By Anonymous

Discuss with a medical practitioner in your rotation who manages patients with chronic illnesses. Has he/she experienced any change with the National Strategic Framework?

The therapeutic hum of the engine filled the cabin as the car tore down the motor way. I sat in the passenger seat marvelling at how proud and tall the hood ornament stood against the backdrop of the endless black tarmac stretching into the distance. The hovering like sensation the car gave us as it smoothed out the inconsistencies in the road seemed surreal, supernatural even. The psychiatrist sat leaned back in the driver’s seat, calmly staring out over the cowl. His right hand gripped the wood grain steering wheel and barely ever seemed to make any adjustments to the car’s trajectory. There was an eerie serenity to the journey, like he’d done it dozens; if not hundreds; of times before.

There was a question that had been nagging at me since we’d torn out of the community clinic car park a few minutes ago, and I sat in the passenger seat in silence slowly working up the courage to ask it.

“What’s up?” he asked me, not taking his eyes off the road. It was always disconcerting how he managed to sense when I was hesitating to say something.

“Well, I know I’m new to this, but aren’t there a host of teams that usually go out to visit patients at home then report the situation to you back at the hospital? I mean there’s Hospital in the Home and the Crisis Assessment and Treatment Team. Is there a reason that you’re handling this particular call out?” I sat there doubting the validity of the question for a moment before he offered an answer.

“Some cases require more… finesse.” With that we turned off the motorway and started to meander down the side streets. The houses that littered the area sat sadly in various states of disrepair. As he navigated the derelict neighbourhoods, he took the opportunity to explain further, “Patient name is Melissa Jenkins, 58 years old, chronic schizophrenia. Background of alcohol and methamphetamine abuse. Discharged from an inpatient unit a month ago after an almost a yearlong stay. Has been unresponsive to our attempts to make contact. We’ve got questions about her compliance, whether she’s adjusting to community life again. She’s been known to our network for a long time. From what I can tell it’s a vicious cycle of poverty, abuse and mental illness.” He sighed. “The underlying issues are difficult to address from our position, but the house call, it goes a long way to help us understand of what’s going on.”

Eventually we pulled into the driveway of quite a dejected looking house. The timber panelling on the façade seemed veritably allergic to the remnants of paint that clung to it, having shed all but a flake or two of the dull white hue. We left the burgundy limousine in the driveway and walked up to the patio, which seemed to hold itself up out of sheer will and little else, the supporting timber pillars were bowed and warped in all directions.

The psychiatrist adjusted his cuffs such that the prescribed inch of shirt was exposed under his jacket, before raising a fist and vigorously rapping on the door. After a moment the door creaked open just a few degrees and I caught a glimpse of a figure lurking in the shadowy interior of the house. “Melissa?” the psychiatrist questioned, “I work with the doctors that treated you in the hospital, I’ve come to see how you’re doing.”

I could sense a reluctance on the other side of the door before it swung open and revealed a small, feeble woman standing at threshold of the house. She seemed to disappear underneath the expansive brown shawl draped over her slumping shoulders. She looked up at the psychiatrist but couldn’t seem to say anything coherent. Utterances of gibberish escaped her thin lips every now and then. She quickly lost interest in us and headed back into the house.

We followed her in and were greeted by a horrid stench. My eyes struggled to adjust to the darkness of the house, but I soon was able to identify the complete disarray that had engulfed the place. A massacre of litter carpeted the floor and decrepit pieces of furniture lay about like the corpses in a battlefield. It looked like it had been abandoned for decades. Dereliction had started to swallow it up whole. The woman seemed to wonder around the house aimlessly, her eyes darting from corner to corner, the murmurs never ceasing. She seemed completely unaware of our presence.

“Melissa,” the psychiatrist addressed her, but she seemed unable to recognise her name. He turned away from her and started investigating a box of medication that sat on the mantel piece. He opened it and emptied the contents out. Tray after tray of sealed, untouched medication spilled out. He looked at me, “we’ve gotta take her in, this doesn’t bode well for her.”

In her listlessness she didn’t put up much resistance to our assistance as we helped her out of the delipidated house and into the back seat of the big Ford. When we had resumed our seats in the front he turned the key and the car rumbled to life. We reversed out of the driveway and turned back the way we came.

Melissa continued to murmur to herself in the back seat. The psychiatrist handed me his phone, “Call the doctor’s office on the psych ward.” He instructed me, “tell ‘em we need to make room for a frequent flyer.”