Like most immigrants from the villages in the Fuzhou area, Mr. Chen speaks a dialect closer to Mandarin than to Cantonese, but distinct from both. At Montefiore Medical Center in the Bronx, where he was treated for dehydration after his release from the elevator, language quickly became an issue when doctors realized that he needed psychotherapy for the lasting effects of his experience, Dr. Tan said.

"We referred him to psychiatry, but nobody could treat him," Dr. Tan said. "The residents don't speak Mandarin. I can't do therapy in Mandarin." Telephone interpretation services by AT&T, known as language lines, which are useful for other medical interactions, do not really work well for this kind of doctor-patient exchange, she added.

Montefiore's policy is to treat residents of its neighborhood regardless of their immigrant status or whether they are insured, but that is not the case with many psychiatric practices. As an illegal immigrant, Mr. Chen could not apply for Medicaid. And at postgraduate centers where therapists in training are willing to see patients for $5 to $10 per session, Mandarin, let alone Fuzhou dialect, is nonexistent, Dr. Tan added.

Eventually, however, she was able to refer Mr. Chen to a Mandarin-proficient doctor at the Charles B. Wong Community Medical Center in Chinatown.

Mr. Chen, a slender man who wore a black T-shirt and dark trousers during the interview, said he was relieved when Montefiore officials who set up his treatment told him he would not have to worry about the bills. He has been taking the medication prescribed by his doctors, he said. But so far, he finds the results disappointing.

"It's helping a little bit, but not the way I was before," he said. "I worry about my health, because the way I am now, I'm not able to work, and we owe so much money, and I have a family to support."

He did not want to reveal where he had lived, where he lived now or how he had tried to work. "It's been very hard since my status has been discussed," he said. "For the past four months, I haven't really been living anywhere stable," he added, describing shared quarters "sometimes in New York, sometimes out of state."