February 1st, 2010

Wish you were here

When the hospital closes, sometimes the best we can do for a patient is to transfer him or her to another hospital where they will receive similar care until they are ready to return to the community. For most of these people, such a transfer is a disappointment but not a defeat. It means getting used to a new environment with new sights, sounds, smells, rules and routines. It means learning to relate to new peers and treatment providers and telling one’s life story over again in pursuit of that elusive yet all important feeling of being understood. Often, a transfer means deferring one’s dreams until the machinery of discharge can be cranked up and started in a new location. All of these inconveniences can be expected even for people who will eventually have a good outcome, who will “get better” and go home. But for some, the new hospital will probably be the last home they will ever know. This is the story of one of them.

He was the first to welcome me when I started working here 17 years ago, meeting me at my car, tipping his woolen ski cap, and introducing himself as, “Bilbo Baggins, at your service.” Bilbo was to become my shadow for more than a decade, serving as a guide for the “new guy,” using me as an escort to the smoking area of the hospital, sharing with me his fanciful and, much too rarely, realistic goals for the future, telling me scattered episodes in the story of his life, expressing his fears and venting his anger at past and present, real and imagined injustices.

The greatest injustice of all was developing schizophrenia. It was not the kind of schizophrenia that remitted with a few young adult episodes or even the variety that lingered in the background, controlled well enough by medication to allow normal life to proceed. For Bilbo it was a slow and steady deterioration that challenged every idea I ever had about the meaning of psychotherapy. Then a colleague offered me a new one that seemed to fit. I was helping Bilbo to deteriorate more slowly.

Bilbo turned 40, then 50 and his own version of a midlife crisis wore the guise of a goofy outfit and a ready description of fantastic happenings that conveyed the deeper truths of failure and loss. He spoke too loudly, stood too close and interrupted conversations taking place anywhere in his vicinity. Like a man whose voice was being muffled by an ever-growing accretion of desiccated dreams, he shouted that much louder. I chose to think he was using therapy to try to get his message out while he still had a voice. Perhaps he hoped I would tell the others that he was still here underneath the funny hat and ill-fitting coat, tell them that he had not stopped trying to feel connected to the life he left behind.

Blessed with a caring family, Bilbo saw them everywhere – his parents who visited him regularly and his extended family and friends, living and dead, who worked and lived with him in the hospital of his imagination. Because he couldn’t go home, he found a way to keep his loved ones with him. He communicated each new fantasy like a man writing postcards from a far off place he was exploring.

Dear Mom and Pop, You’ll never guess who was admitted to my ward today. My old friend from the soccer team at Shirewood High moved into the room next to mine. It’s just like old times. Wish you were here, Bilbo

Dear Mom and Pop, Aunt Matilda is working the three to eleven shift. It’s so nice to have her here. We talk every night after supper and she tells me what cousin Frodo is doing. Wish you were here, Bilbo

Dear Mom and Pop, They told me the hospital will be closing in a few months, but I know that isn’t true. My plan is to stay here a while longer, then move to a halfway house in the community, then to my own apartment, and get a 40-hour a week job. Wish you were here, Bilbo

Dear Mom and Pop, I fired my therapist today. I have been here such a long time. I’m not getting any younger and that clown didn’t help me at all. Wish you were here, Bilbo

Dear Mom and Pop, I have to hurry because they tell me a car is waiting outside to take me to Wobegon State Hospital. I’m sure it’s just a shopping trip to the mall. Wish you were here, Bilbo

That was the last of Bilbo’s postcards from here but I imagine him at Wobegon State, still sending his greetings to his family and anyone else who will make the effort to listen.

Alan Bodnar, Ph.D. is the Co-Director of Psychology Training at Westborough State Hospital, Mass. and a consultant in the field of leadership development.

By Alan Bodnar Ph.D.

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