustrated by its self-fulfilling nature and to suspect a psychological basis.
Approaching it from this direction, I tried some basic "de-sensitization" work leading her - in her imagination - out of her room and into the street. Often such fantasy journeys, if done properly, can lead to real movement on the part of hesitant or phobic clients. In this case, I had to present it to her very casually, almost like a game, to get her to agree to even try it. Over the course of several weeks, we combined this work with a variety of other maneuvers to shake Susie's limiting perception of herself and her torpor, and to get her to step outside of her self-imposed constraints. It was slow going; her attention span was variable as was her commitment to this process, a process of challenging long-held and protective beliefs about herself. All things considered, I suppose it was a tribute to her courage that she achieved as much as she did, eventually walking around with us in the hallway of the hotel, and once, outside onto a back porch. I allowed myself to hope that this might be a new beginning that she could build upon, leading her out of that dismal wreck of a room and into more decent housing, perhaps even into the social possibilities of "group" meetings at the clinic.
At the same time, we all continued to be perplexed by the strange jellied lumps on her face and neck.
Sometimes they would appear to be soft and pliant, while on other visits, hard and crusty. Most frustrating to me was my inability to determine, from week to week, if the masses remained fixed, shifted position, grew or shrank. Any such changes were surely quite tiny, if they existed at all, but even that, I thought, might have been significant. So bizarre did these splotches appear, and so odd an effect did they have on us, that it took several weeks to gather the determination to confront her about them. Even then, it was to no avail: she shrugged them off as "beauty marks"(!), changed the subject, and refused to discuss them. We were left mystified and confused by all of this, and remained so - until we discovered that Susie had a son.

By this time, we had been visiting her for several months; the work was both slow and challenging. While her nutrition had improved with the addition to her diet of the fresh fruit and other foods we provided, our relationship with her remained rather tenuous. Mood swings were common during our visits as were varying states of consciousness: at times she would appear upbeat, chirpy and almost flirtatious. Then, suddenly, her manner would start to become withdrawn or querulous, her speech would ramble and her ideas take strange, dark forms. We would always try to "stay with her" during these changes, provide support as she dealt with whatever demons were upon her at the moment, but often we failed. She would find some pretext to push us away, followed immediately by intense demands for our help, and then tearfully withdraw again. It became clear over time that we were being tested, taken along with her on the same roller-coaster she was riding; what was not clear was how well we could survive the trip ourselves.
Often I would leave a meeting with her exhausted, angry or confused; at those times I knew her illness had taken me to the limits of my skill and patience and still she needed more from me than I could give. In my naivete, I thought "If only I knew more " about this strange woman, if only I had some kind of handle on her condition. Be careful what you wish for.
One day she caught us completely by surprise when she let it drop, quite casually, that a "relative" was coming to see her. This was a stunning revelation from someone who had always been utterly silent about her past life and family. Talking it over between ourselves later, Art and I decided that she must have been feeling rather nervous about the visit and needed to try to express some of that to a sympathetic ear. Her life being as circumscribed as it was, we figured that we were probably the only outlet she had for such confidences. Even then, she had remained rather cryptic about "him", telling us only that he was a "close family member" with whom she had "... a lot of disagreements."
It was not until we came to see her after his visit that she admitted the "relative" was her son, and that he lived in San Diego with his own family. More weeks of persuasion were required before Susie would give us his phone number and allow us to contact him; our hope was that we could involve him in her treatment planning.
When, at last, we reached the son by phone, the story he told us was both sad and shocking; at the same time, it opened up many of the locked doors Susie had placed between herself and the world.
His mother, he said, was an educated and intelligent woman driven deeper and deeper into what he called her "eccentricities" by a life-long, steadily increasing emotional instability. As a child he had watched as her relations with his father became more and more hysterical, at times nearly violent in her irrational demands. At the core of the problem seemed to be her enduring fears of her own unattractiveness and of her husband's infidelity.
"And God knows," the son said, "my father was no ladykiller. He just wanted to come home at the end of the day and put his feet up after dinner. But mom couldn't believe that he wasn't running around on her during work, at lunch, whatever." We had a chance to observe at first hand Susie's strength of convictions - about the voices from the radio - and it was easy to imagine her holding fiercely to such an idea about her husband once it had taken root. She had even gone so far as to become an authority on cosmetics in an effort to prop up her failing sense of her own beauty; a book she authored on the use of skin treatments had been published and well-received.
None of this, of course, made any difference to her husband since it was accompanied by constant verbal attacks on him and increasing accusations; he was only driven further away by her lack of trust and of self-esteem. Escalating emotionality over time lead to the predictable result: he walked out and filed for divorce. Susie's first hospitalization had occurred at this time, a brief stay on a ward in a private psych facility, diagnosis: reactive psychosis.
A number of other hospitalizations had followed over the years, each in response to a crisis or life-transition: when the divorce became final and the husband re-married, for example, or after a nasty car accident, even during the time when the son had finally separated himself from her by moving out of the family home. Each of these events seemed to contain within them a demand that she offer up another part of herself to her demons; in time she lost her youth, her beauty, her family, finally, her willingness to even try to get by any more. She filed for Social Security Disability benefits and moved to Skid Row.
Inquiring more about the "nasty" accident the son had mentioned, we inadvertently discovered the source of Susie's bizarre facial features. A car crash several years after the divorce had necessitated reconstructive facial surgery, a botched job that had produced the lumpy and geometrically square jaw that dominated her appearance. This, in turn, only served to fixate her even more obsessively on her looks. Her daily 'toilette' grew now to include hours spent rubbing different creams or oils into her cheeks in an effort to soften their appearance. Eventually, some of the excess from these treatments began to crystalize, to coagulate into spots, lumps. These were, today, the dark masses we found on her face, not growths or tumors, but crusty residues that she had allowed to remain. In a grotesque reversal of her original intent, continued use of such creams now served only to feed the dark spots and make her appearance weirder and more repellant.
"And you can't talk to her about it," he had said "she just ignores you, like it was nothing at all..."
By this time, Susie's withdrawal from a world that increasingly disagreed with her had become almost total; more and more, she wanted less and less from it. Now she was living alone in a near-empty room, "sending out" for bare necessities and sinking deeper into herself. Yet, even so, she was not at peace. The voices interceded harshly, rudely, between her and any hope of that.
"So," the young man had concluded,"I don't know what to do any more. I come up to see her once in a while now, when I can stand it, and she's living in that shithole like it was some grand estate. And we usually wind up fighting over nothing. And I give her some money before I go. And if I come up again, I know it's gonna be the same."
We were not encouraged by our discoveries.

Months passed, and our visits continued. The only real progress that any of us could see was a tiny movement on Susie's part towards more honesty with us. Now at least we could expect her to keep us reliably informed of the shifting tone her voices took as they moved from neutral murmurs to more caustic, cynical slurs and became mocking, taunting, threatening - terrifying.
Art, in particular, was able to calm and connect with her at the worst of these times, easing her through them with his soft voice and endless patience. I have a mental picture of him from this period that is clear, although it must be a composite from dozens of our visits. In it, he is standing quietly before her in the darkened room, hands in his pockets, listening to her, speaking, listening, repeatedly exchanging his peacefulness for her anguish in a gentle process that would eventually lead to silence. Only after we left and were driving off in the light of day could I see the new lines etched into his face.
Art. We kidded him about his hair turning gray, joked about his being an intellectual. (He was a Ph.D candidate.) I called him "Yuppie Scum!" whenever he wore Dockers instead of jeans on the street (the "official team uniform"), told him to "Go imitate life!" But it was his amazing gentleness that was leading the rest of us to hope we might eventually be able to reach Susie L..., in time, and help her climb out of the hole her life had dug her.
Then his employer, the County of Los Angeles, announced a new series of budget cuts and Art was laid off. In two weeks, he was gone.

The blow to team morale caused by Art's departure was staggering, but to Susie L... it was devastating; our best efforts, redoubled over the next few weeks, were insufficient to prevent her from withdrawing deeper into sadness and psychosis. Robert D... was working with me on her case now, for which I was deeply grateful; he had an intuitively sure touch with the most fragile of clients. We visited as frequently as we possibly could, two, three times a week. Still, in spite of her terror, we couldn't manage to draw her into the clinic for medication to quiet the voices, or to spend some time in the company of others learning in socialization groups to fight off similar, internal, assaults.
Now, it was as if she had a gaping void within her in the place where others felt the presence of their own will, their ability to take action. She would complain of "weakness" whenever we tried to move her, gently, slowly, towards an action she resisted, or feared. It seemed to us at the time that she had too great a need of being taken care of for her to risk an independent movement of any kind. So, she retreated to known, if horrifying, terrain: her room, her bed and her demons. We were powerless to do much more than visit, bring food, listen while she shared her fears, and pray for a break in what looked to be a hopelessly paralyzed situation.
When it finally arrived our "break" - if you could call it that - came from the most unlikely of sources...

Cruising the streets on our regular outreach rounds the following Thursday, Robert and I were ready to pack it in. It had been a light day for us so far. Welfare checks had come out two days before, so many otherwise homeless people had enough dollars for a few days hotel stay and the streets were quiet.
We turned in early and headed back to the team office at the Skid Row Mental Health Clinic, thinking to catch up on some overdue paperwork. Strolling into the Day Room, I glanced around the rows of mostly empty chairs flanking the filing cabinets, desks and other typical clinic furniture, my eyes coming to rest in the far corner...on Susie Lemon.
"Susie!" I said, walking quickly over to the shaking, tearful mass huddled as if she were trying to melt into the couch. "What are you...I mean, uh... hi, how are you?"
Not well, as it turned out, and for good reason: the slumlord who owned Susie's building had not only thrown her out, he had driven her to the Clinic in the Weingart Center and dumped her, with her few belongings, in the corner of Day Room. Here. You take care of her.
And was gone.
A quick interview revealed that, despite her quite understandable hysteria, his action had not been a personal comment or attack; he was merely "evicting" all his tenants so he could remodel, and re-sell, the building as more modern and more commercial. Knowledge of this, however, had little influence on Susie's disintegrating sense of self. Her always fragile grasp on reality had been assaulted too violently these past few months; we knew we had to move fast to get her into a placement that she would see as both comforting and protective. Here, we really did get a break: there was an opening at "Jill's Place".
Known formally as the Downtown Women's Center, this safe haven for the women of Skid Row had been created largely through the single-minded dedication of an extraordinary woman named Jill Halvorsen, and was always referred to as 'her' place by the people on the street. Starting out as just a drop-in center for day rest, it had grown over time into the single most accessible, clean, attractive - indeed, human - dwelling for at-risk women anywhere near Skid Row.
Three stories tall, the residence had been designed by leading architects in the city to convey a sense of "at-homeness" to its occupants. This was achieved through an inspired combination of muted colors inside and out, gentle archways defining space, and cozy communal areas alternating with large airy private rooms. These last contained all the necessities of basic housing - bed, small refrigerator and sink, closets, etc. - as well as room to personalize each one according to the wishes of the individual. In addition, two community meals were served daily by the staff, and all of this was protected by a security system from the predators cruising the streets just a few feet from its front door.
All in all, a model of how to do things right for people who most needed a secure place to call their own. The only problem any of us ever had with Jill's was that it was too small; it could only house a small fraction of the women who needed help, and turnover in tenancy was an understandably infrequent occurrence.
As I said, however, we were in luck. Since we had developed a good working relationship with Jill and her staff, we were aware that one of her ladies was leaving to return East to a family that had almost, but not quite, forgotten her. The timing worked out almost perfectly for us to slip Susie into the gap created. Brenda Mitchell, Jill's on-site manager of the center, agreed to do a fast interview with our client at the Clinic; with her approval, we then transported Susie over to her new home on Los Angeles Street.
After the trauma of the last few hours - and weeks! - we expected that this transition would be a difficult one for her, and we were right. Supporting her arm as we walked her in the front door for the first time, I could feel the tremors shaking her narrow frame and hear the shortness of her breathing. She was clearly somewhat dazzled by the lovely appointments in the halls and small TV lounge we passed through on the way to her quarters. Once arrived at her room, she settled herself on the bed and gazed wide-eyed around her, murmuring "Well, I mean, how opulent..." Compared to what she had been used to, it must have seemed palatial. In a few moments, however, she seemed unable to take in any more, curled up on the bed and pleaded to be left alone for the night. We complied.

In the days that followed, we made a point of not visiting too often, and not staying too long when we did stop by to monitor Susie's adjustment to her new surroundings. Our thought was to give her a break from our anxious ministrations of the previous weeks and let her find her own way among new faces. After a few weeks, however, we were starting to become nervous; she was showing very little interest in the community of which she was now a member.
Not that great demands or expectations were made of her: there was never any "tour director" rounding people up for mah-jong in the parlor at noon, etc. But reports we were getting from Brenda and others led us to think that old behavior patterns were trying to re-establish themselves in Susie's new home. She kept to herself in her room avoiding contact with staff and other residents except occasionally when she would try to wheedle someone into running to the store. Communal areas she avoided, even the lunchroom unless a staff person worked very hard to get her there for a hot meal. We had seen this before and had hoped we could draw her out of her reclusion once we had a more healthful environment for her to explore; we hoped to begin moving her more in this direction once her initial shock from the move was over. As was so often the case, however, circumstances beyond anyone's control took matters out of our hands, and quickly made our plans obsolete.
Late one night Susie had complained to staff of shortness of breath; they called the paramedics who took her to County/USC for observation. Very quickly she was given some medication and released. No one thought too much about it until a similar incident occurred to her a few days later; this time she was admitted to the hospital for further testing.
At first, I was of two minds about this development. On the one hand I was familiar enough with Susie's manipulations to wonder if this wasn't just an anxious plea for some attention, or for someone to cut her some slack. On the other, I was glad that her physical condition was finally being examined with some seriousness; no one of us had ever really understood her health needs and she had, previously, been utterly unwilling to be seen by medical staff. What none of us was prepared for was the kind of diagnosis that her tests indicated.
Robert and I had swung by the hospital to visit her late one day at the end of our usual outreach rounds. As we entered her room, we could hear Susie engaged in one of her customarily punctuated and effusive declamations, this one aimed at the nurse who was trying - courageously - to take her blood pressure.
"Well, it does hurt me, you know, in spite of your very best efforts to the contrary, and I of course do not intend to be contrary, but if you wouldn't mind very much not STRANGLING MY ARM with that VISE! it isn't a tourniquet, is it ?, nor is it meant to be..."
"Hello Susie," we greeted her, smiling and introducing ourselves to the nurse at her side. This was a pretty young woman who seemed to us strangely subdued in the face of the (only semi-serious) verbal battering she was getting from our client, her patient. Susie appeared to be in fairly good spirits, actually, enjoying the attention she was getting and not terribly concerned about her condition which, she felt, was improving. I noticed that the facial masses that had been such a dominating presence in her appearance had been removed. With a start I realized that this was the first time I had ever looked upon her face undisguised, and it was unsettling to me to see how smooth and clear her skin really was, underneath. What had she been hiding? (Stupid question.)
Robert and I chatted for the few minutes that we could spare then took our leave to go find Susie's nurse, who had quietly asked to see us before she withdrew. We located her at the central nurses station where she questioned us more closely about our involvement with Susie, examined our I.D. badges and listened carefully to our description of the outreach program. Finally, with a deep sigh, she seemed to accept our right to be there and to arrive at some kind of decision for herself. By this time, of course, both Robert and I were getting anxious in the face of her interrogation and the grim intensity of her manner; "What's the problem?", one of us finally said.
"Well," she said, "we don't usually discuss this with non-family members, but in this case the family has been ...unresponsive, and you guys seem to be pretty involved. I thought maybe you might want to be the ones to take some action." She took a deep breath, assumed a more clinical stance, and plunged on. "Your client has an Organic Brain Syndrome of unknown origin but of long duration. Her brain is shrinking, rapidly I'm afraid. The prognosis is terminal. She'll need a place to stay for a few months, but then..."
As she went on, explaining what the coming days would be like for Susie, the shock of what I was hearing washed over me.
Our work with sad Susie was almost done.
When the nurse was finished, we thanked her for her help and for allowing us to play a part in this final chapter, promised that we would be "arranging appropriate placement" for Susie's last days, took her card and promised to call when we had worked out the arrangements. Then we shuffled off, down the long corridors out of the hospital and back to the car.
We didn't talk much on the way back to the office. Robert was uncharacteristically somber, silent, and while I was upset, I didn't want to give voice to what I was really thinking: that Art should have been here with us. Someone should have been here to feel for Susie properly, and to mourn.
I couldn't do it. In spite of all the months of working with Susie, I remained - we all remained - curiously, at a distance from her still, saddened by her fate, surely, but...only sad, nothing more, nothing greater. Some bond of deep affection, some vital connection with her had been missed, so access to a greater grief was denied us. And that was the pity, not for Susie, but for a condition, a human condition, that somehow excluded pity, shut it out, made it unattainable.
I think we couldn't talk to each other in the car on the way back, Robert and I, because in the wake of Susie's final aloneness, we were both so completely adrift in our own.
??







McGuire/TALK


CHAPTER TWO: SAD SUSIE

"Candy??"
With the door flung wide, the speaker confronting us was startling: a woman, long, lean, gaunt, with powdery pale skin. A dirty, sleeveless, once-white shift hung limply around her stringy frame, draping down to the ground. The snow of her face was framed by a jet black halo of hair and pierced by two glowing, coal-black eyes, their expression one of abject panic.
"CANDY?" she croaked again.
Most disturbing to me at the moment, however, were the thick globs of a gelatin-like substance that covered parts of her neck, cheeks and huge "lantern" jaw. Thick and pebbly in places, they gave her face a sort of brindled appearance, like you might find on an animal, perhaps a cow; at the same time, their oiliness was vaguely reptilian.
Hovering, almost floating there in the shadows of the doorway, she somehow gave the unsettling impression of both moving out to us - Art and me, standing in the hall - while simultaneously receding back into the murky depths of the darkened room behind her.
We all stared at each other for what seemed like a very long minute; she found her voice again, repeating, "CANDY?"
In a sudden, disorienting shift of perspective, I found myself wondering if we looked as strange through her eyes as she did through ours...

Some background:
With our outreach work becoming better known throughout the downtown area, referral calls had started to flow in to us from a wide variety of sources: businesses, church groups, individuals, even occasionally from other service organizations that had come across someone with needs they were unable to fill.
"Hotel Alert" was such a group, providing food and a certain amount of personal contact for the people living on Skid Row. Their specific goal was to serve at least one hot meal daily, usually in the lobby of whatever hotels would allow them access, and always at reduced prices affordable for those on limited or fixed incomes (SSI or GR, most often.)
Meals became social occasions for the isolated, often elderly tenants of small single rooms. They were served graciously by H.A. staff members who also used the time with the diners to check on their mental and physical health, see if someone was in need of medication or, perhaps too frail to live alone any longer, etc. Such informal assessments would sometimes lead to a referral for an outreach worker to make a more thorough evaluation.
In Sue L...'s case, the staff member who called us had his interest attracted by her unusually vehement refusal of their meal service. At first, he had thought little of it - to each his or her own - but then rumors of her bizarre eating habits and behavior started trickling in from other tenants.
Her particular hotel was, we were told, quite tiny; since there existed no large public space there, an arrangement had been made in which the tenants were served in an adjacent hotel's lobby. Susie, however, would not walk the few feet next door, or even (it appeared) leave her room. Instead, she bribed or cajoled others to act as go-fers at all hours, sending out for an endless supply of junk food snacks and desserts. The Hotel Alert staff was concerned that she might be seriously malnourished. We, in addition, suspected that she might be agoraphobic, an unusual diagnosis for us to be dealing with, admittedly, but we thought we could at least take a look.
Our work up to this time had taken us into quite a few hotels on Skid Row, and it seemed to me then that they basically fell into two distinct types. By far the best were those owned and operated by the Single Room Occupancy Corporation. Publicly funded, SRO's mandate was to buy and renovate older hotels in the downtown area, bringing them up to a condition that was "decent, safe, and sanitary"; at the same time, their rents must remain accessible to those on tiny fixed incomes such as General Relief. Under their director, Andy R., however, SRO's results always far exceeded these minimum standards. A great, grizzled teddy-bear of a man, Andy was a fixture on the Row, and fiercely committed to his work. Without exception, the properties he re-opened were well-designed and maintained, attractive and comfortable. Individual rooms were small, of course, and far from luxurious, but still they stood head and shoulders over anything else available. Whenever possible I would try first to place one of my homeless clients in an SRO hotel before even considering any other options.
The other category of hotel with which I was familiar encompassed the privately-owned, and usually un-renovated buildings that were much more common. To me, these seemed generally shabbier in appearance than SRO's, with hall carpeting torn and stained, peeling plaster throughout public and private areas, and a certain general lack of cleanliness, the kind that can easily come to pervade a building. Often, though the rooms might actually be larger than an SRO room, they were far less comfortable due to older, decaying appointments and furniture. In addition, we often found that many of these hotels were less safe for their occupants due to laxness in security and rental policies. Still, I have to admit that most of them were at least adequate, providing basic shelter cheaply.
Entering Sue L...'s hotel for the first time, however, I realized that there was a third category of which I had previously been unaware.
We could tell from the address that her hotel was located in that section of Fifth Street nicknamed by locals - not affectionately - "the kitchen" (as in "if you can't stand the heat...") Cruising along in the outreach car we passed a few of the street's more squalid hole-in-the-wall stores and flops, until I called out to Art, who was driving, "Hold on, we must have passed it. Let's park and walk back."
Searching for numbers on the facades of the crumbling structures as we went, I soon realized how we had missed it. The entranceway was tiny, un-numbered and completely unmarked, and so choked by garbage piled in front as to be almost invisible. The "hotel" was upstairs, a second-floor walk-up over a dingy liquor store.
As we started up the wide staircase, I smiled, said "Excuse me, gentlemen" to the junkies quietly cooking their fixes on the steps. They glanced up at us disinterestedly and I patted them gently on the arm to move them aside. They gave way to us slowly, then continued their business as we stepped over and around them. Such encounters were common in "the kitchen." I didn't expect any trouble from them and we didn't get any.
At the top of the stairs, a wrecked gate half-hung across the entrance to a drab hallway, uncarpeted and piled with the same mounds of garbage that stood in front of the building.
"Maybe they're waiting for the boys on the steps to finish up, so they can just kick this junk downstairs," I suggested to Art.
He smiled, started down the hall searching for the room number we had been given. It was no easy task in the dirty gloom we were moving through, an almost greasy murkiness cut only briefly, every few yards, by a dim, bare bulb. The corridor we were in formed a square around a central core. Following it slowly, we barely managed to read the few room numbers that remained on the rough, unpainted doors.
In one place, not only the number but the door itself was missing; apparently, the owners had decided it was an unnecessary luxury - for the one communal toilet. Unoccupied, it still threw off a strong fecal reek as we passed and I could see, through rotting floorboards beneath a stained urinal, into a space far below. I wondered if it was the liquor store's stock room.
Occasionally, we could hear music seeping from behind a partly opened door. Once we encountered a small, naked baby boy sitting in the doorway of a crowded room; as Art stooped down to say hello, the child was whisked briskly back inside, the door hurriedly shut. Behind it, a murmur of voices in Spanish marked our passing.
Finally, rounding a corner, we interpolated between two marked doors and decided that a middle one had to be our destination. Art glanced over at me - Ready? - and knocked.
Immediately, a conversation that had been going on inside came to an abrupt halt. After a moment a throaty voice called out, "Who's there?"
We introduced ourselves as best we could through a closed door, said we were outreach workers looking for a Sue L... and asked if we were at the right room.
"Well yes, of course this is the right room, I mean, how could it not be the right room, everybody knows that, of course, it goes without saying it says without going, it's obvious, of course, but the issue remains, I mean...who did you say you were?"
We could hear fumbling noises from inside the room, as if someone were moving furniture around, slowly redecorating while we stood there talking to the air, ignored. I felt about as foolish as usual. Art tried again.
"The Hotel Alert people have asked us to come by, to see if your nutrition is adequate; we have some granola bars here and some..."
"CANDY BARS ?", the same thick voice called out, much more interested now. "Well, I really wasn't expecting guests, I mean," furniture noises picking up tempo now, casters sliding along wood, "but CANDY!...the place is such a shambles, you'll have to forgive..." her voice trailed off as she threw open the door.
And there we were.
"Well, uh, granola bars, actually, health food," I heard Art mumble, after a moment.
"They're like candy, I guess, but better...for you...", I said, trying to regain some of the composure I had lost with her sudden appearance. I offered her a few of the snacks from my bag; "Are you Ms. L...?"
"Ms. L...?", she echoed, tearing off a wrapper and chewing thoughtfully on the treat. "Well! Of course I'm Ms. L...; I'm actually Mrs. L..., that's Susan L... L..., or Susie for short or long, I'm really not Ms. L... as you can plainly see, I'm Mrs. L..., although I used to be a Ms. at one point in time, but that was quite a while ago, and actually I wasn't 'Ms. L...' as such but rather 'Ms. L...', before becoming 'Mrs. L..., so I guess I'm really all of those designations, that is, of course, if one could be said to be a designation, I mean..."
As she chattered along in her distinctive, rhythmic gush, she sat back onto her bed positioned next to the door and I noticed it slide a little from her weight. The sound made me realize that this was the furniture we had heard being moved as we first arrived, shifted away from its place barring the door.
While Art tried to navigate his way through this flood of words, I took a moment to glance around the room. A glance was about all I could take. In spite of its tininess, the place spoke loudly, a litany of squalor.
Peeling paint hung in sheets out from the ceiling and the walls, revealing layers of undercoats in different colors and textures. Slashed diagonally across the wall opposite me, a huge crack ran deep enough to see glimmers of daylight outside, though not deep enough to add any real illumination to the gloom within. This, in turn, was caused by the torn, quilted cloth that had been hung over the rooms' single, broken window, an attempt to keep out the winter cold, largely unsuccessful.
In a corner, I could see that the small, stained sink had an ongoing drip; one of its handles had been wrapped with a rag in an apparent effort to get more leverage to shut it off. This, too, had failed. Bare wooden floors were carpeted only with discarded clothes and wrappers from potato chips, cookies and crackers long-since consumed and forgotten. On an aged dresser, the only piece of furniture in the room besides the bed, sat an ancient hot plate and a large, inverted paper bag.
Suddenly, I realized that the room was empty except for the three of us; the "conversation" that our arrival had interrupted had been a solitary one.
"These are good, very tasty," Susie was saying, as she finished off the last of the granola bars and looked over at me. I took the hint.
"Perhaps you'd like to keep a few for later, " I suggested, handing over a box.
"Oh, well, I mean yes, of course, I'll just pop them in the refrigerator to keep fresh, thank you", she enthused, rising and heading toward the dresser.
I started to say something to the effect that the food was wrapped to preserve it already and didn't really need to be...when I stopped myself and thought, "Refrigerator?"
As I watched, Susie carefully lifted up the paper bag on the top of the bureau revealing an open carton of milk underneath. She placed the box I had given her next to the milk, and then slowly inverted the bag, again positioning it over the two objects.
"You call that a refrigerator?", I asked, looking over at Art who had remained expressionless through this.
"Oh, well, of course, I mean, it acts just like one, you know it keeps out the germs and the light and the bastards and therefore functions as such..."
Art and I glanced at each other, working hard to absorb the implications of this rather bizarre theory of food preservation. Then we started to talk with Susie about her diet and eating habits. As the Hotel Alert staff had suspected, she subsisted mostly on fast food take-out procured through various runners sent to local shops and markets. She told us she was receiving Social Security Disability benefits, so we figured she could probably afford to spend her money in this way as her rent must have been minimal. Still, her haggard and unhealthy appearance, as well as a general air of lassitude around her, convinced us that she was not getting the food she needed. This was to say nothing of her strange speech, loose associations, and odd behaviors.
As usual with us, we tried to avoid pressing too far on a first contact call, so when we alluded gently to the dark masses on her face and she froze up, then changed the subject immediately, we let it go. We both felt that we had established a basically positive connection with her; all that remained was to get her assent to have us visit again the following week.
"Oh yes, do stop by to chat; I love a good chat," she assured us as we left.
The stairway was empty now as we made our way back towards the outreach car comparing impressions of our new client.
"I don't know if she'd technically qualify as 'malnourished'," Art said, kicking away garbage and stepping out to the street. "But she's certainly close to it; and that...that place is clearly the most despicable, unsanitary hovel I've ever seen!"
One of the things I liked most about Art was his sense of moral outrage, his real anger at the appalling circumstances in which so many of our clients had to live, homeless or not. Younger by a few years than most of us, Art was the newest member of the team, and a real addition to it. His background in Community Psychology, combined with a voracious intellect gave him insights and perspectives on our clients that were new to most of us. And as Lani was fond of pointing out, usually at the most inopportune times, his "little beard is just seriously cute..."
Now, he was fuming. Slamming the car into gear, he headed us back to the office, ranting about slumlords, and avarice, etc. All of us on the team had often had occasion to discuss the political issues of poverty in Los Angeles, the forces that kept it in place and our role in dealing with those forces. Over time we had come to the reluctant, but realistic conclusion that it was not our place to become agitators of social reform, or watchdogs over the city's slums: others supposedly already had those jobs. Our time and energy, like our skills, were limited and specific. So, eventually we would always return to the immediate question of what we could actually do for the people we encountered every day, here, now.
In Sue L'...s case, we decided in the car to bring as much nourishing food along with us in future visits as we could carry; this was to encourage better eating choices as well as to build rapport. Only then did we think we could broach some of the mental health issues that we thought were important with her.
"She had some pretty strange ideas," I said, "like about the refrigerator."
"To say nothing of the radio," Art replied.
"Radio? What radio?" I hadn't seen or heard one.
"It was on the floor beside the bed, near the foot. I think it was turned off, but it may have just been turned down while we were there; at any rate, I couldn't hear it at all. But she could. She was definitely responding to something from it whether it was turned on or not."
"I didn't notice."
"It was pretty subtle. Every once in a while when I was talking to her, she would move her head slightly towards the radio and say 'yeah' or 'uh-huh' very quietly. It was almost as if she were agreeing with what I was saying. But then she would nod - toward the radio. She wasn't addressing me."
"...the conversation when we arrived, before she opened the door."
"Yeah."
Over the next few weeks we noticed several more instances of this kind of interaction between Susie and her transistorized "friend". At first she appeared almost embarassed when we asked about it, but soon came to admit quite frankly that she heard voices coming from the radio constantly and regardless of whether or not it was turned on. While generally neutral in content, they would at times veer suddenly into darker, crueler, more intimate tones, sneering at her, commanding that she do things, to herself...
We tried to give her reality feedback on these "voices", and to offer our support in dealing with "them", limiting their effect on her, but with only mixed results. Susie was unable to grasp - or use - the notion that they were originating within her own mind. The fact that we couldn't hear them she attributed to some shortcoming in us, rather than entertain the idea that they might represent disowned, alienated parts of her own interior self. As with any fixed idea in someone's mind, it was just not amenable to reason, certainly not to argument, so we concentrated our efforts on trying to improve her external conditions.
Here, too, we often hit a brick wall. While she gratefully accepted most of the food we brought, we couldn't manage to get her next door for the hot daily meals available there. Instead, she would complain loudly of being too weak to even leave her room. Our sense of the situation was that this was an exaggeration if not an outright manipulation of us and others. She refused, we noticed, to have her condition examined by either a nurse or a clinic doctor, both of whom had agreed to make an (unprecedented) on-site visit with us. With no verification of a physical cause to her supposed "weakness", it was hard for us not to be frustrated by its self-fulfilling nature and to suspect a psychological basis.
Approaching it from this direction, I tried some basic "de-sensitization" work leading her - in her imagination - out of her room and into the street. Often such fantasy journeys, if done properly, can lead to real movement on the part of hesitant or phobic clients. In this case, I had to present it to her very casually, almost like a game, to get her to agree to even try it. Over the course of several weeks, we combined this work with a variety of other maneuvers to shake Susie's limiting perception of herself and her torpor, and to get her to step outside of her self-imposed constraints. It was slow going; her attention span was variable as was her commitment to this process, a process of challenging long-held and protective beliefs about herself. All things considered, I suppose it was a tribute to her courage that she achieved as much as she did, eventually walking around with us in the hallway of the hotel, and once, outside onto a back porch. I allowed myself to hope that this might be a new beginning that she could build upon, leading her out of that dismal wreck of a room and into more decent housing, perhaps even into the social possibilities of "group" meetings at the clinic.
At the same time, we all continued to be perplexed by the strange jellied lumps on her face and neck.
Sometimes they would appear to be soft and pliant, while on other visits, hard and crusty. Most frustrating to me was my inability to determine, from week to week, if the masses remained fixed, shifted position, grew or shrank. Any such changes were surely quite tiny, if they existed at all, but even that, I thought, might have been significant. So bizarre did these splotches appear, and so odd an effect did they have on us, that it took several weeks to gather the determination to confront her about them. Even then, it was to no avail: she shrugged them off as "beauty marks"(!), changed the subject, and refused to discuss them. We were left mystified and confused by all of this, and remained so - until we discovered that Susie had a son.

By this time, we had been visiting her for several months; the work was both slow and challenging. While her nutrition had improved with the addition to her diet of the fresh fruit and other foods we provided, our relationship with her remained rather tenuous. Mood swings were common during our visits as were varying states of consciousness: at times she would appear upbeat, chirpy and almost flirtatious. Then, suddenly, her manner would start to become withdrawn or querulous, her speech would ramble and her ideas take strange, dark forms. We would always try to "stay with her" during these changes, provide support as she dealt with whatever demons were upon her at the moment, but often we failed. She would find some pretext to push us away, followed immediately by intense demands for our help, and then tearfully withdraw again. It became clear over time that we were being tested, taken along with her on the same roller-coaster she was riding; what was not clear was how well we could survive the trip ourselves.
Often I would leave a meeting with her exhausted, angry or confused; at those times I knew her illness had taken me to the limits of my skill and patience and still she needed more from me than I could give. In my naivete, I thought "If only I knew more " about this strange woman, if only I had some kind of handle on her condition. Be careful what you wish for.
One day she caught us completely by surprise when she let it drop, quite casually, that a "relative" was coming to see her. This was a stunning revelation from someone who had always been utterly silent about her past life and family. Talking it over between ourselves later, Art and I decided that she must have been feeling rather nervous about the visit and needed to try to express some of that to a sympathetic ear. Her life being as circumscribed as it was, we figured that we were probably the only outlet she had for such confidences. Even then, she had remained rather cryptic about "him", telling us only that he was a "close family member" with whom she had "... a lot of disagreements."
It was not until we came to see her after his visit that she admitted the "relative" was her son, and that he lived in San Diego with his own family. More weeks of persuasion were required before Susie would give us his phone number and allow us to contact him; our hope was that we could involve him in her treatment planning.
When, at last, we reached the son by phone, the story he told us was both sad and shocking; at the same time, it opened up many of the locked doors Susie had placed between herself and the world.
His mother, he said, was an educated and intelligent woman driven deeper and deeper into what he called her "eccentricities" by a life-long, steadily increasing emotional instability. As a child he had watched as her relations with his father became more and more hysterical, at times nearly violent in her irrational demands. At the core of the problem seemed to be her enduring fears of her own unattractiveness and of her husband's infidelity.
"And God knows," the son said, "my father was no ladykiller. He just wanted to come home at the end of the day and put his feet up after dinner. But mom couldn't believe that he wasn't running around on her during work, at lunch, whatever." We had a chance to observe at first hand Susie's strength of convictions - about the voices from the radio - and it was easy to imagine her holding fiercely to such an idea about her husband once it had taken root. She had even gone so far as to become an authority on cosmetics in an effort to prop up her failing sense of her own beauty; a book she authored on the use of skin treatments had been published and well-received.
None of this, of course, made any difference to her husband since it was accompanied by constant verbal attacks on him and increasing accusations; he was only driven further away by her lack of trust and of self-esteem. Escalating emotionality over time lead to the predictable result: he walked out and filed for divorce. Susie's first hospitalization had occurred at this time, a brief stay on a ward in a private psych facility, diagnosis: reactive psychosis.
A number of other hospitalizations had followed over the years, each in response to a crisis or life-transition: when the divorce became final and the husband re-married, for example, or after a nasty car accident, even during the time when the son had finally separated himself from her by moving out of the family home. Each of these events seemed to contain within them a demand that she offer up another part of herself to her demons; in time she lost her youth, her beauty, her family, finally, her willingness to even try to get by any more. She filed for Social Security Disability benefits and moved to Skid Row.
Inquiring more about the "nasty" accident the son had mentioned, we inadvertently discovered the source of Susie's bizarre facial features. A car crash several years after the divorce had necessitated reconstructive facial surgery, a botched job that had produced the lumpy and geometrically square jaw that dominated her appearance. This, in turn, only served to fixate her even more obsessively on her looks. Her daily 'toilette' grew now to include hours spent rubbing different creams or oils into her cheeks in an effort to soften their appearance. Eventually, some of the excess from these treatments began to crystalize, to coagulate into spots, lumps. These were, today, the dark masses we found on her face, not growths or tumors, but crusty residues that she had allowed to remain. In a grotesque reversal of her original intent, continued use of such creams now served only to feed the dark spots and make her appearance weirder and more repellant.
"And you can't talk to her about it," he had said "she just ignores you, like it was nothing at all..."
By this time, Susie's withdrawal from a world that increasingly disagreed with her had become almost total; more and more, she wanted less and less from it. Now she was living alone in a near-empty room, "sending out" for bare necessities and sinking deeper into herself. Yet, even so, she was not at peace. The voices interceded harshly, rudely, between her and any hope of that.
"So," the young man had concluded,"I don't know what to do any more. I come up to see her once in a while now, when I can stand it, and she's living in that shithole like it was some grand estate. And we usually wind up fighting over nothing. And I give her some money before I go. And if I come up again, I know it's gonna be the same."
We were not encouraged by our discoveries.

Months passed, and our visits continued. The only real progress that any of us could see was a tiny movement on Susie's part towards more honesty with us. Now at least we could expect her to keep us reliably informed of the shifting tone her voices took as they moved from neutral murmurs to more caustic, cynical slurs and became mocking, taunting, threatening - terrifying.
Art, in particular, was able to calm and connect with her at the worst of these times, easing her through them with his soft voice and endless patience. I have a mental picture of him from this period that is clear, although it must be a composite from dozens of our visits. In it, he is standing quietly before her in the darkened room, hands in his pockets, listening to her, speaking, listening, repeatedly exchanging his peacefulness for her anguish in a gentle process that would eventually lead to silence. Only after we left and were driving off in the light of day could I see the new lines etched into his face.
Art. We kidded him about his hair turning gray, joked about his being an intellectual. (He was a Ph.D candidate.) I called him "Yuppie Scum!" whenever he wore Dockers instead of jeans on the street (the "official team uniform"), told him to "Go imitate life!" But it was his amazing gentleness that was leading the rest of us to hope we might eventually be able to reach Susie L..., in time, and help her climb out of the hole her life had dug her.
Then his employer, the County of Los Angeles, announced a new series of budget cuts and Art was laid off. In two weeks, he was gone.

The blow to team morale caused by Art's departure was staggering, but to Susie L... it was devastating; our best efforts, redoubled over the next few weeks, were insufficient to prevent her from withdrawing deeper into sadness and psychosis. Robert D... was working with me on her case now, for which I was deeply grateful; he had an intuitively sure touch with the most fragile of clients. We visited as frequently as we possibly could, two, three times a week. Still, in spite of her terror, we couldn't manage to draw her into the clinic for medication to quiet the voices, or to spend some time in the company of others learning in socialization groups to fight off similar, internal, assaults.
Now, it was as if she had a gaping void within her in the place where others felt the presence of their own will, their ability to take action. She would complain of "weakness" whenever we tried to move her, gently, slowly, towards an action she resisted, or feared. It seemed to us at the time that she had too great a need of being taken care of for her to risk an independent movement of any kind. So, she retreated to known, if horrifying, terrain: her room, her bed and her demons. We were powerless to do much more than visit, bring food, listen while she shared her fears, and pray for a break in what looked to be a hopelessly paralyzed situation.
When it finally arrived our "break" - if you could call it that - came from the most unlikely of sources...

Cruising the streets on our regular outreach rounds the following Thursday, Robert and I were ready to pack it in. It had been a light day for us so far. Welfare checks had come out two days before, so many otherwise homeless people had enough dollars for a few days hotel stay and the streets were quiet.
We turned in early and headed back to the team office at the Skid Row Mental Health Clinic, thinking to catch up on some overdue paperwork. Strolling into the Day Room, I glanced around the rows of mostly empty chairs flanking the filing cabinets, desks and other typical clinic furniture, my eyes coming to rest in the far corner...on Susie Lemon.
"Susie!" I said, walking quickly over to the shaking, tearful mass huddled as if she were trying to melt into the couch. "What are you...I mean, uh... hi, how are you?"
Not well, as it turned out, and for good reason: the slumlord who owned Susie's building had not only thrown her out, he had driven her to the Clinic in the Weingart Center and dumped her, with her few belongings, in the corner of Day Room. Here. You take care of her.
And was gone.
A quick interview revealed that, despite her quite understandable hysteria, his action had not been a personal comment or attack; he was merely "evicting" all his tenants so he could remodel, and re-sell, the building as more modern and more commercial. Knowledge of this, however, had little influence on Susie's disintegrating sense of self. Her always fragile grasp on reality had been assaulted too violently these past few months; we knew we had to move fast to get her into a placement that she would see as both comforting and protective. Here, we really did get a break: there was an opening at "Jill's Place".
Known formally as the Downtown Women's Center, this safe haven for the women of Skid Row had been created largely through the single-minded dedication of an extraordinary woman named Jill Halvorsen, and was always referred to as 'her' place by the people on the street. Starting out as just a drop-in center for day rest, it had grown over time into the single most accessible, clean, attractive - indeed, human - dwelling for at-risk women anywhere near Skid Row.
Three stories tall, the residence had been designed by leading architects in the city to convey a sense of "at-homeness" to its occupants. This was achieved through an inspired combination of muted colors inside and out, gentle archways defining space, and cozy communal areas alternating with large airy private rooms. These last contained all the necessities of basic housing - bed, small refrigerator and sink, closets, etc. - as well as room to personalize each one according to the wishes of the individual. In addition, two community meals were served daily by the staff, and all of this was protected by a security system from the predators cruising the streets just a few feet from its front door.
All in all, a model of how to do things right for people who most needed a secure place to call their own. The only problem any of us ever had with Jill's was that it was too small; it could only house a small fraction of the women who needed help, and turnover in tenancy was an understandably infrequent occurrence.
As I said, however, we were in luck. Since we had developed a good working relationship with Jill and her staff, we were aware that one of her ladies was leaving to return East to a family that had almost, but not quite, forgotten her. The timing worked out almost perfectly for us to slip Susie into the gap created. Brenda Mitchell, Jill's on-site manager of the center, agreed to do a fast interview with our client at the Clinic; with her approval, we then transported Susie over to her new home on Los Angeles Street.
After the trauma of the last few hours - and weeks! - we expected that this transition would be a difficult one for her, and we were right. Supporting her arm as we walked her in the front door for the first time, I could feel the tremors shaking her narrow frame and hear the shortness of her breathing. She was clearly somewhat dazzled by the lovely appointments in the halls and small TV lounge we passed through on the way to her quarters. Once arrived at her room, she settled herself on the bed and gazed wide-eyed around her, murmuring "Well, I mean, how opulent..." Compared to what she had been used to, it must have seemed palatial. In a few moments, however, she seemed unable to take in any more, curled up on the bed and pleaded to be left alone for the night. We complied.

In the days that followed, we made a point of not visiting too often, and not staying too long when we did stop by to monitor Susie's adjustment to her new surroundings. Our thought was to give her a break from our anxious ministrations of the previous weeks and let her find her own way among new faces. After a few weeks, however, we were starting to become nervous; she was showing very little interest in the community of which she was now a member.
Not that great demands or expectations were made of her: there was never any "tour director" rounding people up for mah-jong in the parlor at noon, etc. But reports we were getting from Brenda and others led us to think that old behavior patterns were trying to re-establish themselves in Susie's new home. She kept to herself in her room avoiding contact with staff and other residents except occasionally when she would try to wheedle someone into running to the store. Communal areas she avoided, even the lunchroom unless a staff person worked very hard to get her there for a hot meal. We had seen this before and had hoped we could draw her out of her reclusion once we had a more healthful environment for her to explore; we hoped to begin moving her more in this direction once her initial shock from the move was over. As was so often the case, however, circumstances beyond anyone's control took matters out of our hands, and quickly made our plans obsolete.
Late one night Susie had complained to staff of shortness of breath; they called the paramedics who took her to County/USC for observation. Very quickly she was given some medication and released. No one thought too much about it until a similar incident occurred to her a few days later; this time she was admitted to the hospital for further testing.
At first, I was of two minds about this development. On the one hand I was familiar enough with Susie's manipulations to wonder if this wasn't just an anxious plea for some attention, or for someone to cut her some slack. On the other, I was glad that her physical condition was finally being examined with some seriousness; no one of us had ever really understood her health needs and she had, previously, been utterly unwilling to be seen by medical staff. What none of us was prepared for was the kind of diagnosis that her tests indicated.
Robert and I had swung by the hospital to visit her late one day at the end of our usual outreach rounds. As we entered her room, we could hear Susie engaged in one of her customarily punctuated and effusive declamations, this one aimed at the nurse who was trying - courageously - to take her blood pressure.
"Well, it does hurt me, you know, in spite of your very best efforts to the contrary, and I of course do not intend to be contrary, but if you wouldn't mind very much not STRANGLING MY ARM with that VISE! it isn't a tourniquet, is it ?, nor is it meant to be..."
"Hello Susie," we greeted her, smiling and introducing ourselves to the nurse at her side. This was a pretty young woman who seemed to us strangely subdued in the face of the (only semi-serious) verbal battering she was getting from our client, her patient. Susie appeared to be in fairly good spirits, actually, enjoying the attention she was getting and not terribly concerned about her condition which, she felt, was improving. I noticed that the facial masses that had been such a dominating presence in her appearance had been removed. With a start I realized that this was the first time I had ever looked upon her face undisguised, and it was unsettling to me to see how smooth and clear her skin really was, underneath. What had she been hiding? (Stupid question.)
Robert and I chatted for the few minutes that we could spare then took our leave to go find Susie's nurse, who had quietly asked to see us before she withdrew. We located her at the central nurses station where she questioned us more closely about our involvement with Susie, examined our I.D. badges and listened carefully to our description of the outreach program. Finally, with a deep sigh, she seemed to accept our right to be there and to arrive at some kind of decision for herself. By this time, of course, both Robert and I were getting anxious in the face of her interrogation and the grim intensity of her manner; "What's the problem?", one of us finally said.
"Well," she said, "we don't usually discuss this with non-family members, but in this case the family has been ...unresponsive, and you guys seem to be pretty involved. I thought maybe you might want to be the ones to take some action." She took a deep breath, assumed a more clinical stance, and plunged on. "Your client has an Organic Brain Syndrome of unknown origin but of long duration. Her brain is shrinking, rapidly I'm afraid. The prognosis is terminal. She'll need a place to stay for a few months, but then..."
As she went on, explaining what the coming days would be like for Susie, the shock of what I was hearing washed over me.
Our work with sad Susie was almost done.
When the nurse was finished, we thanked her for her help and for allowing us to play a part in this final chapter, promised that we would be "arranging appropriate placement" for Susie's last days, took her card and promised to call when we had worked out the arrangements. Then we shuffled off, down the long corridors out of the hospital and back to the car.
We didn't talk much on the way back to the office. Robert was uncharacteristically somber, silent, and while I was upset, I didn't want to give voice to what I was really thinking: that Art should have been here with us. Someone should have been here to feel for Susie properly, and to mourn.
I couldn't do it. In spite of all the months of working with Susie, I remained - we all remained - curiously, at a distance from her still, saddened by her fate, surely, but...only sad, nothing more, nothing greater. Some bond of deep affection, some vital connection with her had been missed, so access to a greater grief was denied us. And that was the pity, not for Susie, but for a condition, a human condition, that somehow excluded pity, shut it out, made it unattainable.
I think we couldn't talk to each other in the car on the way back, Robert and I, because in the wake of Susie's final aloneness, we were both so completely adrift in our own.





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Talk to me! (Chapter 1-Roger Doe)
Talk to me! (Chapter 2-Sad Susie)