He was known by the whole clinic as a tough patient.  He missed appointments, saying he was “busy,” but never explaining with what.

He looked like an obese surfer dude; blond, blue-eyed, always tanned.  He was quiet and polite and said little, very little.  His long-standing diagnosis was schizophrenia.

We knew that he lived with his mom.  She had once monitored his medications, but now she was ill. He did not take well to home visits, so there had been none for a very long time. Most anti psychotic medication makes folks put on weight.  I had seen many obese schizophrenics in many clinics, but his elusive nature made us wonder how sick he really was, what his life was like.  We even wondered if he sold the medicine on the street to make ends meet, as some folks do.

He lumbered in, if irregularly, to get his injection.  He always took it quietly. Mention him at a staff meeting, at least within the last three months during which I had called in to consultant, and every case manager turned their eyes heavenward, groaning.  Everyone agreed, he was frustrating, at the very least. Nothing could be done for him; he wouldn’t listen.  He told contradictory stories about his life. People told me he was a substance abuser –crack, cocaine, pot.  I saw no clinical signs of substance abuse when I visited with this patient.  However, I had only seen him twice, for he did not come to appointments often. “I am a busy guy.  I drive around; I do things.” He couldn’t tell me what.  “For my mother.  Sometimes, I like to be with my girlfriend.” Read more on The Starving Surfer…