Day 103 Merry Christmas 1995

We were wakened Christmas morning by Todd E. phoning to tell us that he had found Lee. He had just been discharged from the Emergency Room at St. Paul’s, was en route to Dunsmuir by taxi, was apparently OK and Todd E. would bring him out to Surrey on the Skytrain. We asked Todd E. to bring Lee’s medications from Dunsmuir and heaved a long sigh of relief.

When Lee arrived he was in a terrible state. He was confused, depressed and totally exhausted. He was dressed in a light sweatshirt, jeans, undershorts, and running shoes. These were all filthy. His hair was matted with blood clots, he had several stitches in the back of his head, and the back of his sweatshirt was one great big bloodstain from his neck to his waist. He remembered almost nothing of the previous three days, and nothing of the previous night except he thought he had fallen down once.

His medications were totally confused. He had no idea how to follow the blister pack they were in, and had apparently just punched out pills at random. What he took or in what order will never be known.

We were very surprised to find that the clothes he wore were all that he had when he left the Ward. All of his other clothing had been sent home with us two weeks previously, and staff had kept nothing in reserve. He had been discharged in the clothes he was now wearing, and no-one had bothered to notice that in Midwinter he had no coat, no hat, no gloves, no socks. If anyone had noticed it was of apparently no importance for no- one had bothered to call us. Lee was cold, wet, and miserable.

We later discovered that this was the third time Lee had been discharged from the Emergency Room at St. Paul’s within an 11 hr time span. He was first brought to Emergency at 1324 hrs, Dec. 24 from 1148 Davie where he had apparently fallen down some stairs and hurt his head and arm. Because he was in possession of alcohol, it was apparently concluded that he was drunk and had fallen and in accordance with Dr. Shore’s instructions he was medically evaluated, detoxified and discharged. This was a remarkably efficient detoxification as I know from considerable experience with Lee, that it takes several hours, not just two, to take Lee from a drunk to sober condition. He was discharged ambulatory at 1520 hrs

4 hours later he was brought from 998 Thurlow where he had gotten dizzy and fallen over backwards and again striking his head. He did not remember where he lived. The Social Worker on duty called Normandy Hospital and picked up on the latest drug gossip, advised the Dr., investigated his latest discharge and Peter Weir’s notes, called Dunsmuir to verify his residence, and arranged a taxi to take him there. Dr. Christenson noted on this admission:

“/SW at Normandy ++1 wk.

shooting up in hallway”

Social Work notes Lee is referred to ACT per Peter Weir notes. Lee discharged c/o self in taxi at 2315 hrs.

One hour later he was brought back from Fraser and Broadway and this time he required stitches in the back of his head. Fortunately he was located by Todd E. before his discharge and brought home.

I simply cannot understand, particularly on the second or third admission, why we were not notified. On his second admission the Social Worker was concerned because Lee did not know where he lived. He took the time to call Normandy and get the drug gossip, convey it to the doctor, to research Lee's residence, but did not have the knowledge or time to look two lines down on the Admissions Form to see Patti’s name and our phone no. in the box marked: "Next-of-kin".

Why didn’t the social worker at his third admission call us since he had been made aware we were looking for Lee after being contacted by Todd E? None of it makes sense. Apparently Next-of-kin are contacted only if the patient dies and the Hospital is saved the expense of burying their mistakes. Negligence, stupidity, and/or callous indifference are not laudable attributes for Hospital staff anywhere. For us it was the rule, not the exception in our dealings with St. Paul’s Hospital.

Lee’s discharge was screwed up and doomed to failure before he even walked out of the doors of St. Paul’s. The whole matter of discharge planning was, as best I can reconstruct, dumped onto the shoulders of Peter Weir about the middle of December. The fact that Mr. Weir suddenly came down with an illness, or, far more likely, elected to take his accumulated sick days in order to do his Christmas shopping, did nothing to help matters. I had called the Ward just prior to Mr. Weir’s return and was told that Lee was an extremely difficult placement, and I should wait for Mr. Weir for he was in charge of discharge planning and was extremely capable in that regard.

My assessment of the situation is that on Peter Weir’s return from his illness, he discovered a desk covered with a backlog of cases for discharge. It was time for the annual cleanout in preparation for the Christmas rush. There was no time to adequately prepare Lee for discharge, and the pressure to free up bed space was on. Mr. Weir resorted to a canned formula that had apparently worked for prior patients, made a few calls without a great deal of research, shot off several faxes to various agencies, decided he had done his job, and got Lee’s problem off his back and his file off his desk by advising Dr. Shore that all arrangements had been made and Lee could be discharged. He then went home for a well deserved Christmas. Unfortunately he fucked up. The end result of his carefully planned placement was a disaster.

Dunsmuir House is a facility run by The Salvation Army in downtown Vancouver, and is dedicated to the care and assistance of recovering alcoholics. It has an excellent record helping those who wish to quit drinking. To accomplish this end they have a very strict set of rules, and a vigorous enforcement policy with severe consequences, including expulsion, for violation of the rules. They also had a set of procedures in place for how things ran at Dunsmuir. One of these was that messages are taken for the residents, but they are held at the desk. Lee was not aware of this procedure. No one had told him.

As a short term dumping ground for patients, it was ideal, but Lee’s placement there was a classic piece of incompetence if it was intended as a long term solution. Lee had no intention of quitting drinking. He had virtually no short term memory left, and all his discharge instructions were verbal. He promptly forgot them. He had extremely impaired judgment and virtually no insight into the consequences of his actions, and he was placed in a rule laden environment.

Dunsmuir was never advised that Lee was anything but another recovering alcoholic. They were not informed as to his mental problems, his medical condition, of his need for medication and supervision, nor of any of the supports that were to be in place. There was not even a remote possibility that this would be a “long term” placement. It was a disservice to Lee and an abuse of Dunsmuir House, but from Mr. Weir’s point of view it ideal. Lee was no longer tying up a critical care bed, and his file was off Mr. Weir’s desk. End of problem!