Julia (not her real name)

I first met Julia when she brought in her newborn son, Caleb for a well child visit. She seemed thrilled with her new baby and doted over him as moms do. During the course of getting a history, I discovered that Julia worked as an exotic dancer. She was not entirely sure who the father of the baby was but thought it was her 'agent'. She told me that she planned to have nothing to do with him.

Over the next few well child visits, Julia seemed to be coming unglued. She complained that the neighbours were teaching Caleb to say vulgar words and that she had caught him saying them (he was about 2 months old at the time). Her speech was rapid and she rambled on not giving enough pause for me to interject a word in sideways.

Julia established care with me since she did not have a doctor. Reviewing her medications, I noted she was on medications for bipolar disorder, ADHD and anti-psychotics. I asked her about her psychiatrist and she told me she saw him regularly.

After several strange phone calls to the nurse line, a social worker was sent to Julia's house. Someone had expressed concern for Caleb's wellbeing, although at every visit, Caleb was gaining weight, meeting development milestones and always looked clean and well cared for.

Caleb was taken away from Julia by the court.

Julia's mental health seemed to worsen. She told me that her psychiatrist and counselor had 'fired' her for noncompliance with treatment and missing scheduled appointments. This was confirmed by a letter to me by the psychiatrist that said very little other than that they would no longer see Julia.

One day, Julia came in claiming that someone had come into her house, cut her hair and stole her ADHD meds. She wanted an early refill on them. I politely told her I would not refill the meds until she either brought in a police report documenting what had happened or showed me proof that she had established with another psychiatrist. She lost her temper and stormed out of the office, after telling me that she no longer wished me to be her or Caleb's doctor anymore.

After being rejected by other physicians with whom she tried to establish care, Julia called my office again and asked for an appointment with me. She mentioned that she was told that until she had taken her medications and was more stable, no-one else would take her on as a patient.

Julia still does not have a psychiatrist. She has not regained custody of Caleb. She continues to have good days and bad days and alternates between being flirtaeous and threatening.

Has the healthcare system failed Julia?