In light of the recent welfare reforms, Dr Paul O’Reilly reflects on a former homeless patient that flips the Government’s script
Nothing on God’s green earth quite grinds my gears as much as hearing my patients being depicted as feckless, idle scroungers by politicians who have never met them. Now, when the work and pensions secretary announced a series of changes to the welfare system last month, I’ll admit that she didn’t actually say that part out loud – she did not pick on my lot directly. But the implication was there, or at the very least that is how our folk heard it and felt it. And I thought to myself that if there is one person who might change the mind and heart of a cabinet minister, then it might just be Celia.
Of all the chaotic, street-homeless, used and abused young women I have ever known, Celia (not her real name) was about as bad as it gets. She ran away from ‘care’ aged 14, and for the next 13 years bounced around living on the streets, in prison, in hostels and sometimes in hospitals. For most of that time she was an active injecting drug user (primarily crack and heroin) and occupied all her waking hours either using drugs, or doing whatever it took to obtain the money to buy them.
When I first met her, she was 27. It was also my responsibility to tell her, on a first meeting, that she was pregnant.
It was a shock to the system. Celia had not been so good with keeping her dates, but we worked out that she was about 16 weeks along. We ordered a scan which showed she was carrying twins. Like some women do, even after years of chaotic use, she simply stopped using on the day she discovered that she was pregnant. Doing harm to yourself is one thing; but doing it to your child is something entirely different. We helped her as best we could with opiate substitutes such as methadone.
To begin with she did quite well. She was housed in a bedsit with ‘the most useless boyfriend in north London’ – her words, not mine. She stabilised well to her methadone and attended (at least some) of her antenatal care. The pregnancy went as well as could reasonably have been expected. And, after the birth, she was passed into the care of social services and the specialist maternity drug services.
We did not see her again until about three months after the twins were delivered. She brought in the new arrivals on a kind of triumphal tour down to the surgery. There was a great deal of hugging, kissing and general congratulations all round.
But above all there was a nagging question: if not a sword of Damocles, then an elephant in the room. Celia was still in the same bedsit with two babies to look after, no family support, the boyfriend long gone, occasional visits of the social worker and health visitor. She had her benefit money, no other income and no other visible means of support. So, however nicely you try to put the question, you eventually had to ask: ‘My dear, how are you… ermmmm… so to speak… managing?’
To which she answered, without hesitation, some of the most noble words I’ve ever heard: ‘Oh! That’s easy. They are my babies. Yes, it’s a five-hour day, but when I think back to when I was using, it’s easy.’
For those of us who obey the sun and have the luxury of a whole 24-hour day, it is difficult to imagine the distress of living on such a short cycle. Five-hour days can be the result of various lifestyles – one being dictated by the implacable demands of a small baby; and another being controlled by a large habit.
I have known many mothers of newborn children. They have to live the five-hour day of getting up, feeding the baby, changing the baby, washing the baby, sleeping, and repeat that over a five-hour cycle at the baby’s whim. It seems like an eternity. And I have heard these mothers describe this way of living in many ways, but never before had I heard one describe it as ‘easy’.
But, that is how Celia found it. To her, it was a pleasure and respite when compared with the endless misery of being a street homeless intravenous drug addict. That five-hour day tended to follow:
Get up, make money, use, sleep.
Get up, make money, use, sleep.
Get up, make money, use, sleep.
Repeated indefinitely.
Shortly after that, Celia moved up north to be back near her old family. We heard from her recently. She enclosed a picture of the three of them playing on a beach in bright summer sunshine, all dressed, for reasons that presumably made sense at the time, as reindeer. In thinking of her, I have considered many words to describe my admiration for her and my pride in having played a small part in her achievements; ‘feckless’ and ‘scrounging’ are not among them.
Dr Paul O’Reilly is a GP partner in London who works for homeless people
Well put Paul- it is easy to slip into complacency when we are wrapped up in our own difficulties – thanks for some insight into the reality of life for some people.
That is such a wonderful, powerful, and motivating story. I hope it gets shared widely with a suitable audience and triggers some more positive and successful outcomes as well.
Doing everything every 5 hours for one is often more than enough.
The more of them, the harder it must get.
The only thing I know with a shorter cycle of sleep, wake, eat, clean, sleep, etc is when we hand-reared 3 baby chickens from hatching in 2023, and discovered they only sleep for about 10 minutes at a time, max, in the dark. Fortunately they grow up quick, and could sleep outside from 6 weeks, although they still think they have a right, if the door is open, to run in, up the stairs, and jump on the bed!