Days 75- 98 Discharge Planning

On Nov. 27th during a visit to see Lee on 2 East, I encountered Dr. De Wet by chance as he made rounds at St. Paul’s. During conversation about how Lee was doing, I commented to him that Lee was being held like a trapped animal in a cage. None of the drugs or the counselling was having any effect on his mental state and seeing him in his current condition was almost too much to bear. Patti and I had discussed matters at length and we were not totally averse to the idea that Lee be discharged to the community and take his chances at survival. We were already too aware of the possibility that he would commit suicide, or of an accidental death given his habit of walking into traffic. His death was inevitable and simply a matter of time. We had no idea how the social and medical supports could be implemented to support him in the community, and really did not know what was available. But, provided adequate supports could be put in place, then granting Lee a degree of freedom and control over his life seemed to be the lesser of two evils. It all boiled down to a choice between quality and quantity of life: freedom of choice and reduced life span, or a an extended period under the tremendously chaffing conditions and restrictions he found so intolerable and could not escape. Dr. De Wet said he would take this under advisement.

The first week of December, in conjunction with other anti-depressants, Lee was put on Ritalin and began to display a degree of improvement. On Dec.5th Patti and I had a meeting with Dr. De Wet and again the matter of Lee’s discharge with supports was discussed and left with us to consider. There was no rush, Lee was safe and he wasn’t going anywhere while we thought things over.

Nursing Notes 2 East : Dec. 7, 1995

0730- Awake for the day at 0400 stated “I can no longer sleep

1205 Seen Lee in his room w Dr. Shore. Admitted to feeling much better. Described an

early morning i.e. upon awakening feeling of having a lot of energy wanting to be released as well as a weird sensation in his stomach. Wondering if it was good or bad. Burst into tears when the topic about his family’s move to Cincinnati when he was younger. Said that he still could not let it go & that it still upsets him. Realizes that once he lets this experience go he’d feel much better. Believes that move to Cincinnati “Screwed” his life. Toronto is his favorite place because of his good memories of doing art there. Asked if he could have even an hour’s pass to see an ill friend, but not allowed. Dr. Shore explained the reasons why. Reminded Dr. Shore of his dental appointment for Tuesday.

No suicidal ideation, mood lifted up. State on good terms with parents but nothing in common with Mom.

D/C planning being discussed with the team.

1530 Very pleasant and cooperative. Requested chocolate ice cream and was very

appreciative of writer going to store to buy it for him. C/O sore heel. Found to be ++ dry and cracked. Lubriderm cream & cling applied to moisturize & cushion. Pt. stated relief from padding while walking. Spent day smoking and watching TV. Stated he was “pissed off “ that Dr. Shore wouldn’t give him a pass to go outside. No attempts to leave ward, no voiced suicidal thoughts, friendly & alert

1930- Stan Roberts from Riverview visited and assessed Lee for suitability for inpatient

2400 Riverview admission. Lee spent a settled day. Cooperative eating and drinking

meals. Is able to do own ADC.

Quiet evening. Settled to bed following his medications.

Lee continued to show improvement over the course of the following week, and when we met again with Dr. De Wet on Dec 12th, we were told that he had discussed the possibility of Lee’s discharge with Dr. Shore, and she was, on compassionate grounds willing to consider it. The conversation suddenly shifted and Patti and I somehow had regained all our rights as parents and apparently a whole load of responsibilities as well. Suddenly we were the ones holding up Lee’s release for all we had to do was go and find and get him an apartment and they would do all the rest.

The shit hit the fan. Patti had sat quietly listening and suddenly she had enough. She just exploded and preceded to tell Dr. De Wet that they could just go to hell if that was what they thought was going to happen. The responsibility for finding Lee an apartment belonged to the parties who had screwed up over the course of the last three months. During that period we had been excluded from any control over his treatment; our input regarding Lee had been totally ignored; we were excluded from information to which we had a right because it was "Confidential", and when we were given information it was either misinformation or an outright lie. It was due to advice from him and the staff at St. Paul’s staff that we had given up Lee’s apartment in the firm expectation that he would not survive. It was the staff at St. Paul’s who told Lee we had given up his apartment in such a manner that the disclosure had created a rift in our family that we were still trying to overcome. They had screwed up the situation and could bloody well find him accommodations. How the hell are we to do these things from Surrey? She had to go for treatment of an abscessed tooth and I was scheduled for an angioplasty on my lower right leg. They could get the supports in place, and if we approved of them, then we would consent to his discharge. There was no way they are going to dump off responsibility back onto our shoulders, after the atrocious way they usurped control over Lee and had treated us like shit!! They created the mess, they can clean it up.

It wasn’t exactly pretty but it was accurate. On this basis discharge planning was undertaken. My understanding was that I felt a verbal agreement had been struck with St. Paul’s with Dr. De Wet acting as an intermediary, that, providing adequate supports were in place, we would consent to Lee’s discharge and would hold the Hospital harmless for any consequences. In hindsight I should have insisted that the agreement be in writing, but I assumed, quite wrongly, that professional integrity and honor would make them keep their end of the bargain. Dream on.

On Dec. 18th I went to visit Lee and he was much improved. I attempted to contact Peter Weir , the Social Worker who was to handle Lee’s discharge planning but he was away sick. I met instead with a Mr. Dave Farrell who was covering for Mr. Weir. I expressed my dissatisfaction with the way that communications had been to date, and outlined in detail the conditions we understood were to be met before Lee was discharged. Mr. Farrell understood my concerns and assured me he would convey them to Mr. Weir as soon as he returned from sick leave, and would have him contact me regarding how discharge planning was proceeding.

In the late afternoon on Dec. 21 Mr. Weir called me at work and told me that Lee would be discharged the following day. All supports were arranged and would be in place and lodging has been arranged at Dunsmuir House, a better than average facility run by the Salvation Army. I asked Mr. Weir about this hasty move, and told him I had spoken to Lee the previous evening and he had stated that he didn’t want to go to Dunsmuir since it did not have a stove or fridge. Further Lee had considerable funds available in his bank account and I was worried about his unrestricted access to ready cash. Mr. Weir was not aware of Lee’s bank funds but said he’d attend to it, and while it was regrettable that Lee was not in agreement as of tomorrow he would be discharged and Room 214 was where he was going. End of call.