The power of presence

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The loud voices from the lobby of the integrative health care clinic in which I worked that fall were approaching high-decibel level.

Several of we providers wandered out into the hall from our offices, trying to figure out the source of the disturbance. My medical director caught sight of me and told me, "Get Jesus Christ out of the lobby before the cops get here!"

The man in question was what we call out here in the desert a "desert rat," someone who lives off the grid (or on someone else's grid). He was dusty, dirty, suntanned to burnished leather, and loud. And he was not leaving quietly, preaching about the evils of cops and doctors.

Desperate, I resorted to telling him of a past that I was pretty sure he couldn't resist: "Sir, I am a former Roman Catholic sister. Come talk to me."

He stormed into my office full of his delusion and paranoia. That first time, we must have talked an hour — a luxury, even in the outpatient psych business. I think my medical assistant was afraid to interrupt. At the end of the hour, he agreed to retry the anti-psychotic he had stopped taking a week ago and promised to keep his appointment the following week.

He did. His name was Christopher. After that first meeting, he never missed an appointment, always bringing what he called a "blessing," a dirty, small tote bag of gleanings from the garbage: a faded plastic flower, an old Elvis Presley record, a small tray.

He was always on time and never did a thing I told him to do. He may or may not have taken the medication — I couldn't tell the difference, really. After three months, we had our last office visit, as I was going to work in Kuwait and Qatar. He presented me with an old Little Golden Books children's storybook and, as usual, blessed it.

I had been back from the Middle East for about 18 months, working in an urgent care clinic close to the integrated health care clinic where I had been before. It was 20 minutes before closing one hot August night when my medical assistant said to me wearily, "Ah, Mare, you've got a real firecracker out there, and he wants some kind of meds. Maybe narcotics."

I sighed. We don't prescribe narcotics as a rule in urgent care out here, and it can cause big-time problems. I told Regan to bring him back and mentally steeled myself for a difficult conversation.

But when I walked into the room, I started laughing. It was Christopher, all right! He started laughing, too: "Did you not receive the blessing of a safe return from the Middle East? Where have you been? I need meds!"

We sat down, two old friends. He brought me up to date on work (forget it!), his love life (forget that, too!), and what he had been doing (preaching, trying to stay out of jail). Predictably, he wanted to get back on his medications "so everyone will leave me alone." He brought me out to meet his mother, who was waiting in the car. I had no doubt that she was and is a saint!

For those afflicted with delusions and psychosis, there is seldom anything to celebrate. Their lives are hard, and available psychotropic medications can be very primitive for their complex conditions. This story is not meant to glamorize or trivialize one patient's situation. It is a story of being present. And sometimes, as a physician assistant and a persistent Racine (Wisconsin) Dominican associate, that is my best gift.

All that said, I went home across the desert that night happy, singing a thanksgiving song.

[Mare Wheeler has been an active Racine (Wisconsin) Dominican associate for the last five years. She is a physician assistant in Arizona.]