[Paleopsych] NYT: In the Chaos of Homelessness, Calendars Mean Nothing

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In the Chaos of Homelessness, Calendars Mean Nothing
http://www.nytimes.com/2005/12/20/health/20case.html

    Cases
    By ELISSA ELY, M.D.

    I knew from a note left by her case manager that the homeless woman I was 
waiting
    to see had a history of trauma, terrible mood swings, past suicide attempts.

    I had booked an hour for an intake evaluation. She arrived 35 minutes late, 
sat
    down and shook out long braids. She was plump, and wore what looked like 
someone
    else's ill-fitting button-down shirt. She opened her pocketbook, eyeliner, 
loose
    cigarettes, Kleenex tumbling out.

    "I've got to see a doctor right away," she said, and she began to weep.

    In the next 15 seconds, I learned that she had been beaten by her father, 
that
    she had found her fiancé in bed with her daughter, that she had not slept in 
two
    nights.

    On top of that, she said, she had been late catching the bus from the 
shelter to
    the subway to get to the clinic and late getting the subway to the bus to 
get to
    the shelter the night before. That meant that she had missed dinner and
    breakfast. She didn't know if she could go on one minute more.

    I opened up my lunch bag and handed her the first thing I came across. It 
was a
    large banana. I had been looking forward to eating it. She finished it in 
three
    bites and dropped the peel into her pocketbook.

    We talked a few more minutes but the intake forms remained blank. She was
    essentially incoherent; not psychotic, but washed away in a flood of
    disorganization and emotion, unable to grab any branch long enough to pull
    herself onto land. Finally, I gave her a card with an appointment for the 
next
    week and a week's prescription for a benign sleeping medication.

    Five nights later, I was in a different shelter when the staff phone rang. 
It was
    the drug and alcohol abuse counselor whose office was two doors away. The 
walls
    are plasterboard, and I could hear him talking into the phone from his 
cubicle.
    There was weeping in the background.

    "I have someone who needs to see a psychiatrist right away," he told me.

    "Sign her up," I said.

    "Just a minute," he said, and, putting his hand over the receiver, told the
    weeper: "I'm going to sign you up. You can see her next week."

    The weeping became loud wailing.

    "What's her name?" I asked.

    It was familiar. So, now, was the weeping. A mental image surfaced of braids 
and
    objects tumbling from a purse.

    "Tell her we met last Friday," I said. "I'm the doctor she saw in the 
clinic."

    The wailing continued.

    "Tell her I gave her the banana," I said.

    The weeping stopped.

    "Oh," I heard her say through the wall. "That doctor."

    "Ask her if she's sleeping any better," I said.

    He asked her, then told me that she had not filled the prescription yet. 
"Tell
    her I'm going to see her the day after tomorrow," I said. "We made an
    appointment. Nine o'clock. She has a card."

    "O.K.," he said. "I'll tell her."

    Without the banana, she would not have recognized me. I was simply another 
branch
    floating by. In the chaos of her life, it was natural to see a psychiatrist 
in
    one shelter during the day on Friday and a second one in a different shelter 
on
    Wednesday night.

    But by the happy coincidence of being the same person in two places, I had 
headed
    off redundancy. Luck and a piece of fruit had provided the beginning of
    consistent care. Now we could get down to work.

    Friday morning came. 9:00. 9:30. 10:30.

    She never showed.

    At the night shelter two days later, the drug counselor said he had not seen 
her.
    She had moved into the land of the missing.

    Life should be easier to organize. One patient, one doctor. But the muddle 
is a
    metaphor for homelessness, part of the diffusion that comes when you have no
    base. Calendars and appointment cards mean nothing.

    The solution is unclear, at least to me. A banana makes an impression, but 
not
    for long enough.