During a panel designed to humanize mental illness for me and my fellow preclinical students, a round, but well-kempt bearded man unfolded the details of his life with schizophrenia. He spoke of how his illness had led to years of homelessness, and he recounted in vivid detail the small slights over those years that had dehumanized him. While homeless, what hurt him the most was the lack of acknowledgment. Days would pass without anyone saying good morning or looking him in the eyes. Fear pervaded his stories, and, though his demeanor was well controlled, he quivered while reliving those 13 hard years.
After sharing a particularly vicious anecdote, in which he described waking up to several teenagers urinating on him, he paused to a deafening silence. Inexplicably he relaxed fully, taking in a deep breath and letting it out slowly. Then he told the story of how he came off the street. On a cold night seven years prior, he was contemplating suicide, when he was interrupted by a physician who worked for the organization he was representing on the panel. This physician crawled into the bush where he was hiding out and asked him to come to a shelter for a warm bed. A tear slid down the face of this courageous storyteller as he recounted his miracle—help met trust after years of near misses.
The panel made quite an impression on me and my classmates. We asked ourselves, could we be that physician?
A year later, I was walking from my apartment to a pharmacology class when I saw a man in shorts and a ratty windbreaker. His scruffy beard and odd affect were out of place, and my gaze lingered long enough that we made eye contact. Momentarily I felt uncomfortable, but I recalled something from that panel and said good morning.
“Merry Christmas, sir!” was the cheery rejoinder.
It was March.
I walked five more yards then stopped, turned, and asked, “Are you okay?”
The man in shorts jumped to his feet, but as he approached, I sensed no danger. “Very fine, sir, it’s a beautiful morning, sir, the neighborhood seems nice.…” He spoke quickly and continuously and occasionally answered my questions.
“Where are you from?”
“Wisconsin, that’s where my girlfriend and family is from.”
“Are you feeling alright?”
“Well you see, I have schizophrenia, and I stopped taking my medicine last week or seven years ago, and I don’t know where they is.”
His story echoed a story I had heard before—diagnosed with schizophrenia, off his medication, had not seen his parents or longtime girlfriend in years, a dizzying array of cities, places, times, and feelings racing by.
Not really knowing how best to help, I suggested that he come to the emergency room (ER) with me. I thought that if I got him to see a doctor, there might be a chance for another miracle. After helping him tell his story to the triage nurse, I situated him on a bed in the hallway. Before the doctor arrived, I had to leave for class. When I came back to check on him, he was gone, so I approached the treating physician.
“Psych came down and found that he was not a danger to himself or others. We gave him a dose of his meds and told him to go to his clinic, but.…” He shrugged.
I was stunned. My untrained mind screamed, “If he could do that, don’t you think he already would have done it!” In reality, I nodded and accepted the judgment of my better.
In reflecting on these events, the ER physician acted appropriately and efficiently. The ER is hardly the place to test, treat, counsel, and serve those with disabling but non-life-threatening illness. Yet, I can’t help but feel a miracle was missed. Help met trust on a cold lawn in March, but help did its job, not its calling. We had a chance to make a difference in this man’s life, and I failed. I should have found more appropriate resources for his condition. Instead, I was a naive, idealistic medical student, but I hope that some part of that idealism survives my training … because James deserves better. He deserves a physician who can recognize the opportunity to change a life by doing more than the situation demands. In the future, I hope to be that physician by not losing sight of the opportunities and using my training to become a patient advocate.
Derek K. Rogalsky
Mr. Rogalsky is a third-year medical student,
Georgetown University School of Medicine,
Washington, DC; e-mail: firstname.lastname@example.org.