Can a unique boarding home save my patient?

James is a tall, lanky Caucasian man, well into his 40s. He has brown curly hair and is not a bad looking fellow except for the vacant look in his large brown eyes. He is a pacer, which is a manifestation of his illness, and a consumer of excessive amounts of water.

You have to talk right at James to be understood. I try to make eye contact. Sometimes he doesn’t reply right away.

The Unique Boarding Home was not my pick of a place for James to go, but the quality of the place is probably what I might have come up with, had I had time to do this particular selection. I hadn’t.

The hospital social worker found the boarding house for James at an acceptable cost — $400 per month. It could not have been easy for her, I know, because she has to tell prospective landlords of James’s most recent history, to say nothing of longer-term incidents, and that included threatening behaviors that involving the introduction of a gun and even more damaging and frightening fire.

Fire was the event that got James thrown out at the previous address. Not only was he thrown out, but the police were summoned, and he was carried off to the psych unit at University Hospital. He had been found in an upstairs bathroom trying to light a fire in the bathtub — ostensibly to keep warm, he said.

In spite of James’s history, Unique Boarding Home accepts James at $400 a month. He gets three meals and his laundry done. I have to guarantee payment to Unique, which I do. I promise that James’s dad will make payment promptly, and I know he will, or I would not promise. James’ father handles his money. I have a good relationship with James’s dad. I almost have to, for I rely on him, and he relies on me. He understands how impossible my job can be a lot of the time. He says so. But, I think I can leave it all behind at day’s end. He can’t.

I go to the hospital Psych Unit to pick up James. I had been there two days before to see for myself how James was doing. He looked well-rested, and I could see in his face that he had gained a bit of weight, which he could use.

He appeared as well as I have ever seen him, and I know this is because he has had his medication on schedule. Once away from the hospital, such a schedule is going to go to hell in a hurry. When James was brought to the unit, he had a number of little brown envelopes that contained medication — pills — he was given to take on the weekend when our offices are closed. He had taken none. Most days, on weekdays, he gets his medicine at our offices. He takes medicine in the presence of a nurse who sees that he complies.

The Unique Boarding Home is of white clapboard and is a large, three-storied house. It is located between a gas station and a mini- strip mall on Broadway, a busy street. On the front of the house is a small square sign with the words “Unique Boarding Home” neatly but crudely painted.

Ms. Julie runs Unique Boarding Home, although she does not own it. Another woman does, and it was this other woman with whom I made financial arrangements for James’s stay at Unique. Ms. Julie is a powerful woman. She keeps day-to-day control. She is slightly built, maybe 40-ish, with prominent protruding teeth adorned with a number of gold fillings.

That’s what strikes you upon meeting Ms. Julie — all the gold in her mouth.

She lays out rules to James, and he nods his head that he understands. No drinking on the premises, no drugs (aside from prescription drugs, of course). She gives James a form that spells out his rights in a state-certified licensed boarding house (which this is) and the rules. He must sign this paper, and he does so after a careful reading. I have noticed before that James always reads what is put before him.

He does not seem at all upset or surprised at the quality of the surroundings he is about to enter, and we are on the first floor, the “show floor,” I’d call it. There is a parlor and a sitting room and a TV, and next to that, the kitchen. I know upstairs must be different, rougher.

James informs Ms. Julie that he is a vegetarian. This is the first I have heard of it, and when later I ask his dad, he tells me it is the first he has heard of it also. Ms. Julie tells us that she cooks a lot of vegetables anyway and that James is sure not to go hungry. The next day when I see James, he tells me the food is not only good, but it is plentiful.

It is the day after I place James at Unique that I drive him home. He has been at our office for his daily needs. I want to go back with him because I want to speak to Ms. Julie about assisting James with his weekend medication, which she has volunteered to do. But Ms. Julie isn’t there when we arrive. The house is locked, and James does not have a key, but he says there is a way in around the back, an open back door for this purpose. No residents have keys to the front door.

“Want to see my room?” he asks, and I tell him I do. So we go behind the house. There we find a wooden staircase that leads to the third floor. At the top, the door is open — always open, I suspect — which is probably a good idea, in case of fire. We enter the room to find a man asleep in bed, a thin blanket covering his entire body, including his head. There is no door to the next room.

There are at least three beds in this space, maybe four or even five. James shows me his bed. He doesn’t say anything to the man who is standing nearby and who gets up to turn down the music from a boom box that is placed on a mantel. I assume the man must sleep in one of the other beds. I am not introduced to the man, not that I expect it.

Earlier I had asked James — to what point, I don’t know, just making conversation, I guess — if his bed was comfortable. His response was, “The mattress is a little firm, but it’s all right.” He slept well, he said.

For as long as I have known James, he has lived in mainly black neighborhoods. Years earlier, when he was less sick, he married a black woman with several children (not his). His dad says his wife tried very hard to accommodate James (just as his father has), but his mental illness was just too much for her.

His father told me this story one day in a planning conference we have periodically for James in an effort to help him cope. The father had sympathy for that black woman and no small degree of gratitude for what she attempted to do to make a life for James. It is what everybody around James tries to do but with very mixed results almost all of the time. But for today, for the present, Unique Boarding House has become home for James, and that will continue, well, until it doesn’t.

Raymond Abbott is a social worker and novelist.

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