The home visit
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《加拿大医疗协会学报》
Lena Ivanovic lived with her widowed mother in a semi-detached home on Euclid Avenue. Thursday midnight, the mother phoned Dr. Rubens, frantic. "Lena spits out food. Your pills poison her. Why did you stop seeing her?"
"Mrs. Ivanovic, I left her phone messages." Rubens paused. "No one answers."
"I answer," Mrs. Ivanovic interjected. "Why didn't you speak to me?"
There was some commotion and a torrent of Russian. Mrs. Ivanovic's son, Viktor, took the phone. "Doctor, all day they argue. I came for March break yesterday to study at the library — Lena yanked out the phones — she smashed her cellphone. She won't eat. She stays in her room. I have a final law exam. She yells. What do I do?"
Not again, Rubens thought to himself. "Bring Lena to emergency tomorrow. Do you have relatives or friends to help you?" Rubens asked.
"I have cousins, Alexei and Boris. I'll ask them to help. They came last time."
Rubens recalled her admission two years earlier. "Has she threatened anyone?"
"Not this time. Two months ago she was fine."
Rubens scrawled a note, his spirits sinking. He called the ward; they knew her, but had no beds. He tiptoed to the kitchen for a glass of milk. He recommended milk to insomniacs — a natural sedative. He crept upstairs, watching the falling March snow, past his sleeping children. "It's snowing, Nora," he grumbled, reaching for her cozy warmth.
"Sssh — you're cold," Nora pushed him away. "Who was on the phone?"
"Mrs. Ivanovic. Her daughter is psychotic. She blames me. A month ago Lena stopped coming. Lena told me she was fine."
"You wanted her to be fine," Nora, a social worker, hinted in the dark. "But now she needs readmission. Why didn't you do a home visit?"
"That's what I did before," Rubens said, ruefully. "This time I left messages."
"I'm sorry." Nora hugged him and turned away.
On Friday at 6 am Rubens kissed his sleeping children goodbye before digging his car out of the drift of snow that had accumulated overnight. One phone message awaited him at the hospital.
"Lena refuses to go to emergency," Viktor said. "My mother agrees. She says they'll wait too long. Mother won't listen, she's a martyr." Rubens forgot he was dealing with two people, mother and daughter. Mrs. Ivanovic was chary of doctors and hospitals. This was a problem. Angrily, Rubens pressed call-back.
"Viktor, please listen. At noon I'll make a home visit. Have Boris and Alexei there."
By noon Rubens arrived at their home. He exited a taxi, climbed the snowy stairs and knocked. The son of Russian-Jewish immigrants, he had grown up two blocks away. When his family first came to Toronto their name was Rubenovitch, too long and difficult. His father changed the name to Rubens, working seven days a week in a drugstore on College Street. Looking along Euclid Avenue's snowy length, he mentally surveyed the old neighbourhood — where the bakery, kosher butcher store, fish-market and old mental hospital had been. One group of immigrants came, another left. The streets were different, yet familiar. He shared a room with his bubba; other relatives had a second room; his parents were in the attic. South on Queen and Shaw was the brick wall of the mental hospital. His zaide had stayed there.
After two knocks, Viktor opened the door. He ushered Rubens past a gloomy hallway to a kitchen table where Mrs. Ivanovic sat, pale, her legs crossed, flanked by a weary Boris and Alexei towering above her. Dr. Rubens began, "We must answer these questions clearly." He recited events, checking dates. Afterward he inspected the kitchen, the broken phones, the rear door nailed shut, the crosses placed over windows. The TV was unplugged, sideways, Viktor said, to quiet her voices. "Did she store pills? Does she have weapons?" Rubens took notes. Nothing, Viktor said. Tears filled his grey sombre eyes. She was the smartest. Rubens recalled meeting Lena ten years earlier, a bright third-year law student with hazel eyes in a cherubic face.
He mounted the stairs to Lena's room and knocked. Alexei and Boris advanced as a shield. "Lena?" Rubens opened the door and entered. The room reeked of urine and feces. Lena turned, lifting the sheets. He saw her skeletal thinness. "Lena — I've come to help." She made a fist and cursed. "Please, Lena."
"Devils!" She thrashed on the bed. The stench of her unwashed body rose. "Out!" Rubens descended the stairs, filled the necessary forms, called the police and ambulance. At last the police arrived, and Lena was subdued. She lay spent, breathless.
"See?" her eyes fixed Rubens with icy rage. "See what you did?"
"Lena, I called many times. I came to help. I will go with you in the ambulance."
"No." She turned her head. "Don't look. Go. I never want to see you again." In her eyes was shame. Rubens decided to forgo the ambulance ride and walked south. Snow fell in a haze and lay on his lashes. With treatment her voices would leave. Lena had wanted to be a lawyer. Rubens' zaide had wanted a shoe store. Rubens wanted to cure patients. But life was a burden of hope and despair. Absently, he looked up. He was at Queen and Shaw Street, close to the worn brick wall. The old domes were gone. A tiny park remained with snowy benches. One man sat still and alone. Rubens flagged a taxi, eyed his schedule and called the ward.
Good, they had a bed. In a week or two he would call and visit her.(Ronald Ruskin)
"Mrs. Ivanovic, I left her phone messages." Rubens paused. "No one answers."
"I answer," Mrs. Ivanovic interjected. "Why didn't you speak to me?"
There was some commotion and a torrent of Russian. Mrs. Ivanovic's son, Viktor, took the phone. "Doctor, all day they argue. I came for March break yesterday to study at the library — Lena yanked out the phones — she smashed her cellphone. She won't eat. She stays in her room. I have a final law exam. She yells. What do I do?"
Not again, Rubens thought to himself. "Bring Lena to emergency tomorrow. Do you have relatives or friends to help you?" Rubens asked.
"I have cousins, Alexei and Boris. I'll ask them to help. They came last time."
Rubens recalled her admission two years earlier. "Has she threatened anyone?"
"Not this time. Two months ago she was fine."
Rubens scrawled a note, his spirits sinking. He called the ward; they knew her, but had no beds. He tiptoed to the kitchen for a glass of milk. He recommended milk to insomniacs — a natural sedative. He crept upstairs, watching the falling March snow, past his sleeping children. "It's snowing, Nora," he grumbled, reaching for her cozy warmth.
"Sssh — you're cold," Nora pushed him away. "Who was on the phone?"
"Mrs. Ivanovic. Her daughter is psychotic. She blames me. A month ago Lena stopped coming. Lena told me she was fine."
"You wanted her to be fine," Nora, a social worker, hinted in the dark. "But now she needs readmission. Why didn't you do a home visit?"
"That's what I did before," Rubens said, ruefully. "This time I left messages."
"I'm sorry." Nora hugged him and turned away.
On Friday at 6 am Rubens kissed his sleeping children goodbye before digging his car out of the drift of snow that had accumulated overnight. One phone message awaited him at the hospital.
"Lena refuses to go to emergency," Viktor said. "My mother agrees. She says they'll wait too long. Mother won't listen, she's a martyr." Rubens forgot he was dealing with two people, mother and daughter. Mrs. Ivanovic was chary of doctors and hospitals. This was a problem. Angrily, Rubens pressed call-back.
"Viktor, please listen. At noon I'll make a home visit. Have Boris and Alexei there."
By noon Rubens arrived at their home. He exited a taxi, climbed the snowy stairs and knocked. The son of Russian-Jewish immigrants, he had grown up two blocks away. When his family first came to Toronto their name was Rubenovitch, too long and difficult. His father changed the name to Rubens, working seven days a week in a drugstore on College Street. Looking along Euclid Avenue's snowy length, he mentally surveyed the old neighbourhood — where the bakery, kosher butcher store, fish-market and old mental hospital had been. One group of immigrants came, another left. The streets were different, yet familiar. He shared a room with his bubba; other relatives had a second room; his parents were in the attic. South on Queen and Shaw was the brick wall of the mental hospital. His zaide had stayed there.
After two knocks, Viktor opened the door. He ushered Rubens past a gloomy hallway to a kitchen table where Mrs. Ivanovic sat, pale, her legs crossed, flanked by a weary Boris and Alexei towering above her. Dr. Rubens began, "We must answer these questions clearly." He recited events, checking dates. Afterward he inspected the kitchen, the broken phones, the rear door nailed shut, the crosses placed over windows. The TV was unplugged, sideways, Viktor said, to quiet her voices. "Did she store pills? Does she have weapons?" Rubens took notes. Nothing, Viktor said. Tears filled his grey sombre eyes. She was the smartest. Rubens recalled meeting Lena ten years earlier, a bright third-year law student with hazel eyes in a cherubic face.
He mounted the stairs to Lena's room and knocked. Alexei and Boris advanced as a shield. "Lena?" Rubens opened the door and entered. The room reeked of urine and feces. Lena turned, lifting the sheets. He saw her skeletal thinness. "Lena — I've come to help." She made a fist and cursed. "Please, Lena."
"Devils!" She thrashed on the bed. The stench of her unwashed body rose. "Out!" Rubens descended the stairs, filled the necessary forms, called the police and ambulance. At last the police arrived, and Lena was subdued. She lay spent, breathless.
"See?" her eyes fixed Rubens with icy rage. "See what you did?"
"Lena, I called many times. I came to help. I will go with you in the ambulance."
"No." She turned her head. "Don't look. Go. I never want to see you again." In her eyes was shame. Rubens decided to forgo the ambulance ride and walked south. Snow fell in a haze and lay on his lashes. With treatment her voices would leave. Lena had wanted to be a lawyer. Rubens' zaide had wanted a shoe store. Rubens wanted to cure patients. But life was a burden of hope and despair. Absently, he looked up. He was at Queen and Shaw Street, close to the worn brick wall. The old domes were gone. A tiny park remained with snowy benches. One man sat still and alone. Rubens flagged a taxi, eyed his schedule and called the ward.
Good, they had a bed. In a week or two he would call and visit her.(Ronald Ruskin)