“Are you from LA?” I ask the guy behind the desk.
He shakes his head. “El Salvador. But I’ve been here since I was eleven.”
“I love El Salvadorian food,” I say. “Tamales de elote, pupusas.”
He lights up and tells me about this place on Venice called Gloria’s that makes decent pupusas until Leo shows up. Leo is the director.
Just so you know, I’m not some special, Sherlock Holmes kind of woman who has been promoted into this work because I can diagnose things about people. Government does not work that way. I took this job because it was a promotion. I’ve just been doing speech pathology for about twenty years and have seen a lot and I am not particularly afraid of technology. I have an iPhone. I attend conferences about communication devices and read scientific journals.
What I understand about this case is that police got a call about a woman who was speaking gibberish. She was agitated, attacked a police officer, and was placed on a seventy-two hour psych hold. She has no identification and is unable to communicate. They can’t find any family and since she is non-verbal except for the gibberish, she was given an initial diagnosis as profoundly autistic, and when a bed opened up at Arrowhead she was placed here. I’m here to determine what the problem is.
The file is pretty lean.
I don’t know Leo-the-director very well. He’s a balding, dark skinned guy wearing a saggy gray suit jacket and jeans. He looks tired, but anyone running a psych facility looks tired. “Hi Ros, How was the 405?” he asks.
“Sorry I’m late,” I say. “The 405 was a liquor store parking lot on payday. Tell me about your Jane Doe.”
He shrugs. “She’s not profoundly autistic, although she may be on the spectrum.”
“So she’s communicating?”
“Still no recognizable language.”
“Psychotic?”
“I don’t know. I’m thinking she may just be homeless and we haven’t identified the language.”
“How did you end up with her?” I ask. Nobody gets a bed unless they are a risk to themselves or others or severely disabled. Even then they don’t get beds half the time. There are about 80,000 homeless in Los Angeles on any given night—not all of them on the street of course—some of them are living in cars or crashing on couches or in shelters—but a lot of them are either severely mentally ill or addicted and there aren’t that many beds.
“She’s 5250 pending T-con. Apparently she was pretty convincingly a danger to someone,” Leo said.
“Section 5250” is a section of the California Welfare and Institutions Code that allows an involuntary fourteen day psychiatric hold and “T-con” is a temporary conservatorship that gets the county another fourteen days to keep someone. We’re a bureaucracy. God forbid we not speak jargon, we have our professional pride. At some point in that fourteen days there has to be a Probable Cause Hearing so a court can decide whether or not the hold meets legal criteria. I’m a cog in that machinery. If I determine that she can’t communicate enough to take care of herself then that’s part of a case to keep her institutionalized.
When I say institutionalized I can just see people’s expressions change. They go all One Flew Over the Cuckoo’s Nest. Institutions are not happy places. The one I’m in right now is too bright. It’s all hard surfaces so I hear the squeak of shoes, the constant sounds of voices. The halls are way too bright. It’s about as homey as a CVS and not nearly as attractive. But you know, a lot of people need to stay institutionalized. I had a non-verbal patient, Jennie. She was twenty-six, and after many months of working with her and her caregivers to provide her with training she was finally taught to go and stand by the door of the storage room where the adult diapers were stored to communicate that she needed to be changed. I would like to live in a world where she didn’t have to live in a place like this but I’m glad to live in a world where she has a place to live. I’ve been to visit family in New Delhi, okay? In New Delhi, if Jennie’s family was rich she’d have great care. If her family was poor, she’d be a tremendous burden on her mother and sisters, or more likely, dead of an opportunistic infection.
I’m wearing sandals and the heels are loud on the linoleum. They’re three to a room here but a lot of the people are in the day room or group therapy. We stop at a room. Two of the beds are empty and carefully made with blue, loose weave blankets on them. A woman sits on the third bed, looking outside. She is clean. Her hair is long, brown and coarse, pulled back in a thick pony-tail.
“That’s Jane,” Leo says.
“Hello Jane,” I say.
She looks directly at me and says, “Hi.” This is not typical autistic behavior. Jane is about 5′6″ or so. Taller than me. She’s about as brown as me. My family is Bengali although I was born and raised in Clearwater, Florida. (I came to Los Angeles for college. UCLA.) Jane doesn’t look Indian. She doesn’t look Central or South American, either.
We’re given use of a conference room where I can do my evaluation. I prefer it to a clinic. It’s quieter, there are fewer distractions.
Jane doesn’t say anything beyond that “Hi” but she continues to make eye contact. She’s not pretty. Not ugly, either. Jane actually rests her elbows on the table and leans a little towards me which is disconcerting.
I’m 5′3″. My husband likes to walk so we walk to the drug store and sometimes we go out to eat. He’s six feet tall, a teacher. He’s white, originally from Pennsylvania. When we walk to restaurants from our little neighborhood (which is quite pretty, we couldn’t afford to buy a house there now, but when we bought our place the neighborhood was still rough) there is enough room on the sidewalk in places for about three people to walk abreast. If there are two people walking towards us and they’re two men, I’m the person who always has to get out of the way. A man will unthinkingly shoulder check me if I don’t and occasionally look over his shoulder, surprised. This is a stupid thing, I know. There are a lot of entertainment businesses in our area—people who make trailers for movies or do mysterious technological things involving entertainment. They’re young men. They wear skinny pants or ironic t-shirts or have beards or wear those straw fedora things. I am old enough to be their mother and I am just surprised that they do that.
“Would they run over their mother on a sidewalk?” I ask.
“It’s because you’re short,” Matt says. Matt is my husband. He is middle-aged but he also wears ironic t-shirts. My favorite is his t-shirt of a silhouette of a T. rex playing drums with its little tiny arms. Matt is a drummer in a band made up of old white guys.
Men never do it if it’s two men coming up on two men, they all just sort of squeeze. I get very irritable about it. I grew up in America. I feel American. My parents come from New Delhi and they are clear that my brothers, Jay and Ravi, and I are very American but growing up I felt like I was only pretending to be. Sometimes I think I learned how to be a subservient Indian woman from my parents and I give it off like a secret perfume.
When I was younger I walked very fast, all the time, but now I’m middle-aged and overweight and I don’t dart around people anymore so maybe I just notice it more or maybe I’m just more cranky.
I plan to do an evaluation called ADOS on Jane Doe. ADOS is one of the standard evaluations for autism. It can be scaled for a range from almost non-verbal to pretty highly verbal and since the file said that she spoke gibberish, it was a place to start. I never get to ADOS because it’s obvious pretty quickly that she exhibits no autistic behaviors.
“Hi, I’m Rosni Gupta,” I say.
She studies me.