BUS THERAPY

It has always been a fine line between staff and client. I am a professional in the mental health field. I'm also a "consumer" (the most current politically correct term for a person receiving mental health services) in this area. I'm not sure if I have more stories from my job or from my own life. Here's a story about Gertie (named changed to prevent malpractice suits) and what it's REALLY like to work in the MI field. (And no, the photo of the feet has nothing to do with bus therapy. I just threw it in for fun. Mmm Mmm. Feet.)

By the luck of the short straw or perhaps because I don’t mind driving the hour and a half commute to Chicago, I have been elected to make sure Gert gets to “ride the Dog” back to Michigan where she came from; thus, she is in my car on her way to the Chicago Greyhound terminal.
(Okay, so the feet were weird. Here's a photo of the Chicago Greyhound Terminal, as taken by lbj79us on Flickr. Now THAT's a bus terminal photo to get you in the mood for this blog!)
Gert is decked out in her finest polyester: a blindingly-rude floral top and black, screaming-tight pants. Since Gert came from Michigan without a change of clothing and because she’s been in town for several days, she’s past ripe and has moved to eye-watering. I’m not sure if you understand what it’s like to be with a smoker wearing three day old undies who is wrapped in polyester while in a small car on a hot day. It’s a weird, sick mixture of sour pits and rotten private parts.

I tell you this not to belittle the client but to explain the finer challenges of my job.

It is also important to explain that she’s about four foot eleven and about three hundred pounds; the relevance of this being that not only is she wearing dirty clothes and hasn’t bathed in days, she’s got places filled with crusting perspiration that even I don’t want to talk about. Gert, a 43 year old lady with chronic mental illness, mental retardation and penchant for running away from home, is my charge and I must send on a mission of “Greyhound Therapy.”

(Side note: Any clinician working in community mental health with the chronically mentally ill who says he/she has not heard of such therapy is either lying or brand new to the field. It’s a common practice, better than medication and cheaper than hospitalization. No one wants to bring in more persons to the encatchment area when there are fine enough encatchment areas somewhere else—particularly out of state. Mental health allies frothing at the mouth need to know bus therapy is a successful avenue of treatment—the truth hurts, doesn’t it? Clients taking unscheduled road trips: all aboard!)

Somehow, Gert decided that leaving Michigan and riding a bus to Rockford sounded like a great idea. Never mind she had no money, no knowledge, no luggage of anyone in town and no nothing but a mind spinning with bursts of mania—she had cigarettes and a bus ticket and what more could she possibly need. The police found her first and brought her to us. Since she was homeless and wandering and obviously mentally ill, we are the winners in this community mental health game. Gert doesn’t want to go back and isn’t very helpful in locating her family, but with much discussion and many items of free food (enhanced with free cigarettes—a very hot commodity), the client provides the phone number of a family member and soon plans are under way to get her some medication and to ship her from whence she came. Did I mention she didn’t want to go back?

Because Gert is not to be trusted to taking the Greyhound from our fair city and to transfer successfully in Chicago, I am taking her directly to the terminal. It’s scorching-middle-of-the-summer-hot out and so I have the windows closed and the air conditioning on. She’s really nervous—as she has told me a hundred times, the poor thing—and the more she gets nervous, the more she smells. Kind of works that way for all of us; it’s just that most of us aren’t sweating in three-day-old dirty clothing. Little drips of sweat run down her face; I can see them whenever I glance over. She speaks of religion and of friends and of her hometown and of more religion and of this and that.

Out of nowhere, she adds, “I’ve wet my pants.”

I try not to get upset but can’t stop thinking that this lady has just peed on my brand new car seats. I silently chastise myself for using my own car—a new car—for this endeavor. She adds that she couldn’t wait to go the bathroom and that she’s really sorry about peeing in the car and that she would like to stop when possible so she can stand up. She then goes back to talking about religion, other trips she has taken, her love of country western music. I keep looking forward toward the road and can’t bring myself to say anything. What do you say to someone who has just peed in your car?

Gert asks to smoke while in the car and I say no—I explain this is my new car and that I don’t let anyone smoke in my car. She asks again, perhaps thinking I didn’t comprehend the magnitude of her nicotine addiction. I politely tell her no and again tell her why. Like a slick three-year-old who knows the game of asking over and over and over and over until getting what he wants, she asks again and again and again. On the twentieth time, she asks again and I finally give in. I’m sick of arguing and I’m tired of trying and I’m gagging from the body odor and urine-soaked-petrified polyester, anyway, so I figure smoking might help burn my nostrils numb, even though I’m pissy about this travesty taking placed in my new vehicle. Gert lights the cigarette and begins to suck long drags.

(As a side note, I tell you that you haven’t seen anyone smoke until you’ve seen someone with mental illness smoke—they suck the life force right out of that damned thing. It’s like three drags and it’s gone.)

Well, Gert is on drag number two and out of the corner of my eye I see her drop the cigarette down her top. I’m not making this up. I’m going 70 miles an hour and I see this cigarette falls somewhere into the grand canyon of her bosom while I’m literally just trying to drive and not fall unconscious from the wretched odors emitting from the passenger side. I take my eyes off the road and look at Gert’s chest—damn if she’s not smoldering. I’m not sure if she didn’t know what had happened or what was happening, but she’s just sitting over there jabbering about this and that and not making a move to retrieve the lit cigarette that is now becoming one with her polyester clothing.

Smoke begins to bellow out to the point even she cannot ignore it. She suddenly begins screaming and yelling and failing and trying to rip her shirt off, all while I’m just trying to stay on the road. I end up pulling over on the shoulder and before I can help her, she jumps out of my car and throws her smoldering shirt to the ground. Stomping on it, I wonder what those passing by are thinking. My thoughts are quickly interrupted because my car stinks even more than it had just a few moments early. I yell at Gert to get away from the highway and to put her top back on. She’s obviously upset that the front of her outfit is now rather melted, but she starts laughing loudly when she sees that she has also managed to set her bra on fire. She digs the remains of the cigarette out of her bra and throws it to the ground. Thankfully, she gets back into the car without further incident; after all, she could have chosen to run away or to take off all her clothes or worse. Gert laments that she only has one cigarette left and asks me if she can go ahead and smoke it. I tell her no.

Ninety minutes later, I park the car—unfortunately in the sun, which I do not think about until later—and take her to the terminal. Thankfully, we only have a few minutes before her bus is scheduled to depart—she gives me a big, warm hug and thanks me for the help. While waiting for her to finish her last cigarette, I note that she does not look out of place in this setting. She takes her ticket and gets in line to board the bus. I can hear her telling the bus driver who she is and where she is going and how she got here and why she has no luggage.

I watch her get on the bus and literally stand there until I see the bus pull away. I don’t wave as the bus drives away but I can see her waving. I am too exhausted to wave.

Being with someone manic is exhausting—and, I can keep up with the best of them. I stand there, making sure she doesn’t make a last chance effort to escape the vehicle returning her to her home. Once I can no longer see the bus, I sigh and return to my car. I open the door and am literally knocked back by the smell. Parking in the sun on a 95 degree day with all the windows shut was a very bad idea, as the stench of urine and body odor, stale cigarettes and burning polyester has mixed with the heat. I try not to puke, open all the windows and drive home, all the way ignoring the big wet spot on the passenger seat.

There but for the grace of god I go.