Penobscot Community Health Center
Bangor, ME

Written by Trip Gardner, Project Director

On a Mission

Back Story
Summer Street Community Clinic is a Community Health Center where we offer primary medical, psychiatric and substance abuse services together, side-by-side. Our goal is to connect with people in a way in which it is easier for them to try a new path on their road to recovery. My name is Dr. Trip Gardner and I have the good fortune to be a psychiatrist and co-director of this clinic with my colleague, Family Nurse Practitioner, Mary Jude.

Phil is a very caring man who would do anything to help others. “Too good hearted,” his mom would say. He is a normal looking, middle-aged fellow except for his superhero emblazoned wool hat and the Boston Red Sox blanket he keeps wrapped around his neck as a superhero cape. Phil spent most of his days looking for a “magic switch,” as he called it. He believed that if he found this switch and turned it on, the world would be rid of all its problems. This was not a metaphor, this was not a "maybe there is a switch;" this was, "there is absolutely a switch and I must find it to help us all, no matter what."

To protect his mission he had withdrawn from everyone and everything that would question his mission. This included home. He usually stayed in a large box behind a local department store. He would not allow anyone to help him as he saw this as a potentially disguised threat to his mission of saving us all from the world’s problems. During this time Phil would frequently hear voices that he would sometimes argue with back and forth with great intensity. His behavior frightened others and served to further isolate him. The more active his environment was, the louder the voices would get; so he rarely was able to take refuge in the local shelter. Boxes, overpasses, garages and abandoned vehicles had been his home for many, many years as he kept moving and searching.

Phil initially began coming to our Summer Street Community Clinic about 3½ years ago when he saw our Family Nurse Practitioner, Mary Jude, for a rash. While Mary helped his rash, she talked gently with him. “Phil, you told us you were at the state hospital for a while. If you think you might want to see someone here to talk about how you feel or about medications, just let me know.” She added, “You are in control, you are driving this vehicle. You can visit with someone, check it out, see if it is something you would be comfortable with, and if not you can leave.” She then asked if she could just introduce me and knocked on my door. Phil was polite but obviously did not want to have much to do with another psychiatrist. And he made it clear he did not wish to take any medicine for schizophrenia, which his brain saw as poison. He got help with his rash and was happy with that.

A few days later I noticed Phil on the steps behind the old weathered brick building on Main Street. Phil was smoking a cigarette—carefully scanning his area—when I walked over said hello and asked him if we could talk. He politely said “No Thank You.” I kept saying hello and good morning every time I saw Phil, being careful to be pleasant without pushing too hard. After a few more weeks Phil started returning the hellos. We began talking about the weather, brief and to the point, as New Englander’s do. Gradually our talks started to include cars, as it turned out Phil and I both were fans of the older muscle cars. He seemed impressed by the story of my candy apple red 67 Ford Mustang. With time he even let his guard down enough to talk about our beloved Red Sox.

He came to a point where he began being okay with my questions about where he was eating, how he was staying warm, and he agreed to see Mary for help with typical ailments of homelessness like coughs, sniffles and sneezes. As we would talk with Phil, she and I would ask questions like “Why do you think you have not found the button?” “What if meds helped you see things more clearly? Wouldn’t that help you?” We were searching for anything that would give us an "in"—a “maybe you're right”—so that he could understand what we offered in a different way and might one day be able to yes to the medicine for schizophrenia.

This went on for nine months when he finally agreed to come into my office and tell me his story so I could “understand his mission better.” Phil told me that he had a normal upbringing—he had friends, did well in school, had meaningful jobs and was moving forward when in his 20’s, he started feeling a special purpose and being concerned that others were against this purpose. He then started hearing “spirits” that were guiding him to do something good. This ultimately led to him drawing a picture of the magic switch from a thought inserted by the spirits. The spirit warned him that others did not wish for him to succeed and he began to isolate himself to protect his mission. This led to Phil becoming jobless and homeless. For 5 years he had wandered the streets in search of the magic switch. Along the way he began having delusions that the CIA was following him, monitoring his moves and messing with his thinking through a bug in his brain that also spoke to him, trying to block his mission. Phil even began to believe that members of his family were imposters.

I continued to see him regularly over the next 9 months, listening to his story and trying to help him meet his basic needs. Whenever the chance arose, I would continue to plant thoughts that challenged his reality and offered hope for a new reality. He began to listen more and even started to take the medicine with him saying, “I will take it if I need it,” which meant “ if people get me on edge” or "if I can't sleep.” This worked out to be 1-2 days per week, which would not be enough to relieve his psychosis, but at least he was no longer seeing medication as poison.

Predictably, Phil got sicker (as happened with some regularity each year) and began talking to himself more loudly, not making sense and at least appearing threatening to others. The police were called by the staff at the shelter who were worried about Phil's safety and the safety of those around him. Cuffed, he was taken against his will and his mission to the emergency room where health care providers would hold him down and inject what he saw as poison while he fought to rescue his mission. To get out of the hospital, Phil would take his medicine or at least behave as if he had indeed taken it, say he was not hearing many voices and deny his mission.

Shortly after, Phil and I met again. He was finally able to talk to me about the possibility that he may have schizophrenia. I spent a lot of time explaining what was chemically wrong in the brain with this illness and how the medicine works to fix this. I also explained how the illness was no one’s fault and that it is just like any of the other medical illnesses that strike people unfairly. We talked about Phil’s courage in being willing to listen to me despite the illness telling him I was evil. We also talked about the courage of those with schizophrenia who trust others enough to take a medicine when part of their brain is telling them it is poison.

Phil then looked me in the eye and said “Maybe you are right, Doc.” He decided to take daily medicine for schizophrenia. After a few months Phil was significantly less psychotic. He did not remember his search for the magic button and the voices he heard were softer and friendly. As time has gone on he has gotten an apartment, developed a close friendship, addressed his medical needs, had a needed surgery and now would like to find a part-time job.

Phil is one of the 873 individuals we have served in over 10,000 encounters in the 2 ½ years of our project. The chronically homeless represent only 10% of those who have been homeless, yet utilize 50% of all shelter beds on any given night. They are almost always struggling with severe and persistent mental illness usually of a psychotic nature, as well as past traumas, substance abuse and poor overall general heath. Their illness, their trauma and their experience have taught them not to trust those who say they are there to help.

At Summer Street Clinic, we seek to connect in a way that helps individuals like Phil develop new understandings of trust. We start the connection by chatting with folks in need of our services, and then move on to asking them caring questions about their basic needs (food, water, sleep, shelter). Once we are able to establish a sense of trust with these folks, that we care about the place they find themselves, we are able to move toward establishing primary medical care and subsequently, psychiatric care. Our purpose at each level is to build comfort with being helped and trust in us so that their recovery moves forward.

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