I did home care visits in the core downtown area of our city for five years. Beautiful condos faced the park and a block away others lived in filthy apartments above main street stores.
Ingrid was a middle aged schizophrenic who had lived on the streets in several cities. She understood her subculture well and knew where to sleep and where to get a meal. She was resourceful and capable in spite of her paranoia and delusions. She was obsessively clean, hated indoor spaces and had strange religious leanings. I never inquired about her past but would do so if I met her today. At the time I did not understand mental illness very well. She did not smoke, drink or do drugs and to our knowledge did not have a police record.
Ingrid also suffered from renal failure and was on peritoneal dialysis. She carried bags of dialysate with her and hung them from any available place including tree branches when she did her treatment. On top of this she had a parathyroid adenoma which she refused to have treated. As a result her calcium and phosphorus balance was disrupted and she developed severe osteoporosis. Inevitably she fell and broke her femur and the surgeon stabilized the break with an intramedullary rod. Social Services found an apartment for her and the hospital donated an old hospital bed that was destined for a third world country. A telephone was installed so we could keep in touch with her. I visited the day she was discharged from hospital with cautionary warnings from the case manager stating she was threatening, angry and unpredictable.
For some reason Ingrid and I hit it off and she allowed me to visit her a couple of times a week. It was late winter but she kept the windows of the apartment wide open at all times. The only furniture was the hospital bed but she had a pail, mop and bottle of bleach which she used to clean the floors daily. She lived with purpose and appeared content with her lifestyle.
Because of her severe osteoporosis, the fractured leg became shorter than the other by almost 2 inches as the bone collapsed around the break. One day I visited and she was unable to bend her hip at all. The intramedullary rod had shifted upward into her pelvis. I wanted to call an ambulance to take her to the hospital but she refused. She would only go if I took her so I got her in the back seat of my minivan where she had to stretch out across the seat as she could not sit. She was admitted and the surgeon removed the rod completely. Her gait pattern was terrible as she limped on her shortened leg with the walker. Social Services paid for shoes, a shoe lift as well as a new walker. She needed a sturdy wheeled rollator with a seat but she would only accept a folding aluminum walker. Everything she owned had to be lightweight and portable. I would see her pushing the walker down the street, dialysis bags dangling on the side as she limped with her peculiar gait. She would be lucky if the walker lasted six months with the heavy use it received on rough pavement.
A few weeks later I went to visit her at the apartment and she was gone. No one had seen her leave but the place was clean and empty except for the hospital bed. We heard through the grapevine that she had moved to the streets of Windsor following whatever voices commanded her life. Her resilience was remarkable and I often wonder what became of her. Was she ever institutionalized or did she die as she lived, on her own terms?