One of the episodes of The Walking Dead from this past season was titled “JSS”. In this brutal episode, one learned by the end of the show that one of the characters, then others after her, had learned that all they could expect to do for the moment was JSS, or just survive somehow.
I met a patient recently who embodied that mantra.
Small, petite, with stringy hair and sun-browned skin, she did not look the part of a survivor. She looked frail, unsure of herself, weak and defeated. She had been living in the woods behind a local store, and she did not even have a tent or other covering to sleep under. She had made do with tree branches for coverings and leaves and pinestraw for bedding.
She had a history that is all too common in my profession. She had been raped by the time she was thirteen, kicked out of her home by an abusive alcoholic father at fourteen, learned to live on the street, and had quickly gotten involved in alcohol, marijuana and cocaine before she should have been able to drive. She was streetwise but had no family ties, resilient but homeless, resourceful but uneducated.
Asked about her sleeping and eating habits, she told me that she slept fitfully and that she had survived eating things “that would make a billy goat sick”. The word grubs came up in conversation.
She is not the only patient I’ve seen in the last three decades who has had to make his or her way in the world with little or no physical, financial or emotional support. Many of them are living in the woods around your town, but you never see them. They hitchhike, they panhandle, they scam, they defraud, they beg, they work. They walk or ride or sometimes just stay put for a while. They eat at churches and shelters and soup kitchens. They get themselves admitted to emergency rooms, and then hospitals, and then rehabs or community care homes. Sometimes they need the care. Sometimes they quite honestly just need the three hots and a cot.
They come to see me for real help, sometimes, complaining of depression and suicidal thoughts and voices that won’t leave them alone. Sometimes, they come seeking drugs, not because they take them any more, but because they can sell them for ten dollars a pill on the street and eat for another week. Some are real addicts, driven by the need for more. One man I read about earlier today had dislocated his own shoulder three times in one day to gain admission to three different ERs to get narcotics for his pain.
Sometimes, they are so destitute and tired and depressed that they can barely look at me, barely speak in a voice loud enough for me to hear. Other times, they know that we are dancing, sparring with words, locked in a battle of wits and arguments that they hope to win, convincing me how “sick” they are.
The former folk, the ones who are truly homeless and sick and have no recourse, I still have a soft spot in my heart for. I want to help them, to take them in somehow, to feed them and nourish them body and soul. Sometimes I feel sorry for them. Sometimes I really like them.
The latter, the dancers and shadow boxers, the story tellers and vagabonds, I have little patience with anymore. Yes, I guess I am jaded and a bit hardened after this many years. I guess I’m at worst cynical or at best terribly realistic. I see through the bullshit. I have little empathy for those who want to live off the government teat and bore me with the litany of the sore middle finger or the twingy back or the recurrent headaches that at age twenty five make them unceremoniously unable to ever work or support themselves again.
No, I do not usually have much empathy for those folks who would use me as another pawn, another tool.
Now, don’t get me wrong. I will spend every bit of the time and take every bit of the care in asking questions of those folks, maybe even more so than the others. I will evaluate and assess and think about differential diagnoses and possible treatments for them every bit as thoroughly as I do for anyone else.
Do I blame them for coming into my office and trying to scam me or sweet talk me or seduce me? Not at all. My training was good, and my experience in practice has been every bit as good a teacher as any of my professors in the department of psychiatry and health behavior all those years ago.
I know that all of my patients are doing exactly the same thing. They want to just survive somehow.
They will do what they need to do to live another day, eat another meal, and have a place to sleep. They will find a way to move their lives forward, an inch at a time if necessary.
I learn from my patients. Every. Single. Day.
I learn that people are remarkably resilient in the face of unspeakable trauma and abuse.
I learn that resourcefulness is what keeps us alive as a species.
I learn that most people are trustworthy, say what they mean, mean what they say and ask for help only when they truly need it.
I learn that some people, a few but not many, will do whatever they can to con you and never look back.
I learn to, as Ronald Reagan said many years ago, “trust but verify”.
I learn that I am usually a generous, giving, helpful man, but that like everyone, I have my limits and my breaking point.
I learn that people are people, and that the things that don’t kill them truly do make them stronger.
My patient is coming back to see a counselor, a care coordinator and other members of our team who will help her find housing, food, and whatever benefits she is entitled to. We will treat her depression.
She will just survive somehow.
With any luck at all, she will thrive.