DAYS 59- 69 Introducing Dr. Shore and 2 East

One very tragic consequence of Lee’s Normandy escapade was his acquiring the label of being an “IV Drug Abuser”. This was never true, but on Nov. 12, 1995 based on information received over the phone from Normandy, the On Call physician Dr. Brian J. Woodfall, in absentia, certified Lee on Form 4, M.H.A. citing "destructive behavior, including injection drug use". This first statement might be forgivable given the chaotic events and circumstances at the time, What was not forgivable, was the way that a succession of medical and psychiatric and social work professionals accepted the label without question. Again and again Lee is referred to as an IV drug abuser in his record from St. Paul's Hospital, and I know that this labeling had detrimental effects on his treatment.

During Lee's stay I had occasion to consult with Police Officers, Ambulance Personnel and others who had frequent contact with Drug Abusers and witnessed their treatment after admission to the Hospital. St. Paul's denies the fact, but to be identified as an IV drug abuser within the St. Paul's catchment area of downtown Vancouver is to be virtually guaranteed the revolving door treatment when taken to the Hospital, and the same applies to Mental Health patients unless they are suicidal or in Medical crisis. Police officers complained that they brought people that, in their assessment needed hospitalization, to the Emergency Department only to see the same individuals released before the officers had had a chance to write up their reports. Several Ambulance attendants reported the same practice, and others told me that they many times had lied on their reports about the pickup location of patients, so that they could take them to Vancouver General where they stood a much better chance of being attended to in a proper fashion.

Dr. Sheldon Zipurski, who first saw Lee on his return to St. Paul’s, accepted Dr. Woodfalls' assertion verbatim and repeated the calumny on Lee's second Certification, but he displayed a remarkable lack of curiosity when it came to any questions as to how, why, or what he had taken. Lee had no prior history of drug use, his left arm was in a splint from his elbow to his knuckles, and he was right handed. How had he injected himself? Did anyone see him do it? What did he inject? Was whatever he had taken compatible with the witch’s brew of semi-toxic drugs, eleven all told, that he was taking daily?

The answers are simple: 1. Don’t know 2. No-one and 3. Impossible to say because Dr. Zipurski and the other admitting staff accepted that he was just another junkie and never ordered any toxological scan. Dr. Rhesa Shore, Chief Psychiatrist on 2E, who had him in her care for two weeks previously, who knew his prior history, accepted the label and displayed a total lack of interest as to what he might have taken and how it might have mixed with all the other drugs he was taking on her orders.

What is possibly the most troubling aspect of the matter to me, was the failure of Dr. Joss De Wet, Lee’s personal physician, to scotch the damned lie as soon as it began to appear in hospital records. Lee was his patient for 5 years and Joss knew he was not a drug abuser. Why he did nothing to correct the record as soon as he noticed the error is a mystery. Was it was beneath his notice? Did he ever bother to read Lee’s file? Only he has the answers and he’s never volunteered them. I had a higher opinion of him than apparently was warranted.

On November 15, 1995 Lee managed to escape from the Hospital, this time from the locked Ward on 2 East. The ward phoned and advised us of his escape, and later phoned to advise us that Lee had returned of his own volition.

Lee's Journal Entry: Nov. 15, 1995

here i sit across from st. paul’s hospital.

i actually managed to get out. someone was coming through the door and i just booked out of it. i don’t think anybody noticed. so now i’m trying to relax over a coffee & cig. i’ve already been to the bank, now i just have to go to this liquor and grocery stores. i’ve got to take a cab because i risk any cops seeing me

i’ll be relieved once i’m in a hotel. i still haven’t decided what hotel to go to. the hospital had all my clothes (and everybody else’s locked up). they wouldn’t give me anything. so i wore a hospital gown tucked into my pants and these cloth slippers. I leave and it’s pouring rain outside. i just pray that the tylenol and drano work.

i’m jut afraid the cops will get me.

***

it’s always my luck.

i went to about 6 hotels and they all were full. i’m drinking 4 beer i bought earlier. i’m at the same cafe i was earlier.

i just don’t know what to do now. if i should get really drunk off of the rum i bought and jump in front of a train, or if i go back to the hospital, drinking rum and swallow tylenol and drano.

if i knew for sure that the pills and drano work i’d do the without hesitation.

i wish i had a pill to take and it would kill.

the skytrain would be instantaneous. it’s just getting up the courage to do it. so i think i ought to try the tylenol first. you’d think 6-7 bottles of it would be lethal.

perhaps i’m not completely ready to suicide. perhaps it’s just not the time yet. perhaps i ought to just toss a coin as to do the train thing or the tylenol/drano thing.

i know what i’m going to do- the tylenol & drano thing first.

***

i think for now i will go out for tempura lunch and then i know i’ll probably wind up at the hospital. the only other place is the train station.

***

so here i am in the japan restaurant and i’m pretty wasted- not knowing where to go. one thing in my mind tells me to go back to the hospital- yet another tells me to go to the train station ....

The writing in Lee’s journal scribbles out at this point. He passed out in his favorite Japanese restaurant and was returned unconscious by ambulance. We were made aware of the lie about returning of his own volition when we were sent a bill for the Ambulance ride.

From his escape attempt on Nov. 15 until his discharge from the Ward on Dec, 22, Lee was held in close confinement on 2 East. This was the most stress laden period of Lee’s stay at St. Paul’s. It was filled with escapes and recaptures, misinformation and no information, Certifications and Decertifications, and by what I perceived to be an assumption of a garb of infallibility and omnipotent power on the part of Dr. Rhesa Shore and the other Psychiatric staff on 2 East. There was an assessment of Patti and myself as nuisance factors with a litigious bent:, our input was to be ignored and we were to be given as little information as possible.

On November 17 the stress of dealing with the all the successive crises finally got to Patti and she just ran down. We had now been on a wild roller coaster ride of total unpredictability for two months and the constant uncertainty with which we were trying to cope had finally caught up. Patti's weight had dropped from 123 to 102 lbs, she wasn't able to sleep, and the constant strain of daily travel down to the Hospital with no certainty of finding Lee there finally took its toll. She developed a nasty case of shingles over her back and stomach and her doctor attributed it to the stress she had been under and advised her to rest. She badly needed a break, but there was no way she would be able to rest if she stayed in the middle of all the confusion, doubt, and uncertainty that our home life had become. She had to be removed from the situation, so I made arrangements, packed her up and delivered her into the care of her good friend Allene in Kelowna for a two week rest. She had explicit instructions to rest, recuperate, laugh, play cards, go out to eat and enjoy yourself as best you can. Try and forget for a while. Lee’s locked up and he’s safe. If anything happens you need to know about, I will call you.

On Nov. 21 there was another Family Meeting scheduled with Dr. Shore and her staff to discuss Lee. Patti and I desperately needed some answers to a variety of questions. In an attempt to get some and to try to defuse what was becoming an extremely frustrating and increasingly hostile relationship with the Hospital, the night before the meeting I stayed up very late and crafted a 3 page document that addressed:

1. My concerns related to bad communication with St. Paul’s staff, and a brief summary of the previous two meetings.

2. The matter of “confidentiality” and our right to know what was going on. If there was a problem then let’s get Lee in here right now and sort the matter out.

3. Lee’s mental status and ability to manage on his own, and what were his wishes re: Living Will, should his condition deteriorate further.

4. His “Code” status

5. His suicidal ideation.

6. Options available

7. Lee’s perceived alcoholism

8. What, if anything could be done to ease his mental pain and anguish given that his death was inevitable? Was there any equivalent to a “Brompton’s” cocktail that would give him any degree of tranquillity for the time that he had left to him?

At the start of the meeting I distributed my document to the participants and as everyone was reading it, Lee attempted to join the meeting. In marked contrast to previous meetings where his presence was essential if not mandatory. he was firmly refused entry by Dr. Shore. A brief period of discussion of Lee in very general details followed and then Dr. Shore proceeded to deal with my concerns and questions.

1. It was extremely regrettable about the previous bad relations with the Hospital

and she certainly didn’t want a continuance of what had become a somewhat adversarial relationship. She had no problems discussing matters openly with us and we can only see what the future holds.

2 & 3 Lee was not competent to handle his own affairs and this had been dealt with by his “Committal”. His financial affairs had been referred to the Public Trustee and we would be advised by them in due course. With regard to a Waiver of Confidentiality, or Lee’s wishes, i.e. Living Will, Lee was not competent to consent to anything since he has been “Certified”. As I interpreted it, Patti & I, as Parents and Next-of-Kin had no right to any information that could be deemed “Confidential” by the Staff of the Hospital and neither Lee, nor ourselves, had any control over his treatment should he have a physical relapse.

Lee is “Full Code” since he is not sick enough to warrant otherwise. Even though he suffers from a disease that will eventually be terminal, any deterioration in his condition that is life threatening will be accorded "heroic" measures. His previous chagrine at having survived whatever agent brought him into the Hospital was irrelevant. He was incompetent to judge such matters and he would be "saved" whether he wished it or not.

4& 6. Lee is suicidal and that is what got him committed. At this time there is no option but institutionalization in a locked facility. This was regrettable, and given the limited facilities available, regardless of his placement, Lee was not going to be a “Happy Camper.”

7. Regarding the possibility that Lee might not be an alcoholic but was correct in his belief that alcohol did help his depression, Lee was deluded in his belief and is an alcoholic.

She was sorry but there is nothing equivalent to a Brompton’s cocktail for mental anguish.

It took Dr. Shore less than 10 min to deal with all my concerns and questions. I asked at its’ conclusion whether there was any previous history we could provide and was told that they had all the information they needed. The meeting might as well have never taken place. It accomplished absolutely nothing. I was where I was before the meeting, perceived as a potentially litigious nuisance who was to be given as little damaging information as possible.

Days 70- 74 Maximum Security

Even at this late date, nothing adds up or makes sense of the whole business of competency and confidentiality that went on at this time. From my post mortem review of Lee's Hospital record, I have come to the conclusion that the competency of a "Certified" patient to consent to either treatment, or to the release of "Confidential" information is apparently a "discretionary" call on the part of Hospital Staff. It very much depends on who wants it, is it in the best interests of the Hospital (the patients' interest being secondary), and is the party requesting information categorized as friend? or foe?. This is verified by the following:

1. As of the date of my meeting with Dr. Shore, Lee had been “Certified” 4 times. By Dr. Kitchen on Sept. 29, again on Oct.18 by Dr. Schick but was competent to enough while “certified” to agree to reverse a strongly held position and take AZT as part of his treatment. This was prescribed by Dr. De Wet who had previously been unable to convince him to take the medication while "Competent".

2. After two more “Certifications” on Nov. 12, I discovered that two days later Lee was competent to authorize release of his “Confidential” file to an outside third party, The Community Legal Assistance Society , who were somehow engaged to represent him at a Review hearing that was scheduled for November 29.

This apparently, had been troubling the hospital for on Nov. 18, Dr. Weiss notes in Lee’s competency assessment: “Pt wants to be discharged to a hotel vs parents wishes he remain in a locked facility. Certification issues. Ethical issues. Medical Legal issues.”

Dr. Weiss was again dealing with erroneous second hand information, the interpretation of our wishes as recorded by Hospital Staff . Lee’s parents did not wish him locked up, but, given: the distorted and inaccurate information they were spoon fed; the demonstrated inability of the Hospital to control his actions; the Normandy fiasco; his suicide and escape attempts, there was simply no other option available. Dr. Shore made this perfectly clear to me at our meeting on Nov.21.

Only one week prior to our meeting, Dr. Shore noted “nb. IV drug use” in Lee’s Medical Record, even though there was no prior history of drug abuse. As the Staff Psychiatrist in charge of Lee's treatment she was aware of the Certification, Ethical, and Medical Legal issues that concerned Dr. Weiss in his assessment. She had an opportunity at our meeting to verify or refute Lee's reported drug use; to explore our wishes re his future; to clarify our position relative to Dr. Weiss "issues". She apparently deemed this information “Confidential’ and the topic was not broached. Her statement that Lee could not release information was patently false. He had already done so while still "Certified" for the Community Legal Assistance Society. She was aware of the pending Review hearing and Lee’s need for Legal Representation but chose not to inform us. This was not confidential knowledge and we had a right to be informed about such matters.

It was only much later that this “labeling” of him as a junkie came to our knowledge. I firmly, to this day, believe that by allowing the label “IV Drug Abuser” to adhere to Lee for the balance of his treatment at St. Paul’s, Dr. Shore and Dr. De Wet were negligent, and that by allowing the error to stand in his Record they adversely affected his treatment while a patient in their care. Plans were made, actions taken, perceptions formed, by other Medical, Psychiatric, and Social Services staff who made their assessments of Lee based on an uncorrected error in his Record.

CLAS, the legal representation engaged for Lee, apparently were as unaware of our presence as parents as we were of theirs as our son’s new lawyer. They never contacted us for input or information, and apparently were unaware of our differences with the Hospital over his management. As a consequence we were denied the opportunity to engage Counsel for Lee who had a vested interest in his welfare and who could have provided advice that, given the sheer size of Lee’s file by this time, was not based on a cursory review of a file that was totally biased in the Hospital’s favor, and which labeled him an IV Drug Abuser.

I believe this was a conscious failure, by the Hospital, to disclose fully to Lee’s legal counsel any information that could be considered detrimental to their position, and was a violation of both Lee’s and our rights. To my request to St. Paul’s for the identities of the Panel members at that hearing and a transcript or summary of proceedings, no response has been received. A request to the Community Legal Assistance Society for information related to Lee was denied. I was informed by Mr. James Pozer, the Managing Director, that they were not even prepared to admit he was a client. Even if he was, they were not prepared to supply any information because this was a matter of Attorney / Client privilege and that privilege survives his death. How a "Certified" individual, mentally incompetent to handle his own affairs, is capable of entering into a legal association upon which his whole future depends is beyond me. A request for the identity of the party who engaged their services and to whom they were accountable, so that I might appeal their decision, was totally ignored. Apparently they are a "Star Chamber" appointed by God and accountable to no-one.

Lee, of course, simply took it as a minor ripple in his suicide plans:

Lee’s Journal Entry: Nov 22, 1995

if I had a gun i’d blow my brains out

this morning I saw dr. shore. she said they have been looking for accommodations for me in a locked place. i’d be locked up !!

these past days my mind has been filled with images of the burrard station and me killing myself.

if I could get out of here i’d do it right now. before when i thought of jumping in front of the train i’d feel somewhat scared and a feeling of not wanting to do it. it just seemed too gruesome. now i feel more relaxed about . what i’ll do is walk in the tunnel part, lay down on the track and wait for the train.

tomorrow i’ll hang out by the front door and try to sneak out. i shall do this everyday until i’m out.

the suicide is a bit sooner than i’ve thought of, but with the

position i’m in, the depression and now this.

this afternoon i stood by the front door for about an hour,

hoping to dart through the door.

the staff were telling me to move away from the door as they knew i was going to try to escape. after some talking i thought it was useless to try to escape when they’re all there.

i may try tonight when the man takes away the meals cart. and i’ll try tomorrow when they take the cart. whenever i escape this place it will be the day i suicide.

it weird thinking about it-

maybe tomorrow or next week i’ll be dead.

Lee's Journal Entry: Nov. 23,1995

shit, fuck, shit, fuck, shit!

i made it out the front door, people were chasing after me, i made it across burrard st. when 2 security guards stopped me.

i can’t even suicide

if these security guards never caught me i’d be sitting in a bar now getting drunk before my suicide

***

630 and i wish i could sleep. i love to sleep. that’s all i want to do these days is sleep. right now I want to go to sleep but i can’t.

i’m just pissed off that i ran into these security guards.

I have come to the conclusion after reading all of his files, that after his readmission from Normandy, his subsequent escape attempts, Lee was effectively written off with regard to his medical problems, He was perceived as a terminally ill HIV +ve drug abuser who was beyond medical help, and who’s mental problems and erratic behavior made him a “Management” problem. His treatment for the balance of his stay at St. Paul’s consisted of administering various and sundry psychiatric drugs in massive doses with the sole focus of modifying his behavior and rendering him “manageable”. His medical treatment was confined to maintenance of drugs to prevent opportunistic infection and any medical organic reason for his continuing deterioration was totally ignored, and no follow up studies were made. Lee’s admission to St. Paul’s was the result of an encephalitic infection of undetermined nature. Spinal tap, CAT scan, and MRI showed only diffuse atrophy but no causal agent was ever identified. An EEG showed abnormal patterning but all these tests were run in his first two weeks in hospital and were never repeated to determine if there had been changes of an organic nature. No other tests were ordered, no neurological consults were called for. Whether the damage to his system was progressive or self-limiting, and nature of the causal agent was will never be known.

Lee had severely limited Short Term Memory and judgment, but no quantitative Psychometric tests were ever administered to try to quantify the actual degree of impairment. All treatment was the result of subjective impressions of Dr. Shore and her staff of the behavior displayed by Lee, and his responses to verbal stimuli in one-on-one conversations. Any conclusions drawn from such sessions were almost totally without merit since no attempt had ever been made to gather a data base re his personality, behavior, or mental status before his admission. After five years of treatment, his own personal physician admitted he did not know Lee very well and conceded he was a very private person. Dr. Shore and her staff however, with their all-knowing and omnipotent cognition and intuition felt totally secure in deciding what was “normal” and acceptable to both Lee and ourselves. They possessed no personal knowledge of either Lee or ourselves, of our belief structures and value systems, of our personal principles and ethics, yet they felt free to stand in judgment of both him and us. Their conceit and arrogance should be cited in textbooks as how not to handle a situation.

Lee spent 4 more weeks on 2 East and he never adjusted to the routine or accepted the control placed on him by the Hospital. He got up in the morning for the first of an almost endless series of coffee’s and cigarettes. He sat in the smoking room and watched for escape opportunities. He dreamed elaborate suicide plans, He ignored his fellow patients because they were all nuts. He tried out dozens of reasons on the staff for day pass excuses because of the better escape opportunities they afforded, but most of the time he sat like a caged tiger, watching television and bristling under the restraints of his surroundings.

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.

Days 99-100 Discharge from Psychiatry 2 East

In the week immediately prior to his discharge, Lee was not in a condition that would enable him to cope independently. He was "Certified" by Dr. Shore on Dec 15th, and by Dr. Okane again on Dec. 16. He was not considered competent enough, or trustworthy enough to even be given an “accompanied” day pass to go and inspect his new lodgings.

Lee's Journal Entry: Dec. 22, 1995

i just feel like laying in bed all day. i’m waiting for peter to figure out when we’re going to see the place. i don’t know if i’m going to take it or not. it looks like it won’t be till this afternoon when we go look at the place. i decided that if the place is nice i can live without a stove and fridge until i get something. i just need to get out of here. if the place is a dump, i won’t take it.

i plan on getting drunk today

i’m sick of waiting around here.

He was given a final assessment by Dr. Shore.

Psychiatric Note

Pt up and dressed eager for discharge. Irritable about discharge apartment not having a fridge and stove. Pt states mood is good- no suicidal ideation or intent.

A I dysthymia

alcohol abuse/ dependence

II PD narcissistic w borderline traits

III HIV +ve

P dischg to Dunsmuir House w supports: GP, WECCT, ACT, Meals on

Wheels, Homecare.

Recommendations:

Pt is chronically disthymic w recurrent suicidal ideation exacerbated by alcohol abuse. Benefit from inpatient psychiatric hospitalization has been very minimal.

In the unfortunately likely event that pt becomes inebriated and through his consequent threatening behavior is brought to the ER he should be medically evaluated, detoxified, & discharged rather than admitted for an acute care stay which only aggravates versus alleviates the predicament ie. chronic unhappiness with chronic suicidal ideation & alcohol abuse.

Pt has been encouraged to join AA and attend Robson D&A

Rx R. Shore

All prior certifications were the canceled by Dr. Shore, Lee was given a taxi voucher to get him to Dunsmuir House, his personal effects and $8.50 were signed for, he was advised of his competency status & involvement of the Public Trustee, told he had an appointment with Dr. De Wet the next Thursday, was given the On Call Doctor’s # over the weekend. He was then allowed to leave. Lee was discharged at 1315hrs December 22, 1995.

Days 100- 102 Freedom

Lee's Journal Entry: Dec. 22, 1995

just as i was leaving the ward i ran into jean. i told her it was fate.

we went for cokes and then to the liquor store, then here, the salvation army hotel.

jean stayed for awhile. i drank rum and water as i do now. the place is all right if you want to feel like one of the dregs of society. it’s better than where i was. next month i’ll see about getting into the granville hotel where i’ll be able to gas myself if i want. i’m now listening to my walkman, drinking rum and beer, wondering if i should go to my parents place.

before i left the Hospital i was told that once i got here i would be given my medications. it never happened. jean phoned the

hospital and they said to pick them up at “shoppers drug mart”

i phoned the hospital and they could tell me nothing. so jean on her way home is going to check out “shoppers drug mart” for me. i have to phone her at 6-630PM. i don’t know if it’s a big deal or not. surely i can deal without my anti-depressants for 3 days?

if jean says they are at shoppers I wonder if I should go there before going to my parents, or just wait till tues.

i have no clock in here, so i will never know what time it is when i’m in here.

i’m starting to get drunk

i’ll cut myself off

***

I phoned jean and she said shoppers had no record of a prescription for me. so I wonder what the fuck is going on??? i tried phoning my parents but no answer.

it figures. just when i want to go visit no one is there.

should i leave and just show up.

***

i listen to peter gabriel and i just don’t know. i’ve just talked to dad and asked if i could come visit. “no” dear old bitch mom couldn’t handle it i guess. i almost don’t want to go.

suddenly i feel my entire. perhaps it was a dream.

today i’ve got to go to surrey today. i feel just like laying in bed.

i’ve been smoking way too much.

The evening after his discharge Lee called me at home and asked if he

could come out for a visit and to get some clothes. It simply was not possible or

convenient and I told him to get a good nights sleep and we’d call him in the

morning and make arrangements for him to come out and we'd drive him back into

Dunsmuir House with whatever he needed and check out his new apartment.

Lee simply disappeared.

We called Dunsmuir the next morning and were advised that there were no

individual room phones and we would have to leave a message for him at the

desk. We continued to call and leave messages for the next two days but Lee

never picked them up. They simply stacked up in his box. We explained to

Dunsmuir staff what was happening and they tried to assist and checked his

room, but as of midnight on Christmas Eve Lee was still missing. Our next door

neighbour was visited by her nephew., himself an AIDS patient at St. Paul’s, who

hearing of our plight trying to locate Lee, volunteered to use his “street” smarts to

try and find him downtown. We didn’t give Todd E. much of a chance for success

but it was better than nothing and we agreed. There was nothing else we could do

so we went to bed and tried to sleep. I remember closing my eyes with the

thought:

"And a Merry Fucking Christmas to you, St. Paul's!"

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!

Days 104- 111 Dunsmuir House

Lee's Journal Entry: Dec. 26, 1995

i slept good last night for a change. yesterday i felt depressed. after turkey dinner my mom prepared i start to cry. my mother came over to hold me and hug me. i was really touched by this.

last wed and thurs night i got really drunk.

today i just feel like staying in bed and drinking beer, i’ve got to stay here till at least 4pm. mom & dad are coming around noon and i’ve got to stay here until Meals on Wheels arrives.

i should go downstairs to phone mom & dad to find out what time they’ll be here but i don’t have the energy. i hope there is a bar close by so i can get some off sales beer.

i wish mom & dad would get their asses over here as i’m bored and have no tv or radio. mom is suppose to bring the little tv that she has. i wish i had some food to eat. i wish meals on wheels would get here.

***

meals on wheels brought me a lunch which was pretty good. i’m probably going to eat the one meal brought to me and for dinner have a sandwich and veggies.

mom & dad came by with some of my stuff, also the little tv and a radio. i’m glad they didn’t stay long, mom was looking in the closet and saw a mickey of rum that i stashed away and forgot about. bonus i thought.

***

i drank all the rum. i’m now on my second beer, from the twelve that i bought.

i’m in a strange mood today. the only way i can explain it is thought of being in bed with the comfort and security it brings. there’s even a part of me that misses being in ward 2E. i almost think of going back there.

The day after Christmas Patti and I went downtown to see Dunsmuir House and try to find out just what was going on. Dunsmuir turned out to be a large old building that had seen better days, but it was clean, neat, orderly and above all, a safe place for Lee. He had his own room, with a bed, dresser table and chair, and an adjoining bathroom with a large old bathtub and toilet. The toilet was apparently broken but I showed Lee how to work it and said a little prayer of thanks when two or three days of accumulated shit went down with the first flush and didn’t overflow. Small mercies are most appreciated.

St. Paul’s had simply dumped Lee at Dunsmuir House. He had the clothes on his back, no coat, no hat, no gloves, no socks, no wallet, no identification. They sent him a weeks meds done up in a blister pack he didn’t remember how to operate. They gave him an address and a room number and told him to go there and he went. They arranged for Meals on Wheels to start sometime? but no visiting nurse or homecare had been arranged. Lee though he had $20-30 when he left but he only had $2.24 when we got him on Christmas morning. He was not too happy with Dunsmuir because it doesn’t have a stove or fridge, but that was his only bitch, and he was already planning on moving if he can find a place. Lee had his lunch from Meals on Wheels, was pleased with the little TV we brought him, and was looking forward to giving Dr. De Wet shit when he sees him tomorrow. We left Lee reasonably content. If he can stay away from the booze and observe the house rules at Dunsmuir I feel he might be in the best place to slowly make a transition back to the community.

Lee's Journal Entry: Dec 27, 1997

i got up at 0600 this morning. at 7am i went for breakfast to the cafeteria that is downstairs and had eggs and sausage. i’m now stuck waiting here till meals on wheels gets here. i’m on my sixth beer and i don’t feel intoxicated.

this afternoon i must go to the bank. i wish i didn’t have to.

i wish i could just lay in bed watching tv and eating junk food.

i’m in a really weird mood today.

***

lunch finally came at 1230, fish, rice and some mixed veggies. i’ve got to go downtown to the bank and do some shopping. i just want to lay in bed watching tv and drinking rum

**

i’m depressed. i’m depressed because i’ve been smoking too much and i’ve been drinking too much.

so what do i do this afternoon? i bought a carton of cigs and a six pack of beer and a bottle of rum. i told myself this is the last time that i drink.

i bought some food this afternoon but i feel like going for pizza at the pizza place across the street.

the thought of watching tv depresses me

tomorrow dad plans to come to my doctors appointment with dewet. he plans on asking a lot of questions. i’m going to ask why in hell did i go to that “2E Ward”. i wonder what his answer will be?

***

i’m now drinking my beer and rum and it feels good.

i’m depressed with this hotel/apartment room. it’s so drab and ugly. there’s no fridge, no stove.

i hope at the end of the month i can get in the grandview hotel. even if it is a dump at least they have stoves and fridges. better yet they’ve got gas stoves.

***

today everything is a huge effort, it was a huge effort to go to the stores today and the bank. the only reason i did it was because i needed cigarettes. otherwise i would have spent the day in bed getting up only to eat and use the bathroom.

and now it seems to be this big effort to go across the street for 1 or 2 slices of pizza.

have i mentioned it before? it is obvious that i so often think about and write about suicide. it’s not like i’m planning on doing it tomorrow. i think about it to prepare myself that i must do it when i really start to get ill. i will only do it if my inner self says it’s ok. right now i couldn’t do it because i know it would be wrong. i know it is not the right time- no matter how much i want to do it, i can’t,unless my inner self ok’s it.

***

some grocery items sit outside on the window sill so as to cool. in these months who needs a fridge?

i can’t believe it’s jan. soon. in 1988 when i first found out i was HIV i never imagined i would be alive in 1995. and here i am, without any major problems

i wonder if i should change doctors.

thank god i’ve no penis warts anymore. it’s been months since i had them- thank god.

some gay men get diagnosed with HIV and 2-3 yrs later they’re on their deathbeds. not me? i can’t thank god for allowing me to live a long time with disease.

oh, well. it’s time to force myself to go get some pizza.

***

there is this little voice in my head. i’ve never listened to it before. tonight i bought two slices of pizza, the voice told me to only get one. to my regret i got 2 and could only eat one. so i have one for later on tonight or for breakfast.

i left the pizza place to go to a nearby store to get 2 chocolate bars. the voice in my head said “ forget it, they’re closed.” i got to the place and sure enough it was closed.

this little voice is a part of me that tells me it is not time to suicide, that it will let me know when it is time.

i must start listening to it more often. i must start consulting with it.

When we left Lee we went up to 2 East to see if they still had his wallet and ID. They didn’t. I stated exactly how I felt about the way Lee had been dumped at Dunsmuir. The grapevine works fast and first thing the next morning Patti got a call from Dr. De Wet’s office. She told them about the lack of supports in place, his screwed up medications, and about his great Christmas Eve. She also confirmed his appointment for tomorrow, Thursday, and told them I would be accompanying Lee and expected an explanation about his screwed up discharge.

Thursday, I went down to Dunsmuir House, saw Lee to let him know I was there and went and met the Director of Dunsmuir. He came, met Lee, and started making inquiries on Lee’s behalf. He said that for once it was nice to be able to work proactively, rather than retroactively. I went back and got Lee and we went to see Dr. De Wet. Lee laid right into him. “How and why did I wind up in Hospital for 3 months...” Dr. De Wet explained about suicidal declarations and legal responsibilities for reporting and preventing, and Lee bought none of it. In his mind De Wet was his doctor and anything said between them was privileged. He had bared his soul to De Wet and he felt that the breaking of this trust was unforgivable. He remembered nothing of the days leading up to his crash or of the month following it. The tragedy of the situation was that for all it was immediately apparent to everyone who met him that Lee had severe short term memory problems and a compromised attention span, it was not apparent to Lee. In his own mind, he was perfectly capable of looking after himself, there was absolutely nothing wrong with his memory or he would have remembered it, and he very much resented all the attention and interference in his life.

De Wet told Lee that he really had not expected Lee to make it that long on his own, but he had and that was good.. He was making plans and that was also good but it was necessary to continue to monitor his progress. That was why the visiting nurse would continue to call daily. If Lee showed he was managing his meds and personal care well she would gradually fade out of his life. He examined the split in the back of Lee’s head, discovered a couple of stitches, and scheduled Lee back in the next Tuesday for their removal. When Lee finely went for a pee Dr. De Wet and I had a chance to talk.

I asked him, "What the fuck happened? I thought we had an agreement that all the god-damned supports were to be in place before Lee was discharged. At this point virtually nothing is in place. The kid has a fried mind and that bastard Social Worker at St. Paul's has the balls to tell me that it really didn't matter a shit whether or not Lee wanted to go to Dunsmuir. He's made arrangements and Lee's out on the god-damned street. The bastard didn't even have the time to spare to take Lee down to the place and give him an orientation. He just turfed him out in the clothes he was wearing and nothing but verbal instructions. He should have had the common sense to write things down on paper, Lee can still read, but the stupid bugger didn't even have the smarts to do that. How the hell do you explain all this bullshit?"

He could only reply that to the best of his knowledge, when Lee was released from St. Paul’s, all the supports were to have been in place. He had been insistent enough with Mr. Weir to have elicited the response “Don’t tell me how to do my fucking job!”.

I responded, "Well its about time somebody fucking well did. He sure as fuck doesn't know now. I suggest you bloody well find out what the hell happened because I sure as hell am going to. If this is how you and that god-damned Hospital honor an agreement with a mental patient and his family regarding conditions for discharge, then let me tell you here and now that if Lee crashes again, St. Paul's Hospital is the last god-damned place on earth I want him taken to!"

Lee returned from his pee and we left. I have not spoken to Dr. De Wet since.