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Sandy is standing outside her small brick home smoking a cigarette when the van pulls into the driveway. That she's already outdoors is a minor miracle. Dr. D.J. and nurse Annabel Elsner have been working with her for the past two and a half months, and she's made it out of the house only a few times.
Sandy's baggy sweatshirt and jeans only exaggerate her frailty: 99 pounds on a five-foot-two frame. She beams at the sight of the van, crushes her cigarette and slides into the backseat. Her thin, shoulder-length hair is gathered in a pony tail. She smells of cigarettes.
It's 11 a.m. on a weekday. These meetings are timed for when Sandy's boyfriend is at work and the kids are in school. Right away, she starts talking to Dr. D.J., who's behind the wheel, and Elsner, riding shotgun.
She lets loose with a stream-of- consciousness state of the union, describing the latest exploits of her children and letting the women know that her boyfriend hasn't acted up recently. She refers to her boyfriend, the father of her children, as her husband. She sounds anxious, like a kid who's not sure if she's going to AstroWorld or the dentist.
Dr. D.J. and Elsner are taking Sandy to a follow-up at a nearby MHMRA clinic. Depending on the outcome, this may be the last day they see Sandy professionally.
Their first visit was awkward. Sandy was guarded; she still didn't know if she was doing the right thing. By reaching out for help, she was going behind the backs of her boyfriend and mother. They were the ones who encouraged her to stay home when she lost her accounting job after 9/11. Her family has never been a source of support.
Her parents split when she was little. Sandy and Jennifer spent weekends at their father's house, sitting in a room by themselves while he and his girlfriend shot up heroin. When Sandy's mother remarried, she brought into her home a man who started raping Sandy. Sandy told her mother about it. Her mother told Sandy to put up or shut up. Throughout all of this, Sandy kept telling herself a bit of folklore she heard somewhere: Only special souls pick families like these.
Upon meeting Sandy, Elsner thought, We've got a lot of work to do here.But she also saw Sandy's potential. Later on, she saw a bruise. It took Sandy a month to tell Dr. D.J. and Elsner that her boyfriend hit her. She was too embarrassed.
Sandy "could do so much more," Elsner says in a friendly, down-home drawl. "She's capable of total recovery."
After a few visits, Dr. D.J. and Elsner convinced Sandy to go grocery shopping with them. In the store, she couldn't breathe. There were too many people, too many lights. She clutched the cart to keep from shaking.
But eventually, they paired her up with a psychiatrist at a nearby clinic. She got on antidepressants, mood stabilizers, anti-anxiety meds. They took her to get food stamps and to apply for jobs through the Texas Workforce Commission.
"You gotta realize, I never met nice people before," Sandy says. "They gave me hope, which is really a gift."
As the van winds past a playground and a series of buildings, Sandy points out the window.
"That's the school I got pregnant at," she says. "Well, I wasn't atschool "
Sandy was an 18-year-old high school senior when she had her first child. She worked two jobs to support the child, her boyfriend and herself -- and she also graduated. Sandy loves talking about her kids and her old job, about how she felt validated leafing through invoices.
That validation meant a lot to someone whose earliest thought was I was born to get beaten and abused.
This belief could be the root of one of Sandy's most unnerving mannerisms: the ability to discuss abuse in the tone of voice a person would use to describe the inconvenience of a late fee at Blockbuster.
It's like part of Sandy believes that getting beaten with a broomstick for not fetching beer is a woman's lot in life. She can actually make herself laugh when she remembers one night her boyfriend came home after an especially prodigious bender.
"He was tossing me around like a rag doll," she says. "He punched me, but I just stood there like an idiot 'cause I just couldn't believe that that man punched me. I mean, I could see him slappingme " She starts to laugh.
She ran outside after that, and her boyfriend followed, ripping her clothes as he tackled her into an antpile. He sat on top of her and told her to calm down, while angry ants bit her exposed flesh. She told him to get off her because of the ants. Not because he punched her.
"I was ate up by those ants," she says with a laugh.
"We're getting ripped off," Mitchell says.
When it comes to how the state legislature treats the mentally ill, the MCOT director is outspoken. It's an admirable quality, a refreshing change of pace from the paranoia that pervades MHMRA. A recent wave of layoffs and clinic closures has many within the system worried about their future. Lower-level employees prefer to keep their criticism off the record.