On my voice mail is a message from Donald Wyatt. He doesn’t often call, but every Monday morning he comes to see me at the Louisville, Kentucky, mental health clinic where I’m a social worker.
His message is brief: “I’m not feeling well, and I am planning a trip to either St. Louis or Elizabethtown.”
I smile, wondering at the odd pairing. Elizabethtown is a small city of 50,000 people. And, well, St. Louis is St. Louis, a metropolis.
This behavior is not unusual for Donald. He’s disappeared before, always out of state and by bus. He doesn’t have the money to travel any other way, although once he took his parents’ van and drove to Ohio. (He has no driver’s license.) Never before, however, has he called beforehand.
Usually, a hospital or mental health center calls to notify us that Donald is with them, is OK and is ready to come home. Then I go to the bus depot, buy Donald’s return ticket and have Greyhound wire it to wherever he is.
A slight, clean-shaven man with curly brown hair, Donald is forty-five but looks older. He’s been diagnosed with Asperger’s and Tourette’s. Asperger’s is an autism-spectrum disorder characterized by difficulties in social interaction, and Tourette’s is a neurological impairment featuring physical and vocal tics.
What many people find most annoying about Donald is his constant need to repeat things. Every Monday when he sees me, he says, “I have to get home on my own, go for my bus pass and do my grocery shopping, am I right?”
“Yes, you are correct, Donald,” I say. Then he repeats it all, virtually word for word. He does this with just about everything he says.
He also annoys my co-workers by coming in just as we open on Monday mornings and asking, for example, our psychiatrist Dr. Ames, “And what did you do this weekend, doctor?” while clearly expecting a detailed answer.
Some staff members reply, “None of your business.” This is crushing for Donald; he wilts like a dying flower. It’s sad to see.
I never say such things to Donald, no matter how out of sorts I feel. I simply answer, “I raked leaves, I went out to dinner, I went to the lake,” and so on. Then Donald tells me, in considerable detail, what his weekend entailed. This takes only a few minutes, then he heads off contentedly.
I have discovered that Donald likes to know two things: That you like him (you must say so often), and that you think he is doing well in his life. I always try to buck him up, so that he leaves in good spirits. It’s not much to ask, and sometimes it’s all I can do for him.
Our agency handles Donald’s funds. Each month we pay his rent, phone, and other expenses, then give him spending money, all from his Social Security disability check of $564 per month.
Donald is very good about money; there’s always a surplus in his account. Last time I looked, he had $600 or more, and all the monthly bills were paid. Which brings me to another issue.
When Donald returns from his wanderings, hospital bills often follow. His Medicaid card is mostly good only in Kentucky, so these bills don’t get paid; somebody writes them off. My supervisor recently said that we must begin to pay these bills out of Donald’s funds so that he will realize that his little excursions bring more consequences than just inconvenience and worry to me and his family.
Donald is easily upset, and I’ve not yet told him of this change — but I did tell his mother, who is very involved in his life. (He’s an only child and lives alone.) I also told Donald that I would like him to call me when he feels the need to flee — and so, to my amazement, he has.
After hearing his message, I wonder which city he will choose, Elizabethtown or St. Louis. I have a daughter at college in St. Louis. He knows her name, her date of birth, what she’s studying — things I’ve told him when he inquired about my family. I allow Donald to know all this because I have no fear that he would do something like go to St. Louis to visit my daughter. His mind just doesn’t work that way.
But he recalls these details because his memory is like a sponge, his mind like a computer about such things — especially numbers.
One day we were at the Social Security office, and a woman nearby, conversing rather loudly with a friend, shared that she would be fifty-five on her next birthday and mentioned her date of birth.
Donald spoke up immediately.
“Excuse me,” he said politely. “You are mistaken, ma’am. You will be fifty-four on your next birthday.”
She looked at us hard; I expected her to tell us to mind our own business.
“Why, you’re right,” she said. “I’m fifty-four on my next birthday, and all this time I’ve been thinking it was fifty-five. Thank you, sir.”
How fortunate, I thought, that Donald’s calculation revealed her to be a year younger, rather than the opposite.
Now my voice mail has a second message.
“I didn’t leave town,” Donald says. “I’m at the hospital waiting to be evaluated. I didn’t tell you before, but I’ve felt kind of depressed, not myself, since before Christmas.”
Still later, I get another message. He’s back home, and he wants me to call him, which I do.
“Are you better, Donald?” I ask.
“Yes, much,” he says. “It was decided that I have the flu.”
“The flu,” I say, a little surprised. “I am very glad, Donald, that you called me before you left town.”
“Well, you asked me to do this, and so I did.”
“Yes, I remember that,” I say, thinking how I ask lots of people I work with to do certain things, and yet they don’t always do them. I don’t say this to Donald, of course.
“How about I visit you tomorrow?” I ask. Donald is never much for home visits, but he likes and trusts me, and so, a bit hesitantly, he agrees.
At 10:00 the next morning, I knock on Donald’s door on the tenth floor of a low-rent high-rise.
Donald opens the door, looking pretty much as always. He says he’s feeling much better. Indeed, he says, “I’m happy” (his favorite expression) and adds that he’s been given flu medicine.
I ask why he was choosing between St. Louis or Elizabethtown.
“Oh, that’s easy,” he says. “I had just enough money to go to either place.” (He means one-way.) “I went to the bus depot for an hour, then I left and went to the hospital.”
“I’m proud of you, Donald. You did well choosing to stay around and call to tell me your plans. That was very good.”
“It was, wasn’t it?” he says with a big smile, very pleased.
This would be a good time, I know, to mention that any medical expenses incurred during his wanderings will now come out of his monthly budget. But I don’t.
I have his February budget, which I need him to sign, so I produce it. I have fifteen such client budgets; none of them change much from month to month, but Donald is one of the few persons I work with who adds up all the figures and, when he can, catches me in small errors (not often, I hasten to add).
Today he adds the figures as always but finds no mistakes. He signs the budget with a bit of a flourish and a big, approving smile.
“I’m happy,” he says.
Raymond Abbott is a social worker. This article was originally published in Pulse — voices from the heart of medicine, and is reprinted with permission.