June 1st, 2012

Stop the world, I want to get on

The small room where the treatment team meets was crowded with hospital staff and representatives from the community where George would be going after his discharge. George dominated the tableau more by his imposing size than by anything that could be mistaken for a confident manner. He insisted that he was ready to leave the hospital, praised the members of his outpatient team and the staff of his new group home and had nothing but good things to say about the residence itself. Yet he said it all in a tone of voice barely louder than a whisper.

Someone suggested that he might be having second thoughts about leaving the hospital after more than a dozen years in the same building, surrounded by the familiar faces of many of the same staff year after year. Not at all, he replied, telling us again that he couldn’t wait to start his new life. Yes, another voice added, you are eager to move on but, even so, it can be a bit scary out there in a new place. George recalled his first visit to the new house, lying in bed unable to fall asleep as he listened to the whirr of traffic outside his window.

He was not listening to a lullaby. When I tried to imagine myself in George’s situation, the traffic noises in the street brought to mind the image of the spinning earth and an idea of how hard it must be to climb aboard after so much time away. When you move from the life of the hospital to the life of the world beyond, you enter a new time zone where everything happens more quickly. Not only is it happening now but, in the years that you were away, so much has already happened that you might easily feel like you were just discovering a new planet – or perhaps like you were Rip Van Winkle just waking up from a long, not so peaceful, nap.

Go back to your hometown for a high school reunion and, if enough time has passed, you hardly recognize the place. Buildings have been razed or perhaps only used for something else. Woodlands give way to new housing developments and roads appear to places that didn’t exist the last time you were there. Step out of the hospital and go back to your old neighborhood in the same city and you’ll be lucky to find your way or know what bus to take or where to buy a newspaper. And, if you find the shop you are looking for, get ready to be surprised by how much that newspaper will cost. It’s not that the hospital is completely sealed off from the real world. Items for sale in the gift shop and canteen cost real world prices and there are plenty of trips to local malls to keep people current.

Still it is one thing to have your exposure to the community doled out in prescribed doses and quite another to be hit with everything happening at once.

The whirr of traffic outside the insomniac’s window carries all the sounds of a world that has been spinning at full tilt while his own world had slowed to the pace of an empty hospital corridor. For some time now, he has been building momentum, moving forward through increasingly higher levels of privileges, each bringing more exposure to the world that never stopped spinning just because he was in the hospital.

We all need these kinds of transitions. Just back from a week’s vacation, a colleague collects himself in morning rounds, asking our indulgence while he re-reorients himself to the world of work. A lot can happen in a busy hospital in a week even if it takes some people years to be ready for discharge. The daily roll call of morning rounds tracks the progress of healing with its glacial flow and sudden leaps toward recovery and the inevitable setbacks along the way. Step out of this world for a week and some things will be exactly as they were when you left. The man who has taken to his bed under the lashings of a deep depression is still there. Others remain as confused or unpredictable as ever. Some plod along at a steady pace, going about their daily routine, clear thinking and affable, yet nevertheless stuck. They are waiting for an evaluator to deem them competent to stand trial, for a judge to say that their charges are dismissed or for a vacancy in a group home so they can be discharged.

Any of these things can happen suddenly and when they do, the returning vacationer is often surprised by the change. The familiar name is off the rolls and in its place a newcomer stands waiting to be interviewed, understood and helped to get back to the spinning world.

How do we step into a world spinning faster than the one we are leaving? Credit the engineers of theme parks like Disney World with designing moving sidewalks that match the pace of the rides that never stop. Step onto the moving sidewalk and it will adjust your speed to deliver you safely onto the ride or back into the park. Find the mental and behavioral equivalent of the moving sidewalk and enjoy the ride.

Alan Bodnar, Ph.D. is a psychologist at Worcester State Hospital and a consultant in the field of leadership development.

By Alan Bodnar Ph.D.

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