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A piece of my mind. A modern family.

A Modern Family I FIRST MET JOE ON THE 13TH FLOOR OF AN INNER-CITY hospital. He was lying comfortably in his hospital bed, granted refuge as an unassigned medical admission for chest pain the night before by the inpatient team. Joe was a 73-year-old white man with uncombed hair, bushy eyebrows, and a severely stooped posture noticeable even as he sat upright in the bed. He had a gravelly voice—from years of smoking, I soon learned. On the chair beside him were his clothes, which were worn well beyond their life expectancy. Joe looked like someone who had worked hard all his life and appeared much older than his actual age. Aside from his appearance, I was struck by the tattered text by his bedside. It was an old edition of Age of Enlightenment, with “Enoch Pratt Library” stamped on the first page. While taking his history and performing a physical examination, I noticed that Joe spoke brusquely with many facial twitches and gross motor disturbances. He did not use many big words. I asked him politely about his book, to which he replied, oddly, “Oh, you know. I enjoy reading works of philosophy, particularly about Erasmus and the Reformation.” I had heard of Erasmus before, but was not very familiar with his history or theories. Joe knew all about this subject. He told me that he loved to read. I asked him about the last book he read. “Mein Kampf,” he replied. I asked him what he read before this, and he answered, “The Rise and Fall of the Third Reich.” I wondered to myself, Who is this guy? As it turned out he wasn’t a Nazi at all but absolutely loved all types of military history. His most recent reads had focused on the world wars. Joe’s favorite was the 1895 war novel The Red Badge of Courage by Stephen Crane. Joe continued, “But what I am really looking for, Doc, is a book about World War II by an American author—not a British author—but an American author.” Given my first impression of Joe, I was surprised to learn of his scholarly pursuits. Joe was born and raised on the east side of Baltimore and had made it through seventh grade. When I asked him why he didn’t go further in school, he said, “I quit school the day my father died, so I could go to work at a warehouse to help support my mother.” He had always loved reading and learning and tried his best to make time for these activities. At the age of 21, he married. It was also at this time that he developed schizophrenia. Unfortunately, this factor, as he explained it, was likely in part why his marriage failed after only two months and resulted in no children. That same year Joe was admitted to a state psychiatric hospital, followed by another stay at a different state hospital. These were the first of what were many psychiatric admissions; longer and longer each time and which ultimately became a 30-year period of institutionalization. His twisted facial expressions and thrashing body movements were caused by the cumulative adverse effects of years of powerful antipsychotic medications, which only dampened his disturbing thoughts and the obtrusive voices he experienced. Despite all this Joe was beloved by the hospital staff, where he held the reputation as an exemplary patient. Eventually he earned the privileges to work as an employee, supervising others in the boiler room. The institution became his home. In 1981, President Ronald Reagan rescinded the Mental Health Systems Act of 1980, which resulted in reduced federal funding to community mental health centers. Many patients, who were no longer thought to be a threat to themselves or to others, were released from intensive psychiatric care. This included Joe. After leaving the facility, Joe was offered and accepted a job to continue working at the hospital as a paid employee, with room and board included. Inexplicably, after a year of compensated service, he left. For years after his departure from psychiatric institutionalization, Joe was dutifully cared for by Miss Elsie, a 60-year-old African American woman. Elsie was herself no stranger to difficult times. She had married twice during her life; both marriages ended in divorce from abusive husbands. For more than 25 years she worked long hours as a correctional officer. After retirement from this career, she opened up an adult care service in her twostory four-bedroom home in a working class suburb of Baltimore. Elsie was contacted in 2004 by an admiring social worker from a local hospital, who asked if she would accept a new client under her care. She was told this gentleman had resided in substandard housing under horrible conditions—essentially in a room that was little more than a mattress on a basement floor and virtually void of human contact. This is how Joe first met Miss Elsie, a stranger who would walk beside him for the rest of his life. Joe had neither living relatives nor close friends. He often spent his time alone. On a weekly basis Joe took the local bus to the Enoch Pratt Library, where he would read for hours. On a good day he would walk away with free books in hand. “I can’t believe they give these things away!” he excitedly told me. His prized collection com-