*Names have been changed for confidentiality purposes.
Jack* did not come into the shelter quietly. He blew in angry, yelling, slamming doors, and pointing fingers. His ongoing monologue was heard by everyone within 10 feet — sometimes it formed logical sentences, and sometimes it did not. From what I could gather, he was annoyed with a man named Ernest* – it wasn’t his fault, he would like everyone to shut the **** up, and he didn’t need any of this ****ing ****. To describe him medically, he seemed to be responding to internal stimuli, and his drooping red eyes, lack of coordinated movement and slurred speech pointed to some level of intoxication.
When asked by the staff if he wanted to come in to chat, he responded with an emphatic “no” and stormed off into the main lobby. Something was atypical about Jack’s presentation. Off to the left of the room, standing with her arms folded around herself, was his mother. Her eyes were heavy with the look of someone who had been through this with her son several times before. Yet, her eyebrows were knitted together with genuine concern over her son’s current condition. In order to try and de-escalate the situation, we took Jack’s distraught mother into the clinic room while a social worker went to talk to Jack one-on-one, and we let them know Jack was welcome to come and join the conversation at any time.
In the room, the staff I was with introduced us to Jack’s mother, and let her know that Jack was a client that was familiar to her, as he was a frequent visitor to the clinic building. The staff let her know that while we weren’t at particular liberty to disclose any information we had about Jack, she was welcome to share with us whatever she was comfortable with sharing, even if only for the therapeutic effect of talking about it. Jack’s mom proceeded to give us a full picture of how Jack’s life had played out up until the point where we had seen him today, yelling and angry in the shelter. She described a lifetime of mental health struggles, learning difficulties and neurocognitive concerns about Jack — a myriad of ways Jack’s brain had struggled throughout the years to help him take care of himself. On top of this, Jack had experienced several traumatic events throughout his lifetime that his mother said had caused him to spiral further away from a place where she felt she could help him. He had been abused by a family member at a very young age, and had started purposely hitting his head off of any surface he could find from the age of 18 months. From then on, his mother had watched as he struggled through school, struggled to cope with self harm, depression and social interactions, and then eventually struggle to cope with substance abuse.
All of these things had led him to where he was, in the shelter today, describing vivid hallucinations and bizarre thoughts, confused, and running out of options. He had been kicked out of his previous shelter for this behaviour. Jack’s mother had seen him in plenty different states before, but never like this, she said. She was becoming increasingly worried about him, and didn’t know how to help him. If you were merely walking past Jack in his current state, you might have cast him as a classic young man living on the streets — seemingly intoxicated, aggressive, accusatory and destructive.
It is a rare opportunity to hear such a thorough life history, from birth to present moment, to give you a complete picture of how someone has ended up experiencing homelessness. It is a good reminder that everyone you meet is somebody’s baby.
The next thing we knew, Jack came knocking on the door of the clinic room. When we opened the door, a totally different Jack was standing there, social worker behind him. Jack looked meek and walked in quietly and then sat down next to his mom and held her hand. He apologized quietly and sat there on the examination table, head down, feet dangling off the edge of the table. Suddenly, it felt as if he had shrunk five sizes. After calming down with the social worker, he agreed to come chat. He admitted that the reason why he was so distraught today was that what he thought was weed last night had turned out to be peyote — something he only found out after consumption. He had been seeing and hearing all kinds of things ever since and seemed genuinely scared, ashamed, and unsure what to do. His eyes locked in on his mom like she was the only thing in his life not spinning wildly out of his control.
As a student observer in this situation, I became acutely aware that to anyone without the privileged view that I had at that moment, Jack was still that intoxicated, accusatory and destructive street youth — no evidence of anything otherwise.
He eventually agreed to stay at the shelter that night, and to come to the clinic the next morning to check in on how he was feeling. Agreeing to do that did not untangle Jack’s complicated situation, nor did it resolve any of the larger issues contributing to where he was that day. But for Jack — his mother held his hands and said, “Remember what we talked about about making one good decision a day? You just did that. And I’m so proud of you”.
In medicine, we are privileged to see people in significantly more detail than the rest of the world does. At the same time, we don’t always get the whole picture, and we often get to see people at their worst. My time on this elective, and this appointment in particular, taught me a lot about compassion, and the importance of always remembering that patients come into the office with a whole story behind them. We are just seeing today’s page.