The Doctor is Out

Dr. Bill MacEwan is a psychiatrist with a difference —he doesn’t wait for his patients to come to him

By Marcie Good

Two men stand next to a dumpster in an alley behind the Carnegie Centre.

“You’re back from Sudbury?” says the tall one, who’s wearing a long black coat and single earring.

Trevor, black-eyed and stubbled, nods. Two weeks ago he left his room, with its collection of broken furniture piled in front of the window. He tried the meds, he’s saying, but they made his tongue feel thick and his body ache.

Their voices disappear under the loud warning beep the garage makes as a van drives out. Further up the lane, a man sitting on the ground empties a loaded needle into his arm. It’s a scene loved by television cameras: a tunnel of brick and pavement with no apparent exit. The tall man takes a small rectangular package out of his briefcase.

“I don’t mean to be rude or nothin’,” Trevor says, shaking his head. In other meetings, Trevor has talked about his childhood: a rambling, almost feral story including an incident in which, at seven years old, he shot a man. The taller man doesn’t know if this is true, but he knows that under Trevor’s black bomber, buttoned-up jean jacket, and chain with fist-sized links is a scared and skinny little boy.

Trevor resorts to a familiar theme: the homosexual gangs chasing him. He’s schizophrenic and suffers from paranoia, but these fears have a kernel of truth. Just before he left for Ontario he was stabbed.

A ball-capped man taps him on the shoulder. “Hey Big Dog, need anything?”

“I’m with my psychiatrist!” Trevor admonishes him. “Y’know what I’m sayin?”

Every Monday, Wednesday, and Friday, Dr. Bill Mac-Ewan sees patients like Trevor, often in their rooms at low-rent Downtown Eastside hotels. Usually they’re referred to him by hotel staff or by people at social agencies. Some are harder to track down: “wily coyotes,” he calls them. Today he was directed to the alley by someone from Vancouver Intensive Support Unit, which follows up on offenders with psychiatric illness.

The anti-psychotic drugs he offers Trevor cause more pain than they’re worth, but the 28-year-old has achieved a bit of stability since the first time they met. Then, he put jagged pieces of mirror around his mattress to protect him from spirits. It’s one of his coping techniques, perhaps futile but necessary for his survival in this neighbourhood. More recently, those tools included a round chunk of chalk, his “fake dope,” that apparently has some street value. All these bits of information are useful to MacEwan, but more important, seeing the young man on his own turf encourages a bond. Trevor, whose darting eyes seldom make contact, seems an unlikely candidate for an ongoing relationship. Yet in the alley, he asks MacEwan if they can go for lunch sometime. Chinese, he suggests. A buffet.

MacEwan also runs the Fraser South Early Psychosis Intervention Program at Peace Arch Hospital in White Rock, one of the largest in Canada, and Ward 9a at St. Paul’s. He’s also director of the schizophrenia program at UBC. As a specialist, he often sees patients who have already been diagnosed and treated by a family doctor. But this is front-line work, and he seems to thrive on the unpredictability of these afternoons.

Movies and television love the narrative device of the psychiatrist. They usually sit, like The Sopranos’ Dr. Melfi, in a richly furnished office, walls lined with certificates and books. They are distant and impersonal, say little other than prompts, and once in awhile indulge in a pretentiously worded assessment.

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