Almost 30 minutes had passed, but The Man was still standing outside in the grey morning chill. His soiled tee shirt and loose pants hung from his tall frame. Over the next few minutes, he rarely shifted his feet while staring at a distant point on the ground.
“Hi,” I greeted again. He did not move.
“I’m worried about you,” I offered, hoping for any sign of acknowledgment. None came.
It no longer feels uncomfortable to talk to someone who doesn’t respond. Remember the people in the ICU, their bodies puffy from inflammation and fluid, their respiratory tubes hissing with each mechanical breath? Or the young men tucked into the corners of their jail cells, their heads cradled in their slender arms? Or the people so preoccupied with voices only they heard, their unblinking eyes quivering?
“I’m going to prescribe medicine for you. The goal is to help you think better. I’ll ask the staff to remind you about it. I hope you’ll try it, but if you don’t want to take it, that’s fine. I’ll see you again soon.”
His gaze remain fixed on the ground.
“It’s cold outside. Go back in,” I said. He stirred and mumbled something.
“Go back inside,” I repeated, pointing and taking a step towards his Tiny House. After a beat, he lifted a leg and meandered back to his unit.
Tiny Villages are clusters of small wooden structures, called Tiny Houses. A Tiny House is less than 100 square feet, so most people have only a bed and a storage rack inside. Each unit has heat and electricity, along with at least one window. The door locks. Outside of the two dozen or so Tiny Houses are shared bathrooms, an enclosed kitchen and dining area, plus covered laundry facilities. The houses are usually painted in bright colors. Residents often add personal touches to the small area in front of their house: Wild flowers in small pots; stickers and signs; sometimes inflatable yard decorations. Surrounding the entire Tiny Village is a wood or chain-link fence. Visitors must check in before they enter the front gate.
Village staff had introduced me to The Man about an hour earlier. When The Man opened the door to his Tiny House, the stench of body odor rushed out. For nearly five minutes he stood in the doorway and looked around at the ground. His face was scrunched up in confusion while he mumbled under his breath.
With repeated coaxing we got him out of the morning chill and into a Tiny Office. He didn’t talk to me; he instead talked with someone that only he could see. While seated in the folding chair he laughed, made animated gestures, and muttered about truth and lies. I ended our time together. We all exited the office.
Village staff pulled me aside to tell me more about The Man: Just a few months ago he was able to have a coherent conversation. Before moving into the Tiny House, he lived in a trailer. Before that, he worked in warehouses and lived in an apartment. Alcohol overuse led to problems at work and dismissals. Now he smoked methamphetamine once in a while. Other people in the Tiny Village were worried about his wellbeing, too.
It was when I was leaving the Tiny Village that I saw that The Man was still standing outside. Had he been there, motionless, for almost 30 minutes?
The medications came in a bubble pack, each row marked with the date. One pill for each day, at any time of day, for one week.
On day one, The Man popped a tablet out of its bubble, then swallowed it. Nothing changed.
The e-mail I received a week later contained exclamation points: The Man took the medicine most days that week! He was making more sense! He wanted to take more medication!
Of course I obliged.
The next time I saw him, his unit still didn’t smell fresh. However, he immediately came out and walked with us to the office.
“I’m sorry for having an attitude when we last talked,” he offered. I shook my head; he didn’t need to apologize. What he thought was an “attitude” was actually symptoms of psychosis.
When I asked him what was happening when we last spoke, he replied, “I was annoyed. People kept talking to me.”
“Who?”
He shifted uncomfortably in his chair. “I don’t want to snitch on them…”
I waited. He looked up, took a breath, and continued.
“… but I hear them all the time, 24/7, on and off, it doesn’t matter.” He shared that he had been hearing those voices since he was a kid. “Sometimes I want to tear them apart, I get so annoyed.”
What did he think of the medication? “It helps me ignore them better. When I get annoyed I take it, so I’ll take two a day.”
I nodded serenely. Thank The Universe that nothing harmful happened with his doubling of the dose!
As our time together came to a close, I asked, “Is there anything else I can help you with today?”
A moment passed. He scratched his head. He then quietly asked, “Is there anything that can help me stop using meth?”
When we bring services to where people are, they can make great gains in building the lives they want to lead.
I was worried that, because of The Man’s symptoms, we would have to tread down the road of involuntary treatment. But, the interventions and support of the team prevented this. We avoided the circus of the police and medics coercing him into an ambulance. He escaped the chaos of waiting in an emergency department while restrained to a gurney. Residing in a Tiny Home is not an ideal living situation, but at least he was able to keep the freedoms there that are absent in a psychiatric hospital.
In addition to preserving his dignity, these interventions saved costs throughout the system. First responders were freed up to attend to other emergencies. Because The Man never went to the emergency department, he never received an ambulance or hospital bill. All together that would have summed in the thousands of dollars.
This man, like the women described here, was homeless. Like them, he did not contribute to crime and disorder on America’s streets. He was not a safety threat.
Who was truly unsafe: Us, or him?
Maria Yang, MD 