Mary Beth is a female in her early 30s, quite obese and mildly mentally repaired, as well as suffering from schizophrenia. She lives in a housing authority apartment, which is not a great place. But being highly subsidized, it is cheap! Her apartment is in a perfectly dismal condition. She lives in absolute squalor with garbage strewn around, and I am unable to figure out what to do about it. I am her case manager.

When I transport Mary Beth, I put a heavy blanket over my front seat to avoid urine soaking into the upholstery. I hate to visit her because of what I often find, but I do so often. I have to.

Two things I always try to do with Mary Beth. The first is to keep her apartment sufficiently clean to pass periodic mandatory inspections so she will not be evicted. Sometimes I arrange to pay for cleaning. I do not personally clean for Mary Beth. Her subsidized rent is about $150 a month, including all utilities.

I figure I cannot allow such a rental unit to be lost without an adequate replacement.

Second, on my list of important things to do — I am not sure that one has priority over the other — is to see that Mary Beth is kept in medicine and that she regularly sees her psychiatrist, who is her prescriber.

Here is where the problem develops, at least with this particular psychiatrist. He insists Mary Beth be on a very expensive injectable medicine. It cost over $600 a month and is paid for by Medicare or Medicaid. It is a medicine, which, from my perspective as a social worker, does not work well, not with our low-functioning population.

Some of the problem is getting patients to the office to take the bi-weekly shots. Patients often do not like inoculations (like most people). Still, the doctor insists on this medicine for Mary Beth. And I know for a few of his other patients, even in the face of reports (from me, anyway) that the substance isn’t working very well.

Mary Beth has taken to frequenting the local hospital emergency rooms, wandering in in a virtual stupor. She seldom is admitted.

Instead, if she gives them my name and telephone number, a nurse will call me to report her unwelcome presence in their ER, suggesting somehow it is my fault that she is in such a sad condition I feel badly at these times. I find myself explaining that I do what I can do, but no more. I am not a worker of magic.

One day, all of this changed when Mary Beth went to the emergency psych unit at the university hospital, a place she has visited often.

Sometimes they keep her in a holding bed for additional evaluation. Usually, though, she is not admitted. The reasoning is that she is not a threat to herself and certainly not a threat to others. She would not harm a fly. She is a very gentle person.

A routine lab is done on Mary Beth, and it is discovered she is several months pregnant.

She is kept this time and placed in a psych ward where I visit her several days later. The staff has cleaned her up thoroughly, changed her medicine to Haldol (not a high priced medicine), and she is as clear thinking as I have witnessed her in a very long time. She even tells me she does not want to go back on the injectable. Her wishes do not matter to Dr. P, however, except for this: the hospital doctor believes, and says so in writing, that Haldol is safer than the injectable medicine for a pregnant woman.

Dr. P does not agree, but because Mary Beth is pregnant, and another doctor says the currently prescribed medicine is not recommended. Dr. P will not challenge the decision, not in a million years would he disagree and risk blame later for a problem pregnancy.

Mary Beth’s world seems to awaken with this development, and a big change is in the offing. Additional social workers come out of the woodwork. Where previously I could not get help with Mary Beth, now everybody wants to be involved. A social worker named Donald (also of our agency) is assigned to Mary Beth. The change is made because Donald is headquartered at the housing project itself. It is a new organizational staff practice, a good one, in my opinion.

Donald is a capable and motivated fellow, and he gets a lot of assistance from others. So I am pleased Mary Beth goes to him. Truth be told, I am glad to be off the case.

Clients like Mary Beth are exhausting. I guess that’s obvious.

I coordinate the transfer and speak to several new social workers involved, and even a doctor at the prenatal clinic. Mary Beth, by the way, has had two other children. Both boys and adopted as infants. Now they are nearly teenagers. While she didn’t get to keep either child, they know who their mother is. I met one of the boys on an elevator on his way to visit Mary Beth. I believe her family took the two boys.

I hear news of Mary Beth, news of delivery of still another boy, perfectly healthy. Her aunt and payee (which means her aunt handles Mary Beth’s money) wants the baby, I’m told, and likely will get to have him because she is family.

By now, Mary Beth is being considered for state guardianship.

Something I sought several times but with no success. The paperwork is sailing through the courts. Funny how these things work or don’t sometimes work.

Today Mary Beth lives in another part of the city. She is out of the projects altogether, perhaps permanently, but I wouldn’t bet on that. There is a caretaker living with her on a temporary basis, I’m sure. I saw Mary Beth the other day. She is slimmed down considerably, and her hygiene much improved. She is not in a fog mentally either, so the medicine has to be working. I have never seen her look better.

Additionally, she is as verbal as I have ever known her to be, so for Mary Beth getting pregnant may have saved her life. For sure, it improved the quality of her life, at least for the moment.

Raymond Abbott is a social worker and novelist.

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