By Dr David Laing Dawson
Margaret is frugal. She takes great pride in this. In season she survives on the edible fruits, berries and mushrooms she finds in backyards and boulevards. She would like to teach her survival skills to mental patients. In the winter, she dresses in many layers and sleeps whenever and wherever she is taken in. She will not accept a boarding home, or psychiatric treatment. She defaces her disability benefit cheques and does not cash them. These represent charity and are abhorrent to her.
She would like to see the Premier, "The Highly Placed One," who could, she is sure, correct certain past injustices, and then reissue her cheques as salary. She is a woman of great dignity to whom God delivers explicit instructions, which she is expected to follow and convey to others.
On one of her attempts to gain direct audience with the Premier, she spent a full weekend hiding in a closet in the Ontario Legislative Building. When she tells me this she smiles and seems to recognize both the comedy and tragedy of her life.
When, in the past, she was hospitalized and treated, treated against her will with neuroleptic injections, she spoke less of God, of herbs, elixirs, and the Premier of the Province, and her conversation became easier to follow. But the moment she left the hospital she stopped her treatment and recalled, bitterly, the receiving of The Needle, as a wrong and immoral act, an assault on her autonomy, her specialness, and her humanity. At times she visits with her mother, a short, stocky peasant woman now in her eighties living in a small house not far from the hospital. Old photos of a small German-speaking Romanian village sit on her mantle piece. She has little English but it is clear she is bewildered by our inability to make everything right.
During a very cold January I give Margaret fifty dollars to buy a pair of winter boots. She speaks to God for a moment before accepting. Apparently, He tells her it is all right to take this money and go to the mall. When she returns she shows me the boots she has bought and she gives me twenty dollars in change, for she has found a bargain, which pleases her greatly.
Another day she arrives looking ill and tired, emaciated. I can smell acetone on her breath. She has not eaten for days. She is capable of foraging for food but this is a hunger strike, which only a word, a concession, from the Premier, the "The Highly Placed One", will forestall. It is hopeless trying to convince her that I have no access to the Premier's ear. She has her own knowledge of how the world works. And in her world, within her reality, it is not so far-fetched that the Chief Psychiatrist of the Mental Hospital might stand very near "The Highly Placed One."
Now Margaret drops in unannounced quite regularly. She usually stays a while and sings a hymn. Sometimes she babbles incoherently. Sometimes her ramblings are interrupted with asides to God. Upon His silent instructions she continues, or alters her current discourse. Sometimes she brings jars of liquid, which she claims she has distilled from berries and plants and herbs and which contain all the nutrients any human should need. She gave me a jar, which remains on a shelf unopened. She wants to teach the patients of the hospital her survival skills, her nutritional knowledge. Sometimes when she has sung loudly I realize she is drunk, and the ingredients in her jars are preserved in alcohol. I am always fascinated by the way she constructs a sentence. She uses some combination of Germanic inversion and schizophrenic association
But this time she is dying. Or she will die within days if she does not start eating again. I take her to a hospital ward, escorted by nurses. I tell her I will be giving her a needle in the buttock and that she must start eating. She pauses for a moment, then looks at me, and shakes her finger at me, and says, "All right. You may give me the needle. But not as a husband to a wife." I can feel Freud smiling down upon me. She accepts the syringe of anti-psychotic medication. She begins to eat immediately. This is not the result of pharmacological treatment, but the product of some kind of detente. She stays a few weeks in the hospital, gaining strength and a modicum of sanity, and then she departs.
It is another time, another year, and I find Margaret has been cut off from welfare. Her purse is full of defaced cheques, yet some she has cashed and put in her bank account, which now totals, to my amazement, eleven thousand dollars. With a bank account that large she can no longer receive benefits. But she has no money to use. She is destitute, again not eating. For, in her mind, the money in that bank account belongs to God. She cannot use it. She speaks to God for a moment and apparently He will not alter His policy. She cannot spend His money.
On the telephone, I explain to the Welfare Officer that Margaret has no money, that she cannot access the account of eleven thousand dollars. It belongs to God, and God alone can release the funds, and He has chosen not to. The Welfare Officer, it seems, lacks the capacity to imagine parallel universes with different immutable laws. I then appeal to common sense and economic reason. I explain that unless her office releases Margaret's welfare money, Margaret will not eat, I will have to put her in hospital, and this will cost the taxpayer seven hundred dollars a day rather than seven hundred a month. But the welfare officer is adamant. She will not release funds until Margaret spends the eleven thousand dollars in her bank account. Margaret returns to a diet of boulevard berries and the discarded foods she finds in bins behind grocery stores.
Another year and it is the dead of winter once again; the temperature has dropped to 35 below zero, record lows. It is even colder than that, they say, when the wind chill has been factored in. Margaret is living on the street. She makes her way through the city to the hospital and then to my office and spends the day in a chair in the corridor keeping warm. The deep freeze is not letting up. Non-essential employees are allowed to leave their work an hour early. We worry that our cars won't start, that pipes will freeze and burst, that black ice will make the roads impassable. A storm is coming.
At the end of the day, Margaret is still sitting in the corridor, bundled in her coats. I offer to admit her to the hospital so she might spend the night in a warm bed after an adequate meal. She refuses. She will not allow me to assign her patient-hood. She is not mental she tells me several times. But when I broach the idea of sleeping at the hospital as a guest, rather than as a patient, she accepts, after her usual aside with God. The wards are full though, and the best we can do is offer her a mattress on the floor in an empty room.
The institution sputters here. On the ward that I have chosen as the most suitable, the nurse in charge tells me that moving mattresses is the job of Housekeeping, not Nursing, and the Housekeepers have left for the day to avoid the coming storm. On the telephone I tell the nurse in charge that I will come over and place the mattress myself if I have to, and this appears to motivate a temporary change in job description. They agree, reluctantly, after first warning me of various legal consequences should anything go wrong during the night, conjuring images of Margaret attacking somebody, running amok, or simply dying. The mattress and blankets are placed in a side room on the ward. Margaret finds her way there. She stays a few days, behaving well. She remains quiet, polite. She tidies up after herself. When the cold spell dissipates and a thaw is in the air, she puts on her coats and leaves.A month passes before I receive a formal letter from the president of the union, copy to the Ministry of Health, demanding that I write a letter absolving the nurses of any responsibility for allowing a non-patient to sleep on one of the wards. I had some sympathy for their concerns before the events in question, but now it is over, without tragedy, without incident, without lawsuits, I have trouble understanding the motivation for their request. For a few moments I contemplate their attachment to specific words and how these word symbols can accrue more substance than the physical reality to which they refer. Much like Margaret. As Margaret will only accept my help as long as it is not called `treatment', or `counsel', or `charity', and as long as we don't call her `mental', or `patient', with the same rigid eye on symbol and definition, the nurses, or their union, can only offer help and charity to someone called, officially documented that is, `patient'.
I write the letter they have requested. It is not hard to do. In fact, I find myself taking some perverse pleasure typing in bold, "I and I alone take full responsibility for allowing a homeless woman to sleep in the hospital when the temperature was 35 degrees below zero, Celsius.
Margaret disappears for months at a time. Occasionally I might see her bent against the wind in her kerchief and multilayered coats, making her way along an urban street. And then she would appear again, in my office, asking again if I would put her in touch with The Highly placed One
I have been calling her Margaret in this writing, but my secretary and I never addressed her as Margaret. She would correct us. It must be `Ms.' followed by her last name. Ms. Rossel. With emphasis on the second syllable. Ms. Rossel is here to see you. Ms. Rossel is singing in the corridor. In turn, she always addressed me as Chief Psychiatrist Dawson. Sometimes she added the modifier, a highly placed one. Not The Highly Place One, a title she reserved for the Premier of the Province.
When I left the hospital I had not seen her for some time, and I have not seen her since. It is pleasant to think of her camped out somewhere, cooking her herbs and roots and fruits over an open fire, distilling her elixirs, singing her hymns, communing with God. Or it would be nice to think she found a way of accepting patienthood, organized housing, welfare cheques, food banks, and social workers as highly placed ones who might direct her life in a less eccentric manner. But between these two hypothetical outcomes, I must confess, I am most fond of the first.