“Is that one of yours?” my friend’s daughter asks.  She’s eight.  We’re headed toward Pioneer Place in downtown Portland, OR to catch a movie. 

Her use of ‘that’ as the subject of a sentence, when ‘that’ is a man, unnerves me.  She doesn’t seem nervous at the approach of this seemingly odd fellow, but her mother closes ranks.

“What?” he shouts.  He vehemently challenges an internal voice, an unseen someone.  “Wha-at?” he repeats, angry now.  His way of saying, “Quit messing with my head.”

“Is he one of yours?” my friend’s daughter self-corrects.

“No, but he could be.”

I believe he’s harmless, noisy maybe, this side of shabby, obviously mad, but ultimately harmless.  A scruffy black beard and hair that stands straight up around his head define his appearance.  Black brows meet in the middle of his nose bridge.  His gaze is intense, dark and glaring.  He quiets as we near each other, nods politely, then moves aside to allow us to pass.  He’s close enough for me notice crumbs of meals past in his beard.

Once past us, his quarrel begins anew.

I lead two lives.  On 3East, a locked psychiatric ward in a Portland, Oregon hospital, I stabilize men and women in crisis, move them toward discharge, back into their lives, back into the community.  As a freelancer at Willamette Week and the Oregonian newspaper, I’m out and about in town.

I routinely bump into my patients.  They wander and Portland is a small city, compact, laid out on a grid.  It’s an easy walk from north to south and east to west.  What I’ve noticed is a clear distinction between patients who acknowledge me and those who do not.  The line is drawn along socio-economic divides, as well as the severity of the illness.  There are rules of engagement for such encounters.  I never greet a patient unless he makes the first move.  The initial overture must always be made by the consumer.  Being in treatment – even for depression, which afflicts one in five Americans in any given year – is a sensitive matter.

I know one of the staff at Willamette Week from a weekend he spent on 3East.  He was new in town, depressed and lonely.  He felt – for a fleeting moment – as if not living might be preferable to living, so he checked into the hospital.  He was discharged two days later, armed with a prescription for antidepressants and a referral for outpatient counseling.  He told me he felt ‘normal’ in comparison to some of the other patients on 3East.  During his time on the ward, I don’t mention my connection to WW.  That would be a breach of ethical boundaries.  When I stop by WW to drop off a book review and chat with my editor, he’s the first person I see.  He turns away from me.  Then I pass him as I leave the building.  He’s outside smoking a cigarette.  I don’t attempt to make eye contact. 

Many of my patients are involved in the sex trade, to support their drug habits, pimps, kids.  A visit to 3East is often prompted by an arrest or the need to detox down to a more affordable habit.  “Hey,” “How you doin’,” “There’s my nurse,” they call if they see me on the street.

Over Thai food one evening, my husband notices a young woman at a nearby table.  She looks at me, the briefest eye contact, a flicker of recognition, then nothing.  I never take it personally, that someone is embarrassed to know me in that other context.  “Is she one of yours?” my husband asks.  She’s an attorney and will die of complications of alcoholism in the not-too-distant future.  “Yes,” I nod, and continue chopsticking my Pad Thai.

I literally bump into a young man who I know from two stays on 3East.  “Hey, mom,” he yells out to his mother in another aisle of the one-stop-shopping market.  We’re both trying on shoes.  “See, she’s buying Sketchers too.”  He shows me his new runners, proud to have something in common with me, to share a moment of health, not illness.  But something’s off; his eyes are too bright, his voice too loud, speech too rapid, words tumbling over each other.  His mother approaches.  I know her.  “Is he taking his meds,” I ask.  She shakes her head.  The following week he’s back on 3East, dark and brooding, pacing the ward in his new Sketchers.  Seventeen laps equal one mile.  He doesn’t recognize me or know my name.

Last spring as I walk past a dumpster, on my way somewhere that isn’t the hospital, two heads pop up from dumpster-diving.  “Daddy, look, it’s our nurse.”  She shares what little she has, a broad smile and a generous nature.  Daddy, her boyfriend, waves.  He can’t talk unless he adjusts his tracheostomy tube.  I know them from the local methadone clinic where I occasionally dispense.

I know how it feels to be welcomed.  I’ve learned how it feels to be too visible.  Half visible.  Invisible.  

Evelyn Sharenov