I looked at the clock hanging in the hallway. There were only three more patients left before the lunch break. I desperately needed my daily dash for the safety of my COVID-free car, so I could take off my N95 mask and breathe deeply. This is my daily pattern as a chief physician in a non-residential shelter in my city.
Finding commonalities
The next patient was Carlton. When I entered the exam room, I saw that Carlton had tried. His dull hair was brought up to a semblance of order. He flipped his worn-out shirt inside out to the dirtier side. Carlton may not have benefited from showering for months in the Jacksonville heat. However, he was someone in need of care. I shook his hand and made eye contact.
I ask nice questions to find a common thread when we started our relationship. How did Carlton become so exhausted? My curiosity is a daily checkpoint, ensuring I’m not headed down the same path. Every story is different, but a lack of housing can happen to anyone.
Carlton Story
Carlton started telling me about his past. He was the former CEO of Fortune 500. He flew private company planes and had a yacht. Carlton even showed me a wrinkled photo of his beautiful ex-wife and two children. The children wore matching outfits, and Carlton wore pink shorts with little green whales. Describe his mansion, his zero-edge swimming pool and his fleet of cars.
so what happened?
Carlton followed his evolving life story, telling me how the pressure at work was so intense. His son needed an expensive teacher, and his parents died unexpectedly, making him the self-appointed leader of both extended families. One evening, he was robbed. After that, he started rubbing his hands and washing everything around him. Long-repressed OCD tendencies (commonly referred to as OCD) from his youth came back to life and ate him like a lion.
Ramifications
This strange and unjustified behavior frightened his naive young wife. She withdrew with the children to a different CEO and remarried once their divorce was completed. Carlton’s career faltered. He can no longer make decisions. The whole time he was cleaning his office obsessively. Eventually his company fired him.
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Of course, one by one, everything working for him evaporated, and Carlton found himself living on the street. This was probably the worst situation for an OCD patient suffering from pollution triggers. The mobile shower cart is broken or does not appear. As with others living without a home, he found it difficult to take a shower in the public library tub. Without the ability to keep himself clean, his physical, mental and spiritual condition deteriorates.
Medical examination
I listened to him as he regressed his fall from star rank. His family disowned him. He has not seen his children for two years. Then we reviewed the medical questions, examination, and treatment plan.
I promised we’d see each other in a month. She promised to try and discover housing, a stable food source, and better access to showering. To my surprise, Carlton arrived and hugged me quickly. It felt like we had just won the confidence match.
I’m done with morning sickness, but Carlton has been keeping me busy. I rushed to my car and took off the N95. By the time I got to my sanctuary, I was crying. They were some tears of deep gratitude to the Lord for having relieved me of Carlton’s grief and pain. But for the most part, I was very sad.
Weary society systems
I failed at Carlton that day. The cumbersome system of community psychiatry and the medical community have failed Carleton, too. I had nothing to offer him during this OCD except for the occasional shower and a clean shirt. It was a little too distressing.
In Duval and Clay counties combined, there are approximately 1,222 homeless people at any one time. Of these, a significant proportion suffer from mental illness. It is a catastrophic burden on society to provide adequate care for uninhabited people who also suffer from mental illness. As a society, we must do better to provide affordable and accessible mental health care. Doing so will prevent steep helical inclines like Carlton’s.
Ironically, if Carlton had suffered from one of the many other life-threatening illnesses I would have had the opportunity to offer treatment. Adequate funding is available for cancer, coronary artery disease, diabetes, and HIV/AIDS. Why is OCD treatment underfunded and limited?
We must do more
You might think that OCD is not life threatening. I suppose it’s not usually fatal to the human body, but Carlton is a walking dead man. We must do more to help unwell people, and support legislation that improves funding and access to OCD treatments and training, such as exposure therapy for exposure prevention and response. Finally, we must not continue to let Carlton down. The burden is on us.
Julie McKay is a senior physician at the Sulzbacher Clinic in Jacksonville. She also serves as a board member of JACK Mental Health Advocacy, a non-profit organization created to support families of sufferers and advocate for the treatment of people with obsessive-compulsive disorder and anxiety disorders.
This guest column is the opinion of the author and does not necessarily represent the views of Times-Union. Diversity of opinions are welcome.
