The Voices

‘You can see her in this room Dr. Johnson’. The caretaker of the woman’s shelter was glad that I had come to examine some of her residents. She then politely escorted Felicia and me away from the crowded gathering of the others and into a small side room. ‘You will be able to hear them from here but they won’t be able to hear you talk with Felicia. All of them were really anxious to see the doctor. There just was not enough time to interview and examine them all that day.

Once we were alone, Felicia stood before me her arms shaking like the limbs on a tree caught in a violent wind. She paced in place like a sprinter getting ready for a race. Then she opened up. ‘All I want is to stop the voices. I have not had enough of my medicines since I was released from prison 2 weeks ago. They only gave me just enough medicine till I could see a doctor. I don’t have insurance and I don’t know any doctor. I have been afraid of using all of my medicine because I did not want to run short. So I only use it when I hear the voices. They are beginning to whisper now.’

In order to keep the voices at bay Felicia had devised a plan to make her medications last a long time. She was desperate and knew a psychotic break would happen if not medicated soon. The scenarios for using prescription drugs is as varied and confusing as the stories of the almost 2 dozen or so women in the room we left behind.

I am no psychiatrist or psychologist. But I do know something about compliance when it comes to taking medicines. I never advise a diabetic to take medicine when nearing diabetic coma, or a hypertensive patient to wait for onset of stroke to do likewise. I know that waiting to hear voices is not optimal therapy.

The setting is a ‘half-way’ house for women. They reside here as they transition from jail, or prison. Some of them are escaping violence in their homes, or avoiding life on the streets selling their bodies for food and shelter. This place is safe. Here, they can find consistent comfort of blankets, caring providers and for today, a doctor visit.

My duties as a physician at Miriam Medical Clinic, have brought me face to face with this reality. One woman (transgender) wants to know if we can provide hormone replacement therapy so that she (he) can continue comfortably uninterrupted in this new mode of life. Another woman wants to know if we can treat her hepatitis C, and at the same time check for warts in discrete places.

I have studied and managed illnesses and diseases for a long time. However, providing health care for prostitutes and drug addicts is new to me. And then of course there are the people who have been recently released from incarceration and cannot afford their medications. Medications which if they could afford them, would slow their organ failure, prevent the infections, clear the skin rash, elevate their mood, and of course stop the voices.

This takes a team approach. I asked Kay who is the clinic administrator, to pursue getting a release of medical records from Felicia’s most recent emergency room visit. Then I review the records and discuss the medication regimen with Dr. Pitts our clinic director and clinical pharmacologist. Together, we consult his wife Pat, who is a practicing psychiatric nurse. She helps us formulate a plan that can readily renew the prescriptions.

It's all rather complicated, but for Felicia the voices have been stopped.