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My mother’s family has a burial plot in Beth David Cemetery in Elmont, N.Y. My grandparents, parents and other relatives are buried there. One of those reserved graves will never be filled. It belongs to my cousin, Ruthie.

Three or four years older than I am, Ruthie should have been a grandmother by this time but she’s not. I haven’t heard from her in more than 15 years.

When I was a child, I wanted to be her. Whenever I visited my grandparents in Brooklyn, Ruthie was there. I followed her around like a puppy. She was like the sister I wished I had. She took me to movies and the Young Israel for Israeli dancing. Together we decorated my grandfather’s sukkah with real fruit. We stood outside the home of the Satmar Rebbe and peered through the windows at the Hassidim who eagerly ate the crumbs that fell from his plate.

Ruthie was smart and her Jewish education was extensive. She played the piano and valued learning. She became the first in the family of many girls to go to college. Attractive and fashionably dressed, she got a great job as a well-paid bookkeeper.

I admired her even more as the years passed. We continued to spend holidays together. She was the one who took me to Tashlikh on Rosh Hashanah on the Williamsburg Bridge. Together, we prayed there and emptied our pockets of the crumbs that represented sins we might have committed.

Some years later, the trouble started. I was in college when I heard that Ruthie “wasn’t right” and had to be put on some “mental medication.” At work, she thought people were talking about her and plotting against her. Shock treatments were ordered to get rid of the voices she heard. This caused some memory loss.

At some point, she was married to a religious man selected for her by the family. She remained married about two weeks. The marriage was annulled.

As long as her mother was alive to supervise, Ruthie took her meds. When both parents died, Ruthie stopped taking her pills, lost her apartment, and disappeared.

Family members looked for her. One uncle found her and got her into a facility, but she ran away. The family wanted to give her money. Another uncle had a store on the east side of Manhattan, where Ruthie appeared from time to time. We asked him to hold money that we all donated. He doled it out to her, but eventually the store closed. Ruthie was unreachable again. New York City Social Services Department was contacted. My aunt visited shelters all over the city, but there was no sign of her.

A few times, Ruthie called my mother or me on the phone. Beyond the word “hello,” she did not speak, just listened as we spoke to her. “Where are you? How can we reach you?” we asked. She hung up without answering. Then she stopped calling.

One day, my cousin and her husband were dining at a restaurant in Manhattan. Suddenly Ruthie appeared with her cart of junk. Overjoyed at seeing her, they asked her to sit and eat with them. She refused and fled, never to be seen or heard from again.

If Ruthie is alive, she’s on the streets somewhere, a Jewish bag lady, a tragedy for our family. How naïve we all were to think such a thing could not happen in our family. We cared. We tried to help but we couldn’t.

None of us knew her demons. We hoped that if we prayed, perhaps if she prayed, if a miracle happened, she would be saved. If she’s still out there, she probably lives in a corrugated carton under a bridge somewhere. If she is dead, we cannot even give her the proper Orthodox burial she deserves.

At family gatherings, we sometimes talk about her. Why do we feel somewhat responsible for what happened to Ruthie? Searching for answers, some of us recently latched on to the book and movie “The Soloist.” It’s a true story about Nathaniel Ayers, a talented musician and former cello student at Julliard, who has schizophrenia, which is probably what Ruthie had. The author, Los Angles Times columnist Steve Lopez, found him playing a two-string violin on the street in a tunnel where Ayers lived. Lopez took an interest in Ayers, befriended him, and did everything humanly possible, contacting every agency he could find, to help Ayers and get him to take meds, which he refused.

Ayers had apparently cracked under the pressure of life at Julliard when he was younger. Without meds, he could not be helped. Nobody, not even Ayers’ sister, could compel him to take meds if he chose not to.

Lopez became acquainted with the community of thousands of homeless people, many of them mentally ill, who live on the streets of Los Angeles, people who once were “somebody” and now were nobody. People like my cousin. Every early prediction would have pointed to productive and happy lives for Ruthie and Mr. Ayers.

Steve Lopez was deeply affected by his relationship with Mr. Ayers and frustrated by his inability to help much. Ayers now has a room to live in and a studio to practice his beloved music, but he’s not always there. Sometimes Ayers has a meltdown that scares everyone around him. But initially, Ayers was a stranger to Lopez.

Ruthie’s case was different. She was family. It’s a shock when somebody you know and love falls through the cracks. There is guilt, whether justified or not. You ask yourself if you neglected your duty to your loved one in some way. Should you have taken in a mentally ill but unevaluated person, one who might perhaps be a threat to you and your family, or even to herself?

If anyone had seen the early signs of mental illness, would early intervention have helped? We now know that chemical imbalances that can run in families cause this terrible illness. All we can do is be vigilant within our own families and hope we do not have another such case.

Poor cousin Ruthie. I treasure my early memories of her. Who ever thought she’d turn out to be a Jewish bag lady?

Toby Rosenstrauch, an award-winning columnist, lives in Boynton Beach, Fla.