(6-7-21) This is the first of three articles this week written by Los Angeles Skid Row doctor, Susan Partovi. As with all guest blogs, the opinions are that of the author.
I Meet Patty
By Susan Partovi, M.D.
“I’m your new assistant,” Patty announced one day in 2006 when I arrived at the Homeless Health Care LA’s (HHCLA) Needle Exchange clinic in skid row, now called the Center for Harm Reduction.
She was short, soft spoken and a fast learner who could anticipate my needs in LA’s skid row. I was “the doc” who treated heroin injection users. Each week, dozens would arrive for help with skin infections and chronic wounds.
“That used to me,” Patty confided one day. “I was addicted to crack and was homeless on skid row.”
It was hard to imagine this bashful woman as a hard-core drug user. She would talk about her kids, especially her son. When you work together helping the most difficult patient population, you form a bond. Kind of like war buddies. I remember one day, a regular came in with scabies….again. His hair was long and stringy. He was skin and bones. We stripped him down and Patty and I slathered the anti-scabies cream all over his body.
“You look like a wet puppy,” Patty kidded, causing all of us to laugh.
Another day, we saw a patient with a foot infection. He was a diabetic, but he couldn’t afford his medications. He was crying because he was in so much pain.
“Quick Patty, get me a basin with water and Betadine,” I said after he took off his shoe. We placed his disintegrating foot swarming with maggots in the tub as Patty proceeded to dash out of the room holding her hand over her mouth until she got to the restroom to throw up.
Like I said: we were war buddies!
A Relapse
As is too typical of skid row programs, we ran out of money for a medical assistant so Patty was let go after two years. I didn’t hear or see her until six years later when I was working at the VOA (Volunteers of America) with my Street Medicine program on skid row.
“Hi Doctor Partovi!” she exclaimed. Patty was living in a subsidized apartment for those with mental illness. “I messed up but I’m back on track and doing good!”
It was wonderful to see her, but I was worried because she was living on skid row.
Another two years passed and I was now working as a doctor to women in the LA County jail. A guard came to see me. Patty wanted me to know she was there – as an inmate – but was too embarrassed to see me. My heart sank, she must have started using again.
More time passed and I was back at the needle exchange – this time with two medical residents doing a rotation with me. I was letting them see what street medicine was like. Suddenly, we heard a commotion. A skinny, disheveled, short woman outside the building was struggling to shove a stroller with a missing wheel that was filled with belongings across the street. She was screaming at a man.
“Give me back my things, you f…ing thief!…I used to work here!…I’ll kill you m….er f….er. You stole my shit!”
“You better get this bitch out of my face or I’ll kill her,” the man told us.
“Just walk away, pay no mind to her,” I begged him.
“Dr. Partovi, that’s Patty,” one of my co- workers said. I didn’t recognize her. She was so thin and a mess. I had never heard her cuss before. The only way I knew it was her was seeing a unique mole that she had on her skin.
“Patty,” I called out. “Please get out of the street, come inside with me.” She kept ranting while I kept pleading with the man to walk away.
“Please Patti, let’s catch up. Come inside!” She glared at me but finally entered the clinic.
I wasn’t certain what to say next so I said, “Patty, what’s going on?”
Mental Illness and Drugs
“People keep taking my shit! Spirits are everywhere messing with my head.” Patty started to cry as the residents with me watched.
Patti noticed one of them. “You look like my son!” she blurted uncontrollably . Patty was using meth -the newest scourge of our Skid Row community. Meth is known to cause acute psychosis and long time use can cause chronic psychosis similar to symptoms seen with schizophrenia.
Patty began telling us about the different voices in her head, spirits, and other delusions. I gave her a prescription for medication to help with the voices.
“Come here every week, Patty. We’ll take care of you.”
She smiled. “Ok Dr. Partovi but I only trust you.”
I watched her make her way outside to her broken cart and began to weep. I’m a pretty private person and rarely show emotion, especially in the workplace – especially in front of residents, but my tears wouldn’t wait. A co-worker came to hug me. I felt so impotent.
Should I take her home with me? I wondered. Can I trust her with my animals. What if she thinks one of them is an evil spirit and hurts them? What if she lashes out at me?
Helping Patty: She was one of us
I told my CEO about Patty. “We have to help her. She’s one of us,” he said immediately. I called a friend who worked in mental health and he agreed to help me.
But like most drug users on skid row, Patty proved hard to track now that she was living on the street. She’d come into the needle exchange every once in a while. I would give her samples of medication for her delusions. She would promise to take them, but later admit that she never did. I would check on her and discover she was in-and-out of jail and local hospital psych wards on that oh-so common revolving door for the homeless with mental health issues and/or drug use.
One day, Ben Oreskes, a reporter with the Los Angeles Times, called me. “I wrote a story about this homeless woman,” he said. “After it ran (I’d not seen it), the woman’s daughter reached out to me saying she hadn’t seen her mom in four years. The woman’s name was Patty – do you know how I can find her and bring the two of them together?”
I alerted everyone at the clinic and, by chance, Patty showed up a week later and agreed to speak with Ben. I was delighted that I’d help put them together, but a few days later I got a troubling call.
Patty in a panic, then manic
“Dr. Partovi, I’m here with Patty,” Ben said. “She’s having a hard time.”
They were inside the ReFresh Spot, a community supported place run by Homeless Health Care LA where the homeless can shower and rest. Patty was in a corner when I got there. She was armed with a metal rod and angry but she let me sit next to her.
“I gotta get off the streets, Dr. Partovi, I keep getting attacked.”
I talked to my colleagues there and told Patty we could get her into a sobering center, but she refused to go.
“I need to be by myself.”
She wanted to go to a motel so we began making calls and found a vacancy. I coaxed her into my SUV by promising to make a McDonalds’ run, but first we had to “get her things” at the tent down the street. She spent a good fifteen minutes in the tent where a line of others were waiting. We knew what was going on but didn’t challenge her. Forty minutes later, we were at a motel. I put the room charge on my card knowing I’d be reimbursed, but to be honest, I would have flipped for the bill, too. I would never allow my sister or mom live on the streets – a common sentiment I often say when talking about homelessness.
Ben was still with us, witnessing what was happening but he took off leaving me with a manic Patty. I took her to a grocery store. She ran ahead of me, scooping up items. I felt like I was with a toddler! She kept escaping down the aisles, finding more items to place in the cart. Patty got angry and started yelling at the clerk. I waved my hands behind her – trying to signal to the clerk and he backed off.
She found a piece of foil, which she held to her head. “Keep the spirits away!” She looked at me. “She’s my doctor, I know her, I trust her,” she yelled to whoever was in her head. When we checked out, she tried to get liquor but I shook my head “no” to the checker. We went next door to a pharmacy where I called in a prescription for psychosis and made sure she took her medication. I got her settled into her motel room and before leaving, she disconnected everything that was plugged in and waved a lighter in every corner of the room to ward off spirits.
“I’ll see you tomorrow,” I said, hoping that she would not leave or burn the motel down!
Staying in the motel
Day 2, I showed up the next afternoon with clothes and she was still there fast asleep! I made certain she was taking her medication and when she asked for cigarettes, I walked with her to a nearby market, knowing not to give her money.
Day 3, Ben went to visit. “She’s still here,” he reported. He said she was taking her meds.
Day 4, When I showed up at the motel, I said, “I’m just curious Patty, are you using?” She laughed, “I don’t have any money.”
“Are you hearing voices?”
“No.”
Day 5, Ben picked up Patty’s daughters in San Bernardino while I drove her from the motel to Homeless Health Care LA. During the drive asked Patty why she had started using drugs again. She told me that her mother had been killed by a drunk driver and that the trauma had been too much for her to handle sober. Her relapse led to her being booted out of her subsidized apartment – a common scenario. Many people who get housed are able to get clean. But unfortunately, when trauma occurs, their coping skills are limited and often go back to what they know best…getting numb. I was able to get Patty enrolled in an outpatient drug treatment program, lined up for temporary housing, and a bus pass. By that time, Ben and Patty’s daughters arrived. We had lunch at a local cafe and I got to see Patty as a mom. At one point, she told one of her daughters that she should try the pineapple cake that she was having for dessert.
“I don’t like cooked fruit,” her daughter said.
“Just try it!”
“Oh mom!” It was as if she was a frustrated teenager – as if no time had passed at all. Patty giggled when shown photos of her grandchildren. No one asked, “Where have you been? Why are you using drugs? Why haven’t you called us?”
As we were leaving, Patty asked her daughter for money.
“Oh yeah, here’s a 20.”
I shuddered. It seemed like an innocent act; a daughter trying to do a good deed for her mom. But, in this case, I knew the potential outcome. When Patty and I got back to my car, I said, “It’s none of my business, but what are you going to do with the 20 dollars?”
“Yeah, I saw your face when she gave it to me,” she said. “You can drop me off at the train. I know how to get back.” Before I could respond, she began to open the car door. “There’s a bus stop right here. I’ll call you when I get to the hotel.”
She didn’t call – Making It Happen
She never did call. I went to the hotel the next day. She wasn’t there, nor had she slept in her bed. Her daughter texted me asking me how her mom was doing. I decided to give Patty one more day. Ben and I met at the hotel the following morning. Patty didn’t show up. We loaded her things in my car. Gave the unused food to the next door occupant who also was homeless. I called her daughter.
“We won’t give up,” I assured her.
One of our long-time colleagues, a wonderful man named David, had passed away suddenly. Someone told a story about how David would tell him regarding a task, “Make it happen; just make it happen.”
My colleagues and I were going work with Patty, no matter what it took. We were going to “Make it Happen!”
(Wednesday – Patty’s journey continues)
About the Author: Susan Partovi, MD, is Medical Director for Homeless Health Care LA. She completed her undergraduate work in psychobiology at UCLA and earned her medical degree from Thomas Jefferson Medical School in Philadelphia, PA. During her undergrad years she spent her Saturdays working with a Physician’s Assistant attending to squatters living on a dump site in Tijuana Mexico. She completed her residency in Family Medicine at the County Hospital, Harbor-UCLA Medical Center in Los Angeles where she focused on working with the uninsured and the poor. She spent six years on its faculty before moving to a community clinic where she was introduced to Homeless Medicine. That led to her working almost exclusively with the homeless, creating street medicine programs throughout L.A. In 2004 she started working for Homeless Health Care Los Angeles beginning a “career” in wound care and working with homeless heroin users of skid row. She soon became Homeless Health Care Los Angeles’ Medical Director and continues to be part of their innovative creations in best caring for the homeless…especially the mentally ill and drug users.
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