For our first appointment, she didn’t come downstairs. The building staff, who described her as a high-priority patient, had predicted this.
After I knocked on her door, a gruff voice shouted back, “What do you want?!”
She eventually opened her door. Inside, the room was furnished with only a bed and nightstand. The mattress still looked brand new; no linens or blankets were on it. The only item on her nightstand was a lamp, the shade still wrapped in plastic. The walls were bare; her closet was empty. Blinds kept the sunlight out.
The only personal item in her room was a flattened cardboard box. It was next to her bed. Though she had lived in that unit for almost a full year, she was still sleeping on the floor. She preferred the cardboard to the mattress.
“I don’t need anything, I’m fine, I’m fine,” she grumbled. She pointed an arthritic finger at the door before announcing, “I’m leaving now.” I stepped to the side. She hobbled past me towards the elevator, mumbling to herself. She didn’t close the door to her apartment. I did.
That first appointment was a success! Not only did she open her door, but she also spoke to me. Sure, it was a short and superficial conversation. Her primary goal, it seemed, was to get away from me. But she didn’t yell at me, despite my introduction: “Hi, my name is Dr. Yang. I work as a psychiatrist. I just wanted to introduce myself. How are you doing?”
There was a fair chance that she would talk to me again in the future. I had two goals now: Create conditions so that she would (1) talk with me again and (2) tolerate a longer conversation with me. Maybe two to three minutes next time?
Back downstairs, I tapped out a quick note:
This is a 79yo woman with a historical diagnosis of schizophrenia. She reportedly has a history of street homelessness of at least twenty years, though housing staff believe that she had been homeless for longer. She finally moved into housing about a year ago….
Maria Yang, MD 