When the police brought Jane to 3East, the soles of her feet were blistered. She was young and pretty beneath a layer of urban grime. A concerned police officer picked her up for wandering barefoot around Portland, Oregon on a 90-degree August afternoon, mumbling to herself. She wouldn’t give her name and carried no identification, but went willingly into the cool car.

By the time she came upstairs from the emergency room, she had acquired a pair of blue paper slippers, an involuntary hold because she was a danger to herself, and a name: Jane Doe.

I greeted her at the locked doors that secured 3East. The chain of custody passed from a thoughtful cop to me, a psychiatric nurse still in my first few months of practice.

Everyone has a story, but my patients’ histories were often obscured by and delusions. Given enough time, we could translate their encrypted chatter and make sense of their stories. Jane was my first Ms. Doe. Her story, like her name, was still a mystery.

I escorted her to the interview room and brought her a basin of warm water medicated with Epsom salts. She settled her feet in up to her ankles. I introduced myself and asked her name. I was still self-conscious in that room—everyone could see into it. It was one of a series of first stops on the way to the milieu and established the safety a new patient.

“Jane,” she said.

“Is that your real name?”

“Yes, they gave it to me downstairs.”

I sat quietly while she smiled, nodded her head and moved her lips, apparently responding to internal voices. She didn’t seem distressed. I was accustomed to patients terrorized by the unpredictable commands and vicious criticism of auditory hallucinations. Jane reminded me of a child chatting with an imaginary playmate.

“Do you know where you are?” I interrupted.

“A psychiatric ward.”

“Do you have family? Someone who might be worried about you?”

“No.”

“Has anyone hurt you?”

She smiled. “No.”

I‘d quickly hit a wall with Jane. She clearly showed no interest in me or where she was. I took what medical history I could; she cooperated when I took her vital signs and did a quick head-to-toe exam. I bandaged the blisters on her soles. Other than that, she was healthy, well- nourished, sturdy even.

“I would like to go to my room now.”

She moved lightly on her damaged feet, like a sleepwalker gliding along the shabby hospital carpet. From our closet of donated clothes, she picked out a pair of pink chenille slippers.

The hospital placed advertisements in Oregon and Washington newspapers, showing a woman in her 20s with tangled blond hair. “Do you know this woman?” they asked. “Contact us.”

I worked two back-to-back 16-hour shifts each week. When I returned to the hospital five days after admitting Jane, she was striding purposefully down the long hallway to the community room, hub of the ward’s activities: group sessions, meals, visits, Ping-Pong and, occasionally, violent assaults.

Our job was to stabilize patients in the acute phase of their mental illness. Jane’s psychiatrist had settled on a diagnosis of , a combined mood and thought disturbance. He started her on low doses of a mood stabilizer and an antipsychotic drug to quiet the internal voices.

When I reintroduced myself, she remembered me. Her hair was clean and neat, her shabby clothes replaced by donated jeans and a T-shirt. We sat together on a couch, surrounded by other patients and visitors. I asked about her week.

“It sucked,” she said.

“That bad, huh? What sucked the most?”

“They’re leaving. My friends are leaving.”

I knew she didn’t mean her friends on the ward, but the ones in her head.

“Jane, you have a chance at something new,” I said. I hoped it was the truth.

“Is it O.K. if I don’t like it?”

“It’s O.K. You can try it for a while, before you decide.”

I had been complicit in taking something from her—her voices—and at this stage in her recovery I had little to offer in return. Jane was between two worlds. Without and an , she would soon slide back into a system where she would be just another homeless waif wandering the streets of the Portland.

How we help the most vulnerable among us involves serendipity and the limited tools in our toolbox: conversation and medication, as much art as science. There were few, if any, “ta-da!” moments in psychiatry. Diagnoses were murky and the brain was steadfast in guarding the secrets of its illnesses.

Timing is serendipity. Our intervention came early in Jane’s illness. She responded well to treatment; she was also nearing discharge with no place to go. She needed to be looked after, but no one had phoned to inquire about her. I wouldn’t be able to reach out to her once she left 3East, but I knew I’d think of her—a young woman so uncomfortable in her skin that she denied her name, a young woman running out of time.

The next time I saw her, she had a name and a family—a grandmother with whom she lived in eastern Oregon, who had prematurely grieved her granddaughter’s death until a neighbor knocked on her door holding an advertisement from the newspaper. She had a history. She had been an honors student in high school, then community college. She had plans. Then the voices began.

She quit school, was let go from a series of low-wage jobs because she talked to herself and made customers nervous. Friends fell away. She made it to Portland but left her name behind.

was part of the struggle of mental illness. We see most of our patients more than once. It isn’t unusual to see former patients in the newspapers—usually bad news. Not Jane. She didn’t call or turn up in our emergency room or the newspaper. We hope for the best and brace ourselves for the worst.

Months later, her grandmother left a message that Jane was doing well and was back in school. Her story had some welcome new paragraphs now, if not yet a happy ending.

Copyright: Evelyn Sharenov